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(This is a message from my mother that she asked me to relay:) Thank you for the responses from Alan Bonander and Ronald Vetter (and any others I may have received since!). To review for other readers, my question regarded high doses of medication: Pergolide 0.25mg -- 2.75 mg per day CR Sinemet 200/50mg -- 2200 mg per day Sinemet 100/25mg in liquid -- 210 mg per day Ativan 1mg -- 2 mg per day I will give a summary response with a little more detail. John is 53. The idea keeps recurring that Early Onset is different (and worse). Am I kidding myself to look for more ways to medicate at this point? It seems we have been through many of the routes suggested. The 100/10 was tried in an attempt to reduce the levadopa; John had excruciating mental distress. The balance did not seem correct. At one time, about three years ago, five C.R.s with some Pergolide worked pretty well; then we ran into overdose--and drop-off cycles. We resorted to a liquid mix of Sinemet given every hour; about 0.25 mg Pergolide and a C.R. Sinemet made it possible to sleep several hours a night. The liquid every hour worked well and gave a smooth effect for a couple of years; then it degenerated into "extras" on the half hour. John could not remember (or organize?) to take the medication himself. The amount needed per hour matched that delivered by the C.R. 200/50. The change to C.R.s every 2 hours turned out to be very convenient (as compared to 1/2 hour or 1 hour). At this time John also stopped being able to give himself medication at night. He had been able to work through a small pool of pills and bottles laid out. But a few overdoses, waiting too long, and just not being able to reach the pills ended that. He claims he could keep track of the medication, but in actual fact he does not totally give himself pills even once in the 24 hours. Giving him the pills every 2 hours in the day and 2 or 3 hours at night is an improvement, in some ways, over the situation we had. We tried to lower the Pergolide to a total of 2.35 mg, but the muscles become too hard and the amount had to come up again. We break the 1 mg of Ativan in half so that we have a half roughly for every 6 hours. It fortunately gives relief for very bad spells. It works in conjunction with the other pills and other sedatives tried (such as Buspar) certainly do not. How do I manage as caregiver? I have help in half days during the week and for three nights. I do not wish to appear ungrateful but there is about a 50% or less efficiency rate with having people come in. We tried a live- in caregiver for 6 weeks but, because she was on duty 4 nights, she slept in the day and went off entirely on her own schedule. It was worse because I was locked into one more person's schedule (and the cost was too much). I am caregiver for a person who is very demanding on my physical and emotional strength. I have Chronic Fatigue Syndrome. From a condition six years ago where I often could hardly stand and spent most of the day resting, I have progressed to a "low normal" state. I manage many things quite well; I used to teach high school, but cannot function to that extent. I have been home, resting. When John was home and not as bad as now, the limited activity level at home seemed in a way beneficial. We seem to be entering a different plateau now. I have asked for respite care for John (1 week per month would help). It seems it could be worked out; John feels threatened and doesn't want to try it. We are working on counselling and moving along with plans. It seems the only rational approach for my survival. (One question--have people had good luck with nursing homes and hospitals providing care and especially the monitoring of the medication--when it reaches this stage?) Should I just be looking into hospital care period (for now or for the near future)? Thanks, Ronald, for the wish that I find flowers to smell--I do. Thanks, Darlene.