Chapter 315 - Some Nights are Diamonds, Some are Dung

On Tuesday last I decided to take her fluid intake under my control and then measure the quantity of every piddle. These are the quantities I measured on Wednesday 23th:

0345 200ml; 0530 150ml; 0615 250ml; 0800 170ml; 1230 concurrent with bowel movement; 1430 140ml; 1500 125ml; 1630 100ml; 1830 200ml, 2200 75ml

Thursday 24th:

0030 170ml; 0400 200ml; 0630 150ml

During this same period, I gave her the following fluids:

0915 250ml fruit juice; 1100 250ml soda water; 1200 250ml soda water; 1400 250ml soda water; 1630 250ml soda water; 1830 250ml soda water

The data gathering ceased for the remainder of Thursday because we went to see Polly the PD nurse and the Considerate Neuro in Hot Air City. On Friday I kept her 250ml glass filled with soda water until our supplies ran out. She used the commode only twice early Friday and once early Saturday mornings. So yesterday I almost felt alive during the day.

But yesterday I left her to maintain her own fluid intake. Last night she needed to sit on the commode six (6!) times between 0300 and 0647, each time needing assistance to get out of bed onto the commode. And this commode is too high for her; a replacement for the previous one on which one of the brakes was unreliable, so the replacement will need to be returned. Anyway, today I feel like lifeless excrement.

After last Sunday's close misadventure, I decided we should shop early then go to the Club for lunch. So over to the large hardware store near the 4 lane over-pass to buy a wall mounted remote controlled fan so that she is able to have a breeze on her face now that warmer weather is here. Wall mounting is preferable to the remote controlled pedestal fan she currently uses, reducing clutter and power cords in the TV room. I think I will buy another for her for the bedroom. The fan sounds a little like a 747 with reverse thrust applied but we should grow used to it.

Then to her favourite local rag shop where her left leg began collapsing, so she had to be seated on the walker while I paid for the goods. Once around at the Club she was able to walk in pushing her walker. We stayed awhile, too long perhaps, having her 2pm meds before we left, her being pushed in the walker. Around to the mall. While she remained in the car, I bought some groceries and picked up some meds for both of us at the chemist. She is now sewing. Each time I pass I fill up her 250ml glass with soda water. I decided on soda water because it is simply carbonated water, rather than sugar flavoured water with additives such as quinine, dyes  etc. although there is a small quantity of sodium.

Last Thursday our visit to the Neuro was a little confusing. He seemed to think she was presently taking more L-dopa than she actually is and when he briefly looked at the X-ray scans of her back (I borrowed them from our local hospital) he said they were not applicable since the tingles and pains were in her left leg, not the right side where her spine shows some wear and tear. He had little time available to make changes to either meds or apomine, so we need to return on Monday. I am sure I heard him say something like "polyneuropathy" in the few words he said. The Neuro queried her blood pressure  at 5 and 10 minutes following a bolus dose. No one had mentioned a possible BP change following a bolus, so on Friday she had a bolus at 1312 when her BP was 146/98 67; at 1320 145/98 57 and at 1324 158/93 60; these are all a little higher than usual.

At the moment, she is off so much within 1 1/2 hours of conventional meds times that I wonder whether the apomine is having any impact at all. When I ask, she doubts whether she experiences any benefit from the apomine. On the other hand, yesterday she asked for a bolus at 1300 and agin at 2100; today at 0306 and 1245. She agreed when I suggested that she must feel some benefit from a bolus since she asks for it.

When hand sewing, she sometimes remarks that her hands are too sluggish or "fluffy" to continue working.

She just called me  (1745, 15 minutes before her meds), she had not noticed the time while seated at the kitchen table doing hand sewing, she was very much OFF and frozen, was unable to stand but with assistance she was able to push her trolley into the loo, all the while breathing strongly through her nostrils like a frightened animal. Her speech is thick, slightly slurred. She was frightened of standing after getting off the loo, even while grasping the fire pole, asked to sit again but on the shower chair, then agreed to the wheel chair when I suggested it, wheeled her out to the TV room, where she decided to remain in the wheel chair rather than her recliner. She says she does not know what to do with her feet. I went back out to query what she meant by that but she needed to be wheeled into the loo again (35 minutes after the last time). She seems unable to explain her feet at the moment except that there is very slight tingling when her feet are on the floor but when on the wheelchair foot rests the tingling almost disappears. She spontaneously made a comment about her hands "feeling thick and awkward; haven't felt like that in years, in the early years of my PD". She sees this as a change for the worse, I really hope not. That's 22 years ago.

I left her with another glass of soda water.

Chapter 314 - Making New Discoveries

For ages now I have been haphazardly noting her comments about "tingles" in her toes, feet, legs and buttocks; "ants crawling" inside her legs; that hideous feeling she describes as "someone walking across my grave" when she shudders and twitches with weird feelings across her shoulders, up her neck into her head. Sensations not mentioned often enough to the professionals because such sound so colloquial, so Old Aunt Mary like. Those sensations that reduce quality of life to crap.

Recently she has repeatedly experienced failures of her left leg to support her weight. The failure is somewhat predictable because her left foot begins to "swell" (un-noticeably to me) and her left ankle may roll slightly outward. I think it was Saturday before last she wanted to whisk some cream, her left leg gave way and she saved herself from falling by grabbing the kitchen bench top (Perhaps I had already mentioned this?). Then yesterday, Sunday, we decided to renew our Sunday lunches at the Club, although she felt more confident going mid-afternoon. So we had a light lunch, a chai latte, a muga-ccino, after which she wanted to visit one of her favourite rag shops. So down the street we walked 50 metres or so when we met an elderly acquaintance whose wife also has PD. Suddenly, in the middle of small talk, she collapsed to the left, her walker rotated in sympathy, yet I was able to grasp for her, for my hand was resting on her walker; the three of us, she, me, and the walker performed a pirouette on the footpath as she slumped onto the seat of the walker. A few minutes later we continued on our way. About 150 metres further along the street we came to the shop, but she was uncertain about her left leg and needed to sit on a bench seat, just as the shop doors were shut at 4pm. So an unsuccessful and dangerous walk for her. We returned slowly to our car parked at the rear of the club. Then around to the super market; I shopped, she remained in the car.

This is an evolving scenario. Please read on.

Recently ( I think I wrote about this) she had an X-ray of her lower back to check for spinal injury that may be causing her "tingles" and etc. Last visit to Hot Air City hospital a neurologist commented that the X-ray images were preferred to a report written by others in order to assess how much damage there exists in her spine (there is some apparently). So I collected all the images, even from several years ago, held at our local hospital, to take to Hot Air City when we visit again next Thursday.

I dread the thought of her undergoing spinal repair work, should such be required and advisable, and then suffering the pains of hell (that mythical locality) while dyskinetically tremoring in a hospital bed waiting for nursing staff to muddle and delay her Parky meds, delay bringing piddle and poop containers, or inserting and removing catheters. I don't think she has thought of the complications; I won't mention them. Quality of life could become a fairy story.

Now I consider myself reasonably competent in locating material on the web yet I have never noticed what she found last night: items such as "Neuropathy in Parkinson's Disease May Be Related to L-Dopa Exposure" and "Neuropathy Is Common In Parkinson's Disease". So what is "neuropathy"? Tingling, numbness and pain in the extremities due to nerve damage and/or compression, with a possibility of permanent damage.

For a layperson's description of neuropathy have a look at
 http://www.neurology.org/content/77/22/e132.long
a consumer's version of a study done by Steven Karceski in 2011. I am tempted to pay $30 for the original paper. Once knowing what to look for, one can find many references to neuropathology and PD.

There are many other references associating peripheral neuropathy and L-Dopa and also a lack of Vitamin B12 that may be a causative factor. There seem to be similarities to the feet and toe problems experienced by diabetics.

When our Dr Flower prescribed B12 injections some months ago (the most recent injection was last week) I assumed Dr Flower was routinely responding to a very low result for one parameter in a recent blood test. The next time I see her I must ask whether she is aware of the L-Dopa/B12 association. One way or another, she is an excellent GP.

Interestingly, I indirectly asked my PWP this morning whether there had been any changes in the amount of tingling & etc that she was experiencing; her rapid answer was "Yes, it's only in my feet and toes now". I suspect there is an occasional tingle further up the legs. What has changed? Well, several weeks ago now she stopped taking Comtan which I have recently been told has a 30% positive impact on the quantity of L-Dopa in the system of the PWP and in the last week, at the suggestion of Polly the Wonder Parky Nurse, her Apomine concentration was increased from 2.7ml to 3.0ml in a total of 10ml Apomine/saline mixture as well as using the pump 24 hours per day. This means I prepare two syringes each day, attaching one after the morning shower and replacing it with the second on going to bed between 10pm and 11pm, without changing the needle. So it seems to me we are reducing her L-Dopa intake.

I may attempt to relate these changes to the amount of tingling, for in my "interrogations" of her, I had asked where the tingling/pain was occurring.

She has decided not to attend the "Sheltered Workshop" (Respite), which has been closed for several weeks due to a flu outbreak, tomorrow because she does not wish to freeze and be unable to lift herself off the loo.

Yesterday I pushed her trolley (on which she keeps the necessities and acts as a walker within the house) towards where she sat; the wheels being equally spaced about her feet, each foot being several centimetres from each wheel. She exclaimed that I had run over her feet; I had not. As I moved the trolley back and forth, carefully avoiding her feet, she said she experienced a rubbing/scraping sensation on each foot. Can one's mind generate such sensations? Has she some sort of built in proximity detector? (joke)

Last Tuesday we had an adjustable bed delivered for her. So now she is able to raise her head or feet independently and is less reliant upon being packed up with pillows.

Recently she has mentioned that her fingers are becoming stiff and slow while sewing and when her meds wear off. This is something new for her; a disaster for her should it worsen.

Oh, two other things, I am watching a video course "The Neuroscience of Everyday Life" (a The Great Courses production) in which Prof Sam Wang mentioned that PWP's with their dopamine deficiency, tend not to cope well with trial and error tasks; well, I think he said that, I must return to that lecture again. I have unsuccessfully Googled such a relationship without finding anything. Last year when I first began Lumosity Brain Training I also enrolled her but low scoring on the tests discouraged her from continuing. Yesterday I asked her which of the Lumosity games she disliked the most; she replied "The one with all the peoples names" referring to "Familiar Faces" in which the player, acting as an order taker, remembers the names of customers and their orders at a fast food restaurant. She said she had difficulty remembering customers' names (long term from game to game) but found remembering the customers' orders easy (short term memory within each game).

Chapter 313 - Less Pain Would Be Welcome

I watch her sewing; her feet may be shaking away with a mind of the own yet her upper body seems not to notice, hands and fingers at work until sluggishness beats her, or, as happened an hour or so ago when she had a quilt spread on the lounge room floor "I have to stop, it's too congested in here." Her spatial perceptions on the one hand cause objects to cramp her movements, makes her want to grab at doorways, poles, etc when being wheeled in wheel chair or walker yet at times gaps frighten her, as a few days ago when she had difficulty getting off the commode back onto the bed because of the "gap" between commode and bed, when one was pushed hard against the other and I saw no gap at all. The Happy Physio suggested stuffing a pillow in the "gap" and I find that works.

On most occasions when she needs the commode or toilet she calls for help because she cannot stand alone or walk without her trolley and me behind ready to steady her. Sometimes, having started walking, she may need a kitchen chair at one end or the shower chair at the other end near the toilet (most of her walking is between the TV room and the loo).

She nearly fell yesterday while in the kitchen while beating cream to place on her birthday cake given her by a neighbour. As usual, her left foot became "thick" as she calls it then her left leg simply lost any rigidity to hold her up. She was quick enough to grab the bench top to support herself for the odd second or two until her left leg supported her again. She told me about it later. As the retired Peter Ustinoff look-alike neuro used to say "If someone yells 'fire!' the PWP's will be first out the door". Different brain circuits for emergencies?

She often says that she has no idea where her feet are without looking at them. I thought this only applied to the left foot alone but she says it is also happening to her right foot lately.

When getting off the toilet, her with both hands on the fireman's pole, me pulling her pants up, she will say "I can't find my right foot" which alerts me to tap her foot very gently with mine, and doing so may induce a step, or rather, a shuffle, to get her going. I must be careful not to bump her toes; they are very painful if bumped and often when wheeling her around her toes may bump objects and that probably causes stress to her contemplating my dangerous navigation of wheelchair or whatever around the house. Also when helping her into bed and on and off the toilet my slippers may nudge her toes, not enough for me to notice yet bothers her no end.

Beginning last Monday, she no longer takes Comtan. I have now learnt from Polly the PD Nurse that Comtan has an effect on the levels of levadopa in the system of up to 30%. so having her knock off the two doses of Comtan she was having each day reduces the effective level of levadopa by a third, which may explain why she is mostly OFF and tremoring. On the other hand, I imagine that the taking of Comtan will have positive effect, increasing levadopa levels by up to a third. If this is the case, then that may explain why, when the Peter Ustinoff neuro gave her Comtan years ago, she experienced freaky tingling and shudders in her shoulders, neck and back of her head, perhaps suggesting that she was then over medicated. Recently (See Chapter 285, March 26th 2013), when she was asked to reintroduce Comtan, her other medications See Chapter 284, February 24th 2013) were not reduced to compensate, as would seem logical.

Yesterday she said she had not felt ON all  day (although, historically she has always had difficulty being able to tell me when she was ON or OFF, the feeling was far from binary) and wished for that "beautiful feeling of freedom" she has experienced in the past, although much less frequently lately.  A couple of days ago she said the leg tingles had decreased in intensity, "had become more feathery". I just asked her (1530 Sunday) whether she still had "tingles" and how bad they were, "Yes, just as bad" she replied but when I pressed, the tingles are in her feet, not up and down the whole of her legs, but the feathery feeling has not returned. A matter of present discomfort always being bad.

She has begun to sweat a lot again. On Wednesday morning between 0150 and 0310 she needed her remote controlled pedestal fan while she was battling a panic attack. I commented today that her skin was clammy as I helped her into her recliner. Some months ago we bought a gel filled pillow which she tried out today and found it beneficial in cooling her head.

Last Tuesday she saw the Happy Physio who cajoled her to regularly exercise and explained matters unknown to us about bowel actions, interactions between nerves and muscle groups etc. Now we both exercise for about 10 minutes, me doing Wii Fit Hula Hoops and she on her pedals, although this morning her calves became painful even in power mode on the pedals.

The same day we saw Dr Flower who recommended a neuro should make a decision about the back defects as shown on the X-ray report. After leaving Dr Flower we realised that Dr Flower had been reviewing an earlier X-ray report because a technical difficulty had not sent the latest report through to her. I was able to collect  the latest report as well as a month's supply of Apomine having left the script at the hospital last week. Our local hospital is the only local pharmacy that can supply the Apomine.

On Wednesday, having found a distributor of adjustable beds I decided she should have one as a birthday present as well as to minimise the number of pillows she requires to pack around herself each night. About 75% up the 4 lane to the large outer southern suburb of Big Smoke I realised   I had not packed either her walker or wheel chair in the new car. She was unable to alight from the car and doubted she could walk on my arm anyway. So I looked over the available beds before driving home. At home she was unable to get out of the car until I positioned a kitchen chair beside the open car door. I then helped her transfer onto the chair then onto her walker.

Thursday saw us down at Hot Air City for Polly to check her over. It was decided to increase the Apomine to 3ml with saline for a total mixture of 10ml per day. I had to push her on the walker into the hospital; on the return to the car she walked, with leg pains and burning, plus three rest stops back to the car. I called into a Big W where I bought a collapsible camping chair for her to use when getting out of the car. We used it that day and also on Friday on our return from a second trip to the bed shop, where she tested the adjustable bed, found it satisfactory (a night or two sleeping on it may tell a different story) and we bought it, to be delivered next Tuesday. The same day I had organised for a visit from a local nurse to visit to see how they may support her should I ever be run over by a bus.

Yesterday I shopped at our supermarket; one for pills, the other for food. She remained in the car, not wishing to shuffle through the crowd using painful legs. I bought and installed another grab rail, positioned horizontally between the other two vertical ones so that she is now able to negotiate down the side of the garage without needing to extend herself unduly. Of course the gap between wall and car remains.

She began some quilting this morning but soon gave it away, too many pains in her legs. At the moment she is constructing a calico bag into which we will place the camp chair to be carried in the car to help her get out of it. Yes she was in danger of her left leg collapsing getting in and out of the 4WD; now it is a matter of cajoling her bum off a low slung seat.

Chapter 312 - The Week That Was

Although I didn't note much on Monday, she continued with the schedule of 4 meds at 0700, 1100, 1600, 2100 and that is more comfortable for her rather than 0600, 1200, 1800, 2200 when she was eagerly awaiting her pills an hour before the scheduled time. Mid morning her BP was 111/71 67 according to her wrist monitor. As with showering each day this week (although I think she missed one day) she needed to sit on the commode, being incapable of either walking to the shower or standing beneath it. I made an appointment for her to see Dr Flower in the afternoon, to discuss her leg pains, tingles, numbness, left foot turning, collapsing left leg. Dr Flower was suggesting a neurological problem when my Parky gave her a copy of  http://www.epda.eu.com/en/parkinsons/in-depth/pdsymptoms/pain/how-might-parkinsons-affect-pain/ that I had printed out. Dr Flower began skimming the page, grabbed a highlighter, marked words in the paragraph

2. radicular pain and paresthesia (tingling, pricking sensation)

then printed a referral for an X-ray examination. I suspect this may have been what the other good neuro had in mind before he referred her to Polly the PD Nurse and the Considerate Neuro but at the time my Parky had no wish for scans which she finds stressful because of her shakes have blurred the pictures in the past. At that time another local GP diagnosed bursitis which faded away after Tiger Balm Oil and a hand held massager was applied.

Tuesday was a horror day. Perhaps the expectation of attending the local hospital for an X-ray stressed her too much.  At 0630 shower, Apo pump started at 0700 followed by meds and I attached a TENS machine to each leg in an attempt to ease her pains. By 0740 her left leg was too unstable to push her trolley to the loo so she needed the wheel chair and then for any movement after that, including entering the hospital, to the waiting room, the X-ray room then back to the vehicle. The round trip only took an hour but she was very stressed by the time we arrived home at 1200, even though the X-ray technician was very helpful and quick and she remained still enough that all shots were OK. I helped her remove her bra and to dress in the usual hospital outfit. At home she needed a couple of Panamax to ease her aching legs. At 1220 she said that leg tingles began in both legs, tingles moving up and down from toes up to knees, then stopped and a minute later there were aches at the sided of both legs, and by 1225 she was unable to tell where her feet were, the left turning over and as if something was pulling her left foot sideways. While massaging her feet I noticed one felt hot, the other cool. So I placed the thermistor probe of my digital multimeter between her 2nd and 3rd toes (big toe as number 1); the readings being 27C on the left and 35C on the right. As a control I tested my feet at the same positions and the temperatures of both were between 34C and 35C (meter resolution 1C). At 1300 her left foot was 29C and the right 35C. By 1345 she felt "whoozy", her eyesight was "fuzzy"; wanted to lay down. After 1 1/2 hours of sleep she woke at 1530, needing the wheel chair to the loo. At 1600 her left foot was 31-32C, the right 35C-36C; at 2040 left 29C and right 31C. She went to bed at 2130.

Wednesday began at 0300 when she sat up in bed and said loudly "I thought you hadn't returned.", apparently referring to when I went to the loo some hours earlier. She woke at 0520 with her legs tingling. I helped her onto the commode, no power in her legs, unable to walk; then pain in her calves so I attached TENS to both. In conjunction with Polly the PD nurse, it was decided to return to her schedule of 14th September with meds at 0600, 1000, 1400, 1800, 2200, then to drop off the first Comtan at 0600, but that we decided to do later in the week. So at 0600 she had her meds,  followed by a shower on the commode chair and the Apo pump was turned on at 0632. By 0641 she was dressed but both feet were kicking forwards. While she was able to push her trolley to her recliner she commented that her left foot was "swelling". Half an hour after her 1200 meds her feet began kicking (dyskinesia?), lasting for an hour before she said at 1450 that "meds had kicked in". Around 1600 both feet were tremoring badly so she calmed it by manually rubbing it but since she couldn't reach her right foot (I wonder why?) she asked me to rub it. At 1800 meds she was bothered by bad tremors (small rapid movements) in both feet so I pressed the bolus button on the pump. By 1815 her feet were stilled but tingling. Several minutes later both feet were tightening and cramping. Ever the amateur mad scientist I measured the temperature between her toes; left 24C-25C, right 28C-29C. At 1821 feet began kicking, she was somewhat "frozen" and she had to be taken to the loo on the wheel chair. She had a painful pulsing in her left temple and both feet began slowly describing circles at the toes; I queried whether she did that on purpose, she said "No". At 2050 she attempted to rise for the loo but neither of her legs would support her so she was wheel chaired there. By 2100 she was in bed; meds at 2200 and the Apo pump off at 2205. Dr Flower rang asking her to see her next Tuesday because there were matters to discuss arising from Tuesday's X-rays; I have the impression there may be something serious.

Polly the PD nurse, in one of our frequent email exchanges (I don't think she has any other PD patients to attend to so I am keeping that quiet in case others learn of her ;-) mentioned "diphasic dyskinesia" with a URL reference. What in hell's name is that?? Then I Googled the term to find many other references, one of which ( http://archneur.jamanetwork.com/article.aspx?articleid=581064 ) was written in 1982 about a patient's situation in 1980.

Then again, a very clear graph ( http://www.hindawi.com/journals/pd/2012/943159/ ) that clearly illustrates the condition.

In our case, her PD was diagnosed 22 years ago, yet in all that time I had not encountered the word "diphasic", none of the many neuros dressed in 3 piece suits seated behind wide polished desks ever mentioned the word. When we lived at the Red Centre a visiting neuro commented that her version of PD was "strange". We have always thought that dyskinesia was caused by too high a peak effective dose, not that dyskinesia can also occur as levadopa (or agonists?) serum levels rise shortly after taking meds, then again as the serum levels decrease to a low level. Perhaps I am guessing but perhaps it's feasible to have peak dose dyskinesia as well? Then throw in  some ordinary garden variety PD tremor when the patient is really OFF  plus a little  dystonia, plus perhaps a little Shaky Leg Syndrome to completely obscure the picture, and then expect the Parky to describe her symptoms accurately at three to six month intervals when she is expected to report back to a disinterested neuro who says "try increasing or decreasing this or that medication a little bit and let me know at your next appointment". And to think of that neuro over in Swan Country, after a 450km drive from where we lived, that told her "learn to live with it and stop shopping around for a neurologist". He was a sodding anal cavity.

Back to the future. On Thursday of this week I took no notes while I videoed each "interesting" change in her symptoms through out the day. I must be slightly sadistic because I was somewhat disappointed that what I assume were diphasic dyskinesia bursts seemed less frequent or different to those the day before, although she said she had a lousy day.

Since she had been placed on Comtan again recently, and we keep raising the issue of vague memories of her experiencing head tingling and bad feelings some years ago. Cancelling Comtan was planned from next Friday; we all thought let's do that sooner; therefore she omitted Comtan from 0600 this past Friday 4th October; but continues with Comatn at 1800. During Friday I made few notes; an early visit to the local hospital with a script for Apomorphine which they have never used but say they can source, some $300 of supermarket shopping, some scripts and consumables from our friendly chemist, then late in the afternoon collection of a new vehicle as replacement for our well worn but worn well 4WD (getting into which she has been having greater difficulty). Our Domestic Engineer who comes every second Friday to clean and a friend around the corner were with her during most of my absence. She reported leg tremors from 0600 to well after 0900. She said nothing of pain.

Yesterday, Saturday, I talked her into taking a spin in the new car down the 4 lane to that small town which has a service centre perched on top of a hill so that no one needs to enter town unless really wishing to do so. We left at 1000, had lunch in the new car (now despoiled with chip crumbs) in the car park (she didn't wish to get out) of Kentucky Fried Chook. Then home again by 1400. A long trip of some 120kms at 80kmh; she didn't wish me to drive any faster (yawn). At 1500 she said "someone's walking over my grave", an expression she uses when a shudder passes through her shoulders, wanted to sleep so I helped her to bed where she woke at 1745 with severe tremors (small rapid movements) in her legs, then loo, before 1800 meds (including Comtan) when she was feeling hot so I opened the rear door for her. By 1830 she was too cool, the door shut and she wrapped herself in a poncho. She needed bed by 2200 yet laying down made her legs pain badly.

Today has been a reasonable day; she says she has had no pain yet tremors have continued most of the day. She says no "kicking" like dyskinesia motions of her legs, I have seen none, yet for several periods of an hour or so when she was ON enough to do some sewing at the kitchen table, her feet beat a loud tattoo on the wooden floor at our kitchen table. Her feet have tingled as far as the ankles. Around 1130 she slept in her recliner. Using her pedal machine failed to relieve the leg tremors. At one point around lunch time when she froze I had a heck of a time helping her up from the kitchen table to return to the recliner. One assisted visit to the loo she did, with assistance, with only socks, not slippers, on her feet and she may have slipped had I not been with her.

Dr P.D. Carer has decided that from tomorrow, Monday, she will not take the 1800 dose of Comtan.