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MComes RPH

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MComes RPH last won the day on October 17

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About MComes RPH

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    Board Certified Pharmacist, Medical Board Member, & Consult
  • Birthday 05/24/1968

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  1. MComes RPH

    Gum Enlargement

    Appala, It sounds like you're in top of it. Please keep me posted.
  2. MComes RPH

    Gum Enlargement

    Appala, I would also recommend using Listerine. It may taste bad, but it works well at removing plaque and promotes good teeth and gum health. I forgot to mention the use of a bite guard. Since Parkinson patients have a tendency to grind their teeth, this is a good way to stop and damage to the teeth. I hope this helps and please keep me posted.
  3. MComes RPH


    John, It looks like they have combined all the ingredients together. Their dosing regime is 4 capsules Four times a day. I would suggest to start with 4 capsules in the morning for about a week. After that you can increase by 4 capsules every week for the next 3 weeks if you feel you need to. I don't necessarily believe that you would need all 16 capsules a day, that is why I suggest starting at 4 capsules per day and increasing if you need to. Also, if you are feeling better at the 4 capsules per day then you did prior to using it, you should try that for a couple weeks. This will help to lessen the chance of tolerance with the medication. I don't see any harm in the full dose of 4 capsules Four times per day, but I don't believe it is necessary to start off on that regime. I hope this helps and please keep me posted.
  4. MComes RPH


    Cereus, No problem, any time. You know where to find me. I hope this helps and please keep me posted.
  5. MComes RPH


    Cereus, Great question. I recommend this as an additive to your regular medication regime. It may be used to enhance your treatment or may help you decrease other medications due to side effects. I also recommend that people do not stop taking any of their medication without consulting you Doctor or Pharmacist. I hope this helps and please keep me posted.
  6. MComes RPH

    Privacy vs Research

    Rappleman, I knew that it had been on the books for a while. I had a speaking engagement at the University of Nebraska about 10 years ago and very little was muttered about it. I too usually write in narrative neither choosing sides and reporting facts. I had to pull myself from center because you asked what I thought of this. It does affect me on both fronts, as a patient and a Pharmacist. Keep me posted and I'll do the same. I hope this helps and please keep me posted.
  7. MComes RPH


    Hiker, They should not, but this may be different for each patient. That is also why I recommend that you start low and go slow. I hope this helps and please keep me posted.
  8. MComes RPH


    Hiker, The results would be better is all 3 products were used. What can be done if doses greater than twice a day are needed might be able to keep the Green Tea at twice a day while increasing the others to three or even four times a day. I hope this helps and please keep me posted.
  9. MComes RPH

    Privacy vs Research

    Rappleman, I actually had to pull up the law in order to believe it. I will say, first and foremost, I believe this should be a volunteer situation and not a mandate. I could see how it could be a research opportunity, I also see it as an invasion of privacy. I would guess that most PD patients would volunteer this information with the hopes to advance research and possible development of new physical and medication therapy. I know that many PD patients would try almost anything to better their situation. I did notice that in the law it stated that this is a state law which would avoid the Federal law of HIPPA. It has always been taught and acknowledged that the most stringent law, Federal or State, would be respected as the rule. This is the rule when it comes to medical marijuana. The State may say it is legal, but it is still illegal on the Federal level. In this case the Federal law of patient privacy should override the State law. Also, since this is a state law, there should be no need for a Federal indentifier such as the Social Security number. It can also look like lobbiest for drug companies, insurance companies, and agents for Medicare might be involved. This may result in insurance companies denying claims due to preexisting condition. The last blatant issue I see is that some PD medication can be used for other ailments. For example, Mirapex, Requip, and Sinemet can also be used for Restless Leg Syndrome. This would then force the Pharmacist to report this without a diagnosis of PD. I wanted to reply to this as soon as I read it due to my beliefs as a Pharmacist and PD patient. As I investigate this further, I may post more of my beliefs. I hope this helps and please keep me posted.
  10. MComes RPH


    Hiker, The doses I would recommend would be the following: Great Tea: 200mg L-Tyrosine: 400mg N-Acetyl-Cysteine: 400mg These are the strengths of the individual capsules. The maximum daily dose is actually 4 times a day, but as always I recommend that you start low and go slow. Just because there is a maximum daily dose does not mean that you need to take that amount to be effective. Once, twice, or even three times a day may be effective. I would start off with one capsule of each once daily, preferably in the morning. Try this for a week, at which time you can increase to one capsule of each twice daily, in the morning and late afternoon. I would also recommend not to take the Green Tea too close to bedtime because it can act as a stimulant which can affect your sleep. After the week of taking each twice daily you can then increase to three times a day if needed. After this third week on the medication you may increase to taking each capsule four times a day if needed. Most people have success at lower frequencies, such as one to three times a day. I hope this helps and please keep me posted.
  11. MComes RPH

    Decreasing Diphasic Dyskinesia

    Camt68, I'm glad that things appear to be moving in a positive direction. I know that it can be aggrevating when you still have one nagging issue that persists even though your overall quality of life has increased. I understand that for now you want to use up the remaining Ropinirole ER 8mg and I don't blame you, medication is not cheap. My suggestion would be to add regular strength Ropinirole throughout the day to help decrease the amount of Sinemet you take and to possibly help with the Dystonia. Adding any new medication, especially PD medication, we should start low and go slow. This is the best way to avoid side effects and over dosing of the medication. With that said, I would keep the Ropinirole ER at the time that is working best for you, and add Ropinirole 0.25mg spaced out to start at two to three times a day. This will also allow you to see what times of the day you might need a higher dose. The regular Ropinirole comes in a variety of strengths which allows you a great deal of change. The strengths available are 0.25, 0.5, 1, 2, 3, 4, and 5mg. tablets. You can then adjust each dose accordingly throughout the day to best help with symptom relief. I hope this helps and please keep me posted.
  12. MComes RPH

    Triazolam for root canal

    Market, This class of medication is used quite often in dental procedures to help a patient anxiety for a procedure. This Triazolam does have an onset of action of about 30-60 minutes, and the effects can last up to 8 hours but usually do not. It may be in your system for up to 8 hours, the effects can usually last 4 - 6 hours maximum with the effects diminishing over time. The side effects, which are usually minimal and limited to some drowsiness, will also diminish over time is the happen at all. The dose you were prescribed is a very low dose, but will still be effective. The other medications used for this practice are usually Valium and Xanax. Both of which have a similar onset of action as Triazolom with the same side effects and duration of action. I would make sure to take your PD medication about 30-60 minutes prior to your dental appointment, or the time before the appointment that it takers for the medication to work. I am sure that the dentist has prescribed this before and is versed in the anxiety relief. Many times with PD patients, as anxiety increases so do PD symptoms. That is why I suggest that you take your PD medication prior to the dental visit. The dentist is also trying to be pro-active. If the medication is not taken prior to the procedure, there is a reason to believe it may be needed at some point during the procedure. This would mean that the Dentist would have to stop the procedure, allow you to take the medication, then have to wait for the medication to work, which could take 30-60 minutes. I believe in your situation the benefits much outweigh the risks. The only interaction may be excessive drowsiness, if your PD medication causes drowsiness also. I hope this helps and please keep me posted.
  13. MComes RPH

    Dystonia Pain

    Super, I'm actually able to control the range and strength of the electrical charge to the leads. There is a max level of current that can be obtained, but I have never come close to using it. When the level does get a bit too high the result is some tingling in that area. I do have to present a card at airport security. This procedure has actually been less due to the enhancement of non-magnetic security screening. I have tried several medications for PD and muscle relaxation that have helped, but not to the extent of the stimulator. I hope this helps and please keep me posted.
  14. MComes RPH

    cold sweats

    Maryjane, Unfortunately this is quite common in PD patients. There are several medications available to help this situation. The Amitriptyline you mentioned does help with excessive sweating. If it was effective in the past for him it may be worth a try to ask his new Doctor or Neurologist to prescribe it again, maybe at a higher dose. Another group of medications that also work well are called anticholinergics. Of these, Benztropine and Robinul seem to be the most effective. A class of medications known as antiadrenergic's have also been successful at controlling excessive sweating. In this class, Clonidine and Terazosin seem to be the most effective. An extreme, but effective option is Botox injections. Unfortunately this is mainly used for excessive localized sweating, such as in the case of underarm sweating. Topical applications are also available for localized use. I hope this helps and please keep me posted.
  15. MComes RPH


    Miracle, Unfortunately, as long as the Apokyn is being used the Tigan will also have to be used for prevention of nausea and/or vomiting. Like I said earlier, it is usually started about 3 days prior to the first dose of Apokyn. It is used to control the nausea and/or vomiting of the Apokyn and is normally on used for the first few months of therapy. Keep in mind that not everyone may need and anti-nausea medication. It is used as a preventative measure for the side effect of nausea/vomiting. The belief is to use as a "just in case" because that side effect may make Apokyn less desirable to use. I haven't heard from you in a while, how have you been? Is your current drug therapy working for you? If so, what is your current therapy? I hope this helps and please keep me posted.