<H1>Pop goes the weasel</h1>

I will admit I am a bit of a hypochondriac when it comes to PD. I have to be logical and not attribute every little pain to parkinson's.

Well, that's not going to happen! I am too involved with the condition. For example, check out these symptoms:

1. stiffness - I seem to be stiff all the time, especially my lower back
2. My lower back can be quite painful at times.
3. leg muscle cramps are making more frequent visits
4. I am slow - my god, I move at a turtle's speed
5. I have lost confidence in my ability to walk more than a half mile without feeling dizzy

   WHAT'S HAPPENING?

   I turn to the internet for answers and find from Western Australia Parkinson's the following:

   1. In the beginning
      When you first start taking levodopa, you feel a noticeable improvement in your Parkinson’s symptoms that is maintained throughout the day. Your medicine effectively tops up dopamine levels within your brain for several hours, so most people get effective symptom control with three doses per day.
   2. Why things change
      Parkinson’s is a slowly progressive condition, so the symptoms you experience will change and evolve over time. The dopamine level in your brain gradually declines, which makes it harder for each dose of levodopa to prevent symptoms re-emerging. Doses of levodopa are effective for a shorter time. When this happens, most people start to experience fluctuations in symptom control throughout the day.
   3. What is wearing-off?
      Wearing-off is the term used when the effects of levodopa ‘wear off’ or diminish before it is time for the next dose. Symptoms of Parkinson’s return or worsen before your next dose of levodopa is due, and improve after you take your next dose. Many people refer to themselves as ‘on’ during the time when their medication is working, and ‘off’ when the medication has worn off.
   4. What you experience
      For some people, wearing-off can begin within one to two years of starting levodopa therapy; for others, levodopa may remain effective for five years or more. Everyone’s experience of Parkinson’s is different, so the wearing-off symptoms you notice are individual to you. Many people find that problems with movement (motor symptoms) return during wearing-off, but other symptoms (non-motor) can also occur...
   5. Diagnosing wearing-off Because people with Parkinson’s usually visit their doctor when they are ‘on’ (i.e. medication working), your doctor may not realise that your symptoms return between doses of medication. Don’t wait for your doctor to ask about wearing-off – tell them how long each dose of medication is working for and what happens when it wears off.
   6. What can be done?
      Your doctor can help you manage wearing-off by adding to or changing your medication, dose or schedule. There are several ways to increase the time you spend ‘on’ and decrease your ‘off’ periods. These include:

   • Changing your dose, dose frequency or timing of medication
     
   • Changing your medication to include drug(s) that prevent breakdown of levodopa within your body (these can extend the duration of benefit of levodopa, and may be combined with levodopa in a single tablet or taken separately).
   • Changing the formulation of your levodopa to provide controlled release
   • Adding another class of drug, such as a dopamine agonist, to your medication.
6. Am I experiencing wearing-off? A wearing off question card has been developed by Parkinson’s specialists to help you recognise whether you experience wearing-off. Each question asks whether you experience a certain symptom during a normal day, and whether this symptom improves after taking your next dose of medication. If one or more of these symptoms develop during a normal day, and improve after you take your medication, you may be experiencing wearing-off.

HOW ABOUT ME

Who knows what our dark shadows have planned? We are all different. I started off this epistle by recognizing my hypochondria and so I believe I may be in the early stages of wearing off as my symptoms are a little (tiny) bit worse about a half hour before my mediation is due, but every problem described above in the opening paragraphs can be explained,

• stiffness - I don't do enough stretching and sitting at a computer for hours on end does not help
• Lower back pain - I have had back problems since I was 16; although they have been on hiatus for a few years prior to a couple of months ago.
• Leg cramps are more frequent but not nearly as painful as when they first appeared
• walking ability - first gear speed is persistent but is probably just an indication of the advancement of PD, rather than a wearing down feature.

I hate this condition. I will continue exercising daily to slow it down but I know it will get me in the end - unless of course cures postulated in the media prove to be true, but then, there is that whole "Fake News" kerfuffle in the USA