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On Thu 20 Mar, J.R. Bruman wrote: > Sinemet and Fatigue (20 Mar 1997) > Of possible interest to others on this list, I'd like to share > this recent experience, and ask if anyone else has had it too: > In my (fairly) early stage of PD, I now take the equivalent of > half a 25/100 Sinemet every 3 hours or so (depending on how > soundly I sleep at night). The "end-of-dose" warning comes in the > form of fatigue and depression. Partly to keep in shape, I still > do yard work, with a shovel, lugging heavy stuff, etc. I notice > that any concentrated effort, either physical or mental, seems to > increase the need for Sinemet. > After about a half hour of work, whether it's physical labor or > just doing the daily crossword, I start getting back pain, always > in the upper thoracic area but not always the same exact spot. I > might otherwise ignore the fatigue and just keep on working, but > the pain quickly intensifies until I must lie down. After a few > minutes I'm fine again. Advancing the Sinemet schedule does the > same thing. It "kicks in" in 15 to 20 minutes, sometimes sooner. > If I take it easy for a day or so, I can resume the usual 3-hour > interval. > This tells me that in addition to the steady depletion of dopamine > in the body, there is some kind of storage site where a basic > level needs to be maintained. When you start withdrawing your > "principal" faster than the rate of replenishment, you soon get in > trouble. It also tells me that dopamine affects muscles. Normal > fatigue is accompanied by pain, because muscles can't get rid of > lactic acid, or whatever it is, fast enough, and dopamine helps > them do that. I've written here before about the urgent need for > more info about how dopamine acts 'outside' of the central nervous > system, and this experience seems to emphasize that point. > Comment, anyone? Cheers, > Joe > > > > J. R. Bruman (818) 789-3694 > 3527 Cody Road > Sherman Oaks CA 91403 > > Hello Joe, I have some observations on your interesting email. 1/ I often experience back pain when trying to do things like yard work, and it is much worse if I am in the 'Off' condition. I believe that the cause is fairly straight forward; the typical Parkinson posture - leaning forward from the waist. Try catching a glimpse of yourself in a window or a mirror, and you will be surprised at how far from upright you are. This lean puts heavy stress on the lower back area, -the pain is your body's way of telling you to quit! You say that you are in the fairly early stages of PD, and your tablet dosage rate is consistent with that. I think you are perhaps in a transition stage where over a period like a year, you will find it necessary to take your tablets with increasing frequency, finally settling down at one dose every 2 hours. I must disagree with your conclusions about Dopamine in the body: Dopamine cannot cross the blood/brain barrier. In the body, it is made by the adrenal glands, and has absolutely no connection with the dopamine in the brain, which we know is made (or not made) in the Substantia Nigra. In the body, dopamine functions as a hormone, regulating heart rate and blood supply, whereas in the brain it functions as a neuro-transmitter. For what it is worth, I think the reason that we tire so quickly is that our muscles are already exerting effort, pulling against each other, so that when we exert a force on say a shovel, we have to produce the opposing forces, Plus the force to move the shovel. The amount of dopamine used by the brain has virtually no relationship to the amount of effort being expended by the body. The dopamine is actually used to condition the fluid in the synapses so that the electrical signal from the brain is conducted correctly across the synapse. Regards, -- Brian Collins <[log in to unmask]>