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About jas1125

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  • Birthday 01/01/1970

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  1. jas1125


    Apologies for crashing this tread, but I wondered if a sustained lower dose of Namenda would still be beneficial? My mother was placed on it last year due to an increase in her Parkinson dementia, and was tolerating it well. At the 15mg mark, after a few days, her nursing facility reported that she had a "suicidal" incident in which she expressed she wanted to die. Alarms bells went off, and the Namenda was reduced and discontinued. After discussing this at length with herI truly believe that this was not a real suicide contemplation but more so just depression over her worsening condition and she is now treating with a therapist for the depression. She is scheduled for her follow up with her neurologist in 60 days and I will discuss the Namenda again. Azilect was not considered since she has a slow heart rate. I was curious as to your thoughts on trying Namenda again but at lower dose without increasing, or is the dose of 5 to 10mg insufficient and of no real benefit. I don't want to add more meds to her mix than necessary. Thanks very much
  2. jas1125

    Suggestions on med changes

    Hello Dr. Okun: An update with some questions. As per the above, my mom's Stalevo was reduced to 100, 3x a day with 1/2 Parcopa 25/100 given between doses as a bridge. Her Neupro was also increased to 4mg. This was as of October/November last year. Still on Provigil as well as her prior meds. Most recently, she has been having issues with excessive sleepiness in the morning, to the point in which the nurses in her nursing center are having a very difficult time getting her awake enough to take her meds. It seems that when this occurs in the morning, she remains pretty sleepy throughout the day, making eating and received her meds an issue. Although the Neupro was increased, it is still not a large dose but considering her age 89 and 18 years of dealing with the disease, I wasn't sure if this is contributing to the sleepiness. I have a call into her neurologist to discuss this, but wondering if you had any thoughts or suggestions to try. As always, thank you very much
  3. jas1125

    Suggestions on med changes

    Provigil seems to be working, but now it appears her usual dose of Stalevo may be too much? She takes Stalevo 150 5x a day, every 4 hours, and near the end of the dosing cycle, around the 3 hour mark, she starts with dyskinesia. We've been able to counter this with having some protein when she take her pill, however last night she didn't eat and took the Stalevo on an empty stomach. She thrashed in her bed for more than 2 hours before a Xanax helped to calm her. Going forward, do you have any suggestions I can talk to her neuro about? Options I thought about were going to 4x a day every 5 hours and eliminated one dose, lowering to Stalevo 100 (worried she will be under-medicated and won't respond to therapy) or see about adding Amantadine. She is also on a Neupro patch, 2MG. Your thoughts? Thank you
  4. jas1125

    Suggestions on med changes

    Update. My mother had a stroke and is now hospitalized. Hit the part of the brain that controls waking up per her neuro. No other med change is recommended except using klonopin only at night. What are your thoughts on Provigil? She needs to stay awake in order to return to assisted living and I hate to have her go to nursing home. That will add to her confusion being in the hospital. Her doctor felt she will improve with time. Thanks
  5. jas1125

    Suggestions on med changes

    Dr. Okun: A follow up with a question regarding the above. Made the switch to Klonopin and lowered the Lexapro a bit, which seems to be working well, in addition to the 2mg Neupro patch. She's more social and participating in activities at her assisted living facility. Bad news is she picked up another UTI, which is her 4th this year, so her PCP is considering adding a low dose of macrodantin as a preventative. One thing that is becoming a major issue: She uses a transfer device like the one in the link attached and has been for some time. http://medmartonline.com/bestmove-spryte?utm_source=google_shopping&1008=4240&gclid=CImhw96ZxM8CFQ8waQoddKgDMQ The problem were having now is that at times, she sort of "zones out" when attempting to use it. She'll grab the pull bar, kind of stare off and not make the attempt to pull herself up. She responds to questions and interacts but just seems to be out of it. This is not happening all the time, and it seems to coincide with her down times near her next dose of Stalevo but not always. We've tried to counter this a bit with a small dose of Parcopa to even out the down times. Her strength is very good, and she is not frail for her age and she is in their restorative program which includes physical therapy. There's been some chatter of having to place her into a nursing center due to the non-transferring and I don't want to see this happen since she is doing relatively well overall, all things considered. I do have a mental health nurse visiting her weekly right now, since the staff at her facility feels there may be a behavioral component at work also. This has been more frequent during her UTI treatment, but it still happens when she is not taking an antibiotic. Have you had any experience with this type of "zoning out" behavior? Is there anything we can do to address this, such as medication changes or additions? Her next follow up with her neurologist is the 1st week of November but I'd like your thoughts on the matter and what if anything I can do to help her. Obviously I want her to stay in assisted living as long as possible. Thanks very much for your help.
  6. jas1125

    Suggestions on med changes

    Just came back from her follow up and we're a go for the switch to Klonopin. Lexpro to be reduced slightly to 20mg, and a PRN dose of 1/2 Parcopa during the day to help with off times. Overall she is doing well, but needs some tweaking to the meds. We'll see how this goes before discussing switching out of Lexapro to Cymbalta. Her neurologist is also suggesting a small dose of the Neupro patch to help lessen the down times between Stalevo doses. She had tried this years ago, but on a higher dose (6mg) which caused light-headedness. The suggestion now is much less 1 mg or even half a patch to start with monitoring to see if it is effective. Your thoughts on adding the patch, especially considering her age? Thanks
  7. jas1125

    Suggestions on med changes

    Thanks, that's a good recommendation. Given that she becomes worse with anxiety, I think the first drug to try will be Klonopin, if her neurologists agrees. If I could ask, in general terms, what has been your experience with Klonopin replacing Xanax, and do you have a preferred treatment for general anxiety with mild depression? We tried switching the Lexapro with Celexa a while back and she became withdrawn, so the Lexapro was re-instated. Also, how long should be the waiting period between changes, assuming all her doctors are on board? Thanks again.
  8. jas1125

    Suggestions on med changes

    Doctor: I'm in need of your opinion again. My mother, age 87 currently takes the following: Stalevo 150/5x a day, Plavix 75mg, Dexilant 60mg, Mucinex, Lexapro 30mg and a very, very small dose of Pamelor for sciatic pain and Xanax at 0.25 PRN for anxiety, with a nighttime dose standard.. Included in the mix are Tylenol PRN, assorted vitamins (D, C,) cranberry and CoQ10 (200mg) and NAC 600mg/2day. Overall she doing pretty well, being on her 16th year since diagnosis. There has been a bit of mental decline, mostly in short term memory, but nothing beyond that. At her last visit, her neuro felt that she was still doing very well on the Stalevo dose and I tend to agree. There is some fluctuation of late, but if she is very stiff, she takes half of a Parcopa tablet (25/100). She recently was seeing a mental health nurse for some counseling, and the nurse suggested having a palliative doctor in her company review her meds and exam her, in preparation for her upcoming visit with her neuro on Aug 18th. Of late, her anxiety has gotten worse throughout the day, especially during her in-between times for her dose of Stalevo. The palliative doctor is going to defer to the neuro but made the following suggestions: Change the PRN Xanax to Klonopin to keep her more level during the day. He felt that would be more beneficial to the Xanax due to the longer time. He also recommended that the Lexapro and Pamelor be replaced with Cymbalta, starting at a low dose. Additionally, he thought the Lexapro dose at 30mg was too high. On the plus side, he also felt she was doing very well overall, and did not recommend any meds for her mental status. I agree with his recommendation on switching to Klonopin, and in fact I was going to suggest this to her neuro myself, but again, I wanted your opinion on both that, and on the replacing of Lexapro with Cymbalta so I can be fully informed when discussing these option with her neurologist next week. As always, your assistance is much appreciated.
  9. jas1125

    Olive Leaf Extract

    Mark: Any thoughts on this herbal supplement, especially with any interactions with Stalevo? I've tried all of the drug interaction check sites and found nothing. Several articles however... http://www.lifeextension.com/magazine/2013/6/unexpected-benefits-of-olive-leaf-extract/page-01 http://www.foxnews.com/health/2013/01/23/healing-power-olive-leaf.html http://www.webmd.com/vitamins-supplements/ingredientmono-233-olive.aspx?activeingredientid=233&activeingredientname=olive My mother, age 87 has had several bouts of respiratory infections over the last year and now 2 UTI's in the last 2 months. The last UTI was due to klebsiellia pneumoniae. Her last UTI was treated with Augmentin with a 7 day period. I'm hoping it eliminated the infection, as the infections are starting to make a marked change in her symptoms (mostly cognitive). I'm trying to find some alternatives to boost her immunity and thought Olive Leaf looked somewhat promising. She takes Vitamin C (1,000 MG), a very good cranberry supplement with D-Mannose, along with Vitamin D and a good multi-vitamin. This, in addition to Stalevo 150 5x a day, Lexapro 20mg, Protonix and a very low dose of Xanax in the evening. I was going to post this in the Nutrition forum but I saw that they are no longer accepting posts. Any information would be appreciated....thanks very much and hope you are doing well John
  10. jas1125

    Transcranial Magnetic Stimulation

    Dr. Okun: Anything new on this topic? I found this article from last year https://www.sciencedaily.com/releases/2015/08/150831140202.htm For someone in their mid 80's, would this be worthwhile for a short term benefit? Thank you.
  11. jas1125

    Rytary vs Sinemet cr

    Mark: Question on the Rytary. My mom, age 87 has been on Stalevo 150 5x a day for several years (increased to 150 from 100 about 3 years ago). At her age, and after having 2 nasty respiratory infections this year, she is showing some cognitive decline. Not much, mostly forgetful and sometimes hard to rouse after a deep sleep with some confusion. I know from reading the Ask the Doc forum that Dr. Okun sometimes feels that the comtan in Stalevo is not the best for an elderly person, and I was thinking about discussing Rytary with her neuro at her next follow up in 2 months. After reading the info on it, I'm not sure now. It seems that it is hard to regulate the dosages. She does well physically with Stalevo and at the last follow up her doctor did not want to make any changes and felt that the cognitive issues are not severe enough to warrant any changes. She resides in assisted living facility and it is very hard to make changes to her meds, at least not as easy as watching for reactions if she was at home. Any suggestions would be appreciated, especially given your experience with the drug. Thanks Mark and my best to you for a healthy and Happy New Year.
  12. jas1125

    N-acetyl cysteine

    Sure....kinda dumb of me to forget to add this Stalevo 150/5 per day Plavix 75mg Lexapro 20mg/1 per day Xanax 0.25mg PRN Pamelor...very very small dosage, but can't recall the exact mg...1/day for sciatic pain Mucinex Protonix 60mg/1 per day Tylenol PRN Assorted supplements....mutil-vitamin gummies, Coq-10 200mg, Cranberry, NAC 500mg/1 per day, Omega 3 500mg/1 per day, Probiotic. and D-Mannose 500mg/1 day to prevent UTI. Age 86 and as I mentioned in the prior post, some short term memory forgetfulness and some very mild occasional confusion.(forgets what day it is, but oriented to time and place, month and year). Just trying to see if there is anything to add to slow down cognitive decline.....thanks for your help Mark and hope all is well
  13. jas1125

    N-acetyl cysteine

    Mark...bumping an old thread. Any contraindications for taking Acetyl L- Carnitine? The profile looks safe from what I can find, and I'm looking into supplements to help stave off some cognitive decline in my mother. Not too bad so far, with some short term memory forgetfulness but obviously I don't want it to escalate and also to not add another Rx to the list. Any other info or suggestions would be appreciated.....thanks very much
  14. jas1125

    Possible TIA?

    I had a detailed conversation with her PCP yesterday. No UIT, all negative especially white count and he does not want to treat her. He feels that she has colonized VRE in her rectum/lower intestine. Her urine sample was not obtained by a straight cath as it was during her recent hospital stay and he feels she needs to keep her hands clean to stop any possible spread. His indication was that she has no other symptoms of infection and does not want to treat colonized VRE. I guess that's not unusual for someone who lives in a Personal Care facility. For now his game plan is to monitor and keep alert for any changes. He feels that if she does exhibit UTI symptoms, we re-test and probably use a straight cath to ensure a cleaner sample and see what that shows. I'm ok with this plan, especially with just coming off 8 days of Maxipime for her respiratory infection. She's stil not up to baseline yet as well. As to the drug, her neurologist feels that if she would need it, not to stop Lexapro or her small dose of Pamelor as stopping that could make things worse. I did a bit of research yesterday and it seems that colonized VRE may be lessened by probiotics, so we'll try that. She usually took them but they were switched to Florastor to prevent C-Diff while on the antibiotic. Thanks for replying so quickly
  15. jas1125

    Possible TIA?

    Another example of when it rains it pours.... She just had urinalysis results come back.....all indicators normal, especially white blood count, but the culture shows Vancomycin resistant enterococcus. Count is at 30,000 co/ml and with that amount her doc does not want to initiate treatment yet. He feels the white count is the key and that the specimen may have been contaminated a bit. Apparently the only drug that will clear it is Linezolid. I'm concerned that it will escalate if left untreated but I understand his hesitation especially since her only symptom was some incontinence, and it's hard to differentiate that from her Parkinson's symptoms. She usually doesn't get burning or fevers, only a bad odor (which is not present) and increased incontinence. Are you familiar with Linezolid in your practice? The local pharmacist said to be careful with her Stalevo (and Lexapro) since it could cause seratonin syndrome. Any advise or suggestions would be appreciated.....thanks