Hi Janet,
I'm working my way through some replies, and though I know some of your
questions were answered in my reply to Brian, I'm also going to go
through your letter and answer any that I think were not.
janet paterson wrote:
you wrote:
> >the Sinemet was increased....when Tasmar was approved, it was added and for some time he was taking all three...he began hallucinating, was
dyskinetic, experiencing extreme "on/off" times and lost thirty
pounds, so Mirapex was dropped.< <
> this sounds like levodopa overdose to me
I thought it was levodopa overdose, too.
> it also sounds like he was getting worse after adding the tasmar
> so why didn't he take a step 'backwards' by removing the tasmar
> to regain some ground?
When he started taking Tasmar he felt an immediate 'high,' so for a
while he thought things had improved. However, when the hallucinations,
etc., started he went back to the MDS, who asked him which med seemed to
work best. Since he had felt for some time that Mirapex wasn't helping,
it was dropped.
> >The Tasmar was increased to 600 mg daily,...At some point he was able to decrease the levodpa to about 900 mg daily, but that was short-lived and the levodopa climbed again.
> it sounds like he is self-medicating to an over-dosed degree
I asked specifically if he was self-medicating and the answer was -
"No."
> > we got him admitted to the hospital. He hadn't been able to swallow,
> >he is now almost completely immobile, and in severe pain from
> >muscle cramping.
> has he had muscle cramping before?
> has be been in pain before?
Yes, some.
> would that explain the ever-increasing 'need' for sinemet?
Perhaps. I also think he is still in denial, and felt that he needed
more meds to keep going.
> how much carbidopa is he getting in a day?
He has never taken levodopa/carbidopa lower than 100/25.
> isn't morphine a no-no for parkies?
When I had to have surgery and couldn't have demerol (which I wouldn't
take for all the tea in China), morphine was given. Actually, Susan
Calne, wife of Dr. Donald Calne, recommends morphine over demerol if
that kind is pain killer is necessary.
> when was he last in relatively good control?
> what was he taking then?
During the summer when he was trying to get a balance with Tasmar and
levodopa.
>my instinctive reaction...is to pare his meds down to the hard core basics for awhile
My thoughts exactly.
> i believe that there is some evidence of 'addiction' to levodopa
> [which i admit to feeling cynical about]
I've wondered about that, but have never seen any documentation.
Thanks for your help, Janet. :)
Judith
--
Judith Richards, London, Ontario, Canada
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