Wednesday, December 28, 2011

A Christmas Update

Hi Everyone:

I’m still celebrating the holidays and taking it easy at my sister’s house in Wichita. On Friday, I drove down to Wichita to pick up my dad and take him back to Kansas City. Shortly after we safely returned to town, Sandy and Alyssa went to the airport to pick up Marshall. We felt so fortunate to have my dad in town with the whole family for another Christmas day. We had a special time and hope you did, too.
Sandy sent out all of the Christmas cards the day before Christmas Eve, and the cards promised an update on my health for those inclined to venture to the hinterland to read my blog. Really, there’s been very little change in my condition over the past several months and year. When we’re talking about a progressive disease, like Parkinson’s, this is good, not bad. As promised, however, here’s the latest.

In my last post, I reported that I was trying a new form of the drug, Mirapex, which had just become available in an extended release form that is taken once a day. I have decided to use the far less convenient, but far cheaper alternative form of Mirapex, still available in generic form. This is usually taken in a dosage of two pills three times per day. Instead, what works best for me is a dosage of six single pills distributed fairly evenly across the day. I would miss at least half of my pills if it weren’t for my cell phone, which I program to alert me all six times. I then take a pill as soon as I can, giving me an even concentration across the day and evening.

With this regimen and a once daily dose of Azilect, I feel much more normal and far less symptomatic than without the medication or with any other dosage I’ve tried. It enables me to carry out virtually all of my professional responsibilities at work and do my chores and generally help Sandy out around the house, as usual. My typing is not normal, but before starting medication for Parkinson’s disease several months ago, I really hated to begin a letter or a paper or even an email; it was that difficult to hit the right keys without producing multiple letters or omitting letters in an effort to avoid the heavy, uncoordinated keystrokes. Now, there’s rarely a project that I defer out of consideration of typing problems. I have also gotten more proficient at using Dragon speech recognition software. This is even faster than I used to type; the only problem is that the program sometimes generates wild errors; for example, it loves to interpret some of my breathing or other random noises as WILL WILL WILL or HIM HIM HIM. This is mostly a problem for email, because I’m more apt not to pay it much attention, and I’m less likely to edit carefully. I apologize for this if you’ve seen it in one of my emails, and I’m especially sorry when the program’s interpretation is truly maniacal; I’ve seen some pretty psychotic-sounding ramblings in emails that I failed to edit adequately. Trust me, if you see this, it’s a reflection of my immature use of Dragon rather than my “other voices" talking.
My movement symptoms, then, are relatively unchanged; most of the time, I have the feeling of being a bit low on sugar, or cold, to the point of shivering. In short, I’m a little shaky with my arms and hands and even torso, at times.  These symptoms are bilateral, and they don’t really change when I make intentional movements. My legs are not affected as much, but if I miss a dose of medication, they may feel tired, as if I just got through with a tough workout. I played a couple of sets of tennis today with members of my family, and I didn’t play much differently than ever; my same old bad game. But this is a good indication that I’m hanging in there in terms of my movements.

A general symptom that affects my daily life more directly is fatigue, or sleepiness. I still feel sleepy much of the time, and this generally gets me in bed by 8:30 and asleep by 9:00 or before. I’m having much greater success falling asleep than I have had in the past, but it’s not unusual for me to be up by 2:00 – 4:00 AM, unable to fall back to sleep. At these times, I'm at once sleepy and sleepless. Since I’ve been off for Christmas, I’ve been faring much better in this area, and I’m hoping this is a trend that will continue into the new year.
To manage these movement and sleep issues, I work out, using either an elliptical trainer or my Nordic-track for about 45 minutes a day. I usually miss a day during the week, but try hard to be faithful. There’s no hard evidence that this makes a long-term difference, but there’s a growing body of weak evidence that exercise done to the level of exertion can diminish symptoms. It’s easy for me to believe these reports, because they are so close to my experience; if I’m a little shaky, a session on the elliptical machine can make me feel much better. I’m under no illusion that I’m  beating the disease this way, but this, along with the Azilect, could be slowing things down a bit.

The symptoms that are most troubling for me are most like those I associate with a severe sinus headache. This comes on several times during the day, and I’m certain it’s not directly related to the medication I’m taking. My head feels full and under pressure; sometimes I’m a little foggy and even a bit light-headed or dizzy. This slows me down at work, especially if I’m trying to be creative or to solve a difficult problem. The hardest thing for me to do is to put down the work at these times, take a brisk walk, or go home and exercise; these are the best solutions to the problem, though, and I’m getting better at taking my own best advice.
That’s pretty much the latest. I’ll publish another post after my next appointment with my neurologist in February. In the meantime, my spirits are still high, and I look forward to each day, as usual.

Please refer others interested in my condition to this blog. I thank you again for all of your concern and support.
Best,

Marc


Friday, July 29, 2011

Final Update: 7/29/2011

Hi Everyone:

If anyone tuned in last week, I’m sorry I had no update for you. I’m afraid that my blog has served its purpose well and is no longer necessary. In fact, I feel bad when I don’t have time to update it regularly. That’s completely counterproductive. So, this is the last blog that I plan until there are big changes in my condition or we hear of breakthroughs in treatment of PD.

I do have an update. I have responded well to the rasagiline (Azilect), which I take at bedtime. It makes me a little sleepy, and I’ve continued to have nights in which I don’t wake up at all. This is fabulous. As of this week, I am trying a One-A-Day form of Mirapex; this is in contrast to a form that I was taking six times a day. Obviously, this new form is much more convenient. Unfortunately, there is no generic form, so at present, the One-A-Day form costs a hundred dollars more per month. I'm testing it to see if it seems to be worth the extra money either in effects or convenience. So far I think it's not.

My brother' s band, Tree Frog, is playing in Lawrence tomorrow night. It'll be up big reunion with great music. Sandy and I will go in and then retire at a local hotel. The drive home is not long, but it will be nice that we don't have to make it late Saturday night.

Work is going well. I'm learning how much it had piled up over the weeks and months when I wasn't functioning nearly as well as I am these days. I'm really enjoying getting back to writing in particular. Also, I've been involving myself in projects in the clinic. This is something I haven't done for years. It's good for me, but it is taken up a lot of my time, so I'm glad it's over for the moment.

I want to thank all of you who took the time to tune into this blog as well as those who just took a part of their day to think about me and how I was doing. I'm still available at my e-mail account, mfey@KUMC.edu, and although I don't use it very much, you can always try me on Facebook.

Keep on the sunny side.

Marc

Tuesday, July 12, 2011

New Update, July 12, 2011

Hi Everyone:

I've had a really good week, so I'm pleased to publish a new posting on the blog. The big event was a trip to Akron to see Marshall and his new digs. We stayed at an Embassy Suites between Cleveland and Akron, and that proved to provide the best of both worlds. We ate our way out of Ohio, and we were able to take in several key attractions, like the Cleveland Indians, the rock 'n roll Hall of Fame, and Brandywine Falls. Plus, we got the best darn tour going of the University of Akron's excellent athletic facilities. Marshall was a great host, and we had a blast.

My medications continue doing the job really well. The Mirapex seemed to be working very well on its own. Now, the addition of rasagiline (Azilect) has made things even a little better. The new medication makes me a little drowsy which helps at bedtime, and it seems to keep me asleep even better than my sleep medication. Last night, for example, I slept a full 8 hours without arising at all. That's something I haven't had for some time. In general, I haven't been nearly as sleepy and lethargic throughout the day, which makes me more productive, which helps keep me more positive, and so on.

While we were in Akron, I worked out every morning using an elliptical cross trainer. I really liked the action on that machine, and it seemed to be much better on my lower back and feet than my NordicTrack skier. I was really intrigued because I have seen some video evidence suggesting that fast pedaling like on a bicycle has effects on the brain very similar to PD medications. In some cases people have even gotten off of medication for short periods by adding a bicycle to their exercise regimen. I need to do some searching and find these studies.

Anyway, when we got home, Sandy and I bought a much less expensive home model of an elliptical trainer than the one we used in Ohio. After spending most of the afternoon on Sunday and most of last evening screwing everything together, unscrewing things that weren't supposed to go together, and screwing them back correctly, everything's a go on our new machine. It can very easily be changed from a short ellipse (more like a bike) to a longer pattern (more like the “think” big mantra for those with PD), so I think it will be very useful. At least for now it's a new toy, and it's fun. It certainly can't hurt anything.

That's about all for this week. I hope you all are well. As Mother Maybelle always said, “Keep on the sunny side.”

Marc

Friday, July 1, 2011

Update for the week of June 27, 2011

Hi Everyone:
I'm a little late with this update, but I've got quite a bit of news. First, I promised some information on Roger McGuinn's performance at the Folly Theater a couple of weeks ago. For those of you who are not fans of the Byrds, I apologize. For me, this was big (To be healthy we need entertainment, right?) The concert was just McGuinn on electric and acoustic guitar and on banjo. His typically strong Dylan-esque voice was nowhere to be found, I'm afraid. Age has stripped him of his vocal range and power. On the other hand, he took the audience at the beautiful Folly for a trip through the history of music, the beginning of rock 'n roll, and most significantly, the development of the Byrds. He was personal, personable, fun, and funny as he told story after story, based mostly on his experiences. He and the band were unbelievably connected with musicians from other genres, and he played them all. For Sandy, my buddy Jim Aldritt, and me, it was a night to remember. Don't miss the opportunity to see him if you can.

Last week Sandy and I went to our former home of nine years, London, Ontario, for the wedding of Kate Huner. Kate was born just before we arrived in London in 1981. She and her sister, Erin, and her parents, Norm and Sue, lived next door to us for several years and we count them among our dearest friends. We've seen Kate over the years now and then, but it was a spectacle to see her as a striking woman in her bridal gown. She was truly beautiful, as was the wedding. The wedding gave us a good excuse to pal around for a few days with Carla Johnson and Jim Stouffer, exploring London and visiting some of our old haunts. Always a great time, made greater by the fact that I felt really good, and I slept well, even though I had no sleep medications with me. It was a really nice, relaxing four days.

Now, for the health situation. As most of you know, I had an appointment with my neurologist last Wednesday. I had nothing but good things to report to him, because for the last two or three weeks (since about the time I last published an update post on the blog), my medication, which at one point seemed to have lost its potency, has been doing the trick. My movement has been better and my thinking has been clearer. Dr. Pahwa agreed that my symptoms were not as great as they were three months or so ago at my last examination. Because of this, he decided to keep me on my current medication. It's a dopamine agonist, called Mirapex. It works by facilitating the uptake of dopamine by the receptor neurons. The new drug is rasagiline, brand name Azilect. The mechanism of this drug is completely different than Mirapex. It is an MAO type-B inhibitor. MAO Type-B is important in the metabolism of dopamine and increases with cell death. So I've got dopamine-producing cells that are dead and dying (due to PD), which increases the levels of MAO Type-B, which, in turn, increases the metabolism of dopamine. This is bad, because I've already got a shortage of dopamine. I need more, not less. By inhibiting MAO Type-B, rasagiline can limit its metabolic effects on dopamine, leaving more dopamine in my system.

I took an Azilect pill before bed last night. I haven't noticed much difference in my PD symptoms today, but importantly, I don't notice any side effects either. This is all good. Hopefully it will stay that way for a while.

Have a great Fourth of July holiday. Best to you and your families. I'll be back in a couple of weeks.
Take care,

Marc


Wednesday, June 8, 2011

Update for June, 2011

Hi Everyone:

I'm late once again, and once again I haven't got a lot of news. There are two events coming up some importance to me. First, Sandy and I are going to see Roger McGuinn, long-time leader of the Byrds, At the Folly Theater on June 17. The Byrds were certainly not greater than the Beatles, but no other band has had a greater effect on me( other than the Fab four) . McGuinn won't be rocking out at this event, but I'm really looking forward to it, nonetheless.

The other important event is an appointment with my neurologist on June 29th. I expect to be on some new medication after that date, but I really don't know. I expect to learn a lot at this visit. I'll share the outcome with you at the end of the month.

Things are really busy at work, however, and when I get my work done, I feel good. So I'm going to take a few weeks hiatus. I'll be back in touch at the end of the month with some real news.

Thanks for staying with me. I promise I'll be back in late June, and I'll continue this blog then.

Marc

Tuesday, May 31, 2011

Update for 5/30/2011

Hi Everyone:
Sandy and I didn't do a whole lot that was very special for the weekend, but I do have a positive report on my health. For each of the last three nights I've had a full night’s sleep, eight hours or thereabouts. I've been refreshingly clearheaded over this time. There are the occasional bouts of dizziness, but for the most part, I have felt better on these three consecutive days than on any other three consecutive days for months. In terms of movement, things have been fairly static and generally not too bad. It's the cloudiness in my head that causes me the greatest problems and concern. And whether it's sleep or adjustment to the medication or whatever, my condition has been much easier to deal with over the past few days.
I wish I could account for this improvement by progress in record and play of the Kansas City Royals. That's not been happening. Perhaps my improvement is due to a change in exercise routine. I have added some shadowboxing to my regular NordicTrack regimen, thanks to our Wii system. The aerobics, the balance, and the continually shifting footwork would seem to me to make this a good exercise. I'm having fun with it, anyway.
We DID see Bridesmaids this weekend. It's REALLY funny and definitely worth the money. On the other hand, I don't recommend taking your parents to see this one with you; or your kids either for that matter.
Thanks for staying in there with me. I'll have a new report next weekend.

Marc

Monday, May 23, 2011

Update for 5/23/2011

Hi Everyone:

I've had another pretty uneventful week. The best news is that Alyssa came back from Chicago where she just completed a six-week clinical practicum in physical therapy. Now, she's staying with friends in Lawrence who were celebrating their graduation last weekend. Sandy and I went to Lawrence yesterday to join the celebration.

That's a nice segue to the only real health events of the week. I attended my students' graduation ceremonies all day on Saturday. My head hurt, I felt dizzy and a little nauseous most of the day. I can't be certain that this feeling isn't due to the medication, but I don't know why it's so variable. In any case, we had some rough weather Saturday night; I was woken up by sirens, and we had tornado warnings for our county. That limited the sleep I got Saturday night, and I expected to pay for that all day yesterday. As it turned out, it was a great day; although I was sleepy, I felt pretty normal and, especially, clear-headed. I went to work in the morning and got a lot done. That helped me to relax throughout the afternoon and evening.

So, it was a really good weekend made especially so by Alyssa's safe return. The new week has started off positively, as well. I didn't sleep too well last night, so I'm sleepy this morning. On the other hand, I feel clear-headed and am looking forward to another good day and week. I hope you have the same.

Thanks for checking in.

Marc