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While I teach about PD, my primary interest in subscribing was my father-in-law. He was diagnosed with the disease about 6 or 7 years ago. He was an avid reader of everything on the board and enjoyed all of the interchange. Because I am using the past tense of enjoy, it is obvious that he has passed away. He died last Wednesday. Because he is no longer with us, I will shortly be unsubscribing. Before I do so, I thought I might pass on some of the things we learned in dealing with the disease. It may be of help to others. Let me first say that Melvin was 82 years old. Up until 2 years ago, he was apparently in relatively good health other than a dietary controlled diabetes, PD and bad arthritis of the knees. The arthritis at this time was apparently so bad that he walked with great difficulty. After a year of being confined to a bed, he saw an orthopedist, who stated that he had no knees and recommended that he have both replaced by artificial joints. This was something that he did not want to do. However, after examination by a second orthopedist in another city who made the same recommendation and because his neurologist felt that his PD was in a relatively early stage, he agreed to having it done (his decision alone). (Sorry if this appears long winded, but it is important that you understand the circumstances). The tremor was bilateral with moderate bradykinesia. During the year he was making his decision and awaiting surgery, he had several episodes of confusion. These were very important with hindsight. They were relatively mild and of short duration. They were attributed to the L-DOPA. A month or so prior to the knee replacement, he fell and was hospitalized. Another neurologist, located in that hospital, who had not previously seen Mel, claimed that he was in the end stages of PD and immediately doubled his dose of L-DOPA and placed him on Eldepryl. Mel started with various hallucinations characteristic of these drugs. After several days, he went back to his original dose of L-DOPA and slowly recovered from this change in therapy. He had his knees replaced at the end of January of this year. After a month of physical therapy, he was ready to go home. On the day before he was released, he became very confused. He was reexamined and it was found that he was in liver failure. The confusion that he had exhibited before the surgery, was not in fact part of PD. There were complications of the knee surgery, but in the end it was the liver failure that was the deciding factor. The physicians felt that the liver failure was the result of a long standing exposure to Hepatitis C that went undiagnosed. He did not die of anything related to PD. He died of hepatic encephalopathy. So how can you learn from Mel's passing? First, it was very easy for physicians to claim that all his symptoms were the result of PD. Even the incontinence that he developed about a year before his surgery (later attributed to prostatic hypertrophy) was blamed on PD. What we can learn is that there are many symptoms associated with PD. Do not be too quick to blame new or unusual symptoms on PD. It requires someone who continually treats PD patients to recognize when symptoms are part of the disease or indications of other problems. The second thing that we can learn is that the progression of the disease is very slow. Changes take place over a period of years, not weeks or months. When there is a rapid change, look for other causes. I know that Melvin would have taken great pleasure to have been able to add something constructive to this board. [log in to unmask]