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On Sun 19 Jan, W.S. wrote: > I have a question for the group about pd, > My mother has an appointment with a new DR. > in a couple of weeks, and I will ask him also, > But, she takes only 2 1/2 sinemet CR a day,one > AM, one 5 hrs.later, and the 1/2 around 6 pm. > My question is, about 7 pm., she totaly runs out > of energy, like a baloon with the air being let out. > within minutes, she has to lay down. > Is this what you are refering to as the ups and downs > of sinemet?? or is it a lack of propper sinemet level? > or something elce going on? any advise, thank you > WHITIE > > Hello, Whitie. The reason for your mother's switching Off can be seen quite clearly on the time history graph which feeds my analysis program. Your mother is apparently getting about 5 to 6 hours of effective life out of the standard Sinemet CR tablet. At one time, she would probably have been OK on half a tablet at all three points, but this would not immediately show itself, because the brain can cope quite well with a half-tablet overdose in the early stages ( Refer to my chart A). However, time has moved on, and she clearly needs more than half a tablet now. The result is that as she winds down from the second CR tablet, (at about 6 pm) she is presented with only half a tablets worth of levodopa, and in this game you don't get three strikes : One miss is all it takes, and the margin by which you miss is not very progressive. The answer is pretty simple: replace that half CR tablet by a whole CR tablet. That should straighten things out. If that works, I would suggest that the next step (to keep in reserve until you need it), will be to start to reduce the time between tablets, in response to a probable dip in your mother's condition as she runs out of the old tablet before the new tablet has had time to get going. Don't go to less than four hours between CR tablets though because other considerations then come in to play. Of course, I don't expect you to go away and do all this because I say so, but you might try them on your new doctor when you see him. (is he a general MD, or a neurologist by the way? I would not expect the average MD to have the in-depth knowledge needed for this kind of fine tuning of the tablets). This is no criticism of the MD profession: Here in the UK, and I imagine it is similar wherever you live, the average GP (as we call them :- General Practitioner) probably has no more than 2 Parkies on his books at any time, and they can't be an expert on everything. That is why we have specialists. I will be interested to see how you get on. Regards, -- Brian Collins <[log in to unmask]>