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On Sat 25 Mar, Paul Lauer wrote: > In a message dated 3/25/00 2:40:10 PM Eastern Standard Time, > [log in to unmask] writes: > > << And finally, to demolish the fuzziest piece of logic I have seen in many > a year, which says: If you delay the introduction of levodopa for several > years, you MAY find that the levodopa retains its effectiveness longer > in the later stages. Note the use of MAY find: They are already padding > their backsides in case they are wrong) > >> > Brian< I am not an MD either. I am an Engineer with a MBA and have been able > to appreciate your theories each time I read them. However, if we are > picking, I have two picks of my own about your presentation. First, I am not > the author of the statement above regarding delaying introduction of Levodopa > affecting its effectiveness in the later stages. I think that is not true but > I also think you may be misconstruing the argument being made. Assume > levodopa effectiveness to be straight line (for the sake of argument) on its > way to causing dyskenesia. assume as well that the time period from start to > dyskenesia with a given regime of increasing doses of levodopa, is the same > for any one person regardless of when started It would seem that it follows > that the later you start, the later the appearance of dyskenesia. This > analysis is unrelated to the statement: > > If you delay the introduction of levodopa for several > years, you MAY find that the levodopa retains its effectiveness longer > in the later stages. > > My second pick deals with the SUBJECTIVE assignment by an individual of his > or her "condition" I would venture that a constantly accurate assessment of > ones individual condition is more than difficult. It is impossible. > > All that being said, I admire the work you have done, if for no other reason, > on your own behalf in quantifying both the stage of your PD and what you > understand works best for you in treating it. > > Regards, > > Paul H. Lauer > > > There it is again - I can communicate with an Engineer , so why do neurologists glaze over or look blankly at me when I try to discuss my ideas with them? To address your point Paul, the 'givens' which you assume are reasonable ( I believe that my personal rate of deterioration has been almost linear over my entire life) but the point is that the doseage of levadopa is not the cause of the deterioration, it is the steady decay of the dopamine- producing cells in our brain, and in my 21 years experience I have seen nothing which caused the slightest deflection in the rate of decay of those cells. If we consider some masochist who is diagnosed with 30% of his dopaminergic cells left working (that is the currently popular figure for the onset of PD symptoms) and who finally gives in at a point on his personal rate of decay chart corresponding to say 15% of cells left. It does not matter in the slightest how our hero gets to that 15% point, by a series of wild dyskinesias, or by sitting in a corner shaking, the level of levodopa which he can tolerate at that point will be the same, because it is defined by the number of cells left and that will not change. It is really very simple. You must be one of the newer guys. I would agree with your second 'pick' if it were not for the fact that I have been there and done it, and it works! see my reply to Greg today. Regards, -- Brian Collins <[log in to unmask]> (59/39/34)