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We had our second meeting with Dr. Lieberman at the Neurosciences Institute in Los Angeles. This is a summary of what the evaluation was like. Dr. Lieberman requested that my father come to the meeting "off" Sinemet for at least 18 hours prior. Unfortunately (or fortunately, I'm not sure about this). He had an unusually good day and was not very slow at all. He was also in good spirits. Dr. Lieberman did a series of small tests on his range of motion, rigidity, balance, strength, etc. He had him tap his foot, turn to the left and right, put his hands on his shoulders and lean forward and backward... all the while giving my father a score of 1 to 5 on a sheet that has the separate movements listed. After this test, he gave my father a liquid mix of Sinemet (it looked like he crushed up the pills and mixed them in a blue liquid) that he said was simply a liquid form of what he already takes. We waited for the medicine to begin working (the first sign was the start of dyskinesias) and Dr. Lieberman repeated the same test, scoring my father on a new analysis sheet. He asked if this was a normal representation of the severity of his dyskinesias to which my father replied, "No, they get worse." Then he sent my father to walk around for about an hour, because apparently the Sinemet works better if you move around a bit. Plus it has a tendency to make my father sleepy if he just sits. My father responded very well to this particular dose of Sinemet, probably because he had not had any for 18 hours and it seemed to last longer than usual. It took about two and a half to three hours for him to go "off" and Dr. Lieberman repeated the same scored evaluation again. After scoring my father at four different intervals during the visit Dr. Lieberman said that his recommendation, at this time, would lean toward a pallidotomy and not a fetal tissue transplant mainly because of the severity of my father's dyskinesias. The dyskinesias seemed to concern him and he said that usually their are two kinds of dyskinesias, ones that happen more or less randomly while the patient is "on" and ones that happen most frequently when the patient is either going "on" or going"off". My father has the latter. Dr. Lieberman was not completely convinced yet which procedure would be most benificial so he has put my father on an alternate medication schedule for one month. He also said that for people with dyskinesia patterns similar to my father's, it is extremely important that medication be taken on time. My father has not been doing that and often experiments with his dosages, taking more or less depending on how he feels. Prior to our visit with Dr. L, he was taking his 1 3/4 carbidopa/levodopa 25/100 every four hours (more or less) and found that he was always going "off" before he took his next dose of med. Dr. Lieberman gave him a new schedule that will more or less prevent him from going "off" before his next dose. He did not increase the dosage, but split it so that my father is now taking Sinemet on a schedule as follows: 7:30am - 1 3/4 9:00am - 1 11:00am - 3/4 1:00pm - 1 3:00pm - 3/4 5:00pm - 1 7:00pm - 3/4 9:00pm - 1 11:00pm - 3/4 Dr. Lieberman said that this particualar schedule would be a good indicator of how my father would react to a fetal tissue transplant. His area of cooncentration for this experiment is on how violent the dyskinesias are during this month. If they decrease in frequency and magnitude it is most likely they will decrease with a transplant, if they increase or remain at their current level that will most likely be the case in a transplant situation as well. So now we'll have to wait and see. Dr. L stressed that this is an experiment and that in his experience with the 40 or so Fetal Tissue Transplants they have done at the Neurociences Institute, they have found that pepole with severe dyskinesias before fetal tissue transplant have the same or an increase after the procedure. He did say, however, that other research groups have reported that dyskinesias decrease and didn't imply that either group was right or wrong , only that their findings in that area differed. So my father has been on this new med cycle since Sunday and the first two days he took the right dosages but not at their designated intervals. He had very bad dyskinesias and was extremely frustrated and disheartened. I gave him a gentle hand slap and told him to take the meds ON TIME (he's so stubborn!) or else the experiment would not work. Tuesday he took the meds exactly on time and had very few dyskinesias. I have made a spreadsheet for him to mark down when he takes his meds, when he eats, when he sleeps, when dyskinesias start and stop and how severe, when he goes on and when he goes off. I want to see if there is any pattern to be seen in his eating schedule or anything else. We'll see how it goes and we have another appointment with Dr. L in a month. Dr. L also advised him to eat small amounts of protein (which is widely known to interfere with Sinemet absorption) and in addition to save that protein for his dinner meal. He suggested a largely vegetarian diet (minus the protein from beans and some starches, etc.) for the daytime and told him to eat small meals (more frequently if necessary) because it takes longer for the Sinemet to begin working if you eat a sizeable meal. To sum up. As far as Dr. L is concerned, they are just skimming the surface of knowlege on Parkinson's and that his reccomendations are not THE word only an educated guess based on his experiences and the results of the experiments he has been involved in. He gave me no absolutes, which was as I expected but he was extremely attentive to my father and kept us there several hours until he was satisfied he had seen everything he needed to see at this time. I also requested some directions to published studies of Pallidotomy and Fetal Tissue Transplant and said he'd mail me some literature in the coming week. I'll let you know more about that when I get the articles. Thanks again for listening/reading. These get so long winded but there are alot of little details that could be important and as you may have discovered... Yes I am anal retentive (only in the cliched sense). Regards. Sonia ([log in to unmask])