Tag Archives: prescriptions

My Pharmacist wears an S under his lab coat!!

Day by Day with a Movement Disorder Posted on by 4

Yep, as far as I’m concerned, he’s Superman, ready at any moment to rescue this damsel from danger. I went to my Orthopedist today to get some relief from the painful neck spasms I’ve had for the last two weeks. He prescribed the muscle relaxer, Flexeril, which I have taken before, long before I was diagnosed with PD.

We dropped the prescription off on our way home, and DH went back to get it about an hour later. He came home with Methocarbamol, not Flexeril. Sure enough, I would have had a serious drug interaction with Flexeril and my PD meds. My pharmacist called the doctor and they found a muscle relaxant I could take, all before hubby ever got there to pick it up.

I think that makes three times in the last few months that my fantastic pharmacist has caught medicine errors that my doctors have made.

We live in a very small rural town, and we went without a pharmacist for quite a few years. When this one opened up shop, I told him the first time I went in there that he could depend on us to patronize his shop, even though we realized that we could buy cheaper at Wal-Mart or the chain store pharmacies. He’s not open at night, or on Saturdays and Sundays, but I wouldn’t trade him for anything. He more than pays for his higher prices with his service and the fact that we are close enough to walk to his store if we had to. The franchise pharmacies would require an almost hour round trip, which is no fun if you are miserable. Sure, there have been times when we had no choice but to patronize the big boys on the weekend or at night, but we try our best to give our local fellow as much business as we can.

I’ve said it before, and I’ll probably say it again. Everyone should keep all their prescriptions medicines on file with one pharmacist, and make sure that pharmacist cares about you, and not just about making money!!

Drug Interaction Still Causing Problems

Day by Day with a Movement Disorder Posted on by 10

I went to the Gastroenterologist Wednesday afternoon, and he did X-rays of my abdomen to determine if I was as constipated as he thought I would be, based on my symptoms. He was surprised to find that nothing in my colon was hard or compacted. After examining me, he has come to the conclusion that my problem is caused by spasms of the digestive tract, rather than weak muscles, as he had been telling me it was. So, now he thinks my trouble is exactly the opposite of what he had thought previously!! He prescribed Triavil, which relaxes the colon muscles, and he said I should feel much better by Monday.

I’ve learned my lesson though, so I specifically asked him if he was sure I could take this med with my Parkinson’s meds. He said he did not think this would be a problem, but to ask my pharmacist. Full of hope that he had found a way to stop my very uncomfortable situation, I called our drugstore on the way home to be sure he had it in stock. But, when hubby came back from the drugstore, he didn’t bring in the prescription bag. He said the pharmacist said his computer all but crashed when he put in the medicine, it produced such a strong warning that this was a dangerous combination with my other PD meds!!

At first I handled the news stoically, but later on that evening I went through a rough time of being very depressed, with lots of crying. I called my doctor’s nurse first thing Thursday morning to let her know I couldn’t take it, and to remind her that he would see Selegiline listed in the interaction information, rather than Zelepar, which is just a dissolving form of Selegiline. I think that must be why he didn’t realize I couldn’t take it.

Anyhow, I haven’t heard back from him yet, so DH and I decided it was time to take matters in our own hands. We went enzyme, herb, and spice shopping, as I have been doing some research on my own about Irritable Bowel Syndrome (IBS), and I found some things that should help, without causing problems.

Yesterday, I started taking Turmeric, St. John’s Wort, and Acidophilus capsules. DH’s Oncologist has had him on Turmeric ever since he had colon cancer, and his doctor had already suggested I use it. We had our usual Date Day today, and I continued to belch a lot all day, but did not have any nausea at all, or my usual sensation as if my food was sitting at the top of my throat all day. I’m encouraged that I will find a way to calm my system down and get things back to closer to normal, whether my Gastro can find a medicine I can take or not.

I’m still very wobbly, though, so I used the cane just about everywhere we went today, and I’m using it in the house tonight, too. It may be that it’s just going to take awhile to recover from the really bad state I was in Sunday, plus I may still have some of the Cortisol in my system. I’ll have to see if I can find something about how long it stays in the system after getting an injection. Or, it may be that the St. John’s Wort, added to my other PD meds, is giving me an overdose of Levadopa.

That’s what makes figuring this all out so difficult, as too much PD meds makes for jerky movements, called Dyskinesia. If you’ve seen Michael J. Fox jerking around, you’ve seen it. When PWP have been on meds for a long time their systems process the Levadopa in a very unpredictable way, and you see these wild jerking movements. But early on, if the meds aren’t strong enough, you see tremors. It’s hard for me to tell if my wobbliness is tremor or jerking, so I can’t tell, based on that, if I’m getting too little or too much Levadopa. My hands are only shaking ever so slightly, which makes me think I’m not getting too much. My Neuro will know when he sees me.

By then I should have heard from my Gastro doctor, and I’ll know if the herbs are going to do any good or cause any problems. I will be doing more research, too, to be sure there are no contraindications of these OTC with my prescriptions.

Walking on Jello

Day by Day with a Movement Disorder Posted on by 6

The saga of drug interactions continues, evidently. I had a Celestone shot on Thursday to get the poison ivy under control, as a steroid shot always does the trick for me. My regular doctor has given these to me several times in the last few years, so I was not surprised when I woke up very nervous Friday. That’s pretty much par for the course, plus they make it hard for me to sleep, too. So, I tolerated the shakiness Friday, and we continued with our Estate Sale hunting and went to see our younger DD for an overnight stay.

By Saturday morning I was even shakier, but we had a long way to drive home. I kept the way I was feeling to myself, figuring it would go away, and I did feel better after we ate a big breakfast. But, this morning, I was in really bad shape. I was shaking all over and holding on to furniture and the walls to get around. When my hubby got up several hours after me, I was worse. So, I called the Neurologist’s answering service and the doctor on call promptly called me back. After listening to all this, he told me to go to the ER. He said he was concerned it was an infection (I didn’t think so, but?) and they would be able to give me something to stop the tremors. So, we were off for the hour long drive to get to the ER, with DH trying his best not to show just how worried he was about me, and me trying my best to be still.

They took me right away, but it still took quite awhile to get the results from all the blood work they did. They did not find signs of any infection, and concluded, just as I had, that the steroid shot had precipitated this acceleration of my symptoms. So, armed with four prescriptions and orders to see my Neurologist this week, they sent me home.

So, at least for now, I’m back on Sinemet, which is the “Gold Standard” drug for Parkinson’s. Since I was so nauseated with it when I took it for the Sinemet Challenge that confirmed my Parkinson’s diagnosis, I had asked the ER doctor to also give me a prescription for Lodosyn, Carafate, and Phenergan. This is where my journal of everything that has happened since my diagnosis came in handy. I was able to show him in my journal that this is what my own Neurologist had put me on way back in September of 2006, when I got so nauseated with the Sinemet.

So, I’m typing this with a fairly steady hand, with all these extra meds in my system. I have an appointment tomorrow with my Gastroenterologist to find out what he thinks is going on with my digestive tract, and as soon as I know what is going on in that area, I will make an appointment to see my Neurologist.

This whole experience has been very upsetting to say the least, not only for me, but for DH as well. I hate it that he’s having to take care of me the way he’s had to. I hate it that I couldn’t stop myself from shaking. I hate it that the ER guard came immediately, being so very solicitous, wanting to get me a wheelchair, as I was obviously so feeble looking, wobbly cane and all. I hate being this way. Today I got a glimpse of what the future holds. I hate it.

Can’t Take Meds I Used to Take

Day by Day with a Movement Disorder Posted on by 6

I’ve been working out in the yard a good bit lately, as part of my exercise. I’ve made some headway with our yard, but I’ve also come in contact with poison ivy somewhere along the way. I am extremely allergic to it, so I’m broken out over a large part of my upper torso, front and back, on my neck and face, and even in my hair. I have no idea how that happened. We have new cats outside, too, and I may have picked it up cuddling them.

So, I pulled out my trusty Benadryl, in addition to the topical anti-itch meds I always have on hand. Benadryl makes me sleepy, so during the day I’ve always used something like non-drowsy formula Sudafed. When DH went to the store he couldn’t find the exact same Sudafed I was about out of, so he took what appeared to be a similar medicine to the Pharmacist to make sure it was OK for me to take it. He made sure he told her I had Parkinson’s, and she said it would be fine.

I hadn’t even thought about checking for PD drug interactions, so I’m glad hubby did. Particularly since I did take one dose of the 12 hour Sudafed with Pseudophedrine Hydrochloride in it this morning, and I’ve felt yucky all day long today. When I looked on the new box to see how many to take, despite the fact that DH had asked the pharmacist if it was OK, there in fine print, among the list of conditions that made using it unsafe, was – you guessed it — Parkinson’s. The same warning was on my old box of meds, too, and I hadn’t even thought to look. That’s BAD.

So, I called our local Pharmacist to double check, and sure enough, I can’t take it. DH has gone there now to get Chlorotrimiton, which has nothing but an antihistamine. It doesn’t have any decongestant in it. My Zelepar is in the MAO class of drugs, so I have to pay attention to things like that.

As careful as I am to check on drug interactions with prescriptions, it never occurred to me to check out these over the counter meds, as I’ve taken this combination for poison ivy for years. BAD GIRL, BAD GIRL!!

I’ve hopefully learned my lesson, though, and will not let old habits take over again. Cause the old gray mare ain’t what she used to be!!

Get Help Paying for Prescriptions IF YOU DON’T HAVE INSURANCE!!

Day by Day with a Movement Disorder Posted on by  

One of my new Parkie friends that I have met on the PatientsLikeMe site is knoxgal. She posted an extensive set of links for places to go to get help paying for Parkinson’s meds, for those who do not have insurance. Some of these sites are for other than just PD meds, too. I asked permission to copy her post for any of you who either need this information yourself, or know someone who could make good use of it.

Bridge to Access:

Azilect:

GlaxoSmithKline

Needy Meds:

Partnership for Patience Assistance

Johnson & Johnson:

This is what knoxgal has to say:

Every site is different as to what meds they will cover. Most require the same thing and I am offering this info through trial and error. To get started you will need to contact them to get an application. Fill out the application and note the requirements needed. Number 1 — prescription. Number two–verification of income. Number three– a copy of W2 for the last year. Later, they have requested the last page of my filing with the IRS, showing your income and the amount of your refund etc.

Please note every site requires something different, such as your income, employment status etc. Once you have all of your forms filled out, and documents together, you need to get these to your doctor for him to sign them and he will get them into the provider for you.

I have found that they are really good about automatically sending you refills. You don’t even have to request them. You usually qualify for free meds or discounted meds for a year. After a year is up, you do need to reapply.

I hope this is helpful.

I should think there would be a lot of folks who would find this information helpful, and I want to thank knoxgal for allowing me to copy her post.

PS Just to give you an idea of what a neat site PatientsLikeMe is, here’s the public part of my information on the site, plus you can see what other patients have made public, as well. Right now, they are set up for patients with ALS and MS, as well.

Parkinson’s Patch Approved in USA

Day by Day with a Movement Disorder Posted on by 4

Neupro, a dopamine agonist delivered in patch form, has been available in Canada and Europe for some time, but now it has been approved in the USA. The Requip I am on is a dopamine agonist, so I should be a good candidate for the patch.

I was disappointed on doing some research to find that nausea is still one of the more common side effects. I was hoping that my tummy would not be involved, since it’s not a medicine that is swallowed. There’s also a fairly high incidence of irritation at the patch site, and users are not supposed to put the patch in the same place more often than 14 days apart. Most of the other side effects are true of just about all the Parkinson’s medicines, from dizziness to low blood pressure on standing. As a dopamine agonist, there is a certain level of risk of obsessive behavior and also of suddenly falling asleep. Driving can be risky. Thank goodness we’re both retired, because my not driving has really not been a real problem for us.

So, although I had planned on bugging the Neurologist to change me to the patch as soon as it was approved, now that I know a little more about it, I probably won’t be in such a hurry to push for it.

If anyone reads this who has been on Neupro, or is now on it, please leave a comment about your results and/or side effects.

Zelnorm Is Taken Off the Market

Day by Day with a Movement Disorder Posted on by 4

When I refilled my prescriptions last week, my pharmacist sent me a note that our insurance was no longer covering Zelnorm. I found out today why. It has been recalled. Luckily, the Miralax is doing a good job of keeping my digestive system moving along smoothly, and I didn’t have any problems stopping the Zelnorm. Thank goodness I didn’t have any of the heart problems that some people were having with it!!

That’s twice my pharmacist has come to my rescue. I can’t reinforce enough my suggestion that you buy all your prescriptions from one drug store!

Cymbalta + Zelepar = BIG NO NO!!

Day by Day with a Movement Disorder Posted on by 13

I sent my DH to the drug store yesterday evening to pick up the prescriptions I had ordered earlier. When he brought the bag back, our local pharmacist had written a large note on it. It seems my Cymbalta and Zelepar can have a dangerous drug interaction. So, he didn’t fill the Cymbalta, but told me to call my doctor.

Before calling the Neurologist, I thought I’d look up a little about this combination for myself on the Internet. Well …. I don’t need to call the doctor!! Cymbalta is OUT!! Not only do the two cancel each other out, but the combination can cause something called Serotonin Syndrome/Poisoning, which can be fatal in its extreme manifestation. I have definitely had one of the milder symptoms, which I was blaming on the Zelepar, as it started after I started taking it. Out of nowhere, I would start sweating profusely and be so hot I just about couldn’t stand it. I’ve mentioned this before, as it feels just like menopause hot flashes at their worst.

The Cymbalta prescription came from my General Practitioner, who prescribed it almost a year ago. The Neurologist had a complete list of my medications, so at least he should have known I was on it when he put me on Zelepar, which is the dissolving form of Selegiline.

So, as is so often true, it’s the Pharmacist who is the expert when it comes to such interactions of medicines. This is the best argument I know of to use only one pharmacy for all prescriptions.

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!

Results of Endoscopy and Ultrasound

Day by Day with a Movement Disorder Posted on by 2

Yesterday I had the Endoscopy and Ultrasound to try to determine why I’m having such a terrible time with the acid reflux. I’ve been diagnosed with GERD now for several years, so I generally know what I can and cannot eat. I really thought it was the Sinemet that set off the reflux, but my Gastroenterologist wanted to be sure it wasn’t a lingering infection from the severe colitis I had been plagued with for so long.

Anyway, the tests showed nothing but irritation, not infection, and no sign of gall stones or anything like that, so it was the medicine after all. My own doctor had been called away, and one of his associates, who is not familiar with my case, did the endoscopy. His orders were to take the Parkinson’s meds with meals, which, of course, I’m not supposed to do. He also prescribed Carafate and a week’s worth of probiotics, and to continue the twice a day on Protonix. All this is designed to settle down my tummy and soothe my esophagus.

As for taking the PD meds with meals, I’m not going to do that, but I do eat crackers with them each time, to try to protect my stomach. Hopefully, by the time I’m weaned off the Sinemet and fully titrated onto the Requip, I won’t have the conflict with the meds, anyway.

If I still have problems then, I’ll have to try to get the Neurologist and the Gastroenterologist to talk to each other and decide what’s best for me. I don’t like being the go-between for doctors. They need to discuss this with each other!

I had read that Parkinson’s meds and Parkinson’s itself could cause a person to react differently to anesthesia. Well, there may be some truth to that. I slept until 6:30 PM yesterday evening after we got home from the endoscopy, and then I went back to sleep about 10:00 and slept all night until around 6:30 this morning!! I just about lost yesterday!! I’m fine today, with no ill effects at all.