Tag Archives: dissolves

A Clinical Trial of One??

Day by Day with a Movement Disorder Posted on by 2

In a real Clinical Trial, doctors use a very large number of people, usually, but not always, divided into two groups. One group gets the medicine being tested, and the other group gets fake medicine, called a placebo. At the end of the trial, if the people getting the real medicine have improved considerably more than the group getting the placebo, the medicine is assumed to be the cause of the improvement. That’s a good thing!

They use such large numbers of people to conduct these trials, because there are always going to be unforeseen situations that influence the effectiveness of the medicine for some people. Maybe a few of the subjects have an undiagnosed disease that makes even the best of medicines not work. Or maybe some of them are under a lot of stress that ruins their results.

When you see a new medicine being talked about with glowing praise of its effectiveness, you have to be very cautious about getting all excited about it. I have seen reports like that where the trial only had 16 people in it. That only gives doctors a hint that a certain medicine might be helpful. It’s just not enough people to tell you much.

That’s the problem with trying to find the right medicine for me, or any other PWP. We are, in a very real sense, our own Clinical Trial. The last time I was on Requip, I was terribly bloated, with horrible stomach cramps and gas. So, the Neurologist took me off of it, and he put me on Zelepar. That medicine dissolved under the tongue, so it doesn’t bother the digestive system. My stomach improved tremendously. The question is, was that because of the Zelepar, or was it because, that same week, my Gastroenterologist changed the prescriptions I was taking for my stomach? Also, my symptoms were not alleviated as well when I was on the Zelepar — BUT I had strep throat most of the time I was trying it, without knowing I was that sick.

There’s no way to be sure, is there, with more than one medicine being changed at the same time, and with me being sick, too? I talked with my Neurologist yesterday about this, and the fact that I had gone back to 1 Requip pill a day for several days, because I ran out of the Zelepar samples before my appointment. Even though I had been on the Requip for several days, my stomach was doing just fine.

So, Dr. S. has prescribed another month of Zelepar, to give it a fair trial at helping my PD symptoms. If I am still not getting as good a results with it as I was the Requip, I am to add the old dosage of 3 times a day of Requip to the Zelepar, which I take 2 times a day. I don’t see Dr. S. for 6 more weeks, to try to give me a chance to tell what is going to work best for me.

Parkinson’s Disease is different from many diseases, where there is some MRI or blood test that will tell the doctor what is helping, and what is not. With PD, it really is up to me. I have to be the judge for myself if the Neurologist has prescribed the right medicine and the right dosage. Then he bases my prescriptions on his vast experience with many other PWP he has treated.

But it still boils down to a Clinical Trial of one – ME!

Tummy Improvement OR Walking Faster?

Day by Day with a Movement Disorder Posted on by 8

I’ve been on the new Zelepar medicine for several days now, and my digestive system is behaving just fine. I don’t seem to be getting quite as much help with my gait as I did with the Requip or Sinemet, however, but I’m still on the samples. When I go back to the Neurologist next Friday, it may be that he will order a prescription for a higher dose or more doses, which might make the difference. Anyway, even if the dose stays where it is now, it seems like a reasonable trade off between stomach problems and balance and walking problems. I’d love to walk better, but I can live with it the way it is now, if I have to. It’s nice not to spend part of every day miserable, with a hot pad on my tummy!

I said at first the Zelepar didn’t taste bitter, however, I’d better amend that evaluation. Yes, it is bitter, but not enough to bother me, anyway. (The trick is to be sure you place it under, not on, the tongue.) It dissolves under my tongue so quickly that it’s just a few seconds, and I can swallow it. You’re not allowed to drink or eat anything for at least 5 minutes before or after taking it, but my saliva quickly washes the taste away.

We’re still staying with my Daddy, which means I spend most of my days and every night in a hot house. We tried to find a compromise temperature for the thermostat, but at 101, he gets too cold, while we’re still sweltering. I have noticed that I’m having more trouble with the heat this week, since I’ve been on the Zelepar, than I was before I started taking it. I’m getting what feels exactly like hot flashes several times a day, and I’ve been past that stage for some time now. I have read that Parkinson’s can mess with the body’s regulation of internal temperature, so I guess that’s what’s happening to me right now. Or is it because of the Zelepar? I really don’t know.

I was on Requip before starting the Zelepar. Requip is a dopamine agonist, but Zelepar is an MAO-inhibitor, so they don’t attack the PD symptoms the same way. There’s big news in the Birmingham News today that a doctor at UAB is close to getting FDA approval for a patch version of a dopamine agonist. That will be good news for me, as the Requip did a better job of improving my balance and walking than it looks like the MAO-inhibitors are going to. I’m all for any PD med that I don’t have to swallow!! So this is something else for me to be hopeful about.

It’s great to see that there is good news on the horizon for the large number of people who really suffer with this disease. My own symptoms and discomfort level are so mild compared to people who have had Parkinson’s for years. I pray that all this new research may bring them relief in the near future, instead of years from now.

First Dose of Zelepar, My New Parkinson’s Medicine!

Day by Day with a Movement Disorder Posted on by 2

This is the day I have been waiting for for about two weeks now. I spent that time tapering off of the Requip I had been on, went without any PD medicine yesterday, and this morning I took the first dose of Zelepar.

Zelepar is a quick dissolving tablet form of Selegiline, which dissolves under the tongue. It tasted a little like an orange mint might to me, but it does dissolve extremely fast. There was also a little tingle on the tongue, but nothing uncomfortable. I had read somewhere on the Internet that it tasted bitter, but, for me at least, that was not so. The directions emphasized not to drink any liquids or eat anything at least 5 minutes before or after taking it. I’ll be taking it twice a day while I’m on the samples, but I’m to go back to the Neurologist at the end of this two week trial.

I felt my walking begin to smooth out within about 30 minutes. It may be my imagination, but I think it’s made me a little hyper, too. (Of course, I’ve been so slow the last two weeks it may be I’m just normal now.) I’ll have to be careful when I take the evening dose, if that’s so, or I won’t get any sleep tonight. LOL

I’ve been reading the explanations of what a MAO-inhibitor is, which is the class of drugs that Selegiline falls in, and I think I’ve got it figured out. Basically, it’s some kind of high powered targeted anti-oxidant, that keeps the smaller amount of dopamine that my brain is making from being broken down prematurely. So I’m getting the full benefit of what my brain is naturally producing.

There is also some research that suggests that Selegiline may actually protect the part of the brain that makes dopamine, and possibly slow down the progression of this disease! If you’re not really familiar with Parkinson’s Disease, that may not sound so significant, but it would be quite a break through. All the other meds treat symptoms only. There is a possibility that Selegiline may effect the cause of Parkinson’s!! I’ll not go so far as to get my hopes up for that, but you bet I’ll be watching to see if that turns out to be true.

Tapering Off Requip

Day by Day with a Movement Disorder Posted on by 6

When I went to my Neurologist last Tuesday, we decided I would stop taking the Requip, since it was probably the cause of all my stomach problems, other than the PD itself. Also, it was the likely culprit for my hair loss. So, Dr. S. told me to taper off the Requip before I changed over to the samples of Zelepar he gave me. That meant last week I only had two pills a day, instead of the usual three. Starting Tuesday of this week, I’ve only been taking one a day.

Dopamine is the brain chemical that controls muscle movement, and that’s the one that people with Parkinson’s no longer make enough of. Requip tricks the brain into accepting the chemical in it as a substitute for the dopamine, so it’s called a dopamine agonist. Now that I’m down to one pill a day, I can really tell it! My balance is terrible, and my walking is stilted and jerky.

As long as DH can take over the care giving tasks I’m not up to, I’ll continue to do as much as I can to help Daddy. We’ve only got to make it until next Wednesday, and then I can start taking the new medicine. Zelepar, a special form of the medicine called Selegiline, is a different type of Parkinson’s medicine entirely. It is an MAO-inhibitor. I’ve read what that means a dozen times now, but I still don’t understand it well enough to put it in my own words LOL.

The reason Dr. S. is trying this particular prescription is that it dissolves on the tongue and does not go through my digestive system. It goes straight into the blood stream. With the improvement in stomach comfort that I’m seeing from the Miralax and glycerin suppository combination, I’m hoping this new medicine will be the perfect one for me for the time being.

I do know that at some point I will have to go back to taking Sinemet, which was the first medicine I took. It nauseated me, too, but I’ll cross that bridge when I get to it, because there is a patch form of it in drug trials now.

So for the next few days I’ll be weaving and lurching around here like I’m drunk, but I can put up with it, knowing there’s something new to try just days away. I am ever thankful to God that there are so many researchers working to find new ways of fighting the symptoms of this disease, working on ways to slow its progress down, and ultimately to cure it.

Miralax Effectiveness Evaluation Week 1

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Miralax is a white crystalline powder that is mixed with a liquid and taken each day, one or more times, depending on the doctor’s directions. Its purpose is to soften the bowel movement. It is also supposed to improve the effectiveness of Zelnorm, a medicine which helps to improve the rhythmic muscle action of the digestive system. I had read that it was supposed to be tasteless, but I frankly found that a little hard to believe!

I have been on Zelnorm for some time now, but my Gastroenterologist just added the generic form of Miralax to my prescriptions Friday. I tried dissolving the crystals in water the first time, and, at least for me, I will agree that it is tasteless. It does give the water a slightly thick feel, and I could tell it was going to turn me off of drinking water – a purely mental aversion, but one I needed to heed, as water is extremely important! So, I tried it in apple juice, and that worked for me. Then I got the bright idea to just sprinkle it on my morning bran cereal, since it really does dissolve completely. With a little stirring, it disappeared completely, and I couldn’t even tell it was there. So that’s the way I took it yesterday and today.

I didn’t see any results at all from using it until the third day, and even then it was of minimal help. So, today I went back to using the glycerin suppositories after breakfast, and the combination was very successful. (I had stopped using the suppositories Friday, not knowing how my system was going to react to the Miralax.) The bloating has definitely gone down, as my pants are looser. I’m still belching as soon as I put anything in my stomach – even water – but it isn’t as bad as it was.

Today was the first day in a long time that I didn’t end up with the hot pad on my tummy, trying to ease the pain, so I can see the beginning of some improvement!

I’m sure everyone’s experience with the effectiveness of Miralax will be different, depending partly on why they need to use it. But I can say that someone with Parkinson’s, with a long term constipation problem, should certainly give it a try, anyway. The generic version is not very expensive, it seems to be gentle on the system and suitable for long term use, and it seems to do what they say it will do – all while being as close to unnoticeable as a medicine you have to drink is likely to ever get.

You will find a large number of testimonials about people’s experiences with Miralax at the AskthePatient.com site.

So I’m Stopping the Requip

Day by Day with a Movement Disorder Posted on by 1

I went to my Neurologist today, and we discussed my digestive problems, hair loss LOL, and insomnia. His solution was to taper off the Requip until I have quit taking it completely and see what happens to my stomach problems. He also gave me a prescription for a time release version of Ambien. And, of course, if it was the Requip that was causing the hair loss, stopping the Requip will take care of that situation.

I told him about writing to the National Parkinson’s Foundation “Ask the Doctor” site, and what that doctor suggested. So he’s given me some samples of the medicine the NPF doctor suggested I try. I’m not supposed to use it until I’ve completely stopped the Requip, if I can possibly stand it. But I explained we were taking care of my Daddy, and I might not be able to put up with my impaired walking that long. He wants me to try, so he can get a fair assessment of how the new medicine works, but he does understand our situation.

He gave me samples of Zelepar, one of the brand names of Selegiline. It dissolves on the tongue, so it does not go through the digestive system at all, but straight into the blood stream. I have high hopes for this medicine. It is also a different type of medicine than I have had before. This one is an MAO inhibitor. I’ll have to do some research to fully understand what that means.

I am very thankful that all the research over the last few years means there are a lot more different types of medicines for him to try on me than there used to be for Parkinson’s. None of them slow down the disease, or do anything at all to cure it, but they do help with the symptoms. For now, that is a blessing. Hopefully, in my lifetime, they will find ways of at least slowing the disease down. And who knows, maybe they’ll even find a cure.