I've talked repeatedly about exercise recently. Now, let's take a look at medications.
Prescribed Medications for Parkinson's
- Sinemet (now the generic carbidopa/levodopa ) It's the "gold-standard" for treating Parkinson's. Levodopa is converted into dopamine. Parkinson's results from the loss of dopamine in the brain cells. Carbidopa is added to offset side effects from levodopa. For younger people with early-onset Parkinson's, doctors are reluctant to prescribe L-DOPA (levodopa) at the outset, because dyskinesias usually presents itself after several years of treatment. Dyskinesias is the jerky, dance-like movement of the arms and/or head (think Michael J. Fox in recent TV appearances). Most people assume this twitching is a function of Parkinson's, but it's not. It's the result of extended use of the Parkinson's med L-DOPA. Eighty years old when first diagnosed in September 2009, I started taking L-DOPA right away; I'm still taking the same dosage: 100mg three times during the day at six-hour intervals. I take mine first thing in the morning, and then at 11am and again at 5pm. To carry me through the night, I take an extended release L-DOPA (200 mg) at bedtime.
Initially, I was prescribed the brand name Sinemet. When I found out how pricey it was, I asked for the generic. My neurologist said the generic might be 10% less effective, but I switched to it anyway. So far, it works. I have a sense that I'm starting to have more balance problems, but it's not a major change.
2. Azilect This drug slows down the breakdown of dopamine in the brain, and is usually prescribed along with L-DOPA (Sinemet). I take 1mg once a along with my wake-up L-DOPA. Unfortunately there's no generic for Azilect and, boy, is it expensive. A 90-day supply costs $938.14, a price that my AARP medical insurance plan says it negotiated down from the retail price of $988.28. So, by itself, this prescription would push me into Medicare's "donut hole," when my total drug costs exceed $2840. I fell into the donut hole a short time ago. Once in the donut hole, I can purchase high-priced brands like Azilect at half price. But I'm considering using an online Canadian pharmacy for my next order, since that option undercuts even the 50% discount in the U.S.
For an earlier post I did on this topic: http://bit.ly/k3QsmzOther Prescribed Meds
Blood pressure meds: I take two of these: 1) Hydrochlorothiaz is a calcium-sparing diuretic, helping the body shed excess water while preserving calcium. 2) Losartan is often used in combination with hydrochlorothiaz to treat blood pressure. Both are generics so the cost is manageable.
Cholesterol: I've been taking Lipitor for years, and it has done an excellent job bringing down my cholesterol. When I started taking the drug, my total cholesterol was over 300. At my annual physical this spring, it was 151. My report indicated: "Your HDL, the desirable component, is really outstanding at 61."
With comments like that, I've stuck with Lipitor, even though it is much more expensive than the generic zocor, another statin used to treat cholesterol. Both Lipitor and zocor are equally effective in treating cholesterol, but most people can take half the amount of Lipitor for the same effect. I keep seeing reports that a generic for Lipitor may be available this fall. Hope so.Supplements That I Take Regularly
5-HTP -- This supplement gets a 4-star rating from me. I've discussed it many times on this blog and you can find those discussions by putting "5-HTP" in the search box. My regular dose is 50mg at bedtime.This minimal dosage wards off the depression and insomnia I was experiencing before my Parkinson's diagnosis. Following my engrained belief that "anything worth doing is worth overdoing," I've often added another 50mg 5-HTP with my 11am L-DOPA. After a few days, I become more outgoing. I laugh out loud, talk to myself, and am flooded with creative ideas. But when this starts to build, I've learned to monitor my blood pressure. If it begins to spike, I cut back to the basic one-shot 5-HTP.
For the past few days, I've stopped taking the 5-HTP. A holistic medicine specialist I met with yesterday said this was a good move. Taking a holiday from any supplement is advisable, he said. I used Tylenol PM for the first two nights as a sleep aid, but I don't like taking it much more than that since I've read that extended use of it can cause problems, particularly for the elderly (which my own experience confirms). Last night I did without any sleep aid and got a fairly good night's sleep. I'll extend the 5-HTP holiday for another couple of days.
Vitamin D and Calcium. Last December the Institute of Medicine (IOM) released a long-awaited report on its review of studies involving Vitamin D. It proposed a recommended dietary allowance (RDA) for vitamin D of 600 international units (IU) a day for most healthy adults. The RDA goes up to 800 IU a day for adults age 71 and older. The tolerable upper limit is 4000 IU.
With my gardening and walks, I spend a lot of time outdoors. So I was surprised when my annual physical found that my Vitamin D level was 26. According to my doctor, most authorities now think it should be above 32. My doctor recommended that I take a minimum of 800 to 1200 IU of Vitamin D every day. Since he knew I was taking a calcium supplement (which most doctors recommend for the elderly) and that calcium supplements are usually packaged with Vitamin D, he advised subtracting whatever amount of Vitamin D I was getting with calcium from 800 to 1200 IU recommended for Vitamin D. Since I'm getting 400 IU of D with my calcium supplement, I've added a 600 IU of D to my breakfast pills.Supplements I No Longer Take
CoQ-10: Preliminary studies suggested that large doses of coenzyme Q10 might help those of us with Parkinson's. So I started taking 1200 mg every day. Then, a couple of months ago, NIH stopped a large study of CoQ-10 at the midpoint because data showed it did not offer benefits greater than a placebo. Anyone want several bottles of 600mg CoQ-10?
Ginkgo Biloba: Some small studies found that Ginkgo Biloba showed modest improvements in cognitive function for elederly wirh dementia. But the results from a large study published in December 2009 found no evidence that Ginkgo Biloba prevented memory loss or slowed the progression of mental deline in the elderly.
Multivitamins: Once upon a time, most medical authorities recommended multivitamins. Several recent studies have questioned that general wisdom. Since there was disagreement on what these multivitamins should include, and because I was already taking lots of pills, I decided to bag the multivitamins.
New Supplements I'm Taking for a Test Drive
Resveratrol: This substance is found in the skin of red grapes and other fruit. But, before you reach for that bottle, red wine contains little resveratrol. Studies with mice and other animals have shown that resveratrol had a positive effect on life extension and cancer prevention. Of particular interest to me are the studies showing that it significantly reduced plaque formation (a component of Parkinson's, Alzheimer's and other neurodegenerative diseases) in animal brains. No reports exist yet on studies involving humans. I take one or two Resvantage pills a day. They contain 15 mg of resveratrol and 25 mg of grape seed extract.
Creatine: Naturally synthesized in the human body from amino acids in the kidneys and liver, Creatine seems to benefit muscles. It's widely used by athletes, body-builders, sprinters, and professional baseball and football players. The Mayo Clinic reported that Creatine may build muscle mass, help treat various neuromuscular diseases, and delay the onset of symptoms when used with standard treatment.
So I got a supply of creatine. Following the directions on the bottle, I take a pill before I begin my early morning walk, and another when I get home.
Mucuna Pruriens: The first two supplements listed above are very widely used and known. But this one is more exotic. Mucuna pruriens is one of the most popular drugs used in Ayurvedic medicine, which originates in India. It is a vining plant, also known as velvet bean, native to India, where it has been used for generations to treat Parkinson's. Mucuna Pruriens contains high quantities of natural L-DOPA. One study concluded that this natural source of L-DOPA might possess advantages over the conventional Sinemet and its generic because of its more rapid onset of action and longer "on" time, without an increase in dyskinesias.
The pills I found on line are called "Dopa Mucuna." Each pill contains 800mg of Mucuna Pruriens and 120 mg of L-DOPA. I take two after breakfast.
I asked my neurologist about these supplements when I saw him a month ago. He saw no problem and possible advantages to taking the creatine and the resveratrol. He was going to check on the mucuna pruriens and get back with me, but I haven't heard anything yet.