- 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.