Is the neurologist you are to see in late August a Movement Disorder Specialist, rather than a general practice neurologist. The the latter, I personally recommend seeing a MDS...that is always the best place for any PWP to be.
(1) How many 'good years' can she expect from Levadopa? For me the answer to this question is about dosing and what the patient is willing to "endure" on a daily basis. My first symptom was discovered by an alert Internist in 1988. I have been on levodopa since 1997, but I have taken it in a dose that helped me, rather than a dose that made my symptoms completely disappear. Hence, I have been able to get through the years until 2006 when I began having mild dyskinesia. So mild that I only have this mild dyskinesia for the first 20 to 30 minutes of each dose...every three hours at this point in time.
(2) Is it likely that someone will benefit longer from L-dopa if you have previously been on an agonist? ditto ol'cs
(3) Does the 5 year 'honeymoon' period that people write and talk about include the time on Mirapex? ditto ol'cs.
But personally, I don't know that there is such a thing as a honeymoon period. I know, I too have seen this. PD is relative...relative to the individual patient...relative to the mindset of the patient...relative to the time between first symptom and official diagnosis...relative to how much stress is in the patient's life...relative to whether the patient has dystonia, overall stiffness, dyskinesia, all of of them, none of them, one of them...so many issues color.
But to use ol'cs definition, I guess I have been in my honeymoon period since 1988. I did stop working in the work-a-day world in 2000. I can still fully care for myself from getting out of bed (pulling myself in to a sitting position using the heardboard and the wall to balance myself as I put my feet under me and stand up...I have lived alone the entire PD journey). I still drive...and no I don't scare the other drivers...yet!! To date, I haven't found anything that I can not do when I put my mind to it.
(4) Can she still get benefit from higher doses of Mirapex? I read some of the trials which seem to indicate that the benefits max out at 1.5 mg per day. Are there folks who benefit from higher doses? I think benefit is up to the patient, and how the patient, along with the doctor, feel the agonist should continue. I am currently at 1.5mg a day, along with a total of 700mg of levodopa. The longer on an agonist and as long as it is doing an adequate job, the longer before levodopa.
I could take much more levodopa, since my off time is about 50% (not 100% off, but NOT at my best...my totally at my best is about 30 min each dose), but I don't want to increase my dyskinesia. It has been my decision to avoid dyskinesia by increasing Mirapex over time, rather than increase levodopa, and live through the annoying off. Being a little off for 50% of the day is tolerable to me...a very personal choice...some would say nuts to this.
"Recommended dosage...ADULTS...The usual starting dose is 0.125 milligrams 3 times a day. If necessary, your doctor may increase the dose every 5 to 7 days until the
maximum dose of 4.5 milligrams a day is reached. Dosage is usually increased gradually to minimize the drug's potential side effects. If you have kidney disease, the doctor will keep the dosage quite low."
This website shows the sliding titration scale used to increase dose:
RXList.com...Mirapex...Indications & Dosage