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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)