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I get a report each time I go to the Neurologist. I though I would share one with you. I find it very useful to keep track of what we are doing. Mr. Returns not to have follow-up of his multiple problems 1, Hip pain We initially thought that the hip pain was secondary to radiculopathy and lumbar stenosis. He had a microdiskectomy of L5 5.30.95 He was felt to have herniated an L$ disk in the fall and underwent epidurnal injections in the third and fourth week of October. That did help with the back pain, but the hip pain remains. He was told by DR. B to go out and golf. When he went out and golfed the back pain was not a problem but he developed knee pain. 2. Right Knee Pain. He saw Dr. Forgette and then DR. Lanzer. Dr. Lanzer noted that the patient had obliteration of the joint space. he was able to aspirate 40 cc of synovila fluid. and Dr. L;Lanzer felt that there was going to be a need for a total knee replacement. Dr. L also injected the patient with some cortisone, which helped and the patient is understandably less than enthusiastic about a TKR.. 3. Tortacollis He had his Bo Tox in December (Botulisim injection) This was minimally effective. He went back ton 2 mg of Artane b.i.d. ; he had been on t.i.d. before. with the b.i.d. he does have some visual blurring and some cognitive deficit, no urinary hesitancy, and the question is can he tolerate an occasional day at three times a day when things are bad, and he is going to try that. It's an obvious tradeoff; the Artane helps the tortcollis and makes Mr. R. dumb. dry and blind. 4. Right Arm Pain he does have some musculoskeletal right arm pain from persistent tremor and dyskinesia. We are going to observe this but not do anything about is for the time being. 5. Insomnia. he does have early morning= awakening at 4 a.m.. He does have depression, for which he is on Zoloft. He didn't think he was depressed but his wife immediately tell after a month on Zoloft and she could tell when he wasn't taking the Zoloft, so he takes 50 mg of Zoflot in the morning, and although that helps his mood it hasn't helped with sleep. so he is going to try 25/100 half at bedtime, which appears to help with sleep, so he is going to try 25/100 half at bedtime. If that doesn't work, he will try a full 25/100 CR at bedtime. If that doesn't work, he will try a full 50.200 at bedtime, and if that doesn't work he will skip it and come back and complain, and we will try something else. Also of the Sinemet causes increased dyskinesia during the day we won't be able to use it at night, although is has a short enough half-life that I doubt that will happen. 6. Parkinson's. He is on 0.25 permax three times a day. He is on 50/200 Sinemet Cr in the morning, a half of the 25/100 at noon, and a half of a 50/200 at dinner, and he is going to add the additional dosage. He is on Eldpryl 5 mg half in the morning and one at noon, and Artane 2mg twice daily. 7. Other medications include Zocor 10 mg b.i.d., aspirin one a day, Tenormin 25mg a day, Cytotec 200mg three times a day, and Bentyl 2mg twice a day, and so one can see his reluctance at adding new medication. I'll see him again in two months to see how the Sinemet is working for the sleep, and also because I can't believe how many new problems he can generate every two months.