16 November 2011

Shake, dribble and drool

JON: New drugs – again. My neurologist has prescribed some new drugs, but for once these are not pills but patches (one per day) which cuts down very slightly on the number of pills I have to take each day. With luck I may stop rattling and again be able to sneak up on Marie and the cat.

If you are reading this, you have probably already read Marie’s last blog. She says that she admires the way I have taken the recent news about scary D, although she also finds it disconcerting. I just find it plain weird.

It turns out that I score around about normal in several of the tests. There is a reason for this (arrogant though it may sound): prior to the PD I had very high cognitive functions (i.e. I was pretty damn smart). And as Marie put it, the higher you are on the staircase when you start going down, the further you have to go before you hit the bottom. So now I’m down to rating as normal. Me, normal? That’ll take some getting used to.

Anyway, Marie pushed me into telling my children the results. First she wrote them, and then she made me ring them. Left to my own devices I might well have skipped that little task. I always worry that my speech will let me down on the phone, and the one thing I hate the most is sounding like a gibbering idiot. OK, you may think I should be getting used to that by now, but it’s something I’m quite ambivalent about. Is the embarrassment from appearing to be gibbering worse than actually being a gibbering idiot? And would anyone but me be able to tell the difference?

As you will have noticed from her post, Marie’s reaction to the neurological news was pretty strong. It’s as if a switch has been thrown, as if we entered the neurologist’s clinic as two healthy people, but left a few hours later as a demented patient and his carer. But I feel fine, you know, and the probability is that I will continue to feel fine. Sure, in time I may begin to shake, dribble and drool, but so far so good. The only fly in the ointment is the label on the box of patches which boldly states “for the treatment of dementia in Parkinson’s disease”. Not the most tactful bit of product information I’ve ever seen.

The process for both PD and dementia is one of gradual change. One does not suddenly become demented, it’s a slow process, with luck a very slow process. At the PD meetings we go to there are lots of others with PD. Some are doing OK and have been doing OK for over ten years, while others crumble as we watch. I plan to be in the former group.

A note on general ignorance: At my Danish language class, I did a spot of awareness raising. My target was a 17-year-old girl who just can’t get her head round the fact that there are chronic diseases that don’t get better ever. Girl of 17 to Jon: “So, have you still got the Parkinson’s, then?” Jon (rolling his eyes) to Girl of 17: “YES, of course I do.” Girl of 17: “Oh,” (smiling the bright, vacuous smile of the terminally normal), “perhaps it will get better on its own.” Meanwhile in the corridor, another well-meaning and misguided person is praying for me.

It’s all a bit much. Unlike in America, land of opportunity and an odd taste in outdoor reading matter, it seems you can’t even buy a decent machine gun here, presumably for fear the bullets might hurt some herrings.

13 November 2011

So who's normal?

MARIE: We went up to town a few days ago for the results of Jon’s neuropsych evaluation. Not good news, as he was basically presented with a long list of things that aren’t as easy for him as they should be – like planning, executing plans, staying on track, analyzing, evaluating, structuring, those kinds of useful skills. On the other hand, he scored better for verbal skills than he expected, so that’s something at least.

Of course you can’t test whether someone’s cognitive skills have declined if you don’t know what they were like before, so the psychologist started by taking a thorough educational and work history, from which she concluded that Jon was “originally a highly intelligent male”. A rather surreal factoid is that his mental capacities are now approaching bog-standard normal, which represents a significant loss for him.

There are a couple more tests to come in the next month or two, a fresh MRI scan to compare to the one he had four years ago in Holland, and a spinal fluid sample to be tested for the devil knows what. I believe this is mainly to exclude a few unlikely unpleasantnesses. And to be honest, sufficient unpleasantness has already hit the fan. Jon is now the not-so-proud owner of a box of Exelon drug patches labeled “against Parkinson’s disease with dementia”.

He’s only been using the patches for three days so we have no idea yet whether it will help, but at least it looks like he’ll be spared the rashes that force some people to stop. It seems you start out on half dose for a month to see how well you tolerate the drug, and if no ill effects appear, the dose is then doubled. So it’ll be a while before we can report on the effect.

Jon is taking the whole thing very calmly which I admire while it also puzzles me and maybe just ever so slightly concerns me. I’m not as resigned as he is and tend to get a bit teary-eyed – occasionally also in public, which is marvelously embarrassing.

Anyway, this last bit of bad news prompted me to call our local authority to ask them to come and assess the situation with a view to offering us help of some sort. To their credit, they decided to treat the matter as urgent and are sending someone round in a few days. Whether they will offer help that comes anywhere near to being helpful remains to be seen. I’m kind of expecting an uphill battle.