Hello Everybody:
Thanks to those who took time to comment on my wife's problem.
However, from content of the replies I realized that I should have included
an explanation of Diphasic Dyskinesias.
I think that I can best give you a picture of what is involved by
taking you on an imaginary airplane trip. Buckle your seat belts and let's go.
It is a cloudy day. You take off in the smooth air and you feel that
this is going to be a great trip. Then suddenly you reach the clouds and
considerable turbulence occurs until you emerge in the sunshine above the
clouds. As long as you keep flying just above the clouds the ride is
smooth. But in the distance you see that the cloulds are higher so you have
to plan ahead so when you arrive at the high clouds you are still above
them. Finally you get near the end of your journey. The clouds are a bit
lower but as you go through them you encounter extreme turbulence and you
wonder if the wings with stay on. Finally you come out of the clouds above
the airport and the flying is again quite smooth.
Going through the clouds in the morning and evening is the Diphasic
stage. It is OK-Bad-OK.
If you try to stay up too long your engine will overheat - this is the
Evening Dyskinetic phase. If during your flight above the clouds you go too
high you will be in trouble because your plane does not carry oxygen. This
is the peak dose dyskensia phase.
Of course, if while flying above the clouds you get careless and drift
down into the clouds you will get into the Diphasic stage again and will
find that it is not easy to get out.
This analogy only applies to advanced Parkinsonians. The path of the
flight of the airplane is really just a graph of the sinemet in their
bloodstream.
At one time my wife averaged about 4 hours of Dyskinesias per day. By
organizing a regime that kept her evenly above the clouds the Dyskinesias
have been reduced to about 30 minutes per day. When you come down you have
to get through the clouds as quickly as possible. Anything that delays your
descent makes matters much worse. In fact the evening Dyskinesias can go on
for 2 to 3 hours if you don't get the pills right. This actually happens if
my wife takes sinemet CR past 3 PM.
Most of the Parkies on the list are still at the point where blasts of
sinement can be buffered and stored for later use. Advanced Parkies have
virtually no storage. The dopamine in their brain seems to track the sinemet
in their bloodstream.
I hope that this posting will clarify my problem with evening diphasic
dyskinesias.
In a future posting I will show you how I used EXCEL to determine the
pill regime that would give a reasonably good day. The morning diphasic
dyskinesias are relatively mild and no real problem. If I could find a way
to beat the terrible shakes in the evening my wife's day would be great.
In an April 1992 round table discussion Dr. Lang had this to say about
diphasic dyskinesias.
"Well I've stayed away from this group in this discussion because I think
they would be classified in my hands as advanced patients. In any event,
our success in treating patients with diphasic dyskinesias has been very
mixed. These patients are very hard to manage in the long term ............"
So I am trying to beat this thing. I guess that fools rush in where
angels fear to tread !
Robert Naylor CG for Olive (73, PD 19 Yrs) ([log in to unmask])
