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Mr. Countryman It is important to separate out the effects of too much treatment from insufficient treatment. In general, dyskinesias occur when the dose of Sinemet peaks too high; stiffness and rigidity emerge when the level of medication drops (trough level) too low to be fully effective. Since Sinemet (even CR) is a short acting medication, high peaks and low troughs can occur in the same person. I would recommend that you keep a daily log of your problems, clearly indicating when you get dyskinetic, and when you get stiff and rigid, and the exact times you took your medicine. Strategies for treatment of thses problems can often be developed with that information on hand. Dyskinesias occurring and hour or two after a dose are sign of high peaks; rigidity occurring overnight, or an hour or two before the next dose are a sign of low troughs. There are many possible strategies, such as increasing the dose of agonist, or adding entacapone, or using smaller Sinemet dosing at shorter intervals that can be used for each of these problems. If you take your daily log to your neurologist, he may be able to detect a pattern of problems which he can approach by changing your medications around with these principles in mind. It is important to do this with the supervision of your neurologist or movement disorder specialist. Jorge A Romero, MD ----- Original Message ----- From: "Charles Countryman" <[log in to unmask]> To: <[log in to unmask]> Sent: Thursday, August 23, 2001 5:28 PM Subject: Re: levodopa side effects...need help > Barbara, > > I try to spread my Sinemet CR out over the day in five hour periods > (6am, 11am, 4pm, 9pm). However frequently I wake up in pain and very > stiff early in the morning. Taking a 1/2 dose of Sinemet before going > back to bed helps me a lot. > > I have also had problems with Dopamine Agonists (e.g. low blood > pressure). It helps me to take Amantadine and reduce the Dopamine > Agonists. > > If I am having problems with dyskinesias or very slow movement, walking > around the house and basic T'ai Chi exercises help me get my mind and > body together. > > Have you tried SAM-e (S-adenosylmethionine)? My experience over the > past year is that SAM-e seems to extend the effectiveness of my other > meds and helps with depression. SAM-e may help my liver process the > other meds. I take 400mg of SAM-e in the morning and again in the early > afternoon. > > My re-introduction to this list. I have not been active on the list for > a couple of years. I am 50, diagnosed with PD in 1993 after I was > misdiagnosed in 1991 with carpal tunnel syndrome in my right arm and old > sport injuries in my right leg. My current meds are Selegiline 5mg x 1, > Sinemet CR 200-50 x 4, Ropinirole 1MG x 3, & Amantadine 100mg x 2 (with > a supplemental 1/2 dose of Sinemet CR if I wake up too early) > > Charley ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn