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Advocating for Parkinson’s Disease in a Hospital Gown

surgery

Last week I had surgery. Little did I know that it would be a great time to advocate for Parkinson’s disease (PD).

It began with the registration process two days before my hospital check-in. The hospital’s admittance clerk called me with some last-minute instructions for my surgery, which took place two days after the phone call ended. 

The instructions were routine, such as not eating after midnight, not drinking after 6 a.m., and showering with that pretty, pink liquid soap. You know — the usual. While on the phone, we went over the medications I take, and the clerk asked me how one of my medications worked for me. 

Her husband is in his sixth year of battling Parkinson’s disease, and his symptoms have been worsening in the last year or so. We talked for about 10 minutes, and I felt I was able to encourage her and provide some pointers that might be helpful for them to discuss with his neurologist. She repeatedly expressed her gratitude and was appreciative that I took the time to talk to her.

Surgery day also presented opportunities to share my experience with Parkinson’s disease. 

I discussed with my pre-surgery nurse the dangers of antipsychotic medications such as Haldol (haloperidol) for people with PD. Potential side effects can leave Parkinson’s patients in worse shape than when they were admitted. This is why I wear a red allergy band when I have any procedure in the hospital. The woman had been a nurse for over 14 years and had never heard of Parkinson’s patients having adverse reactions to antipsychotic medications.

After surgery, I had the opportunity to speak with another nurse who asked all types of questions, as she has a close friend who has PD. The nurse was eager for any information to share with her friend. 

I told her about a support group, Rock Steady Boxing, our state’s PD resource center, a physical therapist who does the LSVT BIG program for PD patients, and more. I shared with her my Parkinson’s website, and she took down information to look into Parkinson’s News Today. Her response to the information I gave her was much like that of the admittance clerk: extreme gratitude. 

I reflected on these opportunities and was grateful to have been given them because sometimes I wonder if my experience with Parkinson’s has made a difference for those coming behind me. After looking back, I think so. At least, I hope so.

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Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

The post Advocating for Parkinson’s Disease in a Hospital Gown appeared first on Parkinson’s News Today.

Fighting Fear Ahead of Another Surgical Procedure

surgery

I have had several surgeries in my lifetime but have never fretted over them beforehand. I think that’s because the procedures were all to deal with my Parkinson’s disease, and I explicitly trusted the doctors in each situation.

As I write this, I have another surgery tomorrow, and I must admit that I am a bit nervous. Not because I don’t have confidence in the doctor who will perform the surgery, but because I haven’t had a surgery that didn’t involve my brain. You’d think I have that backward. 

I am going in for something unrelated to my brain and I’m more nervous than I was about having a seven-hourlong brain surgery. And I’m pretty sure I know why. 

Several years ago, I came across a story about Haldol (haloperidol). For those of you who don’t know (and most people don’t), Haldol is an antipsychotic medication used to treat schizophrenia and other mental or mood disorders. The story I happened upon was about a man who lost his father-in-law to what he believed to be negligence by hospital staff after they administered Haldol to him, a Parkinson’s patient. (You can read about it here.)

After reading about the medication’s side effects, I gathered as much knowledge as I could about Haldol and how it affects those who have Parkinson’s. I have tried to educate those who read my blog and my column here at Parkinson’s News Today. I began receiving messages from others who had similar stories. They were heartbreaking enough to unnerve anyone battling Parkinson’s.

This is what unnerved me: The possibility of receiving a medication that could leave me like a vegetable is real. And that is what makes being prepared for a hospital visit extremely important, especially if you are a Parkinson’s patient.

The flip side

There is a flip side to all of this worrying, and it is called success. We register for our surgeries, fill out our questionnaires and HIPAA forms, pay our fees, and stand at the waiting room door that separates us from our physicians and the procedures.

Eventually, we are ushered through the doors, down the halls, and into the rooms where we are prepped. And then we go, hoping for obstacle-free experiences within the four walls of the surgery room.

Fast-forward, and there I was, past all points of progress and ready for surgery: IV inserted, vitals taken, papers signed, rolled into the operating room, and bam! Out like a light. And just like that, I was awake again. That is when I realized that I had found it: success. 

No bad meds were administered, no hurdles were thrown in front of me while I lay on the cold table. I realized then that I had been granted another day to pull up my bootstraps once again, move forward in faith, and trust that age-old promise that all things work together for my good. For that, I am truly grateful.

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Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

The post Fighting Fear Ahead of Another Surgical Procedure appeared first on Parkinson’s News Today.

Spinal Anesthesia Leads to Fewer Post-operative Complications, Small Study Suggests

surgery and anesthesia

Spinal anesthesia may be safer than general anesthesia for people with Parkinson’s disease undergoing surgery, causing fewer post-operative complications, including a risk of death, a small study suggests.

The study, “Spinal versus General Anesthesia for Patients with Parkinson’s Disease,” was published in the International Journal of General Medicine.

Anesthesia temporarily blocks nerve sensation, making it indispensable for many surgeries although its use carries known risks. For people with nervous system damage or impairment, as occurs in Parkinson’s, these known risks are greater.

Few studies, however, have looked at the safety of different types of anesthesia used in surgeries for people with Parkinson’s.

Researchers at the Jordan University of Science and Technology addressed this knowledge gap by analyzing hip surgeries given to 10 Parkinson’s patients at their care center between 2015 and 2018. They evaluated each person’s medical history, the type of anesthesia used, and post-surgical complications.

“Anesthesiologists prefer using general anesthesia (GA) given that PD [Parkinson’s] is a neurological disease,” the team wrote. “However, GA may mask neurological symptoms in the intraoperative period and exacerbate them postoperatively. Furthermore, the anesthetics used in GA have clear interactions with the drugs used to control PD.”

These eight men and two women had an average age of 73.2 (range, 57–90 years old) with disease stages of 3 or 4 on the Modified Hoehn and Yahr Scale, meaning mild-to-moderate (stage 3) and severe disability.

Nine had a history of previous falls, and all were undergoing surgery for a broken hip (neck-of-femur fractures). Two of these 10 patients had evidence of neurological symptoms like psychosis (“mental illness,” according to the study), and hypertension was  the most common comorbidity (co-existing illness). All but one had normal blood pressure at the time of surgery.

Six were given spinal anesthesia (SA) and the other four received general anesthesia. Spinal anesthesia involves injecting medicines into the spinal canal to numb the body from the waist down; general anesthesia can either be delivered as an intravenous injection (directly into the vein) or as a gas, and results in a state of controlled unconsciousness.

No postoperative complications were reported in the six people given  spinal anesthesia while two of the four on general anesthesia were later admitted to the intensive care unit for collapsed lungs, and a third developed a urinary tract infection.

On average, patients who received spinal anesthesia were discharged after 5.8 days. Those given general anesthesia remained in the hospital for an average of nine days, as they required more monitoring.

Pneumonia was reported after discharge by one spinal anesthesia patient, but the researchers noted this person had a history of swallowing problems at the time of admission. Three out of the four people on general anesthesia had post-discharge complications, including deep vein thrombosis (DVT), stroke, pneumonia (largely, aspiration pneumonia), low blood cell counts, and seizures. One, who had both pneumonia and seizures after surgery, died after leaving the hospital.

“Our results revealed that SA poses less risk on such patients compared with GA,” the researchers concluded. “This was mainly demonstrated in the postoperative course since both groups had similar preoperative baseline characteristics and no intraoperative complications were detected.”

Their study also noted that harmful interactions between the levodopa Parkinson’s patients use to treat motor symptoms, and anesthetic medicines can be difficult to avoid. This is particularly true of general anesthesia, where certain medicines like thiopental can lower dopamine release. A case report documents a patient experiencing severe and prolonged dystonic muscle rigidity after surgery using thiopental.

A major concern with using general anesthesia is that it can mask certain Parkinson’s symptoms such as tremors and rigidity, of which the surgeon needs to be aware.

Regional anesthesia, such as spinal anesthesia, carries fewer postoperative side effects and requires less time off of levodopa, the study noted. Spinal anesthesia also lowers the probability of experiencing aspiration pneumonia, respiratory weakness, urinary tract infection, DVT, postural hypotension, and psychiatric crises.

Regional anesthesia, however, may not be the option in all cases, they added. Compared to general anesthesia, patient positioning can be more complicated, and tremors may interfere with aspects of the surgery. Because spinal anesthesia leaves the patient awake during surgery, special attention must be given to the airways, to ensure ease of communication in the event of a sudden onset of Parkinson’s symptoms.

Still, their findings suggests that spinal anesthesia may be the safer option to general anesthesia, causing fewer serious post-operative complications. Further and larger studies, however, are necessary.

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Deep Brain Stimulation is a Long-term, Effective, Safe Treatment for Parkinson’s, New Studies Show

deep brain stimulation

Subthalamic deep brain stimulation (STN-DBS) seems to be a long-term, effective, and safe therapeutic option for patients with advanced Parkinson’s disease, new studies report.

STN-DBS is a non-destructive surgical treatment for Parkinson’s, in which a battery-operated device that generates electrical impulses is implanted to specific regions of the patient’s brain. Since its implementation, it has become an accepted and effective therapeutic option to treat the motor symptoms associated with Parkinson’s and other complications caused by prolonged dopaminergic treatment in advanced forms of the disease.

However, research documenting the long-term effects of STN-DBS on the clinical state of patients with advanced Parkinson’s disease is still scarce. Now, researchers presented two studies during the IAPRD World Congress 2018, held August 19-22 in Lyon, France, where they revealed the effects of STN-DBS after long-term follow-up.

In the study, “Subthalamic deep brain stimulation for advanced Parkinson’s disease beyond the 5-year follow-up,” (abstract e-book, page 11) Russian researchers evaluated the long-term safety and effectiveness of STN-DBS in a group of patients for at least seven years after surgery.

The study enrolled 33 patients with advanced Parkinson’s disease who had undergone STN-DBS surgery with a minimum follow-up period of five years. Several parameters, including motor function, disease impact on daily activities and quality of life, were assessed using the UPDRS-2,3,4, the Schwab & England scale and the PDQ-39 questionnaire, respectively.

After a follow-up period of seven years, there was a significant improvement in patients’ motor functions (42% in UPDRS-3, 24% in UPDRS-2 and 58% in UPDRS-4), ability to perform regular daily activities (23% in Schwab & England scale) and quality of life (9% in PDQ-39 questionnaire).

In addition, researchers also found that 41% of patients who underwent STN-DBS reduced their intake of levodopa and three even completely withdrew from the medication in the course of the study.

“In advanced PD-patients, STN-DBS could provide significant improvement in OFF-state [when medications fail to suppress disease symptoms] and diminish dopaminergic medication up to seven postoperative years,” the authors wrote.

In another study, “Long-term effect of subthalamic deep brain stimulation in young- and late-onset Parkinson’s disease: 10-year follow-up study,” (abstract e-book, page 13) Korean researchers evaluated the long-term safety and effectiveness of STN-DBS in patients with young disease onset (YOPD) and compared it to those who developed the condition later (LOPD) for a follow-up period of 10 years.

The study analyzed motor symptoms (UPDRS scores) of 24 patients with advanced Parkinson’s disease (13 YOPD and 11 LOPD) who underwent STN-DBS between March 1, 2002 and March 31, 2007 at the Asan Medical Center in Seoul, South Korea.

Ten years after STN-DBS, the reduction in the scores of levodopa equivalent dose (a rough technique to compare different medications, LED) and levodopa-induced dyskinesia (measures levodopa side effects, LID) were significantly lower in YOPD compared to LOPD patients.

Levodopa-induced dyskinesia improvement remained statistically significant until five years after the surgery in both groups, but after 10 years, its severity increased substantially in LOPD patients.

However, the decrease in motor symptoms (measured by UPDRS scores), visual hallucinations and adverse effects did not differ between the two groups.

“This study shows that STN DBS showed higher effect on LED reduction in LOPD and LID improvement in YOPD at 10 years after DBS surgery. These results may have clinical implications for tailored application of STN DBS in patients with PD,” the authors wrote.

Altogether, these data suggest that STN-DBS is a long-term beneficial treatment option for patients with advanced Parkinson’s disease.

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Source: Parkinson's News Today