What time is it in Milan?

Between the hard beds and jet lag, we slept rather poorly last night and got up at six in anticipation of an agenda-packed day. The nurse came to get Richard's blood pressure, and blood, urine and stool samples. Then we were shepherded with an Italian family to the outpatient department for tests. Richard had electromyography which tests the muscles of his legs and feet.

After that, Dr. Yang (not the same Dr. Yang from yesterday) who is the supervising physician, came with the other interns to take a comprehensive medical history and performed more motor tests on Richard. Then we rushed down to start acupuncture with Dr. Lee. Electrical current was applied to the needles to stimulate the muscles. All of Richard's needles were put on his legs. The movement of the muscles of his legs made the needles quiver rhythmically. Richard said that he only felt a slight prick when the first needle went in and after that he was not aware of the other needles going in at all. The stimulation from the electrical current was quite bearable as long as Dr. Lee receives continuous feedback as to what was Richard's comfort level.

Physiotherapy came next. The same Dr. Lee prescribed and had Richard perform various isotonic exercises using 5lb. weights in each hand. Dr. Lee emphasized that he was looking for both stability and strength in these exercises. Luckily for Richard, our Pilates instructor, Karen, had coincidentally been having us do the same movements for the last couple years so it was par for the course. By the end of PT, Richard was quite exhausted.

After lunch, a quick nap, and an EKG, Richard attended the second half of his PT session. This time, he practiced throwing and catching a ball with his therapist. Then Richard was asked to walk heel to toe while holding onto parallel bars. It has been a long time since he has walked without the help of his walker but he managed commendably. After this, we went to occupational therapy with Dr. Ye. She evaluated Richard's handwriting which has deteriorated progressively over the past few years. As she massaged Richard's arms and hands, she had him perform a series of exercises using special equipment to strengthen the fingers. At the same time, she put a collar-like device around Richard's throat. The electrical current through the collar was suppose to stimulate the throat muscles and help with swallowing and speech. Later on, Richard amused the other patients in the OT area when he was asked to pick up marbles with chopsticks. This he did with the patients' and Dr. Ye's beaming approval.

Dr. Guo who is in charge of the stem cell injections came by to introduce herself and to confirm our request for four lumbar punctures and one IV. Richard's first stem cell lumbar puncture is scheduled for this Friday. We were told that he needs to rest up in order to improve the effectiveness of the treatment. In an attempt to get a good night's rest, Richard took an Ambien and is now acting out his dreams. I've never seen such a volley of rapid movements in his fingers, hands and arms. This is different from his usual myoclonus when the whole of his upper body jerks forward violently. I am wondering if taking the Ambien is such a good thing. Dr Perlman, if you happen to be reading this post, can you comment to let us know if Richard should stop taking Ambien?