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On Fri 30 Jan, Debbie White wrote: > My mother Joyce (68/11 months) has been on Requip only for over a month and > is only up to 1.25 mg./dose (she takes it either 3 or 4 times a day). She > is working her way up to her final dose (whatever that will be) very > slowly. In an effort to determine what exactly is causing her tightness in > the chest, her doctor took her off all other drugs before starting her up > on Requip (she had been on Sinemet, Eldepryl, and Permax). She still > experiences the tightness in her chest, which bothers her quite a bit and > makes breathing difficult. She is planning to call her doctor tomorrow to > say that she wants the Sinemet back -- that she just cannot take this > anymore. > > This sounds reasonable to me. She gave it a shot, and taking the Requip > alone just isn't cutting it (although she is aware that things could get > better once on full dosage). The question is, is it reasonable to ask my > mother to stay off Sinemet for, possibly, another month or two just to see > what is causing what when, in fact, she might find some relief by combining > Requip and Sinemet. Thanks for any thoughts on this. > > Debbie White > [log in to unmask] > Hello Debbie, I am beginning to see comments by various authorities which confirm something that I have felt instinctively for some time: Dopamine performs a number of faily minor secondary functions in the brain, as well as the obvious function which we know about. For me, that spells out a message that any sensible diet for a PWP should include (but not be limited to) some levodopa. I think that, if you ask around, most people who have had PD long enough to have formed a reasonable opinion will endorse a policy of taking a combination of levodopa (Sinemet) and a Dopamine agonist. As far as which agonist to use, my feeling is that they all work in terms of adding to the effect of the Sinemet without provoking unwanted side-effects. There is some evidence of small differences between some agonists but it is not clear if they are consistent for all PWPs. The obsession of some doctors to get rid of Dopamine or levodopa in the treatment of PD is something which I find ludicrous. Just get your doctor/ neuro to recite the standard definition of PD ;- It is caused by the failure of cells in the substantia nigra, whose job is to produce Dopamine. It seems reasonable to treat the problem by adding a bit of artificially produced dopamine. I believe that almost all of the so-called side effects are in reality under- or over- dose reactions to the crude way that we try to feed a consistent need by throwing lumps of levodopa (called tablets) at the problem. I don't expect you to agree necessarily, but I urge you to go for the 'mixed diet' I am still on Permax (have been since it first came out, plus 800 - 1000 mg of levodopa per day. Regards, -- Brian Collins <[log in to unmask]>