Very interesting question. I have been told that I have not been put on the right dose to achieve best quality of life. However, it is my understanding that the more medication you take the higher risk of getting the involuntary movements. If that happens sometimes those movement become permanent even when the meds have been removed. I know someone here knows the name for that side effect, I think it is called Dyskinesia.

Getting the shakes under control was a priority for me. I have chronic pain from multiple car wrecks so the tremors caused the pain to go off the charts.

Your husband has to decide for himself at what point he is willing to put up with the inconvenience of the Parkinson shuffle and other symptoms. That is the point where his puts a hold on the increase of medications.

Some people are able to get their symptoms totally under control and no one would even know they have Parkinson.

It is good that he can still work. He may want to increase the meds enough so he does not shuffle, which may cause him to fall.

I use a lot of humor to address the questions and stares. He could tell them he is practicing a new dance. I use a walker for short distances, so I tell people I left my roller blades at home. If I use my motorized wheelchair, I tell people I only have a Learner's Permit so watch out. It seems to break the tension. So many people get nervous around someone who is having challenges and feel uncomfortable, not knowing what to say or how to act.

It is good that you can do the "Medical Talk". I have been the medical person in my family. I was the Caregiver, now the roles have changed and my husband has no idea how to understand my medical challenges. Very difficult.

My only advice is to check out the long term side effects of any medication that they want to put him on.

Best wishes-RJ

8mg requip 3 xs a day = no tremor for me. Neuro added Sinemet 25/100 for the "gait" issues. Once meds kick in (1/2 hr or so) I can ride a bicycle, walk, etc. without people picking up that I have Parkinsons. However, I'm concerned that one of the PD meds is causing other issues. Neuro said to leave PD meds as is. Everyone is unique and people shouldn't ask why a person walks the way they do.

Juniper sage, the sinimet should help with the tremors and the gait issues. Drs often try to hold back on starting it because it has a limited efficacy. You need more and more over time to get the same result. At the same time the rate at which pd progresses is different in everyone. LIfe is short and comes with no guarantees.. Make hay while the sun shines. My approach is to get the besr\t possible control now. I still work full time plus a part time business. I go boating and fishing every chance I get. I raise money for pd research thre the Unity Walk and run the local support group. I am a candidate for dbs in November. The balance between symptom control and overmedicated and dyscaneasias is different for everyone and changes over time at varying rates. Don't be med shy. Keep a log of meds taken time, effectiveness, how long to kick in how long to off time symptoms food interaction with meds responsiveness especially In response to a protein meal? by sharing this journal with your dr. he will have a much better tool that the short time spent at an appointment where you want to show how good you are doing.

I will be the "fly in the ointment" for now!

I've had PD for a very long time: 36+ years. In the last 15 years I've been on many different meds, plus I've had DBS for both sides of my body to help REDUCE any dependency on the meds, thus avoiding any possible long term side effects. After these many long years, I have thrown away the usage of all meds but Carbidopa / Levodopa (generic Sinemet).

What I will tell you, and this is my personal opinion based on personal usage with dire results,, get your husband OFF of requip, the sooner the better. Requip and its companion agonist, Mirapex, are by far the worst in side effects and your husband will lose control of all things requiring mental acuity!

Then, get a new doctor.. Preferably a Movement Disorder Specialist (MDS) who will prescribe a titration schedule of Sinemet for him This is a very slow ramping up doseage until his symptoms are under control, as time goes on, the dose will be tweaked to maintain his functionality.

You will read from misinformed PWP that C/L stops working after five years. That is a fallacy! I have been taking it for 15 years now with no side effects. I have friends who have been taking it for 25 or more years with no side effects! Carbidopa / Levodopa (Sinemet) has long been considered the "Gold Standard" in treating the many symptoms of PD!

IMHO: the side effects of Sinemet are much less serious than those presented by either of the agonists I've mentioned, Requip and Mirapex.

Do your homework on the agonists and not only will your husband benefit, but you will also in the long run. If I am an example, then your husband will have a "long run" also!

My prayers are with you both! Jim
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You are right to question the Neuro, do lots of research (many of the PD sites have help lines.....) and it sounds like you are a very attentive caregiver! I thought the Requip mostly helps my tremors; however, this week I had my 24 mg. daily dose lowered to 20 mg daily, and discovered that gait was also impaired. The Neuro suggested changing my dose timing: I used to take Sinemet with Requip at 6:00, noon, 6:00, but now take Sinemet only at the old doseage time, and the Requip 1 1/2 hours later. Back to my preferred no tremor/little gait issues. Hang in there! Have you tried Physical Therapy at all for the foot drag or shuffling gait? I found certain exercises "reminded me" to pick up my foot and not drag it.

Thanks, eebit. I have been trying to find physical therapy for him, but no luck so far. We are in an HMO and they tell us that falls under "specialty physical therapy" and the nearest facility that has it is an hour and a half away. Three hours round trip travel plus an hour or two for the appointment would basically mean a full day off work for him. My husband and I still work full time and since he also has frequent medical appointments for heart problems and has to take time off, there is just no way we can do that. I have tried to find a local provider, there are some classes but usually held during the day time. So now I am looking into working with a personal trainer at the local gym and encouraging that person to become more educated on PD-appropriate exercises. That may be the best we can do for now.

Meanwhile we have moved up to a dosage of 3 mg, three times a day (9 mg. daily) but still not seeing much improvement over 6 mg. I told him we can step back down any time but he is game to continue on so we may continue to step up until 12 mg. and then see how its going. He's never fallen but often has minor stumbles when turning or starting. This summer we rebuilt a back deck and spent many days walking across 2 in wide joists suspended between 3 and 10 feet in the air. He got a lot of satisfaction out of it but oh, I was holding my breath the whole time!

Just a thought - Maybe your HMO would pay for you to go to the Physical Therapist for a couple of consult visits. Have the PT person put together a home program for your husband. Ask for pictures and directions so you can refer to it.

Then take that to local PT office and see if they can help him with those exercises and some core strengthening. Maybe he would not need to go to the local PT if you are able to help him with the home program. Just some thoughts.

Wishing you and your Hubie well. -RJ

I definitely would have titrated up slower (didn't do research and was too trusting.) I was lucky at first in asking at local gyms finding a trainer who had MS, teaching Yoga & Water Aerobics, at a modified level. I think the trainer at the gym idea is brilliant! And a little humor helps: I carry a card that states on the top : I AM NOT INTOXICATED, I HAVE PARKINSONS DISEASE.

Found a guy named Patrick in San Diego pt on a pd site who has exercises on YouTube. ..

You are lucky that Requip works. It did not work for me.went straight to sinamet and then to DBS. Listen to your neuro. If he can tolerate the symptoms , that is good enough. You will never feel 100%. Don't rush to Sinamet it will be there when you needed. It helps from beginning ,but then your body stops producing it and you want more. You re at your max, they cannot increase it no more. That's where the problem starts. If the idiots at work keep asking why he walks like that , tell him to say something smart. Like " I am learning new dance steps. " There is not many new treatments they just rework the Sinamet. The DBS helps, but not for ever. That too has its limitation. Exercise slows the progression of PD. So take walk with him, or swim. That is good therapy.Rest enough , exercise enough that will help.