Dear Sonia: Thank you very much indeed for your careful and thorough reporting. I have a daydream that the fetal tissue transplant idea will come along "just in time" to do my husband a world of good. Your commentary is an inspiration. Many thanks! k. > 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]) > > ====================================================================== Mrs. Karin M. Beros, MSO [log in to unmask] International and Area Studies voice: (510) 642-8542 Office of the Dean, 260 Stephens Hall fax: (510) 642-9466 Mail Code 2300 ======================================================================