Dr James Le Fanu: 14 February
Heart surgeon Dwight McGoon was at the peak of his career at the (world-famous) Mayo Clinic in the United States when he felt a slight tremor in his right hand while separating tissues with his surgical scissors. Realising this must be the first sign of Parkinson’s and that his operating days were over, he resigned his post. There would, however, be a silver lining to his misfortune, for he went on to write a book on the selfmanagement of the illness. The Parkinson’s Handbook (WW Norton & Co, £9.99) has been a boon to thousands of fellow sufferers since.
The main treatment of Parkinson’s is the drug levodopa, which mimics the action of the neurotransmitter dopamine, thus alleviating the three cardinal symptoms of tremor, rigidity and slowness in carrying out movements. With time, however, responsiveness to the drug can become highly unstable: a small increase in dose causes painful and uncontrollable twisting of the limbs while a small decrease results in severe immobility. Dwight McGoon’s great achievement would be, drawing on his own experience, to give the reader the self-confidence to manage these problems themselves.
His solution to the problem of the drug’s diminishing effectiveness is to incorporate the concept of a ‘drug holiday’ into his daily treatment schedule. He’d take it once a day at midday and for the next four or five hours his muscles would ‘regain their useful vitality, I can walk freely again and a smile comes easily’. By evening the rigidity returns and by the next morning his mobility is seriously impaired. This regime both prolongs, probably almost indefinitely, the brain’s sensitivity to the drug while allowing the patient to plan his day sure of at least four hours of near-normality.
This period, he suggests, is also an opportunity to ‘re-educate’ the brain to perform simple tasks. He describes how in the afternoon while enjoying the benefits of levodopa he found he had no difficulty in tying his shoelaces, but in the morning and evening he had to ask his wife for help. Accordingly, he examined in detail – while under the influence of the drug – how the fingers hold the shoelaces and manipulate them. Then, once the effectiveness of the drug had worn off he regularly practised his newfound knowledge. Gradually, he relearnt how it could be done.
Dwight McGoon died 10 years ago from a condition unrelated to Parkinson’s but his legacy lives on as his inspiring book continues to provide more useful advice than might be gleaned from a cohort of neurologists.
This week’s medical query comes courtesy of a lady from York in her late 70s much troubled by bouts of depression over the years but who now, gratefully in good spirits, would like to discontinue venlafaxine, the antidepressant she’s been on for 17 years. She’s tried to wean herself off it over a long period only to find a couple of days after stopping the drug she develops severe withdrawal effects, including ‘electrical shocks’ in the head and feeling very unwell.
‘I understand it is possible I may never be able to get the drug out of my system after such a long time,’ she writes.
These withdrawal effects are almost inevitable having taken an antidepressant for so long. There’s no way of ‘coming off’ this drug other than the slow weaning method, though it helps to have the support of a GP or psychiatrist when doing so.
There’s also a publication on withdrawing from venlafaxine, produced by The Royal College Of Psychiatrists, available on the internet. The other option would be to stay on the drug indefinitely, which might seem undesirable but there’s no reason in principle why not.
Email drjames@lady.co.uk
The main treatment of Parkinson’s is the drug levodopa, which mimics the action of the neurotransmitter dopamine, thus alleviating the three cardinal symptoms of tremor, rigidity and slowness in carrying out movements. With time, however, responsiveness to the drug can become highly unstable: a small increase in dose causes painful and uncontrollable twisting of the limbs while a small decrease results in severe immobility. Dwight McGoon’s great achievement would be, drawing on his own experience, to give the reader the self-confidence to manage these problems themselves.
His solution to the problem of the drug’s diminishing effectiveness is to incorporate the concept of a ‘drug holiday’ into his daily treatment schedule. He’d take it once a day at midday and for the next four or five hours his muscles would ‘regain their useful vitality, I can walk freely again and a smile comes easily’. By evening the rigidity returns and by the next morning his mobility is seriously impaired. This regime both prolongs, probably almost indefinitely, the brain’s sensitivity to the drug while allowing the patient to plan his day sure of at least four hours of near-normality.
This period, he suggests, is also an opportunity to ‘re-educate’ the brain to perform simple tasks. He describes how in the afternoon while enjoying the benefits of levodopa he found he had no difficulty in tying his shoelaces, but in the morning and evening he had to ask his wife for help. Accordingly, he examined in detail – while under the influence of the drug – how the fingers hold the shoelaces and manipulate them. Then, once the effectiveness of the drug had worn off he regularly practised his newfound knowledge. Gradually, he relearnt how it could be done.
Dwight McGoon died 10 years ago from a condition unrelated to Parkinson’s but his legacy lives on as his inspiring book continues to provide more useful advice than might be gleaned from a cohort of neurologists.
This week’s medical query comes courtesy of a lady from York in her late 70s much troubled by bouts of depression over the years but who now, gratefully in good spirits, would like to discontinue venlafaxine, the antidepressant she’s been on for 17 years. She’s tried to wean herself off it over a long period only to find a couple of days after stopping the drug she develops severe withdrawal effects, including ‘electrical shocks’ in the head and feeling very unwell.
‘I understand it is possible I may never be able to get the drug out of my system after such a long time,’ she writes.
These withdrawal effects are almost inevitable having taken an antidepressant for so long. There’s no way of ‘coming off’ this drug other than the slow weaning method, though it helps to have the support of a GP or psychiatrist when doing so.
There’s also a publication on withdrawing from venlafaxine, produced by The Royal College Of Psychiatrists, available on the internet. The other option would be to stay on the drug indefinitely, which might seem undesirable but there’s no reason in principle why not.
Email drjames@lady.co.uk