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Phil, In some ways, your experiences mimic my mother's (Joyce, 67/5 months). She is in the early stages and her doctor just left the area, too. She started on Sinemet (25/100 4x/day) and then, because balance problems still disrupted her life, was given Permax. This was in April. She never worked up to the recommended full dosage (sleep problems at first) and, in fact, was just cut back to .25 3x/day (she was taking it 5x/day) along with the Sinemet. Although she thought the Permax helped with the balance a bit, she recently had difficulty breathing at times and heart palpitation (this is why the dosage was cut back). Since cutting back the Permax, the breathing problems disappeared. Her doctor (the one that moved) told her that she could quit Permax and start trying Mirapex, which she was told becomes available next week. (Of course, she's sitting on about $500 of Permax.) She may very well go with the Mirapex; the Sinemet/Permax combo just hasn't addressed her balance problems as much as she had hoped. (Of course, nothing might.) As for your MRI, there are probably lots of reasons for ordering an MRI (my mother had one early on to rule out certain things). Good luck. If you do start Permax and want to compare notes with my mother, let me know. Debbie White [log in to unmask] > > Well I just passed my one year diagnosis anniversary. I also had my first visit with my new neuro (my last one informed me last month that he was leaving the area). My new neuro is also a MD specialist but seems to be more informed. It is about a 45 minute drive to her office with no traffic, but this seems a small investment in time relative to the time I plan to live with the disease. > > Her treatment philosophy is different from my previous neuro and she informed me that she was not happy with my 4 per day 25/100 Sinemet dosage. She is from the 'Don't treat with Sinemet early' club so it appears we will be experimenting with some new med combinations. She also informed me that I would be starting a regular 30 minute a day exercise program. Goody! Goody! > > My sarcasm aside, I really like her. She seems interested in PD and in treating me. In addition, she is very personable with good bedside manner. Funny how things can work out. > > I do have a couple of questions for the list. She is adding Permax to my Sinemet. I'd like to hear about list member experiences with the drug especially in early onset members. > > Also, I get to take another trip with Prince Vallium for an MRI on my neck. Anyone know what she is looking for? She wasn't specific, but indicated that disorders of the spinal column can sometimes mimick PD symptoms. > > Another point she made was that I have signs of weakness in the side affected by PD. She indicated this wasn't normal in early onset. Any comments? > > Phil Gesotti 47/1+ [log in to unmask] > > P.S. She had a really good physicians handbook on PD. I was reading it while waiting in her office. She told me it was a good book to which I responded that I had copied down the ISBN. > She asked me why. "Was I an M.D.?" She told me that she had much better books that a patient could understand. Slam! > > Anyway, the book was actually good reading for tekies. It had a good block diagram showing control paths in the basil ganglia, neurotransmitters and plus and minus signs for neurotransmitter interaction. Funny how sensitive M.D.s can be sometimes.