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Chris - You wrote, << A sudden improvement after an adjustment may just be a placebo effect, so you have to wait some days to see whether the result is sustained. Adjustments should be made by a physician specialized in the field and NOT BY A NURSE. >> I'm guessing that you're the one who does the stimulator programming for your patients, judging from youru letter. That's great, and I'm sure you're very experienced at it. We're actually much more confident in the adjustments made by the specially trained nurse clinicians at KU med than by any of the doctors. The nurse-clinicians have been trained by Medtronics to perform the adjustments, and do nothing but adjust stimulators all day long. Of course one of the doctors could be trained to make the adjustments, too, but the doctors we see are far too busy to take the time to adjust stimulators on top of everything else. If given a choice, we'd opt for having the adjustments made by whoever has the most experience, whether nurse or doctor. At the risk of making this too long, I might add that Dick was fortunate enough to have excellent electrode placement, and then to get seemingly ideal stimulator programming the first time he was programmed. We've tried a couple of times to have minor changes made in the hope of achieving improvement in one specific area, but those changes didn't work well - we knew it within an hour or so - and he went back to his original settings. Margie Swindler