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#1 Jones

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Posted 08 April 2011 - 01:51 PM

Wife Caregiver : Husband (Lor)has Parkinson., age 78. At this time he is on 1 CR and 1/2 Regular Sinemet every four hours. Problem: Excessively high blood pressure (BP). Approximately (approx)two years ago Lor started monitoring his own BP, mentioning numbers 204 - 212 - 200. Thinking reading was incorrect I began monitoring it myself. BP would gradually drop to 44. Noticed he would go into a deep sleep (coma ?) for approx 1-1/2. I realized this had been happening several times each night and day when his ability to move or communicate was diminished. He was sent to (Neurology Science) where a Neurologist took him off Ropinole/Requip plus his high dose of generic Sinemet and began a smaller dose of generic Sinemet as shown above. It seemed to help for spprox 6 weeks but BP continues to spike from normal to 198 down to below 50. Mentally, he remains functional. During his normal readings Lor is able to communicate verbally, is able to walk, and will try to do things around the house. He is physically weak. His blood test showed some casts on his kidneys. Neurologist recently prescribed Lysinopril. My concerns: His high BP which drops to a low 49. How will Lysinopril react to his low readings? And - health of his organs. Any help on what I can do now. Your response means Lor's health.

#2 Dr. Okun

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Posted 08 April 2011 - 05:13 PM

You have to be very careful and get the neurologist and cardiologist talking. You may want to print this for them as it may or may not help.

In PD blood pressure can drop from PD (autonomic issues). The sinemet can also drop the blood pressure, but here is the trick...between doses it can go up as you wear off. Timing of meds meaning PD meds and also BP meds need to be tailored by understanding blood pressure and PD meds dose and frequency. It is complex and often requires 12-24 hour monitoring to get doses right.

Also remember there are causes of increased blood pressure that must be considered-- renal artery stenosis, endocrine issues, coarctation of aorta.

Hope that helps.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#3 netgypsy

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Posted 09 April 2011 - 11:48 AM

I'm commenting because of my extremely high blood pressure when lying down and my very low blood pressure after eating and bowel movements.

To add to what Dr. Okun has said be sure to check blood pressure when meds are working well. Check it when standing, sitting and lying down and give all three positions enough time for the blood pressure to stabilize. I had a DVT and in the hospital they discovered my really high blood pressure at night.

Here are some quick things to do for both cases - too low after eating for example and too high when meds wear off or lying down perhaps or too much salt.

To get a quick boost in blood pressure have him drink 16 ounces of water. This works very quickly and has saved me from fainting numerous times. I make sure to drink in the morning when I get up and during meals. I've even used it in the hospital when it appeared that my blood pressure was going to drop way too low and in ten minutes it stabilized and started back up to normal.

To drop the blood pressure quickly you can use a nitroglycerine patch. I use the patch at night and it drops my blood pressure at least 40 points which is from 220 to 180. Now this isn't enough of a drop for me so I add a short acting calcium channel blocker, isradipine, You have to be SURE to get the SHORT ACTING because they also make a control release. IF he's fluctuating and too high even when meds are working when standing up or sitting up, the patch is by far the best choice again IF the sinemet isn't dropping it fairly quickly. If you chew a regular sinemet tablet on an empty stomach it kicks in in about 20 minutes. I'd try this first and then the patch, if of course your docs concur. The great thing about the patch is that you can pull it off once the pressure has dropped for whatever reason. But do remember to take it off because I've almost fainted several times when we forgot to take it off. Yes it can cause a headache but for me the headaches went away after about a week of using it.

IF he has some other issue the fluid reducing pills work very quickly also to drop the pressure but again this is up to your neuro and cardio doctors working together. But I will share that WE were the ones who brought the idea of using the patch and the short acting calcium channel blocker to the attention of our doctors. They didn't suggest them and in fact didn't think the patch would work. But it does and I know several other PWP who use it at night for the same problem. Oh - I use 2 sinemet CR 50/200 every six hours even at night and this does help but again this is totally individual but this at least gives you an idea that you do have to take the sinemet at night, especially if it impacts blood pressure as is true for me.

Please share your solutions as we all have this type of issue in some form or another. Good luck.

#4 Dr. Okun

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Posted 09 April 2011 - 01:05 PM

I'm commenting because of my extremely high blood pressure when lying down and my very low blood pressure after eating and bowel movements.

To add to what Dr. Okun has said be sure to check blood pressure when meds are working well. Check it when standing, sitting and lying down and give all three positions enough time for the blood pressure to stabilize. I had a DVT and in the hospital they discovered my really high blood pressure at night.

Here are some quick things to do for both cases - too low after eating for example and too high when meds wear off or lying down perhaps or too much salt.

To get a quick boost in blood pressure have him drink 16 ounces of water. This works very quickly and has saved me from fainting numerous times. I make sure to drink in the morning when I get up and during meals. I've even used it in the hospital when it appeared that my blood pressure was going to drop way too low and in ten minutes it stabilized and started back up to normal.

To drop the blood pressure quickly you can use a nitroglycerine patch. I use the patch at night and it drops my blood pressure at least 40 points which is from 220 to 180. Now this isn't enough of a drop for me so I add a short acting calcium channel blocker, isradipine, You have to be SURE to get the SHORT ACTING because they also make a control release. IF he's fluctuating and too high even when meds are working when standing up or sitting up, the patch is by far the best choice again IF the sinemet isn't dropping it fairly quickly. If you chew a regular sinemet tablet on an empty stomach it kicks in in about 20 minutes. I'd try this first and then the patch, if of course your docs concur. The great thing about the patch is that you can pull it off once the pressure has dropped for whatever reason. But do remember to take it off because I've almost fainted several times when we forgot to take it off. Yes it can cause a headache but for me the headaches went away after about a week of using it.

IF he has some other issue the fluid reducing pills work very quickly also to drop the pressure but again this is up to your neuro and cardio doctors working together. But I will share that WE were the ones who brought the idea of using the patch and the short acting calcium channel blocker to the attention of our doctors. They didn't suggest them and in fact didn't think the patch would work. But it does and I know several other PWP who use it at night for the same problem. Oh - I use 2 sinemet CR 50/200 every six hours even at night and this does help but again this is totally individual but this at least gives you an idea that you do have to take the sinemet at night, especially if it impacts blood pressure as is true for me.

Please share your solutions as we all have this type of issue in some form or another. Good luck.


Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#5 Jones

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Posted 11 April 2011 - 01:18 PM

[quote name='Jones' date='08 April 2011 - 02:51 PM' timestamp='1302288675' post='38205']
Wife Caregiver : Husband (Lor)has Parkinson., age 78. At this time he is on 1 CR and 1/2 Regular Sinemet every four hours. Problem: Excessively high blood pressure (BP). Approximately (approx)two years ago Lor started monitoring his own BP, mentioning numbers 204 - 212 - 200. Thinking reading was incorrect I began monitoring it myself. BP would gradually drop to 44. Noticed he would go into a deep sleep (coma ?) for approx 1-1/2. I realized this had been happening several times each night and day when his ability to move or communicate was diminished. He was sent to (Neurology Science) where a Neurologist took him off Ropinole/Requip plus his high dose of generic Sinemet and began a smaller dose of generic Sinemet as shown above. It seemed to help for spprox 6 weeks but BP continues to spike from normal to 198 down to below 50. Mentally, he remains functional. During his normal readings Lor is able to communicate verbally, is able to walk, and will try to do things around the house. He is physically weak. His blood test showed some casts on his kidneys. Neurologist recently prescribed Lysinopril. My concerns: His high BP which drops to a low 49. How will Lysinopril react to his low readings? And - health of his organs. Any help on what I can do now. Your response means Lor's health.
[/quote

NEW AT "REPLYING TO MEMBERS" Wish to thank you for your response. You could be describing my husband when you dscribe your symptoms. Even meds are the same. Thank God! At last I found this site and your unselfish helpful comments. You can't know grateful I am in reviewing your response. I felt at this end that my husband was written off as unsalvageable. Neurologists we have been to haven't been able to address the BP problems. I will try the things that I can do for him until we see the neurologist June the 14 this year but he will see his primary doctor. April 15. Will keep posted. Thank you all. Jones
.

#6 Jones

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Posted 11 April 2011 - 01:29 PM

You have to be very careful and get the neurologist and cardiologist talking. You may want to print this for them as it may or may not help.

In PD blood pressure can drop from PD (autonomic issues). The sinemet can also drop the blood pressure, but here is the trick...between doses it can go up as you wear off. Timing of meds meaning PD meds and also BP meds need to be tailored by understanding blood pressure and PD meds dose and frequency. It is complex and often requires 12-24 hour monitoring to get doses right.

Also remember there are causes of increased blood pressure that must be considered-- renal artery stenosis, endocrine issues, coarctation of aorta.

Hope that helps.


Dr. Okun, I couldn't be happier with your quick response. The members' response comment on everything husband is experiencing. For years we have talked to doctors and neurologists but my interpretation of their response was that they had never heard of BP spike/drop in PD. I had begun to believe husband had something other than PD. I will be checking in often on this site for additional information that may help my husband and me. Jones here

#7 Dr. Okun

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Posted 12 April 2011 - 03:08 AM

These are tough; I would suggest finding the right dose of sinemet and taking it at close intervals (every 2 hours around the clock)....that would be one solution. Then you can perhaps if needed use blood pressure pill at night a few hours after last sinemet so BP doesn't tank too much at night? There are a lot of ways to solve the problem, just remember that PD meds will drop BP. PD itself also contributes.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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