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Showing content with the highest reputation on 08/01/2018 in all areas

  1. 2 points
    Good Morning Happen to be reading the obits today.There was a women born 1921 who had PD the last 20 years.She lived her llife with a strong will .She also survived cancer twice There is no better friend than a strong will. Listen to your heart and don't let articles and poor doctors scare you.My conndition has improved by adapting to it.My doctor now is me. Havea nice day. Best John Hoefen
  2. 1 point
    Many of our patients have become hypermanic or even had punding (repetitive activities). This can impair sleep and also in some cases result in gambling, shopping, weight gain, etc. One strategy is to reduce the agonist dose and use earlier in the day (shorter acting agonist). Another is to get off the agonist and try levodopa only medication but wean slowly and watch for withdrawal. These may be options to discuss with your doc.
  3. 1 point
    They could also do pharmacogenetic testing to see how you metabolize drugs- One Ome, and some others do it. They don't specifically address carbidopa/levodopa but they do a whole lot of other meds PWP end up on. Nice to know if you metabolize it so quickly that it doesn't have the chance to work, or you don't process it at all so it just builds into a toxic soup. I never needed daily meds before PD, and was known to be hypersensitive. My testing has literally saved my life three times since starting C/L. Insurance typically covers it and it's only $350 or so if you have to pay for it out of pocket.
  4. 1 point
    I'm sorry, but I do not have the link. But here is what I do know and what I have learned from the study by Dr. Shankar. A- Cortisol levels in PD patients peak in the morning and evening B- Glucose levels in diabetes increase in the morning and evening Glucose and insulin metabolism in a great number of PD patients appears very similar a low level form of diabetes where Sinemet interferes with glucose absorption in skeletal muscles. This causes an inincrease in insulin levels as the body tries to overcome this action. **The study noted found insulin levels tripled after a year of therapy on Levodopa. C- Hyperglycemia can quickly trigger hypoglycemia by over production of insulin. Here is a study by Dr.De Leon that describes the reaction. Could Rampant High Glucose Intolerance among Parkinson’s patients lead to an increased risk of diabetes? The other day, I had a follow up with my endocrinologist because I have been concerned about a slowly increasing sugar levels as well as HgA1C (glycosylated Hemoglobin used to detect sugar levels in the last 3-6 months to help diagnose diabetes and then gauge management) possibly being caused of increased night sweats and overall sweating. Although I am not diabetic, I am becoming slowly at risk…which initially I attributed my increase glucose levels to the number of steroids I have received over the past 12 months for treatment of various other illnesses. Then I began to wonder if this process had anything to do with my Parkinson’s? I then seemed to remember reading something about dopamine increasing sugar levels and tried to recall by first year of medical school when we discussed physiology. After my visit my doctor confirmed that I was becoming glucose intolerant and would be best to start treatment to avoid developing diabetes. Well of course this was not a pleasant experience to add yet another medication to my already long list of medicines but more importantly sent me in search of answers? What I discovered to my great astonishment and chagrin was that indeed there is a connection between having Parkinson’s, dopa intake and developing insulinresistance leading to diabetes. What amazed me the most was study after study detailing this information dating back to the late seventies; yet no one in neurology or Parkinson’s specialty much less others outside this field have ever made any comments, concerns, or indications to monitor a patient’s sugars or discuss risk of diabetes!!!! In the presence of high sugars, dopamine stimulates insulin secretion from pancreatic cells. (1) The substancia nigra plays a crucial role in controlling structure and activity of these pancreatic islet cells which produce insulin. When lesions occur in this area of the brain or there is loss of dopamine there is a decrease in the content of insulin thus unable to properly regulate blood glucose levels causing an increase? This process is mediated via D2 receptors in the pancreas. However, as with all things pertaining to the brain things are not always straight forward. At increased concentrations outside of the brain it has an inhibitory role while it stimulates insulin at lower concentrations. Here are some of the studies below. **If you google "levodopa induced hypoglycemia" there is a post entitled "The role of Levodopa induced glycemic in PD normal. " It has a great PDF attachment that you can download that describes this effect. https://www.ehealthme.com/ds/sinemet/high-blood-sugar/ https://www.ncbi.nlm.nih.gov/m/pubmed/8082998/ I know this is a lot of information, but after going through it, if you have any questions feel free to let me know.
  5. 1 point
    This discussion about how administered insulin affects Sinemet and vice versa makes me wonder how Sinemet might affect hypoglycemia in someone who is not Diabetic. I have reactive hypoglycemia where my insulin spikes/blood sugar drops rapidly after consuming too much sugar or carbs, etc.. I try to control it by following a low glycemic diet. But I have always felt that my PD symptoms were worse when I felt hypoglycemic and sometimes even immediately after taking my Sinemet (which I try to always do on an empty stomach) and I may be slightly hypoglycemic. I'm always trying to balance the food intake, Sinemet timing and hypoglycemia. I'm wondering if there might be a way to refine how I'm taking my meds (maybe smaller amounts more often?) or the liquid version mixed with vitamin c you've described before? Seems best to somehow keep the hypoglycemia at bay. Any thoughts you might have on this would be appreciated! Also do you have a link to the article mentioned above? Thanks so much for all Your time and the help you give all of us! It's really invaluable!
  6. 1 point
    Chuck, First, I am sorry for the delay. I had to have emergency surgery about a week ago. One of the leads to my stimulator, that controls dystonia, pulled away from the muscle in the thoracic region in my back. I was unable to use my right arm, until this morning, when I got the okay from my Dr. I still have to use a sling, but at least I can type. When a person has an increase in Sinemet or is just given Sinemet for the first time, the may experience dyskinesia. Dyskinesia is sudden involuntary movements or jerking of the muscles. It can happen in the arms, head, neck, shoulders, and even the hand. We do not see symptoms of PD until 80% of our dopamine cells are dead. So, let's say someone has 20% left. The amount of Sinemet to take care of their symptoms may be much less than for that of a person who has 13% left. This can be confused with an increase in Parkinson symptoms, such as tremor or diffculity when using fine motor skills (eating, drinking, buttoning shirts, etc...) Another possibility could be that the Sinemet, over time, could be affecting other parts of the brain. Keep in mind this is not seen too often. it is believed that Sinemet can effect other parts of the brain over time, thus causing increase tremor, rigidity, and muscle movement. I am not a true believer in this theory because first and foremost Dopamine is the major controller of muscle movement. There would be no other part of the brain or chemical that would affect the muscles to the extent to cause tremors. It was a theory that I wanted to throw out there. I like to give patients the whole scope when I can. I believe there is a simple and reasonable resolution to this issue. I use the saying, "Start low and go slow," when it comes to dosing Parkinson's medication. This means that it should be started at a low dose and increased over time. If you are taking 25/100 three times a day and having this reaction, one of two things can be done. Either decrease the strength or decrease how many times a day it is taken. Since it appears you are very sensitive to Sinemet, I would try the the second option. Make sure you keep a journal and try the following. Take one Sinemet in the morning and wait until you feel an "off" period coming. At that point, write down the time the "off" time started and also note the time you took the Sinemet. Now id the Sinemet gave you very little relief, then it would be reasonable to the the strength. The process above would be started again. I should also state that you need to check with your Dr. before making any changes to your medication regime. I always recommend that all people with Parkinson's keep a journal. If you have Microsoft Excel, you can go the the main page of my Forum "Ask the Pharmacist" and you will see an entry titled "Medication Schedule." I tried to make the most comprehensive Medication Scheduling tool aimed at Parkinson's patients. It is literally all encompassing as far as medication, strength, dosage, off times, possible side effects, etc... I believe the best part about this is that it can be saved on the computer and keep your work there or you can print it off and fill it in by hand. This way you can either email it or print it off and fax it to your Dr. a few days before your appointment. This can save so much time because I know we spend most of our time at a Dr. appointment telling them everything that has happened since the last appointment. This way the Dr. has it ahead of time and can go over it BEFORE you are in the office. I hope this helps and please keep me posted.
  7. 1 point
    I thought most of you would be interested in this, so I decided to post this article from The BBC Health and Science section First hints Parkinson's can be stopped By James GallagherHealth and science reporter, BBC News website 4 August 2017 Share this with Facebook Share this with Twitter Share Image copyrightGETTY IMAGES It may be possible to stop the progression of Parkinson's disease with a drug normally used in type 2 diabetes, a clinical trial suggests. Current drugs help manage the symptoms, but do not prevent brain cells dying. The trial on 62 patients, published in the Lancet, hints the medicine halted the progression of the disease. The University College London (UCL) team is "excited", but it urges caution as any long-term benefit is uncertain and the drug needs more testing. "There's absolutely no doubt the most important unmet need in Parkinson's is a drug to slow down disease progression, it's unarguable," Prof Tom Foltynie, one of the researchers, told the BBC. In Parkinson's, the brain is progressively damaged and the cells that produce the hormone dopamine are lost. It leads to a tremor, difficulty moving and eventually memory problems. Therapies help manage symptoms by boosting dopamine levels, but the death of the brain continues and the disease gets worse. No drug stops that happening. 'First' In the trial, half of patients were given the diabetes drug exenatide and the rest were given a placebo (dummy treatment). All the patients stayed on their usual medication. As expected, those on just their usual medication declined over 48 weeks of treatment. But those given exenatide were stable. And three months after the experimental treatment stopped, those who had been taking exenatide were still better off. Prof Foltynie told the BBC News website: "This is the first clinical trial in actual patients with Parkinson's where there has been anything like this size of effect. "It gives us confidence exenatide is not just masking symptoms, it's doing something to the underlying disease. "We have to be excited and encouraged, but also cautious as we need to replicate these findings." Parkinson's disease 'may start in gut' Century-old Parkinson's question answered Experts excited by brain 'wonder-drug' Early days They also need to trial the drug for much longer periods of time. An effective drug would need to hold back the disease for years in order to make a significant difference to patients. Parkinson's progresses slowly and the difference in this 60-week trial was definitely there, but was "trivial" in terms of the impact on day-to-day life, say the researchers. The drug helps control blood sugar levels in diabetes by acting on a hormone sensor called GLP-1. Those sensors are found in brain cells too. It is thought the drug makes those cells work more efficiently or helps them to survive. It is why the drug is being tested in other neurodegenerative diseases including Alzheimer's. David Dexter, the deputy director of research at Parkinson's UK, said: "The findings offer hope that drugs like exenatide can slow the course of Parkinson's -  something no current treatment can do. "Because Parkinson's can progress quite gradually, this study was probably too small and short to tell us whether exenatide can halt the progression of the condition, but it's certainly encouraging and warrants further investigation." Dr Brian Fiske, from the The Michael J Fox Foundation for Parkinson's Research, said: "The results from the exenatide studies justify continued testing, but clinicians and patients are urged not to add exenatide to their regimens until more is known about their safety and impact on Parkinson's." Follow James on Twitter
  8. 1 point
    There is correlation between insulin levels and Parkinson's patients taking Sinemet. In an article in Neuroscience Todayit showed the direct effect of Sinemet on Insulin. This issue, or interaction, is due to the fact that Sinemet interferes with glucose absorption by skeletal muscle.This causes an increase in insulin levels as the body attempts regulate this effect. It is normal when there is glucose in the blood that insulin stimulated muscle absorption and storage which, in turn, lowers glycemic levels. This study indicated that Sinemet stops this protective action. It is also believed that catacholamines (dopamine, norepinephrine, and epinepherine) may be destroyed by insulin.This could possibly lead to a cycle whereas Sinemet increases insulin which destroys dopamine leading to the need for more Sinemet. I believe you may have to possibly change the time of your insulin. My suggestion would be to take the insulin 1 hour prior to Sinemet or 2 hours after taking Sinemet. I believe that taking it 1 hour prior to the Sinemet would probably be best. I would also suggest you keep a journal of medications, times you take the medication, and any effects it has on you. This should allow you to fine tune when you should take the Sinemet in regards to the insulin.
  9. 1 point
    Cape, Lightheadedness and dizziness are very common side effects of Sinemet. As to why it did not happen straight out of the gate I am not sure. One thing to make sure of is that when he rises from a laying, sitting, or kneeling position that he does it slowly. The same should also be used if he arises from a position of being bent over. Since Sinemet can cause some dizziness and lightheadedness, it must also be pointed out that Parkinson's itself can cause Orthostatic Hypotention. This phenomenon happend when someone tries to get up to quickly and the blood pressure does not correct itself quickly causing the person to feel lightheaded and dizzy. So it could have beed a combination of the two that could be contributing to this issue. I also noticed that you gave him some grapefruit. Grapefruit is actually contraindicated when taking Sinemet because it can cause spike pr decreases in the amount of Sinemet into the system. It may also cause a blockage of Sinemet being absorbed in the stomach and intestines. If he were to take the grapefruit (even grapefruit juice) one hour prior to taking Sinemet or take the grapefruit 2 hours after taking Sinemet he should be in the clear. I hope this helps and please keep me posted.
  10. 0 points
    I am 55 and have had PD for20 yrs. I take Neupro 2 -8mg patches daily (european dosing), Sinemet 25/100 1 1/2 tabs every 2 hrs while awake, azilect 1mg daily. and amantadine 100 mg 3 times a day. I have been on this regimen for about 2 1/2 yrs . I have noticed over the past 3 yrs or so and especially the past year that I get very energised in the evenings. I get a lot of things done which is good. However , its getting so that I have a very difficult time stopping doing things and getting to bed. I am up until 3am many nights, I do not sleep well. I end up getting exhausted, have a couple of bad days where I can;t do much and then I start all over again. Of coarse mornings are hard and I never make appts until the afternoon, Does anyone have suggestions on how to get on a more normal schedule,. Can anyone explain why this is happening?