WHAT THE INSURANCE COMPANIES DON'T WANT YOU TO KNOW 

 ABOUT DENTAL INSURANCE

BY SAM MOORE

I have not been able to take care of my teeth like I should because of my Parkinson's disease.  As a result, I had to make a visit to a dentist.   Knowing that I needed work done on my teeth, I added dental insurance to my health plan with Alignment Ins.
When I had my appointment, I discovered I needed $40,000 of work done.  I ask the dentist what it would cost if  I didn't have insurance.  The answer was double or $80.000.  With a few additional questions, I found that the insurance cut the cost to me by  50%.  That on the surface seems like a terrible burden on the insurance company.  The question I had was, how does the insurance company stay in business?   I ask that question of the dentist.  The response was, don't worry  about the insurance company, they negotiate a rate with the dentist.   This smells bad, somebody is taking a beating.

Guess what,  it is the patient.     I don't know where the fraud lies, but I know somebody is profiting from the situation.   Pinning the blame is going to be difficult.  I have come up with two quiet different scenarios leading to the situation.

The first, lays the blame on the dentist.  I don't believe this is the case.  The second, places the blame, I believe, on the rightful place, the Insurance industry.   In the first scenario, the dentist's conspire to boost the price of their services by a factor of two.  They then clue the insurance companies into the idea of selling an insurance plan.   They convince the public that the insurance is paying for the  service, leaving a significant copay for the patient..  What is really happening is, the Insurance company negotiates a price for the services, individually, with each dentist.

In the second case, the most probable,  the insurance industry, either, cons, or pressures the dentists into increasing their prices.  The insurance company, then "negotiates" the prices of the services.  As a  result, the insurance co. can say they are insuring the patient when actually they are selling a discount card at no cost to themselves.   Check it out, you can get a discount card for free that allows you to get 50% off on your dental services.

I believe greed allows this fraud to continue,  It appears, the insurance industry is the profitee in the fraud.  The dentists go along with the situation because in the worst case they get a fair return for their services, and in the best case they get double the price from the unsuspecting  "uninsured". There are still some conscientious dentist, who have kept their prices at a reasonable level.  They don't get the insurance business because there is no room for price negotiation.

       RYTARY THE KNEW "GOLD STANDARD" IN PARKINSON'S DISEASE TREATMENT
                                                                   BY SAM MOORE


A knew "Gold Standard" in PD treatment is now on the scene and is proving itself.  It is called Rytary, Ry-tar'-y..  I have just started using it so don't have any personal experience yet..  Without the price tag, it would quickly take over the  number one place in PD treatment.  The predecessor,  Sinemet  would  soon be history.
With my engineering background, I need an understandable, development history of any product I endorse.   Without the actual history,  I am compelled to invent my own.   Fortunately, I have a tool that gives  me under the skin insight into the interaction of medications with different absorption characteristics..   The tool is a medication profile plotter.   By entering the dosages and dose schedule of a day's medication protocol, I receive a plot of the days' medication blood concentration.  With this information,  I can reconstruct the thought processes and hard work that went into the development of Rytary.
Rytary is a progression of Extended Release, ER, and Control Release, CR,  Sinemet.  The advantage of ER/CR Sinemet is added therapeutic time.  A plot of the blood concentration, following doses of ER/CR Sinemet, is shown in figure one.

The advantages of this  configuration over IR Sinemet is obvious.  The disadvantage is the absorption time,  it takes too  long for the initial dose to take effect. I remember reading somewhere that Rytary uses a combination of IR and two versions of ER/CR. The developer of Rytary must have taken considerable time and research to come up with the combination of Sinemet versions  they settled on.   The  combination I arrived at in my analysis, 16.7% IR,  33.3% ER/CR 3 hour and 66.7% ER/CR 5 hour.
I have a friend who uses Rytary.  She takes two capsules  of 95 mg. Rytary 4 times a day.  This gives her 24 hour coverage of therapeutic medication.  This profile is shown in figure two.

Using the profile plotter, I would select  10 mgs. IR and 180 mgs. 5 hour.  The 24 hour plot is shown in  figure 3.  The addition of the 3 hour ER/CR does not appear to be of any real advantage.

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For a trial use of the plotter contact Sam Moore at sdurwoodm@gmail.com.  Thirty day trial is free, Donations are accepted.  The plotter was developed to study Sinemet, and requires EXCEL, which is not included.

                                  FRONT PAGE FROM NEWSPAPER OF THE FUTURE

                     THE AMERICAN WORKER AND THE CAUSE OF THEIR PROBLEM

I have been seeking a revelation to explain the plight of the American worker. The answer is unexpected.  It is an old problem and surprisingly began with one of America's favorite sports,  high school  and human nature.   In the early days sportsman ship was taught from the beginning grades. You were taught to accept defeat and as a victor show respect to your defeated opponent.  As years went by, sportsmanship took a backseat to pride in being number one.  Soon winning was everything.  and second place was quickly forgotten.  This was the end of sportsmanship.

As you would expect, this attitude progressed as the younger  players advanced through the ranks, from high school, to college, to professional,  to national,  and so on, until the problem had permeated the entire sports world.  Today, nobody remembers the second place team or individual, twenty four hours after the winner is announced.   When I was named Salutatorian of my high school graduating class, I was treated like a celebrity, equal to the recognition given to the Valedictorian. Today, that achievement is hardly recognized.  

Being number one has become addictive.  No one is satisfied with anything less.  People will even resort to murder to achieve the number one position in any endeavor sports or otherwise.  As a result, we have dictators, Kings and other world leaders who resort to anything, legal or e legal to achieve the spot.  

Greed has become rampant.  The desire for recognition, fame, power, wealth, and all that it brings has ruined many a potential leader.  As a result, they become mean and vindictive and resort to any means to achieve their goals.  The real question is: what is the solution? As for me, "I don't have a clue".

So, let's start a dialog of finding answers.  I'm sure there is more than one answer and the solution may be one or a combination of answers.  Let's start by setting up a  dialog blog.  Who will volunteer to chair and set up the site.        

                                MORE EVIDENCE TO THE DELIMA OF THE WORKING CLASS
                                                              BY SAMUEL D. MOORE    

I watched the national college football game  on tv the other night.  I must say, it ranks at the top for excitement.  However, I noticed one incedent that strengthened my belief as to what happened to sportsmanship and ethics in the world.  The incedent probably  wasn't noticed by anyone else,  but that is the way my mind works.  It occurred  about midway through the contest.
One of the top receivers for Alabama, touchrd the incoming ball but failed to make the catch.   He immediately jumped up, making good catch signs with his arms, in an attempt to influence the official's call.  I believe most people today would ask, "What's wrong with that?".  Exactly, this is what's wrong.  The player knowingly tried to perpetuate a lie instead of accepting the truth that he failed to make the catch.  The desire to suceed overpowered his acceptance of the truth.
This attitude is epidemic in most of today's sports venuies.  The two notable exceptions are soccer and golf.   The result of this attitude is more rules and officials.  It has gotten so bad that it has interfered with the ability to complete a contest.  In football, it is almost impossible to complete a first down.  In basketball, it is almost impossible to make a shot from the field, resulting in the outcome of the game dependent on free throws and official's decisions..  In addition,  the attempts at shifting the blame for fouls  by faking a reaction has gone viral, so to speak.  The acting should have its own Golden Globe awards show.   Remember when:  The official calls a foul and the guilty player immediately raises his hand?

 Those are the sports I am familiar with.  I am not familiar enough with other sports  to comment on them.
The resulting greed and desire for success, has made its way into the political system.  At this point, it is hard to determine if the chicken or the egg was first.  This seems to be a worldwide phenomena.                                    

                         THE UNEMPLOYED OF THE  AMERICAN WORKFORCE EXPOSED
                                                                BY SAMUEL D. MOORE


I have tried to keep this blog out of politics.  I have abandoned that cause due to a posting of Dr. Phil's on Facebook.

WAKE UP AMERICA!!!!!!!

I have respected Dr. Phil until today.  I saw his comments about unemployment on the Facebook and it sent me into a rage.  His true colors are revealed.  Another major disappointment in my faith. Dr. Phil, do you really think the un- and under- employed enjoy their condition.  Face it: The greed of the overpaid CEO's of this country, who, in the interest of there power and pocketbooks, have sent their jobs overseas, in the guise of high wages.  Now to bring them back,  they must accept minimum wages. They are even asking the American workforce to accept lower minimum wages, as a cost of bringing the jobs back, while management takes a bigger share of the profit. This is what we can expect of the administration's support of the American worker?  I am 85 years old, and, if I was physically, able would still be in the workforce, employing my fellow Americans.  I am working today, toward that goal.

I do not understand the fact that the American workforce doesn't recognize this situation.  I guess the truth is, they have been told a lie so much, that they now recognize it as the truth.  All you have to do to recognize the truth of the situation is, look at the economy growth since the democrats took partial control of our government.  Think what could have been achieved if they had full control.  Instead the republicans have thrown up roadblocks to any attempt at helping the citizens of this country, in an attempt to make Obama a failure, purely for bigot reason,s.  " TO HELL WITH THE CONSTITUTION, DESTROY OBAMA".  

I realize that this will anger many people, but, I no longer care. What I am saying needs to be said. If it enlightens just one person it is worth it.  

I hope to return to my original subject in my next posting.

   

                         DYSKINESIA DOSE SUSCEPTIBILITY RANGE
                                                         BY Sam Moore

I have found that my dyskinesia has a susceptibility range.  The range starts at about 100 mgs of levodopa IR and continues at levels of levodopa higher than I have experienced.  The Figure below shows the range I have experienced.   The intensity of the dyskinesea, when it occurs is proportional to the highest level just before the elimination period starts.  At levels less than the susceptible range is a safe range. This range starts at a level where the tremors cease.

The information is patient sensitive and will not be the same for everyone.  Relating the information to blood concentration, one hundred mgs. is equivalent to approximately 18.2 mg/ml blood concentration.  For my body weight, about 5.5 liters of blood.

The blue/green line is for 150 milligrams taken three times a day.  While I was on that protocol I did not suffer with tremors or dyscinesea.  I attribute that to the level being most of the time above the upper limit of tremors. I believe this dose level is too low to be therapeutically beneficial.

The red line is for 200 mg. taken 4 times a day. This was the worst I have suffered with dykinesea, both in length and intensity.   I never want to go through that again.  The higher the peak just before the dyskinesea, the higher the intensity.

I have been looking at profiles of  Rytary.  I think I have it down pretty good.  I understand that a friend of mine is taking Rytary, Two 95 mg. tablets, 4 times a day.  I worked up a model of Rytary so I could plot a graph of the daily profile.  The result is the graph, shown below.
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From my experience, I have found that you can have a condition where you get enough levodopa to eliminate the tremors, without having enough to  be therapeutic.  If I am correct, in the protocol that my friend is on,  I believe she is at this point.  I have taken into account that she is a small woman and would not require as large a dose as a man my size.  I believe in order to have a therapeutic effect you must have enough levodopa to make you susceptible to dyskinesea.  Fortunately, with the Rytary protocol, the level of medication remains at a high enough level to prevent triggering of dyskinesea. In the plots,  I have shown the profile for the 190 mg. tablet.

I am attaching my dose profile for a comparison to the Rytary profile.  I use a protocol of sinemet, because it is cheap, that makes me take my doses every two hours.  It ends up putting me in a dyskinsea sensitive range much of my dose period.  That combined with the large fluctuations of medication level causes me to put up with dyskinesea several times every day.   It is not possible to have 24 hour coverage .  You are limited to 12 to 14 hours.   I miss doses on my schedule, because,  I sometimes am out of range of hearing of my timer, I forget to set or activate the alarm, or I accidentally turn the sound of my alarm too low to hear.

I am impressed by the Rytary profile, because you can get 24 hour coverage and it is less susceptible to Dyskinesea than my current protocol.   Except for the cost, I think Rytary is the best solution yet for a sinemet protocol.

I believe that for ease in comparing results between patients, it makes more sense to look at the profiles in terms of mg/ml, rather than in mgs.  Mgs/ml takes into account the weight of the patient with there associated blood volume.  In order to support this recommendation I have attached a graph with two profiles. One is of  two 95  mg. tablets of Rytary taken 4 times a day by a 155 lb. patient.  he other graph is of two 95 mg. tablets of Rytary taken 4 times a day by a 110 lb. patient.

As can be seen in the graphs,  the dose has a much stronger effect on the smaller patient.   This technique will narrow the gap for comparing results.
I believe that for ease in comparing results between patients, it makes more sense to look at the profiles in terms of mg/ml, rather than in ml.  This takes into account the weight of the patient with the associated blood volume.  In order to support this recommendation I have attached a graph with two profiles. One is of  two 95  mg. tablets of Rytary taken 4 times a day by a 155 lb. patient.  The other graph is of two 95 mg. tablets of Rytary taken 4 times a day by a 110 lb. patient.

As can be seen in the graphs,  the dose has a much stronger effect on the smaller patient.   This technique will narrow the gap for comparing results.

I hope you have found this article beneficial.  If so, please "Like" it on Facebook,  or comment on my blog.  Support PD research on the Michael J. Fox foundation.  Support this blog  with donations to my account  s_durwood_m@msn.com on Paypal, or contact sdurwoodm@gmail.com to send comments.  Both positive and negative comments are welcome, although positive ones are preferred. I will try to respond.                                                    



                         

                              HOW DO YOU EVICT SQUATTERS?

This is a story about troubles with the Parkinson’s clan.  

I have a problem with squatters that have moved in and won’t go away.  It started out innocently enough.  It would be a situation that was unpleasant but tolerable.  It began about six years ago when the patriarch of the family moved in.  The family name is Parkinson.

Soon other members of the family showed up.  There were Tremor,  Stiffness, Lethargy,  Insomnia and several others that moved in and out.

It soon became intolerable.   I started looking for someone to help me get rid of the unwanted visitors.  I selected a specialist with important letters before and after her name, only to be informed that she had no solution for my problem.  I then found another specialist, again with impressive credentials.  He started out trying several approaches.  Some of the approaches did no more than temporally move some of the family out but they always returned.  He tried one approach that involved the marriage of the patriarch to Levo.  At this point, the marriage produced an unplanned son that was named Dyskinesea.  Dyskinesea was too much for the specialist so he recommended another specialist that had narrowed his specialty to the Parkinson’s family.

The new specialist was sold on the marriage of the patriarch to Levo.  He tried marriage counselling to increase the bond between the two.  This worked to some extent; however, the relationship had lots of ups and downs.  Part of the problem with the marriage was Levo's  chronic gastric problem.  The solution to the problem was getting Carbi involved.   Carbi and Levo were twins of the Dopa family,  and had been separated by the marriage.

At this point in time the relationships were complicated by an across the country move.  I moved to live with my daughter and her family.  She fixed up a nice apartment for my wife and me in her home.   

A perfect opportunity to get away from the Parkinson’s clan.  Think again, they found a sucker and they intend to milk it dry.  So now I have to start again.  First find a new specialist.  My fourth specialist was there in name only.  I think he had retired early and forgot to tell anyone.  

So the patriarch followed with his clan and his wife, Levo,  and moved in on us again.

I was getting desperate at this stage, so I decided to foster a romance between Dyskinesea and a new entry, Mary Jane.   Mary Jane became an option because she was living in the state of California,  where we had moved.   This was a failure, so I continued my search for a new specialist.  Enter number five.

Like number four, number five had also entered premature retirement..  At this stage I gave up and decided I would have to go proactive.  I started by going to the internet and researching the various aspects of the Parkinson’s clan.  

I discovered that the Dopa family was extremely sensitive to the timing of their involvement.  I used a timer to time my attempts at involving Levo in the relationship. An immediate improvement resulted.  Then I found that a greater improvement occurred when I adjusted the intensity of my attempts.  By adjusting the intensity of the attempts along with the timing of the attempts, I could get an amplification of the effect.

Something was still missing.  I had no way of correlating the intensity and timing with the timing of the response from Levo.  Then I found that others had measured the push back response of Levo.  I could then predict the action of Levo by plotting the intensity of the attempt against timing of the attempts.  At first I manually plotted the chart using “Paint” and the laws of geometry.  This was slow and tedious, but it was an improvement in performance.  I then went to the computer and developed a spreadsheet algorythm to have the computer generate and plot the data for me.

I tried to interest my fifth specialist in my discovery, but he didn’t want to be bothered with any new ideas.  I found a sixth specialist.  Number six was a jackpot.  He was interested in my approach and encouraged me to continue developing the algorythm.

Number six decided that arbitration was in order, so he brought in two negotiators to try to bring some peace to the family.  He decided on Amanta and Rogeta, two intercessors who were able to smooth over some of the rough spots in the inter-family relationships.  Getting the arbitration process going had its own rough spots due to the high cost of the Rogeta half of the team.  Negotiating the contract price was difficult in itself.

That brings the story up to date.  I still have the clan on my back, but it is more predictable.  My next effort is to help others who have the same problem as I have.

If any reader of this story has any ideas about this subject, please contact Sam at sdurwoodm@gmail.com.       




                “HOW DO YOU EVICT SQUATTERS?” EXPLAINED

The short story  “HOW DO YOU EVICT SQUATTERS?” was written to put some humor into the other wise hum drum life of PD patients.  For most patients the story would make sense; however, for the person unfamilier with the levodopa treatment of PD, some of the situations of the story might not be clear.  I will attempt to give some baqckground on the most prevalent treatment of the disease.

First PD is a progressive disease.  As of this date, it is incurable.  The best that can be done is minimize the symptoms of the disease.  It is believed that either a deficiency of Dopamine or a defect in the ability of the brain to utilize the Dopamine for firing the syenapsis.  The inability of the brain to utilize Dopamine, causes erratic firing of the synapses, resulting in erratic responses in the movement of the patient and slowness of movement with sometime freezing of motion.  This symptom of PD is called Tremors.  Years ago, it was discovered that the medication, levodopa minimizes the symptom, dyskinesea, as well as the other symptoms that tended to immobilize the patient.  

The problem this treatment has severe side effects of its own.  By adding carbidopa to the dose, the symptom nausea is minimized.  The medication, brand name Sinemet, provides a 1:4 ratio mixture of carbidopa and levodopa.  This is available in a generic version with a number of absorption characteristics, Imediate Release, Control Release, Extended Release, and combinations of the three such as Rytary.  

The biggest drawback to levodopa is its short half life. The half life is approximately 1.5 hours.  This means that 1/2 the levodopa is eliminated within 1.5 hours.  In addition, the levodopa is a precursor to Dopamine.  The levodopa does not cross the blood/brain cell barrier, resulting in the requirement of a massive amount of levodopa being  required to provide adequate dopamine.  Most of the levodopa is eliminated and never reaches the barrier.

Combinations of the available characteristics are used to extend the length of time a therapeutic dose stays in the blood stream.  I work with the total medication in the blood stream for my profiles,  A simple conversion multiplier will change the total medication level, in milligrams  to blood concentration, in milligrams/milliliter.  The only added information required is the weight of the patient.

A plot of blood content of levodopa vs time of day gives the “Profile” of the day’s medication protocol.  This is a valuable tool in fine tuning the protocol for optimum results.  Even with the Profile optimized, the protocol is limited in its effectivity.  

With the goal of supplementing the supply of dopamine another approach was desired.  A search for a supplement to dopamine resulted in some agonist candidates. Two such agonist were found, Amantadine and Rotegotine.  Amantadine has been used for several years to relieve the dyskinesea created by a drop in the levodopa level.  It is available in a generic form.  It has an absorption time of approximately 3 hours and an elimination half life of approximately 16 hours.  Since the medication half life is long. the medication blood level remains relatively high throughout the day. Unlike levodopa, the medication crosses the blood/brain barrier.  I assume that the Amantadine has a chemical change in crossing the barrier.  The resulting agonist supplements the dopamine.  A relatively large dose is required to force the medication across the barrier.  The original use for Amantadine was as a deterant to some kinds of pneumonia. 

On the other hand the Rotigotine, is only available as a brand name medication, Neupro Patch.  The manufacturer selected a derma patch as the delivery system. Without financial help, I cannot afford the medication.  The patch is changed every 24 hours.  In the 24 hour period It delivers 45% of the total medication in the patch.  I have been unable to profile the patch.  The modeling is complicated by the dual  and relatively short half life combined by the characteristics of the delivery system.  I believe the total blood stream level, after several days stabilization, is considerably less than the medication delivered in the 24 hours.  Due to the high cost of the medication, some patients have resorted to wearing the patch for 48 hours, thus halving the cost.  I would not recommend that action even though 65% of the medication remains in the patch after 24 hours.  My intuition tells me the variation of medication level would cause an increase in the susceptibility to dyskinesea.

“Mary Jane” refers to my experimenting with PD’s response to medical marijuana.  I know of one case where medical marijuana has extended the quality life span of a cancer patient by several years.      THC is the ingredient in cannabis  that is said to reduce the  symptoms of PD and Dyskinesea.    It didn’t work for me but that doesn’t say it won’t work for others.    Another successful case for cannabis was for alleviating the withdrawal symptoms  from  opioids.  The patient had used opioids for several years for pain relief. When his pain went away he was unable to withdraw from the opioids because of sleeplessness and other  severe symptoms. With the cannabis he was able to overcome the addiction. 

If you found this blog beneficial donate to PD research with The Michael J. Fox Foundation.  Send your Likes or Dislikes to Sam at sdurwoodm@gmail.com.  You can support this blog through donations through PayPal for sdurwoodm@gmail.com.