A Forgetful Friday: Journey With Parkinson’s

“Memory only becomes interesting through its struggle with forgetfulness.” Adrian Forty

“As you get older three things happen. The first is your memory goes, and I can’t remember the other two.” Norman Wisdom

Précis: A short story about being forgetful. Taking our daily requirement of essential drugs is vital to our everyday function with Parkinson’s. Well, for most of the day last Friday, I had forgotten to take all of the required medication.

“Forgetfulness is a form of freedom.” Khalil Gibran

The Daily Take: Usually, there is but one priority when I wake up each morning. Simply put, I get my pills to be allocated and ready to be used for that day [those prescribed by my Neurologist and those that I deem essential in a Complimentary and Alternative Medicine (CAM) treatment plan that I follow]. And typically, on Saturday morning, I get everything out and put them into a weekly pill container for further use. Shown in the picture below, from left to right, are the individual substances/compounds, the weekly container, and the daily pill holders, respectively.

“One of the keys to happiness is a bad memory.” Rita Mae Brown

The Importance of Levodopa- or Dopamine-agonist Substances for Managing the Symptoms of Parkinson’s: The arsenal of drugs to treat Parkinson’s is better than most neurodegenerative disorders. We usually depend on levodopa-containing or -related compounds for therapeutic intervention of symptoms.

My daily use of prescribed anti-Parkinson’s medication consists of generic carbidopa/levodopa [25 mg/100 mg, immediate release (IR) tablets] and the Neupro patch [Rotigotine transdermal patch (6 mg/24 hours)]. My usual plan is to start everything at either 6:00 or 7:00 AM, take 2.5 tablets of carbidopa/levodopa, and apply the patch); then follow 4-hour intervals (10:00 AM, 2:00 PM; 6:00 PM) where I take 2.5 tablets, and then 2 tablets at the final 4-hour interval at 10:00 PM.

Last Friday, for whatever reason, I forgot to apply the Rotigotine patch. So what? It’s only 6 mg of a dopamine agonist. Using the calculation matrix of levodopa equivalent dose [(LED) https://www.parkinsonsmeasurement.org/toolBox/levodopaEquivalentDose.htm ], this is equal to 180 mg of levodopa. The Rotigotine patch represents about 13-14% of my total amount of levodopa or levodopa-equivalent-type drug.

By 4:00 PM Friday, I had taken my third dose of carbidopa/levodopa and was feeling ‘strange,’ exceptionally stiff, and just uneasy. Obviously, one jumps to the conclusion, “Oh, crap, my symptoms are progressing. What now?” I looked back to see how many tablets of carbidopa/levodopa were present in the pill case, and it was the correct number. I went to take a shower to get ready to go to dinner on Hilton Head Island and suddenly realized that I had forgotten to put on the Rotigotine patch. I immediately went to my office and there it was, just sitting at the desk. I put it on and, within an hour, was feeling much better, stiffness better, and the strange ‘feeling’ abated. Had a wonderful dinner, and order in my life was restored.

“Memory embellishes Life. Forgetfulness makes it possible.” Romare Bearden

A Forgetful Lesson Learned: What I know about my Parkinson’s is that I delicately balance it with my treatment of carbidopa/levodopa and Rotigotine patch. It seems to be not too much but just enough to get through a typical day of activity. Clearly, if I increase my workout load, exercise a lot during the day, or have an unusual stress-filled day, my ‘consumption’ of dopamine exceeds my daily intake. I know this.

But each of us, with our Neurologist, needs to devise the best plan for our daily medication regimen. We are all different. And for me, the slightest imbalance of taking these drugs really can alter my day. Lesson learned, check and double-check to begin the day I have carbidopa/levodopa and have remembered to apply the Rotigotine patch. Being distracted made me forget to use the patch that Friday morning. The second lesson learned, stay focused.

“To me there is in happiness an element of self-forgetfulness. You lose yourself in something outside yourself when you are happy; just as when you are desperately miserable you are intensely conscious of yourself, are a solid little lump of ego weighing a ton.” Joseph Priestley

Cover photo image by Engin Akyurt from Pixabay

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