Welcome and glad to have you "listen" to our talk. I would like to make a suggestion to members of this digest. When you talk about Mom, Dad, relative, friend, or yourself, I think it would really help if some of the history is presented like: Age:____ Sex:____Years diagnosed ____ Is the diagnosis Parkinson's disease _____ The reasons are initially obvious but also because it is becoming more important. I am starting to see more papers talking about Young-Onset, Normal Onset and Late Onset. Each showing possibly different manifestations, rate of progression and reaction to medications. Young-Onset is where the symptoms start showing prior to age 40. Late-Onset is where . . . after age 70. Normal Onset is between 50 and 60. The missing years are more dependent on the individual. I will start the introductions: I am Alan Bonander, I am age 54, was diagnosed in 1984 at the age of 44, had my first symptom around 1977 (I do not like taking pills or seeing doctors. I would rather see a dentist because they do something for my money like fill a hole, clean etc. After I have seen my neurologist I have only replaced "US Green" for a few secret code words that must be encrypted by the Pharmacist behind the high wall that exists in must drug stores.) In 1991 I participated in a study using duodenal infusion of liquid form of Sinemet. I have been pumping liquid form of Sinemet along with Permax ever since. The value of duodenal infusion is it bypasses the stomach and pylorus delivering medications directly to the Jejunum. The delivery method is a small medical pump, an IV bag containing the meds and a J-tube for the delivery system. I make the liquid form of the meds by mixing Sinemet pills, vitamin C crystals, Permax pills and ordinary "coffee grade" water. I have to filter the solution to remove the "pill binding" as it will plug the pump lines. In May of 1993 I had a right pallidotomy performed by Dr. Laitinen in Stockholm, Sweden. In the right pall, a probe is inserted into the globus pallidus of the brain. The tip is heated to cause a lesion to reduce hyperactive neuron activity. If all goes well, many of the symptoms of PD are reduced or eliminated on the opposite side of the body from the operation. The operation takes as little as 50 minutes in Sweden, to as long as 13 hours at Emory U. in Atlanta. The difference has much to do with method of surgery. I no longer have the high sensitivity to Levodopa, my uncontrolled sweating is gone, my left leg has less rigidity than my right leg, my left arm has about 50% of the symptoms gone. The lesion is most likely too small. My facial expression, energy, driving are much improved. On good days no one knows I have PD. I still have PD. I am taking the same level of meds as before the surgery which is correct for those on an optimal medication program prior to surgery. They are about 900 mg of Levodopa, 150 mg of carbidopa, 2 mg of Permax, 5 mg of Eldepryl and 20 mg of Paxil. One of the most important functions of a pharmacist is to warn patients about possible interaction of drugs. The only way this can be done is to tell the pharmacist what other drugs we may be taking. I purchase drugs from the local pharmacist and from a mail order pharmacy. My local pharmacist knows all the drugs I am taking even if I do not purchase them locally. Because Dopamine, Serotonin and nenophenern are deficient in PD, any drug which plays with these neurotransmitters has a potential to cause problems. Some of the bad ones are the nausea drugs because they work on the nausea center in the brain. I hope I have educated you in the following: (1) Categories of age of onset (2) A different method for taking PD meds. (infusion) (3) The major problem with all meds is the delivery system. The stomach and pylorus along with food play havoc with drugs needed on a "continuum." (4) The important role of the local pharmacist in drug interaction (5) The important role, we as patients should be giving to the local pharmacist. They really are our friends. Some day when I learn to break down the secret code used by doctors and pharmacists, I will be able to take over the medical world. Welcome to the PD digest -- I hope it will be beneficial for you as much as it is for us. There is a story about a neurologist, neurosurgeon and a pharmacist that needs to be told. All were to die by the guillotine for giving medical assistance to the enemy. The neurosurgeon looked at the big blade and said, "He who lives by the blade, dies by the blade." Put my face down, knives frighten me. They did, the blade came flying down and just stopped inches from the neck of the surgeon. The crowd yelled, "It must be an act of God, release him." And they did. The neurologist was next. When asked if he wanted to be face up or face down, he said, "I have been able to help mankind without the need for such extravagant devices. I want my last moments to be thinking of all the wonderful things I have done without the knife. Let me look at the good earth. They did, the blade came flying down and just stopped inches from the neck of the neurologist. The crowd yelled, "It must be an act of God, release him." And they did. They then brought the pharmacist to the gallows. When asked the same question, he responded, "I have always looked straight in the eye of all of life s problems patients and doctors. I have educated both when they were ignorant of the drugs being used. I am really a problem solving man who has served mankind "where the rubber meets the road." I want to go out of this world as I have lived it, facing this problem. So they set him down face up and started the drum roll. Just as the blade was about to be released, the pharmacist yelled, "Hold it! Hold it! I see the problem -- there is a twist in the rope that is catching . . . Regards, Alan Bonander ([log in to unmask])