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Doug - Y You've received lots of good advice. I'd second the suggestion to see Dr. Rajesh Pahwa at KU Med. in KC. The appointments number is: 913-588-6985. You should be able to drive straight north on I-35 and get there in about two hours. I suggest when someone calls you back (assuming you get an answering machine) that you tell them the urgency of your need to see the doctor due to your employment situation. If you can tell your employer that you have an appointment with a Movement Disorders Specialist and are hopeful that with his help, you'll be significantly improved, I think the employer will hold off on making a decision. If you feel it's necessary, you can frame it in terms of finding out whether there's significant improvement possible or whether you need to go on disability. I wouldn't put it that way, though, unless the employer brings it up first or seems to be strongly hinting in that direction. (I worked as a Human Resource Manager, and this is my view from the employer's standpoint). No doubt others *do* perceive you as looking "mad" a good part of the time. It's part of the facial mask of PD. I and other caregivers have talked privately about how difficult it has been to live with just that aspect of the disease. It appears that our "significant other" is angry with us all the time, and even after we realize that the PD causes it, it's hard to get out of the habit of "interpreting" the look as anger. I'm sure, too, that your wife is frightened and reluctant to face "that bridge" you may be coming to. One suggestion I'd make before you give up on working (or allow your employer to make that decision for you) is to talk with Dr. Pahwa about DBS. Dick, my husband, ended up having to go on disability after 13 years of PD, but had DBS surgery within the next year, and made significant improvements. We'll never know for sure, but we felt that he could have continued working if the surgery had come along a year sooner. He is now 19 years post-diagnosis, and is still far better than he was pre-surgery. Dick's mental function is much better with the DBS - not only do we notice it, but it was shown by objective tests via PET scan in NY as part of an experiment to answer that question. Your confusion and forgetting sound like Dick's problems, but when his stimulator is on, he thinks more clearly and remembers better. The other thing I'd suggest is that you do ask Dr. Pahwa or another doctor about adding Mirapex or Requip if you're not already taking one of those. The symptoms you describe make it sound as if you're undermedicated, but you're likely to have better results adding an agonist rather than just increasing the Sinemet. You may even be able to reduce the Sinemet if an agonist works well for you. Dick went through a period of severe depression both before and after he went on disability. Both agonizing over needing to quit working, and adjusting to it afterward, are extremely depressing in themselves. But we found that when Dick added Mirapex, his depression was instantly gone. We now believe strongly that depression in PD is as much a function of low dopamine as anything else. Good luck to you. If you'd like more info about DBS or Dr. Pahwa, drop me a note at [log in to unmask] We live in Lawrence, KS. If you'd like to talk on the phone, let me know and I'll send you our phone number. Margie PS I grew up in Wichita, and my parents and brother still live there.