At 07:04 PM 2000/05/01 -0400,
i the interogator and bill the interrogatee wrote:
>>         I  am  currently  46  and  I was diagnosed four years ago.  My
>>      first neuro. put me on Sinemet 25/100 at two tablets  a  day.   I
>>      noticed no change in my symptoms.  My second neuro. put me on the
>>      same 25/100 at the same dosage of two tablets a  day.   Again,  I
>>      noticed  no  change  in my symptoms.  This doctor bumped me up to
>>      four tablets a day, but there were still no changes in  my  symp-
>>      toms.   My  third  neuro.  changed the prescription to Sinemet CR
>>      50/200 at two tablets a day, but (again) there was no  noticeable
>>      change in any of my symptoms.
>>
>>         My  current  neuro.  put me on three tablets of Sinemet 25/250
>>      per day.  And, this was the first time that  I  had  noticed  any
>>      change at all.  Some of the symptoms were actually reduced and it
>>      was noticeable.  But, also noticeable, was a major dyskinesia  in
>>      the  form of my head bobbing a lot when I was talking.  This neu-
>>      ro. then "bumped me down" to CR 50/200 at *four tablets a day* --
>>      and  we're talking about maybe pushing that up to five a day if I
>>      can find a way to wake myself at two in the morning.

>>         Ever  since  I  can  remember, I have had tremors in my hands.
>>      Nothing major, but enough to keep me from doing any kind of  "de-
>>      tail"  work  with  my  hands.  Initially, my *symptom* was what I
>>      would have called a twitch in my right  arm.   And,  my  "normal"
>>      shaking had become more noticeable.
>>
>>         About  a  month  or two after I noticed these symptoms, it had
>>      become bad enough to make me seek medical advice.  In addition to
>>      the  twitch,  the  neurologist  noticed that -- as I walked -- my
>>      right arm didn't swing as freely as my left.

>> > what were/are your symptoms?
>> > post-diagnosis? ...
>>
>>         In  the last four years, I have had a variety of symptoms.  At
>>      times, I would notice that I would unconsciously clench my  hands
>>      tightly.  I also developed an ache in my shoulder, elbow, or fin-
>>      gers of my right arm.  A little later, I noticed that the muscles
>>      in  the  right side of my body would tense up.  And, on occasion,
>>      my vision would blur slightly or I would require  brighter  light
>>      to read smaller text.
>>
>>         These  symptoms didn't always build on one another.  Sometimes
>>      one symptom would  fade  while  another  became  more  prominent.
>>      There  was no pattern -- no rhyme or reason I could detect.  But,
>>      when recovering from an illness of any kind, the  tremors  seemed
>>      to  worsen.   And,  in  general, the symptoms seem to be at their
>>      worst in the morning but diminish a bit through the day into  the
>>      evening.
>>
>>         I have gone through a range of styles of tremors. What started
>>      out as a general shaking of the hands eventually changed into the
>>      classic  "pill  rolling"  tremor.  Then,  it  changed to a clasp-
>>      ing/grasping tremor. Either one was controllable  at  rest.  And,
>>      the  non-swinging arm stopped for a while and then changed into a
>>      raised-arm/clenching fist position on both sides.
>>
>>         Eventually,  I  started  noticing  the "slowness of movement."
>>      Walking became harder and it would take quite a bit of effort  to
>>      do  simple things like walking the dog. And, getting into and out
>>      of cars and chairs became a real effort as well. I would have  to
>>      expend a great deal of effort using my arms to pull me out and up
>>      into a standing position.

>> > what were/are your symptoms?
>> > 4 years post-diagnosis? ...
>>
>>         At the moment, on the 4 x 50/200 CR, the symptom that is still
>>      noticeable is the tremors.  I have  noticeable  tremors  in  both
>>      arms  and both legs.  As I remember, the off-Sinemet tremors were
>>      much worse than the current on-Sinemet tremors.  And, except  for
>>      the Sinemet-induced dyskinesia, these are the only symptoms I now
>>      notice.

>> > in what way were they reduced by the 3x25/250IR sinemet doseage? ...
>>
>>         The  first  thing  I  can say is that I generally felt better.
>>      People who knew me and saw me regularly  said  I  looked  better.
>>      The  only symptom that I noticed -- as described above -- was the
>>      arm/leg tremors and the dyskinesia.
>>
>> > in what way were they affected by the 4x50/200CR sinemet doseage? ...
>>
>>         The  tremors  worsened slightly -- almost imperceptibly.  But,
>>      in the year or more since I've been  on  this  prescription,  the
>>      tremors have gradually worsened again to be, IMO, more noticeable
>>      and getting harder to hide.
>>
>>         One  other thing, I do have on-times and off-times.  There are
>>      periods during the day when the tremors will all  but  disappear.
>>      While  at  other  times  they appear somewhat strong.  I have not
>>      been able to determine a schedule or cause/effect or any type  of
>>      pattern at all in these on/off times.
>>
>> > why does your neuro think a fifth 50/200CR
>> > would benefit you at the cost of interrupting sleep? ...
>>
>>         *Our*  opinion  is  :-)  that in the period of time between my
>>      last dose at 6 P.M. and my first dose in the morning  at  6  A.M.
>>      that all of the Levodopa has been consumed or used.  So, it takes
>>      a long time in the morning to get the first (and maybe  the  sec-
>>      ond) to kick in and provide some relief.
>>
>>         So the theory is that the 2 A. M. dose might provide a sort of
>>      "running start" for the 6 A.M. dose to make it more effective.


-----begin re-run-----
my 'take' [i.e. my best guesstimate as a non-medico] on these two doseage
levels:

3x25/250IR = [Instant Release Sinemet]
75 mg available carbidopa
750 mg available levodopa

4x50/200CR = [Controlled Release Sinemet]
200mg carbidopa less 25% = 150 mg available carbidopa
800 mg levodopa less 25% = 600 mg available levodopa

these two doseage levels are the first ones you've had
that meet the suggested daily minimum dose of carbidopa
-----end re-run-----



janet paterson
53 now / 41 dx / 37 onset
a new voice: http://www.geocities.com/janet313/
613 256 8340 PO Box 171 Almonte Ontario Canada K0A 1A0