Med update

Syncopa is not making a difference. Seems to have increased the off time as it takes almost 1.5 hours to kick in.  Will now go back to Syndopa and give it 5 times a day instead of 4 times a day.

- Syndopa, 125/2 mg, five times a day, every 4 hours - 6:30 AM, 10:30 AM, 2:30 PM, 6:30 PM, 9:30 PM. 

- Pramiplex, .5 mg, three times a day, every 8 hours - 8:30 AM, 3 PM, 10 PM
- Neupro patch 1 mg/24 hours

Pop will also track yes/no for Walk, Drowsiness, Medicine Induced Side Effects/Abnormal movements every hour from 7 am to 9 pm.

Med update

Three days ago, changed from Syndopa to Syncopa

- Syncopa, 50 mg, four times a day, every 5 hours - 6:30 AM, 11 AM, 3 PM, 6:30 PM. 

- Pramiplex, .5 mg, three times a day, every 8 hours - 8:30 AM, 3 PM, 10 PM
- Neupro patch 1 mg/24 hours

Syncopa does the same thing as Syndopa - only difference is that it's slow release.

Observation: Syncopa does not seem to ahve helped -with Syndopa, the effect started half an hour after taking med and lasted about 2 hours. With Syncopa, it takes about hour and a half to take effect and effect last for about 2 hours.

Two days ago, doubled the strength of the third Premiplex and changed the times of the Syndopa

- Syndopa, 125/2 mg, four times a day, every 5 hours - 6:30 AM, 11 AM, 3 PM, 6:30 PM. 

- Pramiplex, .25 mg, two times a day, every 8 hours - 8:30 AM, 3 PM,
- Pramiplex, .5 mg 10 PM.
- Neupro patch 1 mg/24 hours
Observation: Sleep was very disturbed. Off time period during the day descreased because of the shorter intervals of Syndopa during the day.

Today changed back to the old frequncy of Syndopa, left Pramiplex dosage the same.

- Syndopa, 125/2 mg, four times a day, every 5 hours - 7 AM, noon, 5 PM, 10 PM. 

- Pramiplex, .25 mg, two times a day, every 8 hours - 8:30 AM, 3 PM,
- Pramiplex, .5 mg 10 PM.

- Neupro patch 1 mg/24 hours

Next step is to increase the strength of Pramiplex for the remaining two times also and after that to replace Syndopa with Syncopa - Syncopa increases the duration of the effect of Levadopa.

Food and drug routine

https://docs.google.com/spreadsheet/ccc?key=0Aoezv6RxCJ00dDBHZDBiaEcybF9YNmRqUERVbVVZdmc

Parkinson's Reference Websites

Mumbai, India based - http://www.parkinsonssocietyindia.com/index.aspx
Parkinson General Website - http://www.parkinsons-voices.eu/patients
Basics of Parkinson's Drugs - http://www.webmd.com/parkinsons-disease/drug-treatments
Blog on Livestrong - http://www.livestrong.com/article/69726-parkinsons-disease-stages/

Medicines

As the disease has progressed, we now need to play a bigger role in determining the type of meds, frequency of meds and dosage.

Week starting 11/11/13, she was on the following

- Syndopa, 125 mg, twice daily. 

Observations:She was having very little on-time and was awake all night and needed to be helped in/out of bed and walking. There is moderate dyskinesia during the on time.

Week starting 11/18/13, we changed to

- Syndopa, 125/2 mg, four times a day, every 5 hours - 7 AM, noon, 5 PM, 10 PM. 

- Pramiplex, .25 mg, two times a day - 7 AM, 10 PM.
- Neupro patch 1 mg/24 hours
Observations: The on-time starts about half an hour after giving Syndopa and lasts for about 2 to 3 hours after giving the meds. She still has trouble sleeping through the night - sleeps about 5 or 6 hours while getting up every hour or two. There is moderate dyskinesia during the on time.

On 11/26/13,  we added a third Premiplex.

- Syndopa, 125/2 mg, four times a day, every 5 hours - 7 AM, noon, 5 PM, 10 PM. 

- Pramiplex, .25 mg, three times a day, every 8 hours - 7 AM, 3 PM, 10 PM.
- Neupro patch 1 mg/24 hours

Observations: Mom slept for about 7 hours only getting up to go to the restroom. The extra Premiplex might have helped. Need to see now if she is alert (not drowsy) during the day.

Potential next steps are to increase the strength of Pramiplex  and also increase the strength of Neupro to 3 mg after the first 28 days (around 12/20). The last resort option would be to increase frequency/strength of Syndopa and also give another medicine that decreases the harmful effects of Sindopa. This is the last resort as Syndopa has long term side effects and causes involuntary movements (dyskinesia). The current level of involuntary movements during the on time caused by Syndopa is already alarming.

Here are the basics of Parkinson's drugs - http://www.webmd.com/parkinsons-disease/drug-treatments

The plan is to do a weekly family conference every Sunday and adjust the meds.