My name is Nigel Oram, I am 77 years old and joined this list about a
month ago. I am replying to Joyce Tames` suggestion that accounts of
single pallidotomies might be useful.
I was diagnosed as having Parkinson`s disease in 1984 although some
symptoms had been apparent in 1980. Until about 1990 I was almost without
any symptoms on a low dosage of Madopar tablets. On the appearance of
Dyskinesia and `freezing' of the legs, Eldepryl was added to my
medication. This, coupled with a muddle about my doses, proved to be
unsatisfactory. Under a new neurologist , I was put on to Permax and slow
release Madopar capsules which proved more satisfactory.
I was still suffering from the symptoms mentioned above and also from
double vision and indistinct speech. A surgeon, whom my wife was
consulting, mentioned that there were some `very nice` operations
relating to Parkinson’s. When I paid my six-monthly visit to my
neurologist , I told him that someone had mentioned brain operations to
me and he too suggested that an operation might be a suitable course for
me and that it would minimise the Dyskinesia.
One of the criteria for a successful subject for an operation is a
positive receptivity to Leva Dopa drugs, a condition which I fulfilled.
Over a number of weeks I went to Sydney to see a second neurologist and I
was also accepted by the surgeon who considered me a fit subject for a
Pallidotomy operation.
"Pallidotomy" is term referring to the surgical destruction
of a group of cells deep in the brain accessed through a small hole in
the skull. The goal of Pallidotomy is to reduce or control Parkinsonian
symptoms such as rigidity, tremor and dyskinesia' [PSS of NSW 13(3)p.15].
The operation is painless because the brain has no nerve ends. The
success rate is very high but there are dangers: the needles pass very
close to the areas of the brain which control eyesight and speech.
As carried out at that time, the operation had cured or at least greatly
reduced Dyskinesia, but it had little effect on rigidity. My surgeon had
met an American surgeon at a conference in Vienna. By using a new
technique, this surgeon had successfully carried out some eighty
Palidotomy operations which resulted in a great improvement in the
patient’s mobility. My surgeon went with this surgeon to the United
States and himself carried out eight operations. The American surgeon
performed a Pallidotomy operation which was shewn on Sixty Minutes, an
Australian current affairs program. The operation had a remarkable effect
on the mobility of the patient, who was a Queensland farmer. His joy at
being able to drive a tractor was great.
On the 25 July a week before my operation, I spent the night at West
Mead Hospital. Here a research team, in association with my surgeon
were to do a before-and-after study which was to be carried out on me.
For at least three hours, my hand grip was tested in every conceivable
position. It was intended that I should return in six months for
comparative tests.
I entered Dalcross Hospital on 29 July. Various tests were performed on
me. I was sent to the Royal North Shore Hospital for a Magnetic Resonance
Imaging Scan.
My operation was carried out on 1 August. Local anaesthetics were placed
in the sensitive layer of my scalp. Until my operation, patients were
sedated while they were being prepared for the operation. I was not
sedated. I appeared to be placed in a narrow tunnel and I had the
sensation of travelling in a rather rough underground train. When the
surgeon comes to operate, he needs guidance from the patient here because
the needle goes very near the nerves which control the eyes. I was
completely still for five hours; according to one person assisting at the
operation, it took about as twice as long as usual because the computer
went wrong!
Before the operation, my symptoms were mild compared to those suffered by
many people. My neurologist described my Dyskinesia as `grotesque’; my
legs froze during the lengthy periods between the exhaustion of one dose
and the effectiveness of the new one. I suffered from double vision.
I had not had any medicine for some eighteen hours before the operation,
so I was unable to walk. After the operation and a short spell in the
Intensive Care ward, I was asked by my surgeon to walk. I was immediately
able to march like a grenadier, to turn or execute any movement. My
Dyskinesia and my double-sightedness had disappeared.
At about 8 am. on 4 August in Dalcross Hospital, the ward sister found
me slumped in a chair in a faint. My wife helped the sister get me to bed
and I was given oxygen. My wife was asked to go and have some coffee and
the sister `did something with a trolley'. She told me that I had low
blood pressure. My blood pressure has always been low and the
Parkinsonian medication lowers it further. When the neurologist Dr Joffe
came to see me, I was able to show him how well I walked. He changed my
medication by removing one Permax and one Madopar half-tablet from the
previous dose of three Permax and four and a half Madopar each day.
5 August I was still a little dizzy but well enough to go to North Shore
Hospital again for a second M.R.I. scan. On 6 August my surgeon ordered
Dexamethazone, I think to reduce any swelling in my head. It was tapered
off and ended on 11 August.
I was discharged on 7 August and returned home after two days rest on 9
August. On 12 August I felt dizzy and slid to the floor in a faint. I
soon recovered. I saw my neurologist at Canberra who cancelled the two
remaining Permax tablets. He said my bed should be raised six inches at
the head end and my intake of coffee and salt increased. On 14 August I
was not walking at all well so I was prescribed a further a further
Permax tablet. I was then on the following regime.
6 am. 2 Madopar capsules
1 Madopar tablet
11 am. 2 Madopar capsules
2 pm. 1 Madopar tablet
4 pm. 2 Madopar capsules
9 pm. 2 Madopar capsules
1 Madopar tablet
As my walking was still bad, my neurologist ordered a return to the
dosage prescribed by my Sydney neurologist. On 30 August, I was working
at my computer. My family found me asleep but were unable to rouse me
for some time. My pulse rate was very feeble. Since then I have eaten a
lot of salt and drunk a lot of coffee. I have hardly suffered at all from
dizziness.
As for walking,I have suffered a decline in mobility since the initial
success after the operation. The difficult periods are those when the old
dose is losing its effect and the new dose has not yet taken effect. In
general, the passage from one dose to another is easy. There is, however,
considerable variety in the way the change of doses occur, the evening
usually being the worst time. Some freezing usually occurs. The extent of
my double vision varies.
On the credit side, I no longer suffer from Dyskinesia. [I sometimes have
minor symptoms which would not observable by outsiders]. My walking has
improved and my speech is clearer. I feel better in myself. I am told my
face has lost its tension and that I look much younger.
*I am indebted to all the medical staff concerned with my treatment for
their efficiency and kindness; and to my wife for keeping admirable
records of dates of events and of my medic-
ation.
Nigel Oram ([log in to unmask])
