Shaking in the morning
 

Hi everybody, I am here to ask questions on behalf of my 91 year auntie.
For the last 5 months she has had been shaking in the lower half of the right arm mostly, but on occasions the left arm will shake as well.

She refuses to go to a neurologist because of a prior testing of an Angiography for a completely different problem, so her GP suspects parkisons, he has slowly been increasing meds [ Levodop & Carbidopa 100mg /25 mg ] , she is currently on 1 tab morning and 2 at night, her shaking has defiantly improved but every morning she gets out of bed and she is fine but a couple of minutes after sitting down at the breakfast table her right arm shakes badly, sometimes her left arm shakes as well, her right arm usually shakes for 1 hour or so then she is fine for the rest of the day just a twitch every now and again.
So my question is the morning shaking a normal thing for this condition ? tablet dose related perhaps ?
If anyone has any thoughts on this it would be very much appreciated.
thanks

Brian,

What I find for myself is that I wake up feeling good, with little tremor. If I don't take any pills, I gradually decline over the next few hours. When I get around to taking my first drugs of the day, I tend to get worse to begin with, with tremor peaking. After a while, as levodopa levels have risen, my tremor almost disappears. Then, as the dose wears off the tremor increases again.

What is the timing of your aunt taking her first pill and eating breakfast?

I am surprised that she is taking only two doses per day, with the larger one at night. The short half life of levodopa means that she has very low levels of levodopa for most of the day. Is she moving around during the day? If she is mobile during the day, in spite of such a long gap between doses, it suggests to me that she is still producing and storing dopamine.

How long is it that your aunt thinks she has had PD? It is more normal to present with the symptoms on one side of the body only. Then, as the disease progresses over the next few years the other side becomes affected as well. Does she have any other symptoms of PD such as slowness of movement, rigidity, loss of smell, constipation etc.?

I think she should see a neurologist.

John

I agree with John. Sounds like the medicine is helping her, but she needs a firmer diagnosis and, if the neuro feels it is PD, fine-tuning of her meds. Once her dose is titrated and stable, she might only need to return to the neuro 3-4 times a year. All the best to you and to her.

Thank you both for your replies, the doctor and the rest of the family wants her to go to a neuro for an experienced evaluation/diagnoses but unfortunately there is no way on this earth that she will go, we have all tried really hard to get her there but nothing has worked and I am sure that nothing will.
Medication wise, she takes one pill directly before breakfast then about 10 minutes later she starts shaking, then at night 2 tablets just before she goes to bed.
She is not very active during the day mostly sitting and does a lot of reading, only moving when necessary, the doctor has been very slowly increasing the meds over the last 3 months and she is due to see him again in about 10 days.
Her symptoms started about 4 to 5 months ago, it was very hard to get her just to see her local doctor then, we have trouble getting to her attend followup appointments now.
She doesn't have any constipation, she is slow moving but at 90 years I think it is more age related slowness than anything else.

She did have a fall and hit her head hard on a concrete path about 9 months ago, she was taking to hospital and a CT scan was done and there was no problem found, after that fall we noticed her short term memory has been becoming increasingly worse over time, she was good before the fall .

Thank you for your interest.

It occurred to me regarding your auntie ... some areas of Australia are served by Parkinson's nurses. Are they available in your area? If auntie won't go to another doctor, she might agree to be seen by a Parkinson's nurse to have her doses tweaked a bit. Alternatively, her general practitioner could try to obtain a phone consult from a neuro regarding that dosing ... if he would mention to the neuro that auntie takes one tab in the morning and two at night and that she shakes after her AM dose, the neuro may be able to guide him quickly to a more tried-and-true dosing pattern. I hope that she does well, Brian, and that she appreciates your kind concern.

I am sorry, I did not have any internet the last few days I just got it connected again.
They are very good suggestions which I will look into, I thank you very much for your help, it is really appreciated.
have a great day
regards
Brian :)