Chapter 489 - Minor Changes

Living 24/7 in a situation hides ones appreciation of gradual changes. One morning a week or so ago while I was positioning her commode chair at her pedal machine I wondered why she was not exclaiming that I was hurting her feet and toes. For I can't remember how long her feet have been so sensitive to touch that she needs to wear shoes whenever not in bed. The shoes are just cheap slip-ons bought at Kmart and have served her well except for a few, still in new condition, on which she removed the elastic straps, intending to modify such for greater comfort. Anyway, on that morning I realised that she no longer insisted on replacing her shoes when removed from the slippers glued onto the pedals of the machine (a pair of large men's slippers glued to the pedals to prevent her feet slipping of those pedals) and I had no idea how long she had not asked the Wild Dog Carers to not bother with her shoes when the wheeled her on the commode from the lounge room into the shower. Next day I queried her about this and she replied "I don't need to do that anymore". In general, her feet don't seem to bother her as they once did. The most I recall her saying of late is that her feet are heavy.Usually late of an afternoon she needs raise her feet onto a chair. The leg/feet supports on her new wheel chair seem of little use to her.

On some days her leg dyskinesias are minimal, on others very bad, onset usually occuring early afternoon. A surprise last Tuesday 8th May, when her dyskinesias were minimal until a short but strong burst at 1800. But first, some background. At her last visit to her neurologist Dr F. I was asked to modify her Duodopa pump flow rates to the following :-

Month 1: 24 March - 23 April Daily Rate 5.7 Morning Dose 5.5 Overnight Rate 2.2
Month 2: 24 April- 23 May Daily Rate 5.9 Morning Dose 5.0 Overnight Rate 2.2
Month 3: 24 May - 23 June Daily Rate 4.5 Morning Dose 6.0 Overnight Rate 2.2

Then from Tuesday 10th April she attended a "Dance for Parkinson's Disease" class at the Church Hall at St Nick's for 4 consecutive Tuesdays. She enjoyed the activity and social contact. There had been several trial classes late last year. Such classes have been conducted in several countries in recent years. At home I showed her the streamed lessons from capture.nbs-enb.ca/dwp/Home.aspx, some of which she followed, seated in her wheel chair. The local classes have now ceased for want of funding. While she attended the classes at St Nick's I had cancelled the Tuesday "Physio" sessions given by a visiting Wild Dog Carer on Mondays, Tuesdays and Fridays. So this week I asked that the Wild Dog Carer participates with her to follow along with the streamed class "Dance Classes for People with Parkinson's, Toronto. ON for March 20 2018".

As mentioned in earlier posts, for a long time now I have monitored the dyskinesias of her right leg with a FitBit device. At our last visit to Dr F. he said it was obvious from the printed FitBit charts I had sent him that the earlier duodopa flow rate adjustments had been ineffective; and that was why we are now using the programme shown above.

Not expecting to notice any change in the FitBit charts, I was quite surprised at the one for last Tuesday. There had been no obvious changes in the FitBit charts on the days she had attended live classes at St Nick's.

Below are the charts for 7th , 8th and 9th May, each annotated with flow rates and FitBit on and off times of attachment around her right leg.

The Wild Dog Carer will be here in about 30 minutes when I intend to have the two of them "dance" along with the same streamed class and the FitBit results will be reported in my next post, whenever.