Hello All,

I hope that the 1st quarter of the New Year is bringing everyone joy and good health.

I have not written in quite some time and wanted to provide an update. Yesterday afternoon we visisited my mother's MDS in Philadelphia. The MDS is still leaning towards a diagnosis of MSA, but appears reluctant to "etch in stone" a particular formal diagnosis. The MDS feels that my mother is realizing "some" relief from her symptoms by taking her ldopa. I should mention that my mother has tailored her ldopa intake to 1.5 pills of IR taken 4x daily. This particular dosage has seemed to provide some relief from her symptoms and has, for the most part, eliminated her bowel issues that she had when taking the extremely HIGH dosage that I had reported back in December and January.

One issue that my mother continues to struggle with is her urinary incontenience. She goes to bed around midnight and wakes about every 2 hours thereafter with a need to urinate. She is, for the most part, able to get herself out of bed to go use the bathroom, however, she has extreme difficulty lifting her legs to get herself back into bed. She must wake my father every 2 hours when she needs to go to the bathroom so he can help her get back in to bed.

The results of the MDS appointment are as follows:

The MDS has prescribed an incontinence medication that my mother is to take one pill at bedtime for around 7 days. If she feels that it is helping, she is to increase the dosage to 2x per day.

After 2 weeks of taking the incontinence medication, my mother is to increase her present klonopin medication intake from .5 mg to 1.0 mg taken 1x in the evening prior to going to sleep. This medication is a sedating drug in hopes to help alleviate the stiffness that she realizes during the evening. My mother has been taking .5 mg of this particular drug off and on for a few months. If the 1.0 mg yields positive results, the MDS recommended possibly taking it during the day to attempt to relieve some additional stiffness that my mother realizes in the mornings.

After 2 weeks of attempting the klonopin dosage increase, the MDS recommended adding a "helper drug" in addition to the ldopa. I cannot recall the name of the drug off the top of my head but I believe it starts with a "C". About a year ago our previous neuro had us try Requip XL. The Requip XL produced horrible rashes on my mother's neck and legs and we obviously ceased taking that drug ASAP. This particular drug that begins with a "C" woiuld be taken, at first, with every other dosage of ldopa to first see if it provided any additional relief to her symptoms. If it does provide relief, the next step would be to take the drug with every dosage of ldopa. One of the side affects is diarrhea, and the MDS mentioned that if we experience that particular side affect that we are to cease taking the medication immediately.

That is about it for now. Any thoughts or comments are always welcomed.

Best Regards,

Matthew R. Smith