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Wednesday, July 29, 2020

The Parkinson's Doctor Will "See" You Now

Two days before my 60th birthday in March, everything in my area closed due to the novel coronavirus (covid-19.) Wonderful Hubby and I cancelled my birthday party and stayed home with my birthday present, Miss Kitty. 

Miss Kitty

Our monthly Parkinson's disease support group meetings were cancelled, so were the monthly social pizza parties. Those of us with chronic conditions (me) or over age 65 (everyone I know) all began self-isolating in earnest. A quilt-making friend made us some humorous face masks and we soon settled into a stay-at-home routine. 

Baseballs for WH, lipstick for me

I was concerned because I had not seen my Movement Disorder Specialist in over a year and  thought I might lose my current patient status. So I sent her a message saying that I wanted to remain a patient, but didn't know when I could travel to see her. My doctor replied, "As long as you are stable, we can wait, but call if you need me." I WAS stable and I didn't mind waiting a few months longer. 

In May, I got this email from my Medicare Advantage Plan health insurance: Due to the coronavirus, telehealth visits, video or by phone, with your primary care doctor and all specialists will be covered and all co-pays are waived. 

I read it again, and had Wonderful Hubby read it too. If I needed (or just wanted) to 'see' my Parkinson's doctor, I could do it right from my own home! To be honest, those 240-mile each way drives to Tucson for a 30-minute appointment were getting tedious.

In early July, I had some things I wanted to discuss with my Parky Doc, so I called and asked about a telehealth visit. My video visit was set up for July 21st and I'd receive instructions via text messaging on how to 'connect' with her via my smartphone. I had my notes all ready and found a well lighted place where she could watch me walk and do all those finger tap type tests. 

My smartphone

The afternoon of July 20th came and I received a call saying my appointment was being changed to just a phone call. This was okay with me.

The next morning, my Parky Doc called me, from HER home. She had some sniffles at work and was quarantining herself while awaiting covid-19 test results. That explained why we couldn't do video.

She asked about my current DBS settings and confirmed what prescription medications I was taking. I reminded her about my shoulder pain fix and my anxious toes. Then she said, now, what would you like to discuss? For the next 25-minutes, I had her undivided attention. We discussed my speech problems and had a laugh when I said I liked wearing a mask because it hid my drooling problem. I asked whether I should consider re-taking the cognitive exam and if so, could it also be done using telehealth. She said she'd find out. And we were done!

I really liked this type of visit. I wasn't tired or stressed out from driving 5 hours, I didn't have to spend a night in a hotel, and when it was done, I went into my kitchen and made my usual breakfast. 

I think I will schedule another telehealth visit before the end of the year. And I really hope that telehealth will still be available after covid-19 is gone! 

Sunday, April 12, 2020

I Have Anxious Toes

Disclaimer: Before taking any prescription medication other than exactly as prescribed, you should ALWAYS consult your physicians. 

I have a confession; I always have a prescription bottle of 0.5 mg alprazolam (generic Xanax) in my medicine cabinet. It's used to treat anxiety and panic disorders and belongs to a class of medications called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. It was first prescribed by my diagnosing neurologist, Dr. Zonis when my step-son Mark died suddenly in 2009. I took half of a 0.5 mg tablet a couple of times a day for a few weeks. 

Over the years since then, I sometimes take half a tablet if I am feeling anxious or stressed. If I have to drive to Phoenix, Arizona, I will take half a tablet to help me cope with the heavy traffic. I take a half when I venture into Mexico to see my dentist.

I do the same if I have to fly somewhere. Trying to get through the airport, dealing with luggage, security screening, retrieving e-tickets on my smartphone and delayed flights are very stressful. Once I'm on the plane, I'm fine. 

My Movement Disorder Specialist and my primary care physician are both okay with this minimal usage and either will happily write me a new prescription when needed. A bottle of thirty 0.5 mg tablets may last me two years. I don't get high, or sleepy, I just feel calmer. 

Now, about my anxious toes. For months, I've had a problem with the three middle toes on my right foot wanting to curl under. Not only is it extremely painful when walking but it also irritates the nails on those particular toes. 

Sometimes, I can walk on my tip-toes and trick them into straightening out but that doesn't always work. On those occasions, I just hobble along on my right heel until I can find a place to sit. It's very aggravating, to say the least.  

It's January 2020, and Wonderful Husband & I are invited to a two-day Parkinson's event in Phoenix. I take half a tablet and I drive to the event hotel. The next morning, I take another half because I will be driving back home later that afternoon. The following morning, I take another half because I will be taking a visiting friend across the border into Mexico. It's not the dentist that bothers me, it's the uneven walkways and the constant hawkers trying to sell me stuff that makes me anxious (the teenage looking soldiers with assault rifles are a bit unnerving too.)

Later that day, I realized that my toes didn't curl when I was in Phoenix for two days and they didn't curl the Mexico day either. Hmm, interesting. 

I contacted my Movement Disorder Specialist to see if this was possible or if it was a placebo effect thing. She said Xanax can have a muscle-relaxing effect in your brain. She advised me to continue taking it for a week and then stop for a week and let her know the results.

I took half a tablet every morning for the next four days. No curling toes! I stopped taking it for a week and the curling toes returned. I started taking it again and the toe-curling stopped again. 

I told her about my results. She wasn't surprised and wrote me a new prescription and so far, half a 0.5 mg tablet every morning is working. 

I'm happy and my feet are happy. No more anxious toes. Yippee!

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Wednesday, January 8, 2020

Shoulder Pain with Parkinson's

My shoulder problem began more than two years ago when it was time to put on my pajamas. I went to take my pullover shirt off, using the two-handed crossover method I'd used all my life and...OUCH!

There was a pain in my left shoulder joint. I reached back with my left hand to unhook my bra and another OUCH!  

I tried to remember if I had done anything unusual recently but there was nothing. When I went to put my left arm under my pillow for sleeping, this was also painful, so I slept on my right side all night. 

By morning, I was a grumpy Parky. I could find no humor in this situation. I didn't want to aggravate my left shoulder, so I chose a button-up shirt. I was careful not to raise my left arm too high or behind my back.  

Thinking that it might be a Parkinson's disease rigidity problem, I tried taking more carbi/levodopa. All that did is cause more dyskinesia. I tried increasing my left side DBS settings, but that didn't help either. 

I made an appointment with Ana, my primary care provider. She did an exam and suggested trying a course of methylprednisolone and gave me some exercises to try. I went back 6-weeks later, nothing had changed, so she gave me a cortisone shot. This didn't work either. 

I made an appointment with an Orthopedist that Ana recommended. He took x-rays of my left shoulder  and it was normal. A month later, I had a CT scan with contrast done on my left shoulder. It was also normal (of course.) 

He said there MIGHT be a small bone spur that's causing the problem. He suggested exploratory surgery, but I declined. So he gave me a cortisone shot in the left shoulder and said if it doesn't work, come back when you want surgery. This cortisone shot didn't work either and there was NO WAY I was going to have someone go digging around looking for something that might not even exist. I would just continue to be careful how I moved my left shoulder.

Then June 2019 came and I had my DBS battery replaced. I increased my DBS settings on my right side because my right foot was dragging. The small amount of carbi/levodopa I was taking, half a 25/100 pill every other day, caused severe dyskinesia. I cut back to twice a week, then once a week, and finally stop taking it completely. 

YumaBev with arm behind back

Shortly thereafter, without thinking, I reached back with my left arm to unhook my bra and there was no pain. I reached my left arm above my head and no pain! Yippee!!  
YumaBev with arms raised up

I asked my Movement Disorder Specialist when I saw her in December if my left shoulder problem could have been caused by the carbi/levodopa?

Yes, she said. You probably developed what is known as levodopa-induced dystonia. Isn't that interesting?? Just what we Parkies need...another medication side effect.