Janet,
I'm thinking about something Camilla says:
**__**__**__**__**__**__**__**__**__**__**
* *
* "IF THE ONLY TOOL YOU HAVE IS A HAMMER,*
* EVERYTHING LOOKS LIKE A NAIL" *
* ---Abraham Maslow *
**__**__**__**__**__**__**__**__**__**__**
IF THE ONLY TOOL YOU HAVE IS A HAMMER, THEN ALL YOU CAN DO IS HAMMER.
OR:
If the JP I know can't get a balance...then she does not have enough
tools.
"Several strategies can be attempted for controlling motor
fluctuations."
"A switch to the sustained-release preparation of levodopa,
*1*Sinemet CR, can help."
*2* "a dopaminergic agonist often can help"....
*3* "Drugs that can block COMT provide another option."
Janet, I attended a Parkinson's Medication Seminar in March and posted
some highlights from my notes. I think a reposting of some ideas now
might be helpful.
Dr. Linda Sigmund, MD. (a Movement Disorder/PD Specialist in Northern
Virginia) reported to us that:
..the Neuro Convention consenses gave strong recommendation for use of
Dopamine agonists for there L-Dopa sparing effects, reductions in
Sinemet dosages for longer years of protection before unwanted side
effects from Sinemet, they decrease on-off times, decrease dystonias and
dyskinesias, and are thought to be neuroprotective...and now having 4
different ones to try gives a wider range for options/solutions.
she went on to say...
...COMT inhibitor Tasmar...out for three weeks now...improves 'ON' time,
decreases 'OFF' time, smooths out between Sinemet times, increases
availability of Levodopa, has an overall increase of energy effect as
reported by a significant number of patients taking it, is used in
conjuction WITH the dopamine agonists and Sinemet (add a little Tasmar
to the Mirapex and Sinemet for lower doses of both, to decrease the
chance of side effects from any one of them), it's taken three times a
day (8hrs apart), will decrease amount of Sinemet you need if you take
over 600 mg a day, usually the only side effects are exterienced in the
first 72 hours and are nausea, loose stools and bright yellow urine, if
any dyskinesias occur then decrease the Sinemet more don't stop or
decrease the Tasmar or agonist.
and...
...one example of what a movement disorder neurologist would do that a
general neuro might not know to do is: she said she might perscribe a
Regular Sinemet in the morning with Tasmar, followed in one hour by a
Sinemet CR and the med transition will smooth out and compliment each
other. By adding a little agonist to the mix, the patient will reduce
their need for higher Sinemet doses. She said smaller amounts of more
meds works best with those with PD under 70...for those over 70, less
different meds is better because to an older persons less tolerance for
variety.
Janet I know you don't like too many ingredients at a time in your
chemical stew and on principle I agree with that...but my experience as
a nurse is that "a little of several things, is better that alot of one
thing". One at a time of course but balancing with only one side of the
see-saw occupied seems to be tougher to do these days.
Just some thoughts from your cyber sis,
Gail Vass
