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FROM:   Will A. Kuipers, 103325,2723
TO:     Brian Collins, INTERNET:[log in to unmask]
DATE:   10/6/96 5:35 PM

Re:     Copy of: When to start PD Medicines

Brian Collins wrote eloquently about this
Subject: When to start PD Medicines

  <To: Cindy Birk Conley

  <Hello Cindy, I think you will find that the opinion among the majority of
  <neurologists these days is that the timing of the introduction of Levadopa
  <(which is by far the most important drug in overcoming the symptoms of PD),
  <does not influence the duration of effectiveness, or the build-up of
  <tolerance.  The view expressed by your doctor is ,I think, governed by the
  <observation that later on it becomes more and more difficult to find a
  <dosage regime for Levadopa( Usually the drug Sinemet) which is effective
  <and without side effects. The probability however is that this increased
  <sensitivity is caused by the continuing progress of Parkinson's Disease,
  <which always gets worse, never gets better, and would have got there with
  <or without the use of Levodopa.
  <There is a warning however: Some doctors go a bit overboard with this
  <strategy, and prescribe large doses such as the 250mg version of Sinemet.
  <Your mother will probably be able to take even that high quantity in her
  <present state, but later on there could be trouble. The message is: Only
  <take enough to do the job, and creep up to that minimum level slowly and
  <carefully. In fact that is good advice to apply to all Parkinson's Drugs;
  <they are powerfull drugs and should be treated with care. But for the
  <improvement that they provide, it is worth the effort.

  <Regards,  Brian Collins.

Hi Brian,

I have often wondered about this. There does not seem to be a constancy in the
way
doctors prescribe PD medicines. Each seems to be doing  his own thing.

When I was diagnosed 5 years ago I was put on 2 Eldepryl 5 mg. daily (in the
morning and
at noon) and 2 Cinemet CR (50-200) also daily (in the morning and in the
evening).
Why he started me off on CR I don't know. Other patients get other meds and
dosages,
I found. Are we the private research projects of our doctors?

Anyway, maybe because of the CR I never experienced "on" or "off" conditions.
Everything is
the same throughout the day. As a matter of fact I am at my best in the early
morning.This is
probably an envious situation when compared withothers with severe ups and
downs, but it
makes me sometimes wonder why I take these meds.

The only thing I remember from the first year, that was an improvement, was a
reduction
of stiffness in the neck and back, which made driving a car easier. ( Nowadays
getting in and out
of a car is more of a problem due to arthritis of the knees ). I have no
problems walking, but
my voice is affected.

I wonder if there are more people with no clear on or off symptoms, either due
to the meds
or due to the fact that maybe their PD has not progressed very far.
One way to find out is to temporarely quit taking the meds, but my dr. has
cautioned against this.

This may have been discussed in this list before. I joined only recently.

Will A.  Kuipers            ( Dallas, Texas )      ( 75 / dx '91 )
INTERNET:[log in to unmask]