On Sun 02 Apr, Mario A. Gonzalez wrote:
> For the last  years I have had a Mild to Moderate PD. I have been getting by on
> 25/100 Sinemet 1 a day, 1 MG Mirapex 3 X day and Eldepryl 2 X day.
> I had heart bypass surgery on Nov 1998. Beginning on March 1999, I started to
> feel a heavyness in my legs, but I  did not pay much attention to that, walking
> took care of it.
> Last November,  I experienced what I called a Frozen state where I almost keeled over.
> I talked to  my Neurologist who said that I was on a very low dosage of Sinemet, so he
> upped it to 25/100 twice a day.
> That has not helped much, I notice that any kind of physical activity gives me the
> heavy legs. Whereas before walking helped, now it aggravates it.
> I have read about INTERMITTENT CLAUDICATION, SCIATICA and a host of other
> possibiities, but I guess my question is: Can this be caused by an acceleration of
> PD to a different stage?
> Need your comments, please.
>
> thanks,
>
> Mario A Gonzalez [log in to unmask] 53/4
>
>
Hello Mario,  to save myself endless repetition I  wrote everything I knew
about  levodopa in an article which you can read by accessing the Web site
given below.  (It also has many other articles  of interest to PWP.
I would say that all you have learned so far is that your neurologist does
not understand the most basic rules about treating  PD. That is, the
effective life of a Sinemet tablet..: The hard fact is that no matter  what
you do  or how you try, your  single sinemet tablet will take 30 to 40
minutes to begin to affect the brain  ,it will then last about 2 hours,
and will then cease to be effective. Nothing can be done to lengthen this,
(That is not quite true- a new class of drug exists called COMT inhibitors
which block an enzyme which normally exists to break down Dopamine.  These
new drugs are heavy stuff, and should not be used simply to get a bit more
time out of a tablet.)

 As far as I am concerned my target is to be 'ON' from the time I wake up
to the time I go to sleep : Say 18 hours. In my case a tablet lasts 2 hours.
Thus I need 9 tablet taken every 2 hours to get the effect of one tablet
through the entire day.

I firmly believe that the brain is given a much smoother and less stressful
life if it is exposed to a controlled, steady flow of levodopa rather than
the 'on again- off- again' exercise resulting from incorrect chaining of the
tablets.

Now is the time to think about what dose size is appropriate: using the
tablet which you have as an example, it holds a nominal 100mg, and has a
life of 2 hours giving a rate of 50mg per hour. This is a good starting
point foor most people to try. DO NOT make your next step one where you
add another nine tablets on top of the baseline layer. that is a gross
step. Instead, you should proceed in small steps, using low- value tablets
and break pieces off them.

The above suggestions are simply intended as a guide, showing up the key
factors. I would be fascinated to hear  the comments of one of those people
such as the person who advised Mario, and to see if they are impervious  to
logic.

In summary, your symptoms are typical of underdosing, and I don't believe
there is anytthing more sinister going on than that.
Regards,

--
Brian Collins  <[log in to unmask]>  (60/39/34)