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Hi Brian Collins You wrote: >With reference to the posts from Wesley Balk, amd Bob&Joy Graham, > >I have mixed views about the book by Dwight C McGoon. The first 70 >pages are by far the most readable and understandable descriptions of how >the brain operates (In the areas relevant to PD) that I have read. After >that he goes into his drug holiday mode, and I stop reading. To put it >delicately, I think it is rubbish. A good debate is healthy! Maybe a few others would like to read McGoon and see what they think? > It appears to me that people who say that they do benefit are those who >are taking what I regard as an overdose of levodopa. It is possible for >some PWPs to take an overdose first thing in the morning (They often talk >about the 'tablets cutting in' as they go zooming through the ideal dose >on the way to the overdose). By the occasional tablet administered at the >right time, it is possible to stay in this overdosed state most of the day. >However, 'What goes up must eventually come down', and this is where the >trouble starts: the dyskinesias have to be faced, and seem to occur as the >PWP comes back down through the various levels to essentially an un-dosed >condition. > The stresses involved in this nightly wind-down must be considerable, >and the concept of a drugs holiday more attractive. Also, having purged >this possible overdosed condition, the rigours of an advanced Parkinsons >condition with no medication is to me totally unacceptable .Brian wrote: > About three >months ago, I sufferred a 'shut-down' of my digestive systemsuch that for >two days I could get no result from the tablets, because they were not >reaching the lower intestine, and hence not getting into the bloodstream. >There is no way that I woould voluntarily decide to go through those days >again. Brian, that must have been scarey. It is no secret that a sluggish digestive system can mean that the levodopa just does not get absorbed. It is one of the many factors in getting the most out of medication and enabling lower doses too. I remember reading somewhere (?) about a Sinemet tablet completely undissolved in someone's constipated gut. Where was that? Anyone remember? >Joy Graham writes : >"There are many theories about putting PD medications into the system. >school believes that a constant supply of levodopa such as you get in the >slow release (Sinemet CR or Madopar HBS) is more beneficial in the long >run than the stops and starts of regular dosing. Many neurologists won't >use the CR because you actually need MORE of it to get the same response" > >Joy, I would say that Every neurologist acknowledges the desirabilty of a >constant, steady supply of dopamine to the brain systems. If this is so, why don't they all suggest Sinemet CR right from the beginning? What I didn't mention was the effectiveness of liquid Sinemet which comes (probably) closest to your desired model of tablets with different release rates (since these are not available-- hey Brian why don't you go into business!!) Where people go >off the rails is in thinking that that means the CR tablets should work OK. >The point is that the rate of release of a CR tablet is just one rate of >release in a broad spectrum of release rates. What we really want is a >range of tablets, each containing a different release-rate so that we can >'mix and match' to get the right rate for us (Remembering that in 6 >months time the percieved required rate will have changed. This would be a nightmare for people to work out, don't you think? If a person could prick their finger (like Diabetics can) to find the blood level of levodopa - then it may be easy to decide which of these differing release tablets to take. I can imagine most people would get very confused. Just thinking out loud when I should be writing the next Newsletter. Joy Graham