Questions for my mom
 

My mother is 82, and has had Parkinsons for 11 yrs. About 10 yrs prior to that she had a 6 inch tumor removed from her spinal cord, and functioned well after that until the parkinsons. She takes sinemet cr 25/100 every 4 hrs, or sometimes after 3 hrs. When she is ON she still hangs laundry out, works around the house, etc. She is tremor dominant, and when she is off she becomes very weak, can barely walk, and more recently has trouble swallowing and breathing. She says it feels like her throat is swollen on the inside, and it feels like there is a shelf behind her nose where mucous gets stuck. She becomes very nasal / hoarse,her voice and appearance change and she is also depressed during this off time. Benadryl does not work for this, says it makes her head 'roar'. This does not happen with every off time, it is every evening at 6pm and last 2-4 hrs. It will let up, then starts again when she trys to go to bed, also there is something about laying down that starts all of this also. Her MDS has recently started her on Zelapar in additon to the Sinemet, but she has not taken it the last 2 days, she says there are some side effects, and it doesnt help the symptoms. Has been on it about 3 weeks 1 pill a day. The Dr. wanted her to increase to 2 a day but she did not get that far with it. She is very sensitive to meds. She uses vicks and Astelin during this off time, but they dont help much either. When the off time eventually goes away, so does the sinus, breathing issue. An allergy Dr. ran test on her several years ago and the only thing that she reacted to was the test spot. He told her it may be something in the Sinemet Cr, but if that were true, wouldnt those symptoms be there after every dose? She was also given Remeron, but is affraid to take it. Her MDS said that those symptoms are the parkinsons coming thru, but again why only in the evening?
I have lurked here since old b/t days, but have never posted. I have learned a lot from this forum and from all of you. Thanks.
Narda

there are many drug therapies......
 

your mom can try.. Agonists, COMT Inhibitors, etc. Remind your mom, that almost all PD drugs have side-effects, but that they usually go away with in a couple of months, or you learn to live with them. Some she simply will not be able to tolerate, but most she will, and they will help her.
Patience is the key! It takes a while to arrive at a effective drug protocol.

Charlie

Sinemet CR
 

Not all doctors agree on many different medications. Sinemet CR may not be strong enough to kick in. The symptoms you describe sound as if she needs more sinemet. Maybe you could discuss with the doctor to add levodopa/carpidopa 25/100 1/2 tab to one or two of her doses and see how she does.

Your mother must be lucky to have a daughter as wonderful and caring as you. God Bless and Peace be with you.

Vicky

sorry, I did not see.......
 

the CR, I agree with Vicki. A change to regular Sinemet will most-likely help her.

Charlie

Super1950.........
 

YOu said sinemet cr 25/100 ??? Sinemet cr is formulated as 50mg carbidopa to 200 mg of levodopa, that is 50/200, it is a peach colored tablet not a yellow colored one. I think that mom should take up one or two 25/100 sinemet regular release along with a 50/200 Controlled release sinemet every 8 to 12 hours, this giving her a total l-dopa intake of 800-1200mg /day. Start off with 800 mg/day total L-dopa as 1200mg may be too much rigth now. Maybe also include 100-200mg/day of amantadine, and some Klonopin for tremors 1-2 mg /day. I'll bet that she is undermedicated and doesn't have anything in her bloodstream as a dopa reserve. Just my opinion. cs

Thanks for your replies, long day, just got home. I forgot to put she is taking Two- 25/100 sinemet cr (mfg by Merk)every 3-4 hours, and her MDS said if she needs them in the night to take them. She has to take the brand name, and she did try regular sinemet, which caused nausea/vomiting resulting in her weight going from 143 in 2001 when she started regular sinemet (the neurologist also had her on comtan back then too) to 101 at her last MSD visit 3 weeks ago. She did try brand name sinemet again a few years ago in addition to the CR, but the nausea/vomiting started again.

The main concern now is the feeling that her throat is swollen, feeling of not being able to breathe, and the mucous. All of which go away when the sinemet cr eventually works. The Zelapar was just introduced 3 weeks ago to be taken in addition to the CR because the off times are lasting longer, I guess its really too soon to tell much about the Zelapar.
Thanks
Narda

You really are going to have to go back to the doc to sort this one out. Your mother's age makes treatment choices complex, i.e. some of the helping drugs that might be used, like the Anticholinergics, are very hard on the senior set, yet the right one closely monitored could provide relief.

The tightness of the throat can be a Parkinson's symptom, but it can also be a PD symptom that is aggravated by her environment. The throat acting up in the evening may be from fatigue or as the house cools and the furnace runs more the air gets dry. Forced air furnaces blow dust around no matter how spotless we are. So air quality, PD and fatigue can act on the throat. A humidifier or vaporizer in the bedroom can help. A window open a crack for some fresh air may help. With the medications you mentioned be really careful as many cold meds are out. They are relatively new drugs to me.

Remeron is an antidepressant and can take one to several weeks before you mom would notice depression lifting. Zelapar is a drug that helps Dopamine work better, and it is not to be taking with a number of cold medications hence the check with your doctor suggestion. Lastly, if she has mucous staying stuck it would be useful to insure she doesn’t have a throat infection - sometimes they are stubborn and just don’t go away unless treated. So in summary:

Anticholinergics – for difficulty swallowing, careful with elderly
Air quality and humidity - check
No cold meds or antihistamines without doctor b/c of medication interactions
Throat infection – check

As always suggestions only – seek medical help.
Regards, Guy