A Small Setback for Georgia

On Thursday, April 29th, Georgia had an appointment with her neurologist.  The doctor confirmed that she was doing well and gave the go ahead to start taking  the full dose of Mirapex the next day. She ordered the l-dopa discontinued at the same time.

We also found out Thursday that the insurance company wanted to send Georgia home the next day. The admissions office at the rehab center applied for an extension to allow time for her to get established on the new medication. The facilities doctor and the neurologist both called the insurance company to verify the medical need for the extension. The physical therapy department put in their request for more time since they felt she needed one more week to get steady on her feet and to practice going up and down stairs (she had only tried that once)..

Friday morning the nurse at the rehab center followed the doctor’s the instruction so Georgia was on Mirapex only. In the afternoon, we found out the extension had been denied so I took her home that evening.

Georgia slept most of the day Saturday and was sick to her stomach. On Sunday she was still sick and very sleepy. I tried to hand her a small glass of 7-UP but she could not hold it. As soon as I let go the glass hit the floor. Every time she tried to raise her hands, they would jerk back down. I called the neurologist who instructed me to skip the Mirapex the next morning and call the office to let them know how she felt without the medication. In the afternoon, the home nurse made her first visit and saw the jerkiness in her hands.

Monday morning I skipped the pill and called the doctor’s office as soon as they opened. I let them know that she still had no control over her hands. The doctor told me to go ahead and give her the Mirapex and called a prescription for l-dopa in to our local drug store. I picked that up and gave the pills to Georgia twice that day. She had an appointment with her internist that afternoon and by then she had much better control of her hands and was feeling pretty good.

Tuesday morning was the first home visit by her new physical therapist and that went well although Georgia was having some trouble with short term memory. The nurse made her second visit in the afternoon and Georgia was doing better both physically and mentally then. Later, she started to show the jerky hand movement again but not as bad as before. She got another l-dopa pill at 4 PM and shortly after that her hands were OK again. I was seeing a pattern here. After she took the pill, she was pretty good for a couple hours but declined for the hour or so before it was time for the next one.

About 7 PM, three hours after the last pill of the day, Georgia was walking across the bedroom – using her walker – when her hands failed her again and she fell to the floor. She was also mentally “out of it” and wasn’t understanding me when I asked her to get her feet under her so I could help her up. I decided it was time for her to go back to the emergency room and called 911. The same ambulance crew who took her in the first time responded to this call. They remembered her and didn’t even ask if she wanted to go to the hospital this time. They just put her on the gurney and into the ambulance.

So, after four days at home, Georgia ended up back in the hospital for a few days and she is now back in the rehab center. She is off the Mirapex and back on carbidopa-levodopa at twice the dosage she was on before. So far, she is responding very well to the medication and is better physically and mentally than she has been for a couple months. She will probably only be in rehab for a week or ten days this time. Just long enough to make sure she is stable on the meds and to get the extra physical therapy she should have gotten last time. At some point, her neurologist will try another substitute for the l-dopa but that is months down the road at this point.,