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Walking difficulty due to Parkinson's?

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I am 58 years old, and was diagnosed with Parkinson’s in April of last year. I am taking Sinemet 25/100 (five/day), Azilect 1 mg (one/day), and just started Amantadine 100 mg (one/day). I’m also on Synthroid 25 microgram (one/day), Sanctura 60 mg (one/day for overactive bladder – typical Parkinson’s side effect), Proscar 5 mg (one/day for enlarged prostate), and Primidone 100 mg (two/day).

 

I’ve had a gradually worsening right-hand tremor since late 2002 (first thought it was Essential Tremor, which was diagnosed in March 2006 and why I’m on Primidone; current – second - neurologist has kept me on it.) Slight tremor in left arm and right leg.

 

I’m having difficulty walking more than a hundred feet. (And when I do, my left leg is too tired to do it again for an hour or two.) And three years ago I was alternating running and walking for thirty minutes a day, three days a week. And the difficulty’s due to left leg – not right leg – weakness. I sprained my left ankle (a mild sprain at that) in Dec 2005; ended up in a soft cast (removable at night) for two months starting in July of 2006 due to lack of healing. Inability to get my strength back in that leg led me to the second neurologist last year. I also had three months of physical therapy last year (Feb – April), to little effect.

 

I exercise (exercise bike or elliptical, 20-25 min) three to five times/week. Days I exercise, it takes eight or nine hours for my left leg to recover enough to walk. As a result, at work I don’t move from my desk, except to go to the bathroom. My walking might be improving at a glacial rate, but medication doesn’t seem to have helped.

 

Does it sound as if my left leg weakness is due to Parkinson’s? The orthopedic surgeon who put me in the cast thought my problem was neurological; the first neurologist thought it was orthopedic. What can I do, if anything, to strengthen my left leg and get my walking (and running?) back?

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It is tough to say whether your left leg problem is dur to PD, due to something else that is worsened by PD, or totally independent of PD. The fact that you do not experience distinct pain and numbness on that leg or the back, tells me that this is most likely due to PD. But I cannot be absolutely sure. You are probably undermedicated. I would probably not try to increase your sinemet too high and too soon given your age, but that is not the worse option, especially if you are desperate.

 

The easist is to simply increase your amatadine to twice per day, then three tiems per day, then 4 times per day. If that does not work, you can add entacapone to each sinement dose, or add a dopamine agonist (like requip or mirapex).

 

Yours,

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Dr. Fernandez

 

Thanks so much for your quick reply (on a Sunday, no less!). I really appreciate the time you and your colleagues take to answer all these questions.

 

As it so happens, my neurologist wants me to increase my Amantadine to twice daily after two weeks. So we'll see how that turns out.

 

Thanks again!

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Well, the Amantadine didn’t do much. So, on 21 July I started six sinemet daily (one pill, six times per day). Soon I was walking nearly half a mile on an indoor track in eight minutes or so, after fifteen to twenty minutes on an elliptical machine or exercise bike. (I’d been doing the elliptical or exercise bike since 2006, but couldn’t walk much until recently.) I would then have difficulty walking the rest of the day. I could do this five times per week. But occasionally I could walk farther – in early October I walked one mile in about fifteen minutes. Days I didn’t exercise I could often walk – around the house and at work – almost as well as I ever could.

 

In early October, I saw my neurologist’s Nurse Practitioner (my appointments are every three months or so; I see the neurologist about half of these) and updated her; with her approval I started two pills (sinemet), three times per day (5:30 AM, noon, 6:00 PM). Within two weeks, I could walk two miles, in less than thirty minutes, once or twice a week. The other days I would do fifteen to twenty minutes on an elliptical machine or exercise bike, followed by walking about a mile.

 

Sometimes, even on days I exercise, I’m able to walk normally by about one or two in the afternoon. I definitely notice off and on periods now (never did on the lower doses) – I’m really off when I get up in the morning, and am walking okay about twenty minutes after taking my pills. (Don’t notice a lot of difference in hand tremor or hand bradykinesia when I’m off, mainly in walking.)

 

I also noticed when doing my leg exercises (one-leg toe raises, started during Physical Therapy in 2007) – I seem to be getting stronger now, week by week. (Saw little or no improvement, even after months, last year). Also seem to be getting more endurance with exercise (little or no improvement before six sinemet per day).

 

I’m now about to get into a study of the rotigotine patch to reduce off time.

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