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Monday, September 11, 2017

Return of the Tauroursodeoxycholic Acid

I wanted to squeeze in one more post I've been needing to do before I turn my attention mostly to my experiences with the DBS (deep brain stimulation) surgery coming up.

I'm typing this one out rather than a video blog in part because my wife is napping and will soon go to bed and I don't want to disturb her and also because if I type it out, I don't have to pronounce that big drug name and make a fool out of myself. <g> You have my permission to pronounce it in your head anyway you want.

The abbreviation for this substance is TUCDA. What is it? It is ursodeoxycholic acid that has been joined to taurine, a sulfur-containing amino acid in your body important in the metabolism of fats. Thus the prefix "tauro" to the word.

So then, what is ursodeoxycholic acid (UCDA)? Glad you asked. It is a type of bile acid naturally produced in our bodies that is prescribed by doctors to dissolve a certain type of gall stone. The liver in processing UCDA combines it with taurine. To pre-combine it saves the liver some work. Plus TUCDA is a supplement sold over the counter, usually touted as a way to keep your liver healthy for people working out (I assume because some of the "supplements" they take aren't so good for the liver). However, especially if you have good drug insurance, if you can get a doctor to prescribe UCDA for you as an "off label" use, it is much cheaper than buying TUCDA from your drug store, health food store, or online.

Why would I want to buy it? For those new to the blog, I direct your attention to the posts in January and February of 2015. You may not have the time to read them all now, so I'l summarize what you'll find. I had read a couple of people's experiences with this substance, and how it seemed to improve their symptoms as well as showed promise of possibly slowing down the disease progression based on cellular studies and one small clinical trial for a related disease (ALS) where it successfully extended the patient's life indicating a slowing of progression in that disease. At the time, however, it still lacked any clinical trials for Parkinson's showing a significant number of people would be symptomatically helped by it or that it would indeed slow down the progression.

With that, and studies showing the drug was safe for most people, I decided to verify for myself whether it would help me any. Low and behold, to my surprise, it did! I sincerely didn't think it would because I'd tried so many other things that claimed to help or "cure" PD only to get zero results from them, that I fully expected this to also fall into that camp. If you read through those posts, you'll see the significant improvements in symptoms that I was having at the time that I concluded was due to taking TUCDA.

Consequently, I continued to take them after the test was over, and I did so through 2015 and 2016. During that time period, my disease did progress (few expected it to actually stop the disease, just slow it down) but it was primarily due to getting off the drug Amantadine twice. Once at the end of 2015 in order to be part of a clinical trial on an extended release Amantadine, and then the end of the clinical trial in May of 2016. Both times I had to increase my dosage of levodopa to compensate for the worsening of symptoms: from 100 mg 3x/day to 200 mg 3x/day, and then to 200 mg 4x/day due to earlier off times.

By the end of 2016 or the beginning of this year, our finances became very tight. So much so that I simply didn't have the money to pay all the bills. Since my monthly supply of TUCDA ran me around $80/month, it came down to not having the money to buy it. So I stopped and hoped for the best.

In many ways, my symptoms that I had before taking TUCDA were worse than they are now. A big part of that is in February of 2015 I embarked on an intensive exercise program that I'm still very active in. I've noticed several symptomatic improvements from that as well, and there are clinical trials proving that cardiovascular exercise does slow the progression of Parkinson's Disease. Ironically, I'm probably in the best physical shape of my life right now. Improvements from exercise I've noticed include nearly total regaining control of my bladder, a clearer head--less times I've felt a grogginess in my thinking--, improvement in gait, improvement in balance (though dyskinesia does a number on that too), being able to open packages with my bare hands (I often needed scissors to do so) are examples.

Despite all that, sometime in the Spring, I believe, I was having significant off times again. I added another half-pill of levodopa to the dose, so  uped it to 250 mg 4x/day. Then in June I had to add a half of the now 250 mg pill I was taking to deal with the symptoms so that I was taking 375 mg 4x/day. The disease did seem to be progressing faster this year since getting off TUCDA, and there was nothing like getting off Amantadine that I could point to for the cause.

As some reading this know, in August, I started getting Medicare. It is the main reason I can afford to get DBS surgery at this time. One of the other benefits I get with it is paying only a $5 co-pay for the three medications I've been taking. So what cost me just over $100/month was now costing me $15.00. Cool!

Well, I happened upon those post back in Jan and Feb of 2015 and I recalled how it helped then, how things had seemed to go downhill this year, and thanks to the reduction in how much I had to pay for my drugs, I could now afford to get back on TUCDA. So I looked and found one that was even cheaper than before, costing me under $60 for a month's supply. I think I paid $54.00. So I ordered some and started taking them again.

That was about two weeks ago. What's happened since then? One of the unexpected symptom improvements last time was my voice. I had begun to lose my low bass notes. Had trouble hitting them, and if I did, had trouble holding onto them solidly. What has happened since getting off TUCDA in Jan of this year? I was retired as a chanter because of trouble singing songs I knew well. And in July, I was seriously considering whether I should continue in the choir because I couldn't hit the low notes well or with any volume. I felt I was contributing very little and would be better to go sit with the rest of the people and leave the singing to the others.

These last two Sundays, almost immediately upon taking TUCDA, just as it happened last time, my low range has returned. I was able to sing solidly in choir, and my reading voice was loud as before. I need to keep taking this if for no other reason, because it helps me retain my vocal range and voice.

The first week of taking it, I noticed my dyskinesia increased. Those are uncontrolled movements due to overstimulation of the nervous system by the drugs I'm taking. For me it involves head bobbing due to muscles in my neck tightening uncontrollably, and my left leg wiggling because it wants to move! When that happens, it is a sign that you're getting too much levodopa. So I stopped taking the extra half-pill I'd added on last time and that dose seems to be working fairly well, whereas before I had a big off time. Now the end of my dose even with this lesser amount of levodopa, is better than it was before adding that half pill in. Which indicates that either the TUCDA is improving my symptoms once again, and/or is making the levodopa and other drugs more effective.

The only other possible explanation for those improvements is I did switch my diet from ketogenic to plant-based about the same time I started taking TUCDA again. It is possible that played into it. Not as likely since it will take a few weeks for my body to switch over and the full effect of the new diet to manifest itself in symptom improvements. And nothing other than TUCDA has ever affected my vocal decline like that, and that fast. Within the first week, I could tell that by the end of playing pickle ball, when before my symptoms made it near impossible to play, now they are minor enough I can still play with some gusto. I don't think a diet change would have made that improvement that fast.

So that's my report on that front. It will be interesting to see how much I can reduce my medications after the DBS. Even if I'm able to totally get off of them, I may still take TUCDA to keep progression as slow as possible.

This Tuesday, I have my MRI done. I'll be under general anesthesia for the first time in my life. I'm hoping for it to be nothing more than taking a 2-4 hour nap. It'll go quick for me. Not so much for my wife who will be sitting in the waiting room.

Be sure to follow this blog by email using the form below the comment section if you want to stay updated on not only how the MRI goes Tuesday afternoon, but the rest of my DBS adventure.

Thanks for reading!

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