PARKINSON'S NEWSLETTER of the Delmarva Chapter, American Parkinson Disease Association October 1996 FAX (410)749-1034 e-mail [log in to unmask] - SNAIL-MAILED 505 COPIES 10/23/96 GENERAL INTEREST: UDALL BILL ELDEPRYL UPDATE ALTERNATIVE MEDICINE REGIONAL INTEREST: BALTIMORE SYMPOSIUM LOCAL INTEREST: BERLIN [MARYLAND] MEETING-JOHNS HOPKINS NURSE ON CAREGIVING [OCTOBER] SALISBURY [MARYLAND] MEETING-PALLIDOTOMY PATIENT TELLS STORY [NOVEMBER] BAD NEWS ABOUT UDALL BILL The Udall Bill as a part of the National Institutes of Health Revitalization Act came out of committee in the senate and was passed by the entire senate unanimously. The bill was virtually intact except that funding was reduced from $100 million to $80 million per year. We had well over half the members of the senate as co-sponsors. We also had over half of the members of the house as co-sponsors, and passage would have been almost certain if the entire House of Representatives had been allowed to vote. The Udall Bill never got out of committee. With help from Congressmen Bliley (R. VA), Bilirakis (R. FL), and Smith (R. NJ) passage would have been easy. Unfortunately, Congressman Bliley as a committee chairman with assistance from Congressman Bilirakis delayed any semblance of introduction of the bill until just before adjournment. At that time Congressman Smith let it be known that he would vigorously oppose the bill and thereby delay the closing of congress for an unknown amount of time. Congressman Smith was apparently against the bill because it may have provided some funding of fetal tissue transplant research. Fetal tissue transplantation is probably not a viable cure hope for us anyway since the French 'morning after' pill is soon to become readily available in the U.S. We will try again next session. The bill has received bipartisan support, and we expect bipartisan support again. This time it should be easier since our story has been told enough to make our congressmen aware of our problems. POLITICS: Senator Joe Biden (D, DE) and Congressman Wayne Gilchrest (R, 1stMD) were co-sponsors of the Udall Bill and are up for re-election. President Bill Clinton took a controversal stand for us when he lifted medical research bans imposed by former President George Bush. Check on the challengers. ELDEPRYL HAS GENERIC AND GOES TO CAPSULE Eldepryl, also known as Deprenyl or Jumex, is selegiline hydrochloride. The pills were small round white tablets packed in thick clear glass bottles until a couple of years ago. Then it was slightly reformulated to include a little vitamin C, reshaped into a tiny shield, and packed in short tan plastic bottles. Now it is a blue capsule in a very standard looking off-white plastic bottle. Now there is a generic version of selegiline hydrochloride tablets available through pharmacies from Lederle. Current quoted price for 60 doses from Super G [Giant] pharmacy in Salisbury is $138.96 for Eldepryl and $114.96 for Lederle. A price war may break out as more generics become available. The profit margin on Eldepryl has been significant. Several people in the U.S. have taken a =FEdrug holiday=FE by flying to Hungary and buying a couple years' supply at a price of approximately $2.00 U.S. per 60 Jumex tablets and paying the air fare from the savings. In the latest A.P.D.A. mailing there is a Lederle coupon for a free bottle of 60 tablets. The coupon expires 11/29/96. Coupons worth almost $115 in free medicine are not often seen. The new Eldepryl capsules are the exact same formula and identical to the tablets according to the U.S. manufacturer, Somerset Pharmaceuticals. The shelf life of th capsules may be shorter. The tablets I bought on 8/23/96 had an expiration date of January 1998, the same expiration date as the ones I had purchased on 5/31/96. The capsules I purchased 10/14/96 have a June 1997 expiration date. I telephoned Somerset Pharmaceuticals and asked if the formulation was changed and why the expiration was so short for the capsules. I was told the formulation is the same, but the F.D.A. on short notice had approved only 18 months from manufacture as maximum shelf life. I also asked about the advent of generic selegiline hydrochloride and was told that the generics are not equivalent to the Somerset product and that the potency of the generics varies from 40% to 300% of the proprietary Eldepryl. Switching to the generic may require a new prescription since Eldepryl capsules are not generic tablets. The switch to capsules is almost surely a ploy to discourage the use of generics. The varying degree of otency, if true, could be a serious problem for us with Parkinson's. Some drug companies are considering producing a patch with Eldepryl or making a tmed-release pill with a laser-holed plastic outside coating similar to ProcardiaXL, a heart medication. The drug has had a very strange history. It was developed in Hungary during its Communist years. It was originally intended to be an antidepressant, but it failed miserably for that use. The first human clinical tests for use as an anti-Parkinson's drug were under the supervision of a former Nazi SS physician. Until recently it was manufactured exclusively in Hungary and was a major portion of Hungary's exports, second only to light bulbs. Marketing of Eldepryl in this part of the world is handled by Sandoz Pharmaceuticals, a Swiss firm which a few years ago tried to take over McCormick and Company (the Baltimore spice maker) but was persuaded by handsome payments from McCormick not to. Eldepryl [then called Deprenyl] was studied intensely in the DATATOP which supposedly tested the effectiveness of Eldepryl and vitamin E alone and in combination with one another. Vitamin E was found to be not effective, but Eldepryl was thought to preserve or protect brain neurons. This is still being argued. It is known that Eldepryl does provide some symptomatic relief at least for some Parkinson's patients. Eldepryl is not without serious side effects. The commonly given anesthetic or pain-killing drug Demerol[meperidine] can be fatal to patients who have taken Eldepryl during the preceding two weeks. A recent British study has found that the mortality of patients on Eldepryl is higher than similar patients not taking Eldepryl. This study, according to some, is seriously flawed and is in direct conflict with the DATATOP studies. Should you use Eldepryl, the generic substitute, or neither? The answer is far from clear. I find that Eldepryl provides me with symptomatic relief, and I hope it provides me protection from brain neuron cell death. If it did not provide symptomatic improvement, I would not take it! This is the position taken by the Parkinson's Disease Foundation. (I'll try my coupon.) SHOULD WE CONSIDER ALTERNATIVE MEDICINE? The medical profession, led by people who have been graduated with the M.D. degree from accredited medical schools, have taught most of us that their kind of medicine and healing is the only safe and effective system for health care. Are they right or just persuasive salesmen? The traditional system of medical care is no longer the only health care available. The D.O. (Doctor of Osteopathy) degree frowned upon thirty years ago is now usually accepted as a general equivalent to the basic M.D. degree. Nurses who were expected to provide only tender loving care and to carry bed pans are now as nurse practitioners providing first line medical care. The Doctor of Chiropractic (D.C.) practitioner is still usually considered to be non-traditional and somewhat below the M.D.'s and D.O.'s, but many medical insurance plans give them tacit recognition by paying their fees as a medical cost. The medical community has done wonders for us. As a result of their expertise, refrigeration, indoor plumbing, central heating and air conditioning, and several other improvements to our environment, our life spans are increasing and our quality of life is going up. The "good old days" with outdoor privies and a life expectancy of less than 50 years are behind us, but we want and expect even more. Traditional medicine has done much for us, but we want more. The failure of the traditional medical system to provide all we want has led to the rejuvenation of alternative medicine, some of which may be of value today and a part of traditional medicine in the future. Some is pure quackery promoted by well-meaning practitioners and patients who sincerely believe in the alternative medicine they are promoting. Some alternative medicine and probably some traditional medicine are creations of charlatans designed to bring profits or honors. The problem is how to find out what is good, what is useless but harmless, and what is bad. At the Salisbury Business Expo trade show, I was shown a revolutionary health product from Japan, a pair of alnico magnets which will cause a red light to go on when the magnets are spun. There were also magnetic pads which I was told might help Parkinson's disease symptoms if I placed them in my shoes. I told the salesman that my trouble was not in the feet and left. I received in the mail some material on a nutritional supplement which I started to discard as quackery since the claims for it ranged from curing cancers to helping with coronary artery disease and Parkinson's. In looking through the material, I saw that the publisher was in the business of selling the product. Then I noticed=7F names of practitioners who reported good results from use of the product. They were affiliated with highly esteemed traditional medical institutions. Vitamin and mineral products are generally tolerated by traditional medicine since they seldom cause harm. Many vitamin products are made by or sold by major ethical drug companies. We know that vitamins are necessary for good health, but do we get enough in our regular diets? Calcium supplements once thought to be useless are almost universally praised for women today. The usual disclaimer statement found in newsletters says that you should ask your doctor before trying anything new. Your doctor is part of the traditional medical system and probably taught to tell patients to use only traditional medicine except for assistive prayer and chicken soup. The traditional medical system, including the F.D.A., knows that many of us use alternative medicines from time and tries to protect us from what they believe to be harmful to us and occasionally what may be bad for the traditional medicine provider. Should you use remedies from the health food store such as melatonin and CoQ10 which are gaining in reputation even among traditional medical people? Are large doses of vitamin C as beneficial as claimed by a famous Nobel Prize winner? Is acupuncture a viable and useful cure for many of our ailments? Some exercise is good for us, but how much is enough? Are organically grown bug-bit vegetables better for us than what we usually find in the supermarket? We as patients must take a larger part of the responsibility for our own care. We need to consider ALL medical options carefully. PALLIDOTOMY PATIENT AT NOVEMBER MEETING Nick Nieberding will relate his experience as a Johns Hopkins pallidotomy patient at our November meeting. Nick, the Ponzetti's Pizza man, is one of our younger members and a fellow who will "tell it as he sees it." The November meeting will be in Salisbury at the Asbury United Methodist Church near Salisbury State University on Tuesday, November 26, at 1:00 p.m. MEETING TUESDAY OCTOBER 29 AT 1:00 ATLANTIC GENERAL HOSPITAL IN BERLIN JOHNS HOPKINS PD CENTER NURSE SPEAKER FOR OCTOBER MEETING Paula Goldberg, R.N., nurse coordinator for the Parkinson's Disease Center at Johns Hopkins Hospital, will be our featured speaker at the October meeting. Ms. Goldberg is the person you get when you call the A.P.D.A. Information and Referral Center at Johns Hopkins. She has gained considerable experience in working directly with Parkinson patients and their families at Johns Hopkins. Her talk will deal with the role of the care giver and probably include=7F several tips to make caregiving more efficient and effective. Care givers need care too. This is a topic which we have not considered before as a central theme for a meeting. Your ideas and experiences can be a help to others at our meeting and through Ms. Goldberg to members of other groups in Maryland as well. To get to Atlantic General Hospital from Salisbury, take Route 50 east toward Ocean City. Do not take Route 90. Pass the first two roads to Berlin. Turn right on Route 113 and quickly get in the center lane. At the traffic light turn left [do not make a U-turn]. Turn left at the Berlin Nursing Home. Atlantic General is near the end of that road. Go in the front door and turn left. We meet in the room just before the cafeteria. BALTIMORE SYMPOSIUM FULL OF IDEAS The Parkinson's Disease symposium held October 5, 1996, had about three hundred attenders. The talks went well, and the sound system worked most of the time. The presentations were not videotaped. Dr. George Paulson of Ohio State University Hospitals stated that the progress of the disease cannot be predicted and that we should not give up, because of the possibilities of new discoveries. Dr. Stephen Reich of Johns Hopkins Parkinson's Disease Center saw a bright future for Parkinson's patients, at least in part because we now are able to create Parkinson's symptoms in animal models for more effective research. Dr. Ted Dawson, also of Johns Hopkins, said two causative factors were agreed upon: risk increases with age and males are more likely to have Parkinson's. Infections, trauma, genetics, toxins, fewer dopamine producing cells to start with, and environment are all possible causes of Parkinson's. The body makes free radicals and other toxins. Our cell defenses may be defective. Dr. Ted George, formerly of Johns Hopkins but now of Wayne State University Hospital, talked about the many manifestations of Parkinson's, particularly dysfunction of those activities of the body we do not consciously control. He stressed being sure to inform your doctor of ALL symptoms, even mild ones, to help sort out what is caused by Parkinson's and what is caused by drug side effects. Leslie Gibson, R.N., a humor specialist, quoted, "Yesterday is history. Tomorrow is a mystery. Today is a gift. That's why we call it =FEThe Present.'" Dr. Fred Lenz, a Johns Hopkins neurosurgeon, stressed the idea that the pallidotomy and thalamotomy operations are low risk surgeries so long as the patient's neurologist is a part of the team from the very beginning, there is considerable brain mapping before the operation, and only one side is done at a time. The patient panel dealt with coping. Ed Calhoun discussed his drug interaction problems and how he dealt with both Parkinson's and kidney cancer. Bruce Miller, a salesman, told of his stuttering and emotion problems and how he is working to find a substitute for the stereotactic frame used in neurosurgery. Will Johnston told of his stay-busy activities in medical studies, newsletters, and political lobbying. Tom Collins discussed how understanding improved family relations. Jeanne Michaels told about the slow progress of her Parkinson's and the near-miraculous improvement of a young lady who had a pallidotomy. Marvin Mervis talked about some daily tricks he uses to get by, and he recommended a book that he said changed his life, As a Man Thinketh, by James Allen which says good actions and thoughts can produce nothing bad. It was a long and busy day. THERE WILL BE NO MEETING IN DECEMBER DISCLAIMER [in 7 point type] At the suggestion of the APDA Director of Chapter Operations: The information and reference material contained herein concerning research being done in the field of Parkinson's disease and answers to readers' questions are solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. Three neurologists and three patients were going to ride on a train. Each neurologist bought a ticket and took a seat. The three patients bought one ticket and boarded the train and jammed themselves into the rest room. When the conductor came through he collected tickets from the three neurologists. He then tapped on the rest room door and said, =FETicket please.=FE One hand came out of a barely opened door and handed over the ticket. The neurologists realized they had learned something from the patients. On the return trip the three neurologists bought one ticket, and the patients bought none. The three neurologists jammed themselves into a rest room. The patients did the same. As the train pulled out one patient left one rest room and tapped on the other rest room door. "Ticket please." Will Johnston [in 36 point script] WILL JOHNSTON 4049 OAKLAND SCHOOL ROAD SALISBURY, MD 21804-2716 410-543-0110 Pres A.P.D.A. DelMarVa Chapter 63 Dx1991 Symptoms 1971 =20 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ + + + Repeal the 23rd Amendment before 2000 + + + ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ =20