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Dr. Okun

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Hello Dr. Okun,

 

I am writing to you, because I had an issue to come up this morning on the 14th of May. I took my night meds last night at 1730 hours. When I woke up at 0800 this morning, my muscles were frozen. I took Requip 2mg, 1 Sinement ER, and another Sinement, Neurontin, and the rest of my night meds. I realize you cannot take meds while you sleep, and I think we're both have an understanding about that. My question is: Is it possible my Parkinson's is progressing, when the muscles freeze up?

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Usually not.  Some people have trouble being frozen in the AM or trouble getting back to sleep.  We usually add night-time doses of Sinemet when people awaken to go to the bathroom and occasionally use apomorphine on awakening.  One other strategy is extra sinemet upon waking; chew it and take with orange juice.

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A neurologist I saw many years ago told me that drinking coca-cola when taking Sinemet would speed up its absorption.

 

Recently, I read an article that said to stay away from all caffeinated drinks as they interfere with the absorption of sinemet.

 

Are either one of these statements correct in your opinion?

 

Does chewing sinemet and taking it with orange juice speed up its absorbition?

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Correct, orange juice, coke or anything that lowers pH helps absorption.  Chewing the SInemet also may help speed absorption.

 

There are several studies actually showing low dose caffeine actually helps PD symptoms like tremor (Ron Postuma published a nice study).

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In the morning, I generally take my PD meds first and foremost. I take them with juice or soda. I do notice like when I eat protein because I am waking up and I get hungry. I will take an extra Sinement just so the brain blood barrier will accept the artificial dopamine along with protein. When the brain sees the two coming to the brain blood barrier. The brain recognizes the protein before the artificial dopamine. One thing, I do notice is Dyskinesia is really noticeable until the dopamine levels out back to the baseline. It generally takes about 3 hours for me. After I get through working out. I notice my tremors is more noticeable until it returns to the baseline, which is a normal reaction, which, I read that on the National Parkinson's Disease Foundation's website.

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When I take my 1mg of Requip and my Sinement ER, I am usually dialed in within 1 hour from taking my PD meds. I have the poor posture, rigidity muscles, and slow gait, and after I go out running errands for about 2-3 hours, I get really tired.

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My MDS didn't like it that I was on Sinement ER. He said it's too early. Obviously, my APRN didn't have a lot to say to me when I went and visited him today. My MDS wants me to take Sinement 25-100 twice daily, along with my Requip 4mg three times a day. 1 in the morning, 1 at lunch, and 2 at bedtime.

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