- WHILE I WAS AT WORK
I NOTICED IT. I WAS SITTING AT MY DESK
AND, YOU KNOW, I WAS GOING TO THE COMPUTER, AND ALL OF
SUDDEN MY PINKIES JUST STARTED JUMPING UP OUT OF CONTROL
AND I COULDN'T STOP IT. - IT'S VERY HARD
FOR HIM, YOU KNOW? HE TRIES, YOU KNOW,
BUT WHEN HE'S OFF MEDS, HE CAN'T REALLY INTERACT
TOO MUCH WITH PEOPLE. - AND SO I HAD TO, YOU KNOW,
QUIT MY JOB, YOU KNOW, BECAUSE I COULDN'T PERFORM,
YOU KNOW, AT 100% ANYMORE. IN THE VETERANS HOSPITAL
I WENT IN THE YEAR 2000, AND THEY, UM,
DIAGNOSED ME WITH PARKINSON'S AND THEY STARTED ME
ON MEDICATION. - PARKINSON'S DISEASE
IS PRIMARILY A DEFICIT
OF DOPAMINE IN THE BRAIN. - DOPAMINE IS A CHEMICAL
MESSENGER IN THE BRAIN THAT CAN AFFECT MOVEMENT. - LEVODOPA IS WHAT WE CONSIDER
THE GOLD STANDARD DRUG IN THE TREATMENT OF
PARKINSON'S DISEASE. IT HAS THE BEST EFFECT
FOR THE MOTOR SYMPTOMS OF PARKINSON'S DISEASE WITH
THE LEAST AMOUNT OF SIDE EFFECTS COMPARED TO THE OTHER DRUGS. - SO WHAT LEVODOPA DOES
IS IT ACTUALLY HELPS REPLACE THE DOPAMINE THAT'S MISSING
IN THE BRAIN. - WE USE A SIMPLE ANALOGY OF
EITHER BEING "ON" OR "OFF." WHEN A PATIENT IS "ON,"
THAT MEANS THEY'VE TAKEN
THEIR MEDICATIONS. THE MEDICATIONS HAVE KICKED IN. THEY'RE STARTING TO FEEL
THE BENEFIT FROM THE MEDICATIONS AND THEY FEEL SOME IMPROVEMENT
OF THEIR PARKINSON'S SYMPTOMS. AND WHEN THE MEDICATION
WEARS OUT OF THE SYSTEM, THEY START TO TURN OFF,
MEANING THAT THE MEDICATIONS
AREN'T WORKING AS WELL. THEIR PARKINSON'S SYMPTOMS
ARE MORE PROMINENT. - AND, YOU KNOW, IF I DON'T
TAKE MY MEDICATION, YOU KNOW, THE TREMORS START, YOU KNOW? - AND THEN THE OTHER HAND,
SAME THING. MR. GOMEZ, IN HIS
"OFF" STATE, HE HAS
MORE PARKINSON'S SYMPTOMS, AND FOR HIM, THIS INVOLVES
MAINLY SLOWNESS AND TREMOR. YOU NOTICE THAT HE HAS
MORE TREMOR ON THE
LEFT SIDE OF HIS BODY, PARTICULARLY IN THE LEFT ARM. - "OFF" STATE,
HIS TREMORS ARE THERE. HIS STIFFNESS IS THERE. HE'S UNABLE TO LIFT
HIS LEG AND WALK NORMAL. HIS STUTTERING IS THERE.
IT'S VERY HARD FOR HIM. - AND IF YOU DON'T MIND
DOING IT ONE MORE TIME,
JUST TURN AROUND AND GO BACK TO THE OTHER SIDE. - WHEN HE'S ON THE MEDS,
HE'S ABLE TO FUNCTION. THE TREMORS SUBSIDE. - AND JUST GO
BACK AND FORTH LIKE THIS. ALL RIGHT, IT SEEMS
A LOT BETTER THAN BEFORE. - HE'S ABLE TO WALK
A LITTLE BETTER, HE CAN
LIFT HIS LEG A LITTLE BETTER, AND HE'S ABLE TO SPEAK CLEAR. - AND THE SAME THING ONE MORE
TIME, JUST GO BACK TO THE DOOR. IN PARKINSON'S DISEASE,
THERE IS A PROBLEM WITH THE MEDICATIONS THAT WE FIND,
THAT WE CAN'T KEEP THEM AT A STEADY LEVEL
IN THE BLOODSTREAM THROUGHOUT THE COURSE
OF THE DISEASE. ACTUALLY, EARLIER IN THE DISEASE
IT'S EASY BECAUSE THE BRAIN IS ABLE TO TAKE UP AND STORE THE
MEDICATION THAT WE GIVE THEM. SO WE CAN GET AWAY WITH
GIVING THE MEDICATIONS
A FEW TIMES A DAY, AND THE DOPAMINE IS RELEASED
AT A CONSTANT LEVEL
THROUGH THE DAY. - OVER TIME, AS THE
PARKINSON'S DISEASE PROGRESSES, YOU WILL FIND THAT
SYMPTOMS WAX AND WANE. WHERE YOU WERE GETTING BENEFIT
FOR A FULL 4 OR 5 HOURS FROM THE MEDICATION,
YOU'RE NO LONGER LASTING
THAT ENTIRE TIME AFTER YOU TAKE
THE LEVODOPA DOSE. IT'S BECAUSE OF THE FACT
THAT THE DISEASE ITSELF
IS PROGRESSING. - SO OUR GOAL IN PARKINSON'S
IS TO KEEP THOSE LEVELS
AS CONSTANT AS POSSIBLE SO THAT THE PATIENTS CAN HAVE
CONTINUOUS SYMPTOM RELIEF
THROUGH THE DAY. - LEVODOPA ITSELF DOES
NOT AFFECT THE PROGRESSION
OF PARKINSON'S DISEASE; IT PURELY HELPS TO TREAT
THE SYMPTOMS. - PATIENTS FREQUENTLY NEED
MEDICATION ADJUSTMENTS
IN PARKINSON'S DISEASE BECAUSE THIS IS
A PROGRESSIVE DISEASE. AS TIME GOES ON, THE TYPES OF
MEDICATIONS THAT PEOPLE NEED AND THE DOSING FREQUENCY
AND SCHEDULE CHANGE FREQUENTLY. SO I USUALLY ADDRESS THIS
AT EVERY VISIT WITH PATIENTS, AND OFTEN EVERY 6 MONTHS
OR 12 MONTHS WE'RE MAKING
A MEDICATION CHANGE. - IT'S VERY IMPORTANT
THAT PATIENTS TAKE THEIR MEDS EXACTLY HOW THEY'RE PRESCRIBED. IF YOU SKIP A DOSE
OR MISS A DOSE, THE MEDICATION'S GONNA WEAR OFF, AND THEN YOU WILL HAVE
YOUR PARKINSON'S SYMPTOMS. AS TIME GOES ON, IT CAN
GET HARDER TO GET THE PATIENT BACK INTO THAT "ON STATE"
WHERE THE MEDICATION IS WORKING IF THEY'VE COME OFF OF THE DRUG AND THEY'RE HAVING
REALLY BAD SYMPTOMS. IT JUST GETS MORE DIFFICULT
TO CONTROL AS THE DISEASE
PROGRESSES. - THERE ARE SEVERAL
STRATEGIES TO KEEP UP
WITH MEDICATION REGIMENS. ONE IS TO HAVE A FAIRLY STRICT
SCHEDULE WITH THE MEDICATIONS. - A PILLBOX IS REALLY KEY
TO SORT OF KEEPING YOURSELF ORGANIZED. IT HELPS TAKE
THE GUESSWORK OUT OF, "DID I TAKE MY MEDICATION?
DID I NOT TAKE MY MEDICATION?" BECAUSE YOU CAN CHECK INSIDE
THE BOX AND SEE THAT IT'S GONE. - ABOUT 6 TIMES?
YEAH, I TAKE MY PILLS. I TAKE ABOUT 30-SOME PILLS
A DAY NOT JUST FOR PARKINSON'S, BUT FOR OTHER THINGS
I HAVE, YOU KNOW? - MR. GOMEZ HAS A MORE
COMPLICATED SCHEDULE IN THAT HE HAS TO TAKE
THE MEDICATIONS EVERY FEW HOURS. - MY WIFE'S THE ONE THAT
KNOWS ALL MY MEDICINE BECAUSE SHE'S THE ONE
THAT KEEPS TRACK OF THEM. - THERE'S SO MANY THAT HE
DOESN'T KNOW WHAT IS FOR WHAT. I TRY TO SET IT UP DAILY
OR EVERY TWO DAYS. - IN THE BEGINNING, HE COULD
TAKE THEM EVERY 4 OR 5 HOURS. BUT WE FOUND THAT
HIS MEDICATIONS BECAME SHORTER IN DURATION OF THE EFFECT
EVERY TIME HE TOOK THEM, AND SO WE HAD TO SHORTEN
THE INTERVAL TO EVERY 3 HOURS. THIS IS TYPICAL OF THE MORE
ADVANCED PARKINSON'S PATIENTS
WHERE THE DRUGS JUST DON'T LAST AS LONG IN THE SYSTEM
AND YOU HAVE TO GIVE THEM MORE FREQUENTLY. UNFORTUNATELY, THERE ARE
SIDE EFFECTS TO EVERY MEDICATION DESPITE HOW GOOD
THE BENEFITS ARE. LEVODOPA HAS THE LEAST AMOUNT
OF SIDE EFFECTS TYPICALLY OF ALL THE PARKINSON'S
MEDICATIONS. THE ONES THAT I WARN PEOPLE
THE MOST ABOUT WHEN THEY'RE
STARTING THE DRUG ARE NAUSEA, WHICH IS PROBABLY THE MOST
COMMON, AN UPSET STOMACH. - IT CAN ALSO CAUSE SOME OTHER
ADVERSE EFFECTS LIKE AGITATION, CONFUSION, DIZZINESS. THOSE MORE OFTEN HAPPEN
WHEN YOU'RE ON A LITTLE BIT HIGHER OF
A DOSE OF LEVODOPA. IF THOSE TYPES OF SIDE EFFECTS
HAPPEN, WE USUALLY
TELL THE PATIENT TO MAKE SURE THAT THEY TALK TO
THE DOCTOR, BECAUSE THERE MAY BE SOME ADJUSTMENTS IN
THE MEDICATION THAT WE CAN MAKE TO HELP REDUCE
THOSE TYPES OF SYMPTOMS. - THERE IS A COMPLICATION OF
THE MEDICATIONS THAT ARE USED TO TREAT PARKINSON'S DISEASE
CALLED DYSKINESIA, AND WE THINK OF THIS AS A SIDE EFFECT
OF MAINLY THE LEVODOPA. IT'S A SYMPTOM WHERE YOU GET
EXTRA MOVEMENT SUPERIMPOSED ON TOP OF THE NORMAL
VOLUNTARY MOVEMENTS. AND SO THE PERSON CAN APPEAR
AS IF THEY'RE RESTLESS OR MOVING AROUND EXCESSIVELY,
OR SOMETIMES THEY CAN HAVE MUSCLE SPASMS AS PART OF
THESE MOVEMENTS. - WELL, YOU KNOW...YOU KNOW, BUT IF I TAKE TOO MUCH,
I GET WILD. I DON'T KNOW IF YOU'VE EVER
SEEN, YOU KNOW, MICHAEL FOX. YOU KNOW HOW HE MOVES?
YOU KNOW, I GET
LIKE THAT SOMETIMES. - ONE OTHER IMPORTANT THING
TO REALIZE ABOUT THE MEDICATIONS IS THAT EVERYBODY HAS
A DIFFERENT RESPONSE TO THEM. SO PARKINSON'S DISEASE IS
A VERY INDIVIDUALIZED DISEASE IN THAT EVERYBODY IS AFFECTED
DIFFERENTLY BY THE DISEASE. IN THE SAME WAY, EVERYBODY
REACTS DIFFERENTLY
TO THE MEDICATIONS. - I ENJOY PLAYING CONGAS. I USED TO PLAY IT, YOU KNOW,
BEFORE I GOT SICK. [MAN SINGING] WHEN I TAKE MY MEDICATION,
YOU KNOW, IT MAKES IT A LOT EASIER. YOU KNOW, SO IT HELPS ME
A LOT, YOU KNOW. AND WE SOUND PRETTY GOOD,
I THINK, YOU KNOW, BECAUSE PEOPLE STOP AND LISTEN TO US. SO I GUESS WE'RE PLAYING,
YOU KNOW, WELL, YOU KNOW. - I JUST WOULD LIKE
TO SEE HIM LAST, TO SPEND TIME
WITH HIS GRANDKIDS, TO BE ABLE TO WALK
HIS DAUGHTER DOWN THE AISLE, TO BE ABLE TO SEE HER BE 16. - IF THEY WANT A BETTER QUALITY
OF LIFE THAN WHAT THEY GOT
RIGHT NOW, TAKE YOUR MEDS. YOU KNOW, ENJOY LIFE, YOU KNOW, BECAUSE IT'S NOT
THE END OF THE WORLD. THAT'S MY ADVICE,
YOU KNOW, TO THEM.
