On Sun 04 Jan, Manfred Heiderich wrote:
> Hello,
>
> My name is Manfred Heiderich. I am a retired academic, 65 years old and
> was diagnosed with PD 5 weeks ago. I joined the list on Dec. 20 and have
> been following the messages and exchanges with great interest.
>
> I have several questions:
>
> 1. My symptoms are mild. I feel hardly handicapped at all. Why then should
> I start drug  treatment (with Sinemet CR)? My understanding is that no PD
> drug (with the possible exception of Selegiline)  actually checks the
> progress of the disease; they merely mask the symptoms. If that is true,
> why should I risk getting drug side effects (I espedcially dread nausea)
> before my symptoms pose significant problems?
>
> 2. My prescription (which I have not yet taken) is as follows: one tablet
> of Sinemet CR 100/25 a day in the morning after a meal. If the release
> time of Sinemet CR is 2 to 5 hours what happens for the rest of the 24
> hours? Isn't it better to take Sinemet CR before a meal?
>
>
> 3. Isn't Requip designed for a person like myself in the beginning stages
> of PD and without previous intake of carbidopa-levodopa?
>
>
> Your responses are appreciated. My thanks to Barbara Patterson for her
> warm welcome.
>
>
> Manfred
>
> [log in to unmask]
>
>
>
Hello Manfred, A good set of questions, I must say. My views follow. I should
tell you that you will not find unanimity in the answers that you get, so in
the end it will be up to you to make a decision.

1) It is entirely up to you to decide if you need the drugs. Selegiline as a
means of delaying symptoms seems to work with some people, but in the long
term the latest results seem to indicate that the net gain was about zero
(Over a 5-year period). Personally, I don't like it.  To cater for the theory
that Oxidative stress or 'Free Radicals' are to blame, instead of Selegiline
I take a large dose of Vitamin E. It's supposed to have the same effect.

The philosophy of when to take Sinemet is another source of strong emotion. I
do not subscribe to the school which says 'Delay intro of sinemet as long as
possible, because it will be more effective in later years.' That very fuzzy
logic is still quoted, but I think the majority  accept that it doesn't make
much sense.
   However, that does not mean that you should rush off and start swallowing
sinemet CR as fast as possible. I entirely agree with you that there is not
much sense in taking 1 tablet per day when their life is only 4-5 hours. The
best philosophy I can give you is to take only as much as is needed to control
the symptoms.  And don't fall into the trap of thinking that people come ready
-calibrated in units of whole tablets. At this stage in your symptoms, it may
well be that all that is needed is a half or even 1/4 of a sinemet CR 100/25
at say every 4 to 5 hours. Yes it is better to take the tablet about 15 to 30
mins before the meal. At these low doses it is doubtful if nausea will occur.

2) I chuckled a bit when I saw the words 'Requip' and 'designed' in
conjunction. It seems to me that the drug manufacturers these days tinker
away until they find a drug which seems to be potent. They then start trying
it out on animals to see what reactions it produces, and gradually home in
on a specific
disease. A considerable number of the drugs we take were found by accident .
Cabergoline for instance is not cleared for use here in the UK, But it is
cleared as a means of drying up the milk from breast-feeding mothers!
  It is true that the manufacturers claim that it can control PD symptoms
in the early years, but then just about anything will do the same thing. You
could probably do as much good by shaking a stick at it!. In later years, a
mixture of Sinemet and one or other of the agonists will be the best bet.

Well there you are, I will be interested in seeing what other advice is offered
By the way, my stats are:  Diagnosed 1979. Age then 39. first symptoms 1973.

Regards,
--
Brian Collins  <[log in to unmask]>