Golden Slippers

The dyskinesias keep her moving while she sits in the wheelchair. She comments on the heat, and I mention she has the ocean breeze on the east coast, which we lack. Her live-in assistant wheels her through the hallway. They are off to explore a nursery in Plant City. As we speak I imagine how this would be, holding a conversation while randomly moving your body. I concentrate on the content of her words, because her face moves away. She is accustomed to it, having had dyskinesias for many years, but perhaps it disturbs her, still.

We are wearing the same shoes. Hers are fancier, being glittery gold. She had identical ones to mine, but lost her left one while walking on the beach. A wave came, ran over her feet and sucked her shoe off, taking it into the surf before she had the wits to go after it. She bought the glittery pair in Sarasota at a swank shoe store, for twice as much money.

With dyskinesia, and sitting in the clinic’s wheelchair, she is still a cheery person. The superficial veins on the top side of her feet are so numerous they give her feet and ankles a bluish cast. Her face is beautiful and marked by age and the sun. She wears her long hair in a pony tail.

To improve her sleep, she has found a single tablet of diphenhydramine, the ingredient in Benadryl, helps her to fall asleep. The doctor comments she may find she sleeps the whole night through, if she takes two. She is one who would benefit from the partial dopamine agonist Pardoprunox, which recently completed stage three clinical trials. Whether the FDA will allow the product to come to patient’s hands, and how long they will take to make the decision is anyone’s guess. The drug has been in testing for the last five years. In the meantime, the doctor recommends amantadine, three times a day at 100 mg. Given early in the process of the disease it may provide some protective and slowing affect. In later stages of the illness it can give some patients a therapeutic window without daily dyskinesias.

The Cochran Review states, “There is not enough evidence about the safety and effectiveness of amantadine for people with dyskinesia in Parkinson’s disease.” Though a physician might not routinely recommend the medication, when a patient sits in front of you complaining of obvious debilitating dyskinesia, any relief is helpful. A study of PD patients with severe dyskinesia found those given amantadine were significantly improved over baseline at days 15 and 30 of the investigation. Over the next seven months the average dyskinesia score returned to baseline for all those given the drug. After withdrawal of the medication two patients experienced episodes of severe body heat, which ceased with reintroduction of the drug, and a slower more gradual withdrawal. Side effects of the medication include confusion, hallucinations, tachycardia, and swelling of the feet. Such fallout is similar to all anti-parkinson drugs, and the doctor states it is actually one of the more benign drugs.

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