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Sherry, Jeanette gives some good advice below. Greg is wrong when he says that Mirapex cannot be utilized without l-dopa. I think he has it mixed up with the COMT inhibitors. Mirapex, Requip, as well as the other older agonists Parlodel and Permax can be utilized without Sinemet. Sinemet is not necessary for the diagnosis of PD although it helps. Because of the possibility of developing dyskinesia from the Sinemet it is felt by many that its use should be delayed as much as possible. Probably that is what your doctor is trying to do. If the results are unsatisfactory then a trial of another agonist or Sinemet is indicated. Don't delay in taking Sinemet because of the possibility of dyskinesia later on however. If you need it to function reasonably well then by all means take it. Regarding Greg' s other comment I agree that everything being ideal PWPs should see movement disorder specialists either for consultation and/or follow-up depending on their accessibility. Jeanette makes the point of not accusing the MD of making a mistake. That makes sense unless you are damned sure that he is wrong as opposed to approaching things differently than you would like. It throws him on the defensive and he/she is only human and will feel threatened and that interferes with communication between you and him/her. Ask her/him what his/her plans for you are if plan "A" doesn't work. Usually it takes several weeks for agonists to reach maximum effectiveness and unless it is absolutely clear that they are not working or you are having side effects or are very uncomfortable or disabled by the PD symptoms you should continue them. Charlie ----- Original Message ----- From: Leo Fuhr <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, November 29, 1999 2:36 PM Subject: Re: Question on Mirapex > There has been much discussion both on this list and among neurologists > about when to introduce levodopa, especially is the patient is under 50-55. > Some neuros seem to take the delay levodopa plan and try agonists and > other drugs alone. In some pwp, this therapy gives sufficient relief of pd > symptoms. In other pwp, the introduction of levodopa alone or with > agonists, segeline or other meds is more helpful in controlling pd > symptoms. > > Ask your neuro why he wants to try Mirapex another 4 weeks? Is it because > he thinks an increase in the daily dose may be needed to obtain theraputic > dosage? Have you tried keeping a drug/symptom diary? This is a daily log > that shows time of dose, time of meals(& type of food), and the pd symptoms > as the day progresses. This can be very helpful to detect if the drugs are > working or causing side effects, and can help show problems relating to > timing of food intake and meds. > > Being proactive and by that I mean learning all you can about pd, pd meds > and therapies is important for pwp. You must be sure you are doing an > excellent job communicating your symptoms and your concerns to the nurse > and to the neurologist. I try to not ever accuse the dr. of an error, > choosing instead to indicate my disappointment that what has not seemed to > work must be reexamined and a diff solution be tried. I also make a point > of writing my ?? on paper with a copy for the nurse, one for the neuro and > one for me to take notes as to the answers. In that note, I always thank > the nurse, the doc and the university for the concern and help they > demonstrate for me and my needs. > > As to giving up Mirapex, your neuro should know if he/she wants to try a > diff agonist or if adding levodopa with the Mirapex is the plan that may > help you function best and control the pd symptoms. Normally titrating > slowly up and down is the plan I follow with my neuro's approval. > > Yes, PD meds are confusing and having a chronic illness can be depressing. > BUT.......you have this group to help with the confusion and we even can > lighten the day with a story or a joke on occasion or offlist. > > Good luck, > > Jeanette 49/47/44? > > ---------- > From: Sherry Macredes <[log in to unmask]> > To: [log in to unmask] > Subject: Question on Mirapex > Date: Monday, November 29, 1999 12:20 PM > > Dear Experts.. > > I am new to PD and need more info on meds to keep my neuro on his toes! I > have been using Mirapex alone since dx in early Aug. After a long battle > of > increases I am now up to 4.5MG per day with no positive results. Now my > neuro wants to keep me at this level for the next four weeks to be sure > there > is no improvement before trying something else. After reading the posts on > the list over the last few weeks, it seems strange to me. How can I be > sure > it's really PD? Shouldn't I have been given some sinemet to see if I > improved to be sure of dx? Don't most people need more than one > medication, > should I give up on Mirapex before adding something to it? It's all very > confusing....not to mention depressing. Thanks for your input, > > > Sherry > 49/48/43