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Patrick Exley

Panic Attacks or Something Else?

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Hello. I'm a 40 year old male diagnosed with Parkinson's Disease initially in May 2015 and then confirmed with DAT scan in Jan 2016. I'm currently on Stalevo 200 4x per day, Rasagiline 1mg & Sinemet ER 50-200 1x per night. I also typically take 0.5mg of Lorazepam to help me sleep at night. Without it I tend to wake up with stiffness in my left leg (although the Sinemet ER has helped reduce this problem). I'm still working full time, and Parkinson's really hasn't impacted that part of my life at all until about 2 weeks ago. I travel 40 to 50% of the time so am very accustomed to that. But 2 weeks ago I quickly developed shortness of breath, chest tightness, tingling in hands & feet, indigestion, etc. one morning within about 4 to 5 hours. I went to the ER thinking I was having a heart attack, and everything checked out fine (heart ok, lungs ok, no blockages, no clots, bloodwork ok). The EMS suspected it was a panic attack. About a week later I had a repeat of this, again while traveling for business. I knew that my heart & lungs were healthy so I was able to control my breathing & cope with the symptoms that subsided about 5 hours upon initial onset. Since then I've been fine aside from the occasional palpitation. I was able to run 2 miles this morning & put in a quick 30 min of weight training without any real problems. My resting HR can be a little high sometimes (today it is about 80 & climbs to about 90 to 95 when standing), but this usually doesn't bother me. I'm just curious if you've experienced this before in Parkinson's patients, and how is it treated? A mild anti-depressant assuming it is anxiety? The strange part is that I don't feel any more stressed than usual. MY PCP has recommended that I see a cardiologist to rule out autonomic dysfunction, but I haven't booked this appt yet (hopeful that it is just anxiety). I have an appt w/ my neuro in two days so I hope to understand more about what is going on, but am a little concerned. Is there an easy way to distinguish between anxiety/panic attacks & autonomic dysfunction? I've probably done too much reading on the Google. :) I do have REM sleep disorder too...typically acting out dreams nightly. Thanks in advance for any feedback!

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Dr. Okun    409

Usually this is Parkinson related and if you have never had this in your life before PD it may be wearing off and taking meds at closer intervals may be helpful and alleviate this issue.  Ask your doc about every 4 or 3 hour dosing of Sinemet.

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otolorin    28

Hi,Patrick, doctor Okun is right,I have experienced similar symptoms with or without sinemet.I was told by my MD exactly what doctor Okun said.It helped to some extent,but wearing off of medications bring out all the symptoms you mentioned,anxiety,panic attacks,SOB,e.t.c.I just learned to live with these symptoms/side effects.

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Thank you both for the replies. I met with my neuro yesterday, and we are trying a new medicinal cocktail. I was on Stalevo 200 4x per day along with one Sinemet ER 50-200 at night in addition to the 1mg of Rasagiline daily. We are keeping the Rasagiline, but replacing the Stalevo with Sinemet 25-100 as needed (up to 10 doses per day, but I'm hopeful that 6 will be plenty) and Neupro patch (2mg to start for 2 weeks & then 4mg). I'm one day in, and feel a little better already...hoping that trend continues. I'd be interested to hear others' opinions/experiences of Neupro, good or bad. Thanks!

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Dr. Okun    409

Posting for you.  On Neupro and other agonists remember to monitor for impulse control behaviors (even if less on the patch).

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