The Intellectual Migrants : Side Effects of Azilect for the Treatment of Parkinson's Disease

Welcome to My Site

If this is your first visit, welcome! This site is devoted to my life experiences as a Filipino-American who immigrated from the Philippines to the United States in 1960. I came to the US as a graduate student when I was 26 years old. I am now in my mid-80's and thanks God for his blessings, I have four successful and professional children and six grandchildren here in the US. My wife and I had been enjoying the snow bird lifestyle between US and Philippines after my retirement from USFDA in 2002. Macrine(RIP),Me and my oldest son are the Intellectual migrants. Were were born in the Philippines, came to the US in 1960 and later became US citizens in 1972. Some of the photos and videos in this site, I do not own. However, I have no intention on infringing on your copyrights. Cheers!

Monday, June 6, 2016

Side Effects of Azilect for the Treatment of Parkinson's Disease

Lately Macrine has been complaining of neck stiffness/soreness. I had a feeling it is a side effect of Azilect- One of the drugs she is taking. Along with Azilect, 1 mg( Rasagiline) she is also taking Carbo-Levo Dopa( 25-100 mg) to control her movement disorders, tremors and other symptoms of PD. I believe this stiffness of the neck is due to Azilect as described in the package insert below.

Azilect is a very expensive drug. When it was first prescribed for her, I inquired from several drug outlets in our area( CVS, Walgreens, Walmart, Costco) on the price for a 90 day supply. At that time I was quoted a price from $1590 to 2060 for the 90 day supply. I can not believe on the price, so I inquire on the Mail Order Prescription Benefits of My Federal Insurance. It will cost me only $80.

So What is Azilect?

Azilect (rasagiline) is a monoamine oxidase-B (MAO-B) inhibitor used to treat the symptoms of Parkinson's disease. Azilect is sometimes used with another drug called levodopa. Common side effects of Azilect include dizziness, spinning sensation, joint pain, headache, depression, heartburn, nausea, fever, muscle pain, dry mouth, stomach upset or abdominal pain, hair loss, skin rash, numbness or tingly feeling, loss of appetite, constipation, diarrhea, vomiting, weight loss, impotence, loss of interest in sex, trouble having an orgasm, strange dreams, or flu symptoms.

The recommended dose of Azilect for the treatment of Parkinson's disease patients is 1 mg administered orally once daily. Azilect may interact with ciprofloxacin, theophylline, or antidepressants.

For additional details on Azilect

http://www.rxlist.com/azilect-side-effects-drug-center.htm

From the Package Insert of the Drug: Get medical help right away if any of these serious side effects occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, vision changes (e.g., double/blurred vision), sudden sensitivity to light (photophobia).

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Lowest and Highest Point in My Professional Career

Mt McKinley-the highest point in the United States I have often been asked by friends and relatives, what were the lowest and highest point in my professional career as a Chemist here in US. Without hesitation and doubt, my most unhappiest moment or the lowest point in my career was when I was laid off with only one day notice(fired/restructuring) from my job as a Principal Research Chemist for Stauffer Chemical Company in Richmond, California in 1986. Also without hesitation, I can state without doubt that the happiest moment or the highest point in my professional career was my promotion to Chemistry Team Leader in FDA including the award I received for expediting the manufacture of a burn ointment needed by the terrorist victims of the 9/11/01 bombing in New York and Washington, D.C. The following are excerpts from my autobiography, on the two unforgettable events(low and high) in my professional life. Lowest Point in My Professional Career:The Death Valley of My Life In 1974,I had a choice of working for a private company or the Federal government. I chose to work for Stauffer Chemicals in Richmond, California because I needed the money (higher salary than what the Federal Government was offering me at that time). I started as a Research Chemist and after 10 years (1984) reached the position of Principal Research Chemist. This is the highest technical position ( without supervisory duties) attainable in the company at that time. In 1986, a mass of layoffs occurred at Stauffer Chemicals. The company was getting out of the pesticide business. I was one of 60 employees relieve of our duties after just one day of notice. I just can not described the feeling of being laid off after 12 years of service and good performance. You feel betrayed,unwanted and unappreciated, and envious of the other employees not fired. How I wish I took the Federal job offered to me at the time. With this experience, I vowed I will never work for a private company*.

Death Valley-the lowest point in the United States Highest Point in My Professional Career-The Mt McKinley of My Life I was hired by FDA as a Research Chemist in 1990. In 1994, I was promoted as Expert Research Chemist( GS-14). In 1997, I was again promoted to Chemistry Team Leader, supervising the work of six reviewers ( five with doctorate degrees). As far as I know, I was the first Filipino-American who has achieved this position in FDA. As team leader, I was responsible for assigning, prioritizing,and assuring the technical accuracy of all chemistry, manufacturing and control issues for all new drug applications submitted to the Division of Anti-Infective Drug Products. As a team leader, I also give advice, instruct and promote high morale and teamwork in my group. In 1998, I won the Equal Employment Opportunity (EEO) Award. The citation reads, “For outstanding accomplishments in fostering the objectives of the EEO Program by hiring minorities and encouraging their professional growth while providing excellent leadership.” I have received numerous certificates of appreciation, awards in leadership and communications, commendation for teamwork and excellence in the accomplishment of the FDA mission. I have also received several letters of appreciation from private industry for my review work. In 1995, I was elected to the United States Pharmacopeia, (USP), Committee of Revision(CR), Standards Division. As an elected member, I was responsible for establishing standards of identity, safety, quality, purity of drug substances and drug products as well as in-vitro and diagnostics products, dietary supplements and related articles used in health care. Election to this body is a very selected process. It is held every five years. In 1995, there were more than 700 scientists nation-wide from academia, government, and industry who volunteered to serve. USP narrowed it down to 256 final nominees. Of the 256, only 128 were elected. Election to the USP Committee of Revision confirms that the person is both the national and international expert in the field of election. In my case, it was in the field of antibiotics, natural products and botanicals. The University of the Philippines Alumni Newsletter congratulated me with this statement, “ We join with your colleagues and your family in congratulating you for this singular honor, which brings prestige to the Philippines as well”. In March, 2000 I was reelected for another 5 year term. My career in FDA would not be complete if I do not mentioned the terrorist bombing of the World Trade Center in New York and the Pentagon in Washington, D.C. I remember clearly what I was doing and how I felt afterward. That morning in September 11, 2001, The office of New Drug Chemistry had a joint meeting with representatives of Pharmaceutical Manufacturers Association at the Hilton Hotel in Gaithersburg, MD. At about 9:20 AM, we received an announcement that the meeting is canceled and we can go home, since the World Trade Center in New York was burning. All of the attendees went to the hotel lobby and the TV was announcing the news. I felt sick, depressed but helpless to see the burning WTC building. Later, I learned that the Pentagon in Washington DC was also bombed and another plane crashed in the field somewhere in Southern Pennsylvania. I also found out that this United Airline plane was intended for the White House. Had it not been for the courageous heroics of several passengers, the White House would have suffered the same fate as the WTC and the Pentagon. The most heinous crime of the century produced thousands of burnt victims. Two drugs in my Division, Sulfamylon and Silvadene, approved for the treatment of burns were out of supply. A chemistry manufacturing supplement has to be approved as soon as possible to manufacture more of these ointments in a new facility. This required a review by the chemist, an inspection of the facility by a field inspector, my approval as the chemistry team leader plus the paper work by the project manager. The drugs are needed immediately, so we have to do an expedited review of the manufacturing supplement. It took us only 12 hours to approve the new facility and the review of the chemistry supplement and its manufacturing and control procedures. This review normally will take at least one month to three months depending on the availability of the field inspector and the schedule of the review chemist. In December, 2001, the four members of my review team received a special cash award and recognition award from FDA management for our work on expediting review of two drugs, Sulfamylon and Silvadene. Of my more than a dozen awards I had, this one is the most appreciated. I felt that I have done my job as a public servant and had helped the victims of the terrorist attack in a timely manner. In January, 2002 I received another award for my work on Doxycycline, an antibiotic needed to treat anthrax victims due to bio terrorism activities from unknown terrorists. *Afterthought: I should really thank Stauffer Chemical Company management for firing me even after 12 years of excellent performance. This experience gave me an incentive to work for the Federal Government, otherwise, I would probably be working in the laboratory all my life. FDA had challenged me to my utmost ability. I learned not only to be a "work" oriented but also a "people" oriented human being. My 12 years in FDA had been the most productive and satisfying years of my professional career.

Memories of My Parents-Dr. David Jamili Katague and Mrs. Paz Barrido Balleza Katague

David Jamili Katague Family taken in front of their Residence in Barotac Viejo, Iloilo in 1956. Front Row(Left to Right): Papa David, Efren, Amor, Ruben and Mama Pacing Back Row( Left to Right); Me, Myrla, Agnes and Erico My father, Dr. David Jamili Katague, D.D.S. was born in Guimaras, Iloilo on December 29,1905. He was the middle son of three brothers, Julio ( the youngest) and an older brother (I forgot his name). His parents were poor, but have a small property in Guimaras and Binalbagan, Negros Occidental. My father was very smart. Since his own parents can not afford to sent him to college, a rich aunt from Leganes, Iloilo adopted him. He was sent to Iloilo High School in La Paz, where he graduated salutatorian of his class. His childhood friend, Atty. Paciano Villavieja was the valedictorian. He was a freshman in high school when the three brothers of Guimaras,Iloilo change the first letter of their last name from a "C" to a "K". He did not tell me much of his college days, but he finished dentistry(Doctor of Dental Surgery) at the University of the Philippines,Manila in 1929. That same year he passed the dental board examination( # 2 nationwide) and married my mother, Paz Barrido Balleza of Barotac Viejo, Iloilo. They resided in Jaro and built a two-story house in Arguelles Street. My father had a dental office in the first floor of their residence. After five years of marriage, they were still childless, so they adopted a son, named him Rodolfo. A year later (1934), I was born on December 20. I grew up in Arguelles street until 1941, when the Japanese-American War started in the Philippines, then we moved to Barotac Viejo where I finished high school in 1951. My father's childhood years was very normal for that time. When he was in high school his father died and his mother remarried the younger brother of his Dad, so his mother's name was still Mrs. Catague. This second marriage produced nine children, three girls and six boys. The family resided in Binalbagan, Negros Occidental. I had two occasions in my childhood years visit relatives in Binalbagan. My father was a people person. I remember during our monthly shopping trip for supplies in Iloilo City, that he would greet and smile to every person we met along Iznart and JM Basa Streets. On one occasion, he greeted a person with enthusiasm as if they were long time friends. Afterward, I asked him who the person was and he said he does not even know his name. He treated men, women, young and old alike. I told him he would be a good politician. He could also draw freehand. His sketches and freehand drawing were beautiful. I know now that my children and grandchildren talents of drawing, sketching and painting is from his genes, since I have no ability at all to draw, paint or sketch. My mother on the other hand was very reserved. However, although she had not finished high school, she was good in mathematics. She could add and multiply in her head. One day, a vendor came to the house and was selling some farm products. She ask for the price and the vendor said 3 for 1 peso. Without blinking and hesitation, she said here is 8 pesos give me two dozens. I was amazed in how fast she could compute in her head ratio and proportion problems. The marriage of my parents resulted in seven children. I am the oldest(chemist and Citizen journalist), followed by Erico(lawyer), Myrla (education), Agnes(dentist), Efren (engineer), Ruben ( accountant) and Amor(chemist). Agnes is now in Maryland. Myrla resides in Toronto. Efren resides in Sydney, Australia. Ruben is in Bacolod and Amor and Erico are still in Iloilo. All of them are married and have several children and grandchildren. My mother, Paz Barrido Balleza family are big landowners in Barotac Viejo and the neighboring towns of Banate and Ajuy. The Balleza family were considered rich at that time. She was born on January 14,1909 and is the youngest of three children, the only girl with two older brothers, Modesto, Jr ( lawyer) and Jose who are much, much older than her. My mother's parents both died, when she was only in high school. So, she was under the care of her oldest brother, Modesto. At that time, Modesto Balleza family has a big house in Iloilo City, just across the street from St. Paul Hospital and one block from Assumption College-an exclusive school for girls. My mother went to high school at Assumption College until she was a junior. In her senior year, she met my father, falls in love with him, stopped school and got married. My mother with tears in her eyes told me, that the reason she married without finishing high school, was to get away from the control of his oldest brother. When their parents died, there was no Will. Thus, the properties ( rice lands, coconut lands, fish ponds ) were all under the control of her two brothers. The division of property according to my mother was very unfair. The brothers claimed the best rice lands to themselves. What was left for her to inherit were the properties in the distant barrios, rice land with no irrigation, except for one parcel of rice land( 20 hectares) near the town. Of course, she did not received one-third share of their parents properties. When she married, control of her properties was given to her. My Dad then help her manage the rice lands and other properties. I remember, we have more than 20 tenants come to the house in Barotac Viejo, almost every week during the planting and harvest season, besides the encarcado ( the overseer) of my mother's properties. At the side of our house, we built another house to store the rice harvests, so that we can sell the rice when prices are high because it is off season. The proceeds from the rice harvests were the one that send all seven of us to college. The income of my father as a dentist was just enough for our daily expenses. His dental patients oftentimes had no cash. In exchange for his dental services, they would bring chickens, eggs and vegetables and other farm products. Later, my father decided to quit his dental practice and spend full time in managing my Mom's rice land, fish ponds and other properties. My mother was very frugal. She would not leave a morsel of rice in her plate. I remember her say, "If you do not finish your food, God will punish you". So even today, I always have a clean plate after lunch or dinner. My mother had a strict budget and allocates 10% of the farm income into her savings. By the time, I was in college, they have enough savings to purchase a commercial property in Iloilo City. With the back pay, that my father received having served as a Dental Officer in the Philippine-American Army from 1941-1945, they were able to build a commercial building at Iznart street, just across the YMCA building and very close to the provincial capitol. The building we called “KATAGUE BUILDING”. When my father died in the early 1970's, the building was not properly maintained. In the late 1980's, my mother died. The seven of us decided to sell the building and land. The land was valued more than the building, because of its location. The new owner demolished the “Katague” building, built a bigger building and is now a school and a bank office in the first floor. When my parents died, they have a "Will" allocating the lands to the seven of us. As the oldest child, I inherited the best of the rice land, the 20 hectares of rice land near the town with irrigation. At about this time, the Agrarian Reform Program was in full implementation. My inherited rice land was the first one reformed. Since,I was residing in the US at that time, I was not able to do anything. Today, the 20 hectares are now owned by my parents former tenants. I have not received a single peso from the Philippine Government. The only land left for me was a 7-hectare upland parcel planted with corn and beans. My sister in Iloilo is now managing it for me. The rental income is barely enough to pay for the annual taxes. Ten years ago, I visited the rice land that was land reformed. I cried when I remember the history of this particular piece of land. Of the ten tenants that benefited from this program, only one approached me and acknowledged his gratitude. He told me, he was able to send all his children to college from the proceeds of my inheritance. As a matter of fact his oldest daughter after graduation from college married a US navy man and now resides in Northern California, only about 40 miles from us. So, this is a segment of my parents life experiences, as I recall it today. To my children, grandchildren and relatives, I hope you find my parents' life-story informative.

Amor (Knitz), Macrine and I visiting the tomb of our parents in Barotac Viejo, Iloilo on December 18, 2008. The tomb has been renovated and improved with contributions from Agnes, Efren, Amor and myself about five years ago. Note: My mother was also generous. She donated a parcel of her inheritance of more than 14,700 square meters to the local high school (Barotac Viejo National High School). Her brother, Jose also donated the biggest portion of land for the school. Below is the "sign" in front of the high school acknowledging the donation. Macrine took this photo of Knitz and I at the entrance of the high school. During my time, this high school was not named as a national high school.

Childhood Memories of the Japanese-American War in the Philippines

General MacArthur Returns Memorial, Leyte Island, October,1944 I am writing this blog for the benefit of my children and grand children and the new generations of Filipinos who have no knowledge or memory of the Japanese invasion of the Philippines. It was 13 days before my 7th birthday when the Japanese bombed Pearl Harbor, Hawaii in the morning, Sunday , December 7, 1941. That same day in the evening, Japanese planes had taken off to attack several targets in the Philippines. The Japanese had planned six landings: Bataan, Aparri, Vigan, Legaspi, Davao and Jolo Island. For the sake of clarity in this narrative, here are the important dates of that war:

December 7, 1941 Sunday Morning Bombing of Pearl Harbor, Hawaii

December 7-22, 1941 Start of Bombing of the Philippines and Japanese landed in several places in the island.

April 9, 1942 The Fall of Bataan and the Death March

May, 1942 The Fall of Corregidor and General MacArthur fled to Australia

October 1944 General MacArthur landed in Leyte " I Shall Return"

September, 1945 Japanese Surrender

July 4, 1946 Philippines Independence from US

When Japan started bombing the Philippines, I was in 2nd grade at the Jaro Elementary School,Iloilo. When my family heard of the bombings, we all panic and decided we moved from the city of Jaro, a most likely bombing target to our farm in Barotac Viejo, least likely target for bombing and Japanese occupation. Barotac Viejo, my mother's ancestral town is a small town about 60 Km North of Jaro, Iloilo City. I remember every one in my family was in chaotic mood and within a couple of days we packed all the essentials we could take and the rest of our household goods we left behind at our residence in Arguelles Street. I remember clearly my mother ordered all her china and sterling silver buried at the backyard of our house. We left all the furnitures and household goods that were heavy and cumbersome. ( Later we found out, our house was bombed and all the china and silver were stolen) The house was 80% demolished and all the furnitures were either destroyed or stolen. So for a while we settled in a small farm house of one of our tenants in one of the distant barrios of the town. As war progressed and we heard Japanese forces have penetrated most of the big cities in the Philippines and are starting to occupy even small towns, my father who was a captain and dental officer for newly organized Philippine Guerrillas- a resistant movement, decided to move to the jungle in the interior of Panay Island. I remember we walked for 3 days in the jungles, creeks and mountains just following a small path. My parent's tenants create a path for us with their bolos or machetes. We found a hidden valley with a creek with crystal clear water. Our tenants started building a bamboo and nipa hut, an out-door kitchen and a dining area. Using a bamboo sledge and a water Buffalo, our tenants brought us about 20 sacks of rice, salt, sugar and a few spices. In the jungle we started to clear areas where we could plant vegetables, corn and sweet potatoes. We also started to raise chickens and ducks for eggs, pigs for protein and goats for our milk. One of the most traumatic experience, I had was the night our tenant helper killed a python about 30 ft long. It was in the middle of the night, and it was very dark. Suddenly, we heard our two pigs squealing with fear. My father instructed our helper to investigate the pig pen area. With just a kerosene lamp our tenant could actually see the python strangling one of the smaller pig. Our tenant helper then started attacking the python with his machete and a big log. After about 10 minutes of struggle, our tenant was able to kill the python but our small pig was dead. The incident was a blessing in disguise, since that whole week we had protein in our diet. Our tenant after the incident commented in the local dialect( Napatay ko an man-og sa hadlok) translated literally as "I killed the python with Fear". This incident confirmed that the jungles of Panay island are filled with pythons, mosquitoes and other wild animals ( pigs and deer). My pets were the chickens and the goats. One of the chicks, I raised personally and even slept with me. He got attached to me ( fingerprint) and kept following me where ever I go. That chicken believe I am her mother. My mother tolerated it, since there were no other kids in the jungle except my younger brother. To keep us from being bored, my father home schooled us ( me and my brother as well as two of my older cousins). Every day for almost 4 hours, we were taught arithmetic, spelling and history. We were lucky to have brought with us a few books in Philippine and US history. Every now and then our tenants would bring us additional supply of rice and tell us news of the extent of the Japanese occupation.

Filipino-American Guerillas-a resistant movement against the Japanese, 1942-1945 Photo from ibiblio.org Late in the war when the Japanese war atrocities appeared to stop, we decided to move from the jungle to a seaside village and stayed at the house of one of our tenants. My father instructed us not to talk to any stranger, and if asked what our names, we do not give Katague as our name but Katigbak. Rumors have circulated that the Japanese have commandeered a list of all guerrillas, and my father's name is in that list. There were a few natives that work as spies for the Japanese- known then as collaborators. One day, we saw a platoon of Japanese soldiers in uniform complete with guns and bayonets passed by our village. The whole village was agog with excitement. My brother and I also watched hiding in the bushes. I was trembling with fear that one soldier will see us. Fortunately, the soldiers continued their march to next village. That incident of actually seeing Japanese soldiers was one of the highlights of my experiences during this Japanese war.

Japanese soldiers killing Filipino civilians and raping the women. A scary and frightening incident occurred to my mother's relatives at the time when were hiding in the jungle. My mom's cousins family of 30 individuals ( children, cousins, aunts, brothers and sisters) were also hiding in the jungle on a mountain ridge next to us. We heard that they were all killed by the Japanese soldiers who were able to penetrate their hideouts with help of spies collaborating with the Japanese. Only one member of the clan was spared. She was handicapped and in a wheel chair. During the massacre, she fell on the creek and was mistaken for dead and was left alone to tell the story. When I was in graduate school, I was often asked by friends if I harbor resentment to the Japanese because of the atrocities they have committed. My answer is a resounding no. My family never did experience a personal attacked by the Japanese. However, my mother in law has never forgiven the Japanese for killing her sister who was a nurse in the Philippine Army. One of my classmates in Illinois, whose father was killed by the Japanese will not seat in the same table in the school cafeteria with other Japanese students.

When General MacArthur landed in Leyte, that was the happiest day to all Filipinos. The Japanese started to retreat and peace in the Philippines was welcome with excitement. The schools were planning to reopen, so from the sea village we move to another barrio much closer to town. In that barrio, we built a much bigger house. In the back of the house, there was a hill. On a clear day you could see the next island of Negros. It was also an observation hill for us. We could watch Japanese and American planes "dog fight" during a clear day. My brother and I actually saw two planes attacking each other and one plane blown to pieces and burning as it falls from the sky to the sea between Panay and Negros Islands. What a thrill! We assume, it is a Japanese plane since the Americans are winning all the battles at this stage of the war.

Me and Eric, my younger brother-This picture was taken on my 11th birthday, December 20,1945. When schools reopened, we were required to take a test, to see what grade level is our current knowledge. I passed the test for a 4th grade level, although I was only in second grade before the war. So, I completed six grades in only four years. I was two years younger than most of my classmates. This was the result of my father's drilling us every day with arithmetic, spelling and history while we were hiding from the Japanese in the jungle. On July 4, 1946 the Philippines was granted independence by the US. In 1947, I was freshman in our local high school. In 1951, I graduated valedictorian of our high school class, then later enrolled at the University of the Philippines. In 1955, I graduated with a Bachelors degree in Chemistry. A year later I passed the Board Examination for Chemists, 3rd place nationwide. In May, 1957, I married the former Macrina Nieva Jambalos from Boac, Marinduque. We are still married and yesterday was our 52nd wedding anniversary.

Our Wedding Day, May 8,1957(I look so thin, my friends call me Pancit-local name for rice noddles) Note: I was born in Jaro, Iloilo on December 20, 1934. I was a sickly child having had polio until I was two years old. Luckily, I recovered only with a slight limp on my left foot. My parents informed me that I was a precocious child since I started reading local magazines when I was only three years old. By the time I was 5 years old, I mastered playing mahjong and pangingue ( a card game similar to gin rummy) with adults in the neighborhood. I remember clearly, that we live in big house at Arguelles Street where my father has his dental office. The front yard has several plumeria trees( kalachochee)and a big mango tree at the back. I was 7 years old when the American- Japanese war started with the bombing of Pearl Harbor.

Picture of Me(left) and my younger brother, Erico taken on April 2, 1937 in Arguelles Street, Jaro, Iloilo. I was a shy boy, very dependent on my yaya( nanny) at that time according to my Mom.