Henry,
I need to preface this for legal reasons that since I have not
examined your wife and do not know the actual clinical situation except
from what you have stated that I am not suggesting a specific course of
medical care for your wife. My comments are only my opinion based on
the facts that I have.
I am a psychiatrist with PD. I too am disturbed by the "cocktail of
medications" that you report that your wife is receiving. She is taking
Effexor, Ativan and respiridol all of which are psychiatric medications.
You do not state the doses of wach of the medications. Ativan, and
Vicodin have the potential of being addicting. Regarding the PD meds
artane is usually not enough for PD which has advanced to any degree.
A couple of questions- Have you heard the doctor specifically tell her
or you that she has PD and not the parkinsonian side effects of
neuroleptic medications? Drugs in the class of respiridol can and often
do cause symptoms similar to those of PD? The illnesses that they are
used to treat are often associated with marked behavior change. While
respiridol in my experience my have less parkinsonian side effects than
the older "neuroleptics" it usually agrivates the symptoms of PD. What
are her doses? What is the justification for thje pain killer Vicodan?
Has she been in chronic pain and if so from what cause? Is her
neurologist a subspecialist in movement disorders? Hs she seen a
psychiatrist? Usually neurologists will work with a psychiatrist when
there is a complicated regimine of psychiatric drugs.
Concerning contact with her neurologist, your wife has the right to tell
her physician that he/she cannot give you any information about her
condition. She however cannot prohibit you from giving him/her
information concerning your wife. A letter to the neurologist might be
in order giving him the benefit of your observations and that of your
family.
The medication combination on the surface seems to me to be
pharmacologically irrational- But having said that in the practice of
medicine sometimes the "irrational" works. There are many cases where I
have changed medications of a patient who has come to me taking an
"irrational" combination only to have the patient deteriorate and an I
have a number of patients that if I would review only their medication
list I would question the judgment of the physician who put them on the
combination- except for the fact that it was my prescriptions and they
work!
Commenting on another thread associated with this- my definition of
the most important thing that need to know as a physician is to know
what I don't know.
Even if her neurologist is incompetent I think you are in a difficult
position since she is satisfied . If you think he/she is grossly
incompetant you might file a complaint or at least present the facts as
you see them tho the state Board of Medical Examiners. If he/she is
inappropriately prescribing narcotics or is grossly irresponsible they
likely have received other complaints.
Good luck
Charlie
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CHARLES T. MEYER, M.D.
MADISON, WISCONSIN
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