Stem Cell Story

It was a strange time to talk about stem cell research. We were at a post funeral reception in one of the most beautiful gardens I have ever seen outside the city's Botanic Gardens. I knew only a few family members, who were all busy greeting people, so I found a place to sit and tried to make light conversation with the person next to me.

What do you talk about after funerals with people you've never met? The obvious answer is, you talk about the deceased. How did you know him? Wasn't it a beautiful service? And then you share a memory or two in hopes it will spark something and your small talk won't fizzle. 

This time it was a challenge. The woman I spoke with didn't know the man who had died or his family, whom her husband had known growing up. I was definitely starting to fizzle when she mentioned her husband has Parkinson's disease. Imagine my relief! That doesn't sound right, but at least it gave us something to talk about.

I was even more excited when she told me he had participated in a study on stem cell treatment soon after he had been diagnosed - years ago. I asked if I could talk with him. She agreed and led me over to where he was having a smoke with friends. What he told me was impressive. The study had been done through the University of Colorado with private funding. This was during the Bush years and the moratorium on federal funding of stem cell research.

He has never been on medication for Parkinson's and has only the occasional tremor when he is very tired. Otherwise, he's fine.

I didn't have time to ask any more questions. It was a funeral reception, after all, and I didn't want to take up too much of his time. I have a whole list of things I'd love to ask, such as:

Did this involve brain surgery? What were his symptoms before the treatment? How many participants had good results? Did he, or does he use any alternative remedies to help with his Parkinson's. I wanted to ask him about one remedy in particular. I couldn't have been sure, but he had the aura of permanent mellow which is often associated with the early and enthusiastic cannabis researchers.

Oh well, I was glad I had the chance to talk with him. I'd love to learn more about past studies in stem cell treatments. I'll definitely be asking my neurologist about this when I go in to see her again. It would be really cool if Colorado was one of the leaders in this research.

If nothing else, we know Colorado will be right in the forefront with cannabis research. If we can't be cured, at least we can be mellow.

New Technology for Deep Brain Stimulation Surgery

MRI Interventions

It's still brain surgery and those are two words I don't like hearing together.

I was talking with Dr. Steven Ojemann, a neurosurgeon at University of Colorado Hospital, about the new ClearPoint MRI platform for Deep Brain Stimulation (DBS) surgery. This technology was developed at The University of California in San Francisco, which is where Dr. Ojemann did his residency. His advisors, Dr. Philip Starr and Dr. Paul Larson, are two of the doctors who have worked on this project and continue to be advisors to MRI Interventions, the company which manufactures this system.

Dr. Ojemann has followed this project from the beginning with great interest and in October of 2013, the system was brought to Colorado and installed at UCH. Since then, Dr. Ojemann has performed DBS surgery on 7 patients with Parkinson's disease using the ClearPoint platform.

In Deep Brain Stimulation surgery, one or two thin metal electrodes are placed in the brain at a very specific target. They are then attached to a computerized pulse generator, something like a heart pacemaker. This is implanted under the skin in the chest. This pulse generator will be programmed and adjusted by the neurologist so the patient can achieve the best relief from their symptoms.

In conventional DBS, a stereotactic frame is attached to the patient's head and then an MRI or CT scan is done with the frame in place so the surgeon can see exactly where the target area is in the brain and plan for the trajectory of the electrodes. Then the patient is taken to the operating room. The surgeon will have to adjust for uncertainties, such as the normal shifting of the brain. To do this, a microelectrode is placed in the brain and used to provide “brain mapping”, recording physiological pattern characteristics to let the surgeon know they are at the target, before the DBS electrode is placed. Sometimes it takes several attempts before the desired target is achieved. The patient has to be awake during this process. They are also required to go without their medication.

Having to be awake during brain surgery is a definite turnoff for some patients. The use of microelectrode recording for brain mapping is controversial. Are the benefits worth the risk? Each time the microelectrode passes through the brain, there is a small risk of intercranial bleeding.

With the new ClearPoint platform for DBS surgery, the patient can be asleep the entire time and they do not have to stop taking their meds. The procedure is done while in the MRI so the pathway of the electrode can be seen in 3D, real time. Ideally, this can allow the surgeon to make adjustments during the procedure so obstacles, such as blood vessels, can be avoided and the electrode can be placed at the desired target the first time.

The advantages seem obvious, but are they?

Dr. Ojemann was quick to say that at this time, we cannot claim the ClearPoint system is better, that it has a better outcome than the conventional DBS surgery. However, the data is favorable and he is impressed so far. This new technology does not eliminate all of the risks. It's still brain surgery.

There have been challenges. In the beginning, at UCSF, part of the procedure was done in the operating room and part in the MRI suite. After initial concerns about infection in this setting, rates have been very low with modifications allowing the entire procedure to be done in the MRI suite.

Another challenge was the magnetic field. Instruments had to be adapted to be MRI compatible. (Okay, I'm trying to write a serious article here, but my imagination is going wild at this point. I'm picturing various surgical instruments flying around the room and sticking to the MRI machine. I'm grateful they've solved this one.) Also, if a patient isn't a candidate for an MRI (ie – someone with a cardiac pacemaker), they obviously are not a candidate for the ClearPoint procedure.

Also, visualization of the target is not the same in each patient. There's iron in our brains and, in some people, this iron is more concentrated in certain areas such as the subthalamic nucleus – which is generally the target. Iron concentration makes it harder to visualize on the MRI. The older we get, the more iron tends to be concentrated in our brains. (This might be why our brains seem a little rusty as we get older?)

All in all, Dr. Ojemann is obviously excited about the possibilities of this new technology. In addition to being useful for people with Parkinson's, there are other applications including treatment for epilepsy, brain cancer – especially deep seated tumors, and surgery for children – who would not be able to tolerate being awake during the procedure. DBS surgery is also used for dystonia, which often has its onset in childhood.

Deep Brain Stimulation is not a cure for Parkinson's disease, nor is there conclusive data to show it staves off the progression of the disease. It's a way of treating Parkinson's which can be especially helpful for those patients who are still getting benefit from the medication, but are having lots of off times. Many of those patients say DBS has given their life back to them. It's not for everyone, but for many people, this has been an amazing treatment.

The ClearPoint technology is an exciting development. The whole ability to create images of what is going on inside our bodies has advanced by leaps and bounds. CT (computed tomography) scans were introduced in the mid 1970's. The first commercial MRI scanner was patented in 1980. Since then, the ability to image the human body has advanced to the point where, according to Dr. Ojemann, they can create a 3D image that is almost like having a specimen in front of you. And, he said, imaging is only going to get better with time.

As he explained this to me, he spoke with a sense of awe and wonder. At the same time, he said he hoped that 5 years from now, the treatments for Parkinson's will be even more advanced, targeting the PD at its source. He also hopes there will be a new treatment will not require brain surgery.

It was my turn in feel the awe and wonder. Even brain surgeons can hope they won't be needed.

Dr. Paul Larson discusses the ClearPoint System's ability to allow a surgeon to perform only one penetration to the brain for electrode placement in deep brain stimulation surgery. Please LIKE this video!

Managing our PD Treatments

The challenge of managing Parkinson's disease - written for PhRMA Conversations

I believe one of the biggest challenges we face with Parkinson's is the management of our therapies. The medical world tends to rely heavily on prescription drugs and surgical procedures such as Deep Brain Stimulation (DBS) to help us control our symptoms.

I do not feel qualified to write about DBS surgery as I will not consider this treatment. This was a decision made after much thought, research, and discussions with family and friends. I am sure others will speak on this topic.

While I am incredibly grateful for medications which make it possible for me to continue walking and functioning as normally as possible, they also create other issues. Drugs do not have side effects, they have effects, and we need to pay attention to all the effects of the drugs we are taking. In Parkinson's disease, this can be very challenging as so often we are taking 6 or 7 different drugs in our attempt to manage our health. Questions need to be asked: Are we being prescribed another drug because of our Parkinson's or is it given to us to help us cope with the effects of another drug? Are all these drugs necessary? Are there other ways to treat the symptoms with exercise, diet, or lifestyle changes?

It is often said, it takes a cocktail of drugs to treat Parkinson's. This cocktail can include a dopamine agonist, Selegiline (as a neuroprotective), Comtan (makes Sinemet more effective), Provigil (prevent daytime sleepiness), a drug to help sleep at night, and an anti-anxiety drug as well as Sinemet. It can be almost miraculous in helping people with Parkinson's to live a normal life or it can be a time bomb resulting in physical and behavioral effects such as obsessive/compulsive disorder (compulsive gambling, eating, shopping, sex), disinhibition, hypersexuality, delusional behavior, increased heart rate, and weight gain, among other things.

The most frightening part of this is how the effects can creep up slowly over time to the point where we don't realize the medications are causing these effects until they have damaged our relationships with friends, family, and coworkers, sometimes irrevocably.

So what can we do?

I would like to see a team approach to Parkinson's disease with neurologists, physical therapists, nutritionists, and psychologists working together with patients and their partners or advocate of their choice. Drugs need to be prescribed and monitored very carefully and alternatives to drugs should be considered before simply automatically prescribing one more medication. Experts agree that exercise can improve symptoms of Parkinson's disease and may even delay its progression. I would like to see more studies on the effect of diet on Parkinson's and also studies on the use of Cannabis with Parkinson's.

More than anything, I would like to see a change in attitude towards the management of Parkinson's and other chronic disorders. Can we find a balance between medication and lifestyle changes? Can we be less dependent on pharmaceutical drugs to make us “normal”?

How normal do I have to be, anyway?

The PD We Don't See

““Words are like nets - we hope they’ll cover what we mean, but we know they can’t possibly hold that much joy, or grief, or wonder.” ”

— Jodi Picoult

Tonight my dear husband, what's-his-name, made me sit down and watch a video about the non-motor symptoms of Parkinson's disease. I was going to watch it earlier this afternoon, but I suddenly had to lie down and take a nap. When I got up, I had more energy and decided to get lots of chores and errands done. This included a trip to the thrift shop where I picked up an old Victor Victrola cabinet on impulse. I have no idea where I will put it in our house, but it was too cool to pass up. When I got home, our son (John? Tom? Dave?... oh yeah, PATRICK) was there because it's Saturday and he won't pass up the chance to have a hot meal each week. He and his father helped haul the cabinet into the house.

Chris then asked what I was going to do with the chicken I had gotten out for dinner. “Cook it,” was my reply. Beyond that, I had no idea. Planning ahead isn't my forte. Eventually, dinner was made (curried chicken), Patrick left, Emma was working on her homework, and I sat down to learn about just how wonky I really am.

Here is the link to the video:

The PD You Don't See

It was humbling to watch this and recognize my own challenges with word retrieval, sleep, temperature regulation, too much saliva when I'm trying to talk, among other things. The doctor recommends we do all our important stuff in the mornings when we are functioning at our best, which is, of course, why I signed up for a 400/500 level college class that goes from 5:30 to 8:30 pm. Let's face it, by 5:00 my brain is saying “Thhhhhat's all ffffolks” and turning down the sheets, letting me go out into the cold without it.

Oddly enough, I do most of my writing in the evening. Hmm.

However discouraging these challenges can be, there is an upside to some of these strange symptoms:

Disordered autonomic nervous system – Hot flashes aren't just for women, men with PD get them, too. Saves on heating bills.

Word retrieval – I'm getting better at swearing. Those words I can always retrieve.

Impulsivity – Used sparingly and carefully, this can add a little fun into our lives. Besides, we really NEEDED an old Victrola cabinet in our house.

Vision problems – Hey, the world is just a little softer place now, that's all. And you'll always look good to me.

I'm not trying to brush off this stuff. It's important we parkies pay attentions to all this and make sure we eat right, exercise, get plenty of sleep, don't overdo it, get enough cognitive stimulation, and make sure we get out into the world. There's also some stuff I don't like to think about at all, like being more susceptible to things like strokes and melanoma. Pay attention, but don't dwell on that stuff. Make things fun.

Which is why I'm sticking to my college class, even when my brain has clocked out for the day.

“The most wasted of all days is one without laughter.”

— E. E. Cummings

Big Bird and The Count

 I was Big Bird. He was The Count.

Our first child came to us, not in the usual way, but as a foster son. He was nine years old, tiny, with too thin arms and legs, and almost white skin. He had a family living in the mountains and the small community didn't have a school program to accommodate a student with cerebral palsy who used a wheelchair. For whatever reason, his family decided the best solution would be to have Jimmy in foster care during the school week.

I was working at the school in Denver he was to attend. When I learned of a child who needed a home, I jumped at the opportunity. I was 22, newly married, and couldn't wait to be a mom. Chris agreed, maybe because we were newly married. He was a great Papa from the beginning.

We were naïve. We had about as much training for taking care of a disabled child as the average parent of a disabled child, which is to say, none. A short visit from his mother to tell us of Jimmy's likes and dislikes and a few other important details, and we became instant parents to a nine year old boy. It was up to Jimmy to teach us now.

It was a full year. Chris became proficient at wheelchair repair and I created simple adaptive tools and learned how to carry a nine year old on my hip. We became aficionados of Sesame Street and Jimmy solved the problem of what to call us. Mom and Dad wouldn't do. Those titles were already taken. So, I was christened Big Bird and he was The Count. I can't remember the name he had for Chris. Bert, maybe?

On one occasion, we got lost in the old Children's Hospital with Jimmy in his wheelchair and couldn't find an elevator. Like a scene from The Twilight Zone, every way we went, we ran into long stairways. I'm almost positive we ended up bumping down at least two of them. Fortunately, Jimmy only weighed about 40 lbs at the time.

He had two surgeries that year and I sat with him so many times, trying to take his mind off the pain by letting him “punch” me in the face. His fist would connect with my chin and my chin would move to one side, making me talk funny. It was a fun game for both of us and it made him laugh.

He left us after a year, just three weeks before John was born. I visited him at school a number of times and when the SEMBCS Sullivan school closed, I lost track of where he had gone. Some years later, I was able to visit again when our neighbor had Jimmy in her summer class in Jefferson County. A few more years went by and his mother brought him to see us when he was 21. He was graduating from high school and would be moving to a group home in Loveland.

Then I really lost track of him. His parents had divorced and I didn't have their contact information. Several times, I tried to find him, but without luck.

Last week, a friend posted a note on Facebook about her foster daughter. It made me think of Jimmy again. On impulse, I went to Google and typed in his name, remembering this time to put Jr. after his name. Right away I found him. The first entry listed his name and birthdate. There could be no mistake. My heart started to beat a little faster as I clicked on the entry.

What I found was his obituary. Jimmy had died just three years after I last saw him.

I was in shock. I didn't sleep much that night and got up at 5 am to look through our photographs. I hope my parenting skills are never judged by how organized my family photos are.

How do you say goodbye to someone who left 18 years ago? How do you grieve?

At the same time I was cruising through Facebook and Google, I had also found a lovely wool sweater listed for sale or trade on a Waldorf site. It was a lovely, handmade sweater, just right for a little girl. I wrote and asked the seller to look at my website to see if there was something I could make for her in trade. Ten minutes after I found Jimmy, she wrote back asking if I could make a wool picture. It wasn't for her, she explained. It would be put in a shop and sold to raise money for a camp for disabled children.

I am working on it now. It will be a gift in memory of The Count, from Big Bird.

Christmas Pudding - A Holiday Adventure

“Cornelius, let's arrange a signal for you to give me.

If it's really an adventure, give me a signal. Say a word.

Say, like 'Pudding'.

All right, Barnaby. For adventure, 'Pudding'.”

(from the Matchmaker by Thornton Wilder)

“So, what are you making?”

I was caught by surprise and didn't even look around. I didn't have to. It had been some time since Mo, aka Marshmallow the Opinion Fairy, had come to visit, but I would have known her voice anywhere, anytime. I wasn't going to answer, but she had startled me and I'd almost dropped the pot of rice.

“Horchata. Don't talk for a minute, okay?!”

I heard a small hrrumph sort of sound and miraculously, it was quiet. I made Mo sit while I buzzed the rice mixture up in the blender then poured it through the sieve. Only when it was done, did I turn around and greet my old friend.

Mo: Old friend? Come on, I'm not so old.

Me: Don't get huffy, you know what I mean.

Mo: So, what's up with the horchata? It's not your usual Christmas treat.

Me: I know, but it sounded really good this year and I wanted to try making it.

Mo: Meaning, you've never made it before? What time is everyone coming over?

Me: Not till 4. You're welcome to stay.

It was nice to see her again, even though I knew she'd be challenging me at every turn. Already she was questioning my horchata. Really.

Mo: Thank you. I think I will stay. What else is for dinner? It smells good.

Me: Vegetable soup, chili, salad, squash and apples, carrots and green beans.

Mo: Sounds awfully healthy.

Me: Well, there's pumpkin pie, too. I made it with coconut milk and gluten free cookie crumbs in the crust.

Mo: What about your truffles? You always make truffles for Christmas.

Me: Not this year.

Mo: What? Why?

Me: We've been busy. Emma and I have been to Chicago twice in the last five weeks, we had lots of parties to attend, and then everyone got stomach flu. Besides, I'm trying to keep to a healthy diet.

Mo: And making your family and friends suffer along with you.

Me: I doubt they'd want truffles right now. Anyway, I'm kind of on my own here. Everyone else is still recouperating. Got to keep it simple.

Mo: Which means making horchata?

Me: I want something special and a nice cup of hot, spicy horchata sounds really good.

Mo: Hot? I thought it was served over ice.

Me: I know. All the recipes I've found say to serve it cold, but I've only had it hot. It can't be too difficult, can it? All I have to do is heat it up. I'm going to put it in the crock pot and keep it warm.

Now, if you wouldn't mind stirring the soup, I'll pour this into the crock pot, then start getting the dishes out.

We worked together for awhile. I was grateful for the help and the company. To be fair, my family had helped with a lot of the preparation earlier in the day, cutting up vegetables and such, but for the last hour or so, I had been working alone. Now, with Mo's help, everything was coming together. She even dusted the living room furniture.

After another hour had passed, we decided to give the horchata a taste test. I lifted the lid of the crock pot and dipped the ladle into the creamy hot mixture. The ladle came up out of the depths with a “gloooop” sound and what was inside looked like congealed oatmeal. I almost cried.

Mo: Uh, oh. What happened?

Me: I don't know, but I certainly can't serve this up to anyone.

Mo: Which is too bad, considering you've got about 3 gallons of it.

Me: There's got to be something we can do. Any inspirations?

Mo: Sorry. Wrong fairy. The Inspiration Fairy is my 3rd cousin. If you want my opinion...

Me: I'll ask for it. Until then, unless you have something nice to say or can work a miracle, don't.. say... anything.

Mo: !

No, she didn't start swearing. Something started to escape, but she clapped her hand over her mouth just in time. I was pleased. I still have an effective teacher look.

A few minutes later, she crept quietly up and tapped my arm. The next thing I knew, she had flown through the air backwards and had landed on top of the dog. I turned my teacher look on the dog and Mo escaped with only an affectionate lick. I helped her up.

Mo: What did you do that for? I didn't even say anything.

Me: I'm sorry, Mo. My meds are wearing off. It's not safe to surprise me right now. I never know what my arms will do when that happens.

Mo: Okay, okay. Give me a towel. Is it okay if I suggest something?

I handed her a washcloth and nodded. It was the least I could do.

Mo: Make rice pudding. It's congealing anyway, and it smells really good.

Me: Brilliant.

So, together we looked up a recipe for baked rice pudding. My mixture was congealed to the point where it wouldn't pour into the baking dish. I added a little bit of almond milk and a couple of beaten eggs. This was going to work!

We were ready. Dinner was done, the house was clean, the buffet table was set up, and the pudding was in the oven. Time to rest a little. I poured some Bailey's into a thimble sized cup for Mo and we sat back and chatted for awhile. When everyone came, I turned to introduce Mo, but she had vanished. Maybe she was afraid of my grandchildren.

Mo: I am NOT afraid of your grandchildren, I'm just not feeling very social right now.

Her voice had come from the direction of the Christmas tree. I looked over, but couldn't see where she was hiding. Once everyone arrived and was served, I put some dinner out for Mo on the fork of one of the branches. We had a wonderful evening. The little ones played and opened presents, and the rest of us talked together.

All too soon it was time for our evening to end. We said Merry Christmas and hugged and watched everyone as they went out into the cold night. When the door was locked and my family had drifted off to their various corners of the house, Mo came out from the tree.

Mo: How was the pudding?

Me: Pudding?

Mo: You know, the stuff you put in the oven to bake?

Me: OHMYGODIFORGOTALLABOUTIT!

After startling, Mo began to laugh and laugh. I went in, turned off the oven and opened the door, fully expecting to find a rice loaf, a rice brick, or just simply rice hardened onto the baking dish. I took it out and did what the recipe told me to do. I checked for doneness with a knife. For some reason, Mo collapsed in giggles again. To my surprise, the knife didn't bounce off, but it didn't come out clean, either. I dipped a spoon in the pudding and it came out with a glooop noise and the stuff inside the spoon was the consistency of congealed cream of wheat.

We were making progress.

Not deterred, I spooned some into dishes for Mo and me. Then I added a little Bailey's. I think we just invented something new. It's not bad.

Just don't ask me how to make it.

Did you take your meds? A short history

 This is really two blog entries in one. It is a review of a new pill dispenser called E-Pill, designed by a Parkinson's patient to help keep us all on track with our meds. First, however, I thought it would be helpful to have a little history on this subject. If you want to jump directly to the second part, go ahead. I promise I won't be offended. (But just think of what you could have learned)

Everyone knows the best way to treat Parkinson's is to actually take your medication on time. This is easier said than done. Ever since the first physicians wrote prescriptions for carbidopa/levodopa in cunieform, they have tried to find creative ways to make sure their patients remember to take their pills. At the same time, patients were working on another development: the excuse for not taking their pills.

The earliest known method involved timing each dose with the length of time it took for an oil lamp to burn. This wasn't totally reliable.

Doctor – So, Esther, how's the shakes? (This was in biblical times before Dr. James Parkinson was born.)

Esther – Not so good, doc. I'm shaking so hard I almost burnt the house down trying to light the Sabbath candles.

Doctor – Are you taking your medication whenever your lamp runs out of oil, like I told you to?

Esther – I tried. The lamp ran out three days ago and I'm shaking so hard I can't light it again.

Next, they tried an hour glass.

Doctor – Thomas, you don't look so good. Are you using the hour glass Brother Luitprand sold you to tell you when to take your pills?

Thomas – I tried, but the sand ran out while I was out on my boat.

Doctor – But Thomas, this is portable. You should have had it with you.

Thomas – I know, but my wife was using it to time her baked chicken.

In the middle ages it was popular to time medications with the ringing of the church bells for the monastic hours. It worked fairly well until the time of the great plague. Then the funeral bells rang all day and no one ever knew what time it was and didn't care, anyway.

The pill organizer was invented by a distant ancestor, Zerviah Meletivea Myers, whose husband, Bill, was always forgetting to take his Sinemet. She thought it would be helpful it he had a way to carry the pills with him. She even made it pretty with an embroidered insert in the lid. Bill thought it looked frilly and hid it in the bottom desk drawer with the last years' seed packets. He told his wife it had been stolen.

The most effective method of reminding patients to take their medication was called, The Spouse. It involved enlisting the husband or wife of the patient to confine their conversation to these few words, “Have you taken your pills yet?” This only worked if the patient had a spouse and even then, the spouse was at risk of if he/she “asked one more time”. In worst case scenarios, the effects could require prompt medical attention or a divorce lawyer.

Of course the spouse was at risk either way. When the patient forgot to take his/her pills, the spouse endured the consequences of their freezing, shaking, rigidity, and needing a piggy back ride home from the fields.

Fortunately, in our modern times we have developed ways to make sure we never forget to take our medication.

Next:  A review of the E-Pill Dispenser and Alarm

Did you take your meds? - a review of the E-Pill Dispenser and Alarm

 Fortunately, in our modern times we have developed ways to make sure we never forget to take our medication. Here are the ways I have found which are effective for me:

Cell phone alarm clock – I can set this to any time during the day and set the particular music for the alarm. This is high tech. I have my phone with me all the time, so I always hear it.

The downside is, sometimes I simply turn it off and forget to go get my meds. Later, as I start to feel wonky, I can't remember. Did I take the pill or not? This is normal, not dementia.

E-Pill Dispenser – This is something new. One of the cool things is it was designed by someone who actually has Parkinson's disease. I assume this person had already tried many of the other methods I listed here.

Cool thing number two: This is a pill organizer and medication alarm all in one. When the alarm goes off, the medications are right there.

Cool thing number three: If I don't turn off the alarm and take my pill, there will be a flashing, “Missed dose” sign on the clock readout.

Since using the E-Pill Dispenser, I haven't missed any doses. This might have something to do with my cell phone alarm still going off, one minute after the E-Pill alarm. It also might have something to do with my spouse coming in and asking, “Have you taken your pill?”, ten minutes later.

Out of the three methods I am currently using, I would say the E-Pill Dispenser is the one I would recommend. It is small enough I can carry it in my purse, yet large enough to hold a week's worth of meds. The alarm isn't nearly as pretty as the cello music which plays on my cell phone alarm, but it certainly gets my attention. The alarm times are very easy to set and easy to read. The alarm will continue for 4 minutes before stopping and activating the “missed dose” sign.

If I were able to make a small improvement, I would ask for an automatic snooze period, after which the alarm would go off again. The “missed dose” readout is easy to miss. I also like the music on my cell phone alarm. When the beeping of the E-Pill goes off in a store or airport, I tend to assume it's just part of all the other background noises. Then my daughter nudges me and says, “Mom, it's your alarm.”

There's nothing wrong with the beeping alarm. I just have to get used to it. For now, I have my cell phone alarm still set as a back-up. Part of the key for me is not to rely soley on one method of remembering.

There will never be a perfect way to ensure we take our meds until someone invents a pill organizer with a GPS and the ability to find us wherever we are and insist we take our meds while they watch.

Oh, right. That's already been done. It's called “The Spouse”.

I'll take the E-Pill.

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