I met Louise for the first time in Brookside Health Centre at 10:00am.

Key points:

My tremors are likely to give me more trouble at times of worry, hurry, stress, etc. If that begins to cause me difficulty I could think about increasing my Sinemet dose.

Equally, it might help me to consider a low dose of Citalopram as suggested by Dr Furby. Louise agreed that I was not depressed. She explained that the Citalopram would be prescribed not for depression, but to enhance the activity of the Sinemet. Apparently Parkinson's patients do find this helpful.

The function of Rasagiline was likewise to improve the ability of Sinemet to cross the blood brain barrier. I had been prescribed Rasagiline on initial diagnosis as a first step in medicating the condition.That was three years ago. Apparently patients are no longer started on Rasagiline. I asked whether I should stop taking it, as it costs the NHS about £1,000 a year. Her answer was no.

Lifestyle is important. the brain must be kept well fed and watered, and given enough good sleep. Some PD patients find their REM sleep disturbed, sleeping so much during the day that they have poor sleep at night. I do not appear to have that problem (yet!). However, power naps are OK.

I should aim to take in more liquid: tea, coffee would be fine as long as I avoid taking in as much caffeine as would disturb my sleep.

Later on I may find it difficult to get out of bed in the morning, and if that becomes a poroblem I may have to take my first dose before getting out of bed. But for the time being I need not worry about that, or more generally about separating Sinemet doses from mealtimes. My PD has not reached the stage when protein in the gut would neutralise the effect of the drug.

Having a good balanced diet is important. I should avoid fads, like cutting out butter. My present regime appears sound; breakfast of olive oil fry-up or fibrous cereal with milk by turns; light lunch of cheese and biscuits with fruit: apples, pears, bananas, sometimes grapes; light supper around 7:00pm