Think / Able - and Check out My Parkinson's Facebook Page

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Monday, January 15, 2018

Trades, Value Choices, and Big Decisions that (HOPEFULLY) Pay off in the Long-Term - Baseball as a Metaphor for Medicinal Decisions

            As a baseball fan, the middle of January should bring about the signs of the coming season. The baseball preview magazines should be telling fans what they can expect from their teams, but this year, pretty much nothing was done. If you’re a casual sports fan, you probably wouldn’t recognize the names on the free agent list this year. The Cubs’ former Cy Young winner Jake Arrieta is still unsigned, and so is former World Series hero Eric Hosmer. Yu Darvish’s lousy World Series and injury history has left him without a team. JD Martinez is still hoping for a big payday after his Tigers / Diamondbacks statistics, and so is slugger Mike Moustakas, but teams paying out for offense seems to be at a premium in an era of stats crunching and years of control within the league minimum salaries for time in grade. Sure, the Angels paid for pitcher / hitter Shohei Ohtani, but that seems to be more about his potential uniqueness in ability with a bat and a fastball as well as his popularity coming from Japan to the United States. The Rockies paid for Wade Davis’s relief pitching abilities, but other than that, nobody seems to be paying for a person who can’t sell a jersey at a mall store anywhere in the country. Other than some low-level, short-term free agent signings, the biggest moves have come in trade with teams like Tampa Bay calling the season before it starts by moving Evan Longoria to San Francisco. Yesterday, the Pirates followed suit by shipping Gerrit Cole to Houston. Derek Jeter’s Marlins opened the true offseason for business with a fire sale for anyone with a name and value. Now, Marcel Ozuna is a Cardinal, Dee Gordon is a Mariner, and Christian Yelich is on the trading block. Giancarlo Stanton’s humongous $30million per year went back to Jeter’s beloved Yankees for pennies on the dollar and Starlin Castro, but at least they took that money out of the revenue that they had to spend, so the Marlins can reinvest in players who are cheaper and offer 6+ years of control before the first mega-bazillion dollar free agency testing moment comes.
            And that’s what baseball and life is about: TRADES, VALUE CHOICES, AND BIG DECISIONS THAT (HOPEFULLY) PAY OFF IN THE LONG-TERM.

            Yes, it seems that Annie Savoy was right (in the movie Bull Durham) that “bad trades are a part of baseball,” but bad trades can be a part of everyday life, too. As anyone with a medical condition knows, there are side effects to every medication that we take. Doctors tell us about these potential problems so we know what to look for (after all, we don't want to trade Frank Robinson for Milt Pappas). Pharmacists tell us about these and sometimes call us to the side when we get our medication so that they can protect us from adverse reactions that could have slipped through. It’s nice to have this safety net when the reaction comes up from what the doctor knows or what the system tells him or her.

This is what happened to me, as my doctor said it would when I followed his directions and mixed Lexapro and Azilect. I’ve been OK with the combo due to low dosage (as he said I would), but to trade for Parkinson’s protection at short stop and anti-anxiety effects as an eighth-inning set up man, I gave up casually drinking beer, low lows, some amorousness, and money. Some of these are better trades than others. Playing beer at third base was a situational game that only occurred in later innings every six weeks or so for an inning or two at a time. I rarely miss it unless I see Yuengling beer at a restaurant or everyone else has a beer to hold at family gatherings. With health insurance, the money for the 2 medications meant I had to cut back going out to eat once or twice a month. This trade lost me nothing in value over replacement player, so I just made do with what I have. The biggest causation effect that comes from this is that one Appleby’s waitress comes up short in her tips one night a month. I’m positive someone else is coming to fill in the position. As for amorousness, sure it was a solid first basemen that looks good on paper, but it was aging rapidly. Besides, when it comes to wins above replacement, there are other options available to keep myself in the game, especially when the real nature of the game that’s being played is to hold off the body’s immune system from throwing at the heads of neurons that have been damaged by viruses and being there at my best physically and mentally so that I can win at the game of life.

Personally, I’ll make that trade any day of the week and twice on Sunday.
Other trades bring worse effects. I traded money and a player to be named later for Amantadine, and while I didn’t mind trading sleep for it, the livedo reticularis rash (see below) had to go. Hence, my team’s general manager went with trihexyphenidyl, which was open for acquisition from the free agent pool, and I got cognitive issues in a very short period of time. That's not even counting how it was only carrying a .294 on-base + slugging at the time.. At that point, I counted my losses and gave this medication its unconditional release for the purpose of waivers. I’m sure he’ll work well in another system, but around my team, he was a clubhouse cancer causing me to forget in mid-sentence. I couldn’t chance the game with him at the plate or on the mound. I need a pitcher who knows what to throw without a catcher going out to the mound multiple times an inning. I need a batter who can put the ball in play and not strike out looking 40% of the time.

Now, ropinirole is my go-to workhorse. Some people have compulsiveness issues with it, but I don’t. I manage it quite well, taking it before the end of the previous game, and it takes me through the next day’s outing with a quality start every time, though it still can’t excel against conditions in the extreme heat and more tremors in the cold.

Fortunately, I knew that going in. 

Some people are enticed by big names on the market because they have big names. For years, this was the Yankees. Now, it's the Red Sox, who are trying to quit cold turkey. These people set themselves up for the Scott Boras clients of the world. These are the Otezlas, Eliquises, and Abilifies of the world that offer big name rewards via the media for the first 30-40 seconds of their promotions, but then come the side effects that can range from feeling like you want to die to near death to paralysis to death. I don’t say this to pick on them. Lots of medicines offer the same problems. I could list any of them. These 3 commercials just end up on television a lot more often than others. You've probably seen them, too. The catch is, this is America, so instead of going to the doctor to diagnose a problem, you go to him with a self-diagnosed problem that you want treated with a brand-name medicine. I'm sure that makes sense, and yes, it does pay back for years of research, but... WEBMD self-doctoring anyone? Yeah Internet and capitalism!!!

And by the way, disclosure here, I really can’t deal with the Otezla people doing their thing with Katrina and the Waves in the background. That’s a trade I couldn’t make, even if I had plaque psoriasis and it needed to go.

So in the end, the message here is that medicine is the following:
1)      A decision to be talked over with the doctor - not the Internet only.
2)      A potential reward.
3)      A potential risk.
4)      Something that might not work, though it might not create risks.
5)      Something that takes time to get into the system to work (for example, “some people see results in as little as 1-2 weeks” but most are longer).
6)      A trade of benefit for things we might need to give up to prevent risks (for instance, the whole “If you’re thinking about getting pregnant…” thing).
7)      Not for everyone (for instance, the whole no birth control pills for smokers risk)
8)      A problem if stopped early (for example, when I removed trihexyphenidyl, my symptoms were exacerbated).
9)      Something we need to know when and how to take as something more than a number of pills per day (At bedtime? After meals?)
10)  Something that is habit forming.

I’m not afraid of Big Pharma. I’m not sold on alternative medicines. I want the best bang for my buck when it comes to the game of taking the ground lost in my war with neurological disease back from Parkinson’s, and I’m sure you do, too. That’s why we ask questions. While I have ZERO interest in medical cannabis, I still asked my doctor about it to find out his professional opinion, and I was told that it wasn’t enough bang for its buck. That answer works for me. Besides, I know the way it works. I’ve been sent the video many times, and I watched it, but I’m not sold on stopping tremors with those side effects and costs either so as to obtain their benefits.

In the end, what we take and don’t take medicinally are our value choices, as are the things we’re willing to give up. Sure, there are things that Parkinson’s will take from us, but in the meantime, this id-driven selfish brat is taking them back by any means necessary.

Long live the stats and magical powers of ropinirole and Azilect, which will carry us through to a World Series trophy in late October. When it comes to the game, better living through chemistry, nutrition, and value choices.

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