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My wife's neurologist told her that he couldn't help her any more. That she has all the meds that she should have. She takes 4 sinemet 25/100, 1 eldyprel 2 artane, 3 klonopin a day. The first dose in the morning lasts about 4 hours. the next doses of sinemet lasts about 3 hours each. As you can see, she is in the off state 10 to 11 hours a day. The doctor says that the sinemet causes her left hand and foot to have tremors. The artane is for the tremors,he won't increase it either. She wakes up with foot cramps almost every morning. The klonopin is to help with that, but doesn't do much good. When she asked what to do about the pain, he said "take an aspirin". The pain is so bad that she can hardly walk until the sinemet kicks in. On the meds, she has tryed sinemet cr, but it causes to many side effects. Permax made her gums bleed. I know that alot of you take alot more sinemet then she does. I have increased her sinement to 6 a day on some days, which helped. Also 3 to 3 1/2 artanes. only can do that so often because of her lower perscription amount. She works much better on that amount. I belong to an HMO so I can,t change doctors that easly. Is there any expert PD doctors in Southern California that any of you know of that I could go see? I know that I will have to pay out of my pocket, but she needs help? If I sound pissed off, I am!!! I just don't know what to do any more. I guess I'm starting to ramble, sorry. I may write more later Alan Michael