Our Parkinson's Place: Tips to improve hospital stays for PD patients

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Thursday, May 19, 2016

Tips to improve hospital stays for PD patients

By Ann Miner
For the Desert Dispatch

Posted May. 19, 2016

My mind is whirling. The postman just delivered the latest edition of “Every Victory Counts,” a manual published by the Davis Phinney Foundation for Parkinson’s. Every page stimulates me to share with readers, so tighten your seat belts. Here we go.

Today’s column is devoted to hospital stays for people with Parkinson’s. The first thing a PD patient must do is discuss your medication needs with your nurses. Bring a complete list of your medicines, dosage and the time(s) of day you take them. Be sure your hospital care team understands that Sinemet and Stalevo (carbidopa/levodopa must be given at the time it is ordered. Parcopa or dissolvable carbidopa/levodopa can be used if you are unable to swallow.

Describe your symptoms to your hospital care team. Dyskinesia, on-off motor fluctuations and gait freezing may not be familiar to them. They will better understand why it is important to get your meds on time if you let them know how your movement and abilities change during your on or off state.

Your motor symptoms can worsen when you are coping with a medical illness in addition to your Parkinson’s, so you might not be able to move as well and might find tremor, dyskinesia, and freezing worsen during your hospital stay. Also, hallucinations and confusion can occur or worsen in the setting of medical stress, or as a result of new meds, such as for pain or sleeping, and so on.

What To Ask Before Discharge

· Have your neurologist and primary care physician been notified of your condition while in the hospital?

· When should you see your primary care physician?

· Should you get additional rehab, such as physical therapy?

· What important tests, procedures or new diagnosis have you had?

· What meds have been changed and why?

How do you get a copy of your hospital records sent to your doctor(s)?

Medications To Avoid

Some medications can worsen movement symptoms of PD, including slowness, stiffness, tremor and dyskinesia. These drugs, listed below, are used to treat psychiatric problems such as hallucinations, confusion or gastrointestinal problems, such as nausea. The stress of your illness, hospital stay or new medications can increase your risk of hallucinations while hospitalized. Common anti-hallucination medicines to be avoided are listed by generic or chemical name, followed by the trade name.

Anti-Hallucination Medicines To Avoid

The anti-hallucination medicines quetiapine (Seroquel) or clozapine (Clozaril) CAN be used with Parkinson’s. The following should be avoided:

· Aripiprazole (Abilify)

· Chlorpromazine (Thorazine)

· Flufenazine (Prolixin)

· Haloperidol (Halidol)

· Molindone (Moban)

· Perphenazine (Trilafon)

· Perphenazine and amitriptyline (Triavil)

· Risperidone (Risperdol)

· Thioridazine (Mellaril)

· Thiothixene (Navane)

Anti-Nausea Medicines To Avoid

· Metpclopramide (Reglan)

· Phenothiazine (Compazine)

· Promethazine (Phenergan)

Medicines To Avoid If You Are On Rasagiline (Azilect) or Selegiline (Eldepryl)

· Pain meds meperidine (Demerol), tramadol (Ultram) and methadone

· Antispasmodic med (Flexeril)

· Dextromethorphan (cold medication) and ciprofloxacin (antibiotic)

This is not a complete list. If you have questions about other medications, ask your pharmacist or doctor.

If you have had Deep Brain Stimulation (DBS), be sure your doctors and nurses know about it. In most cases, MRI and diathermy cannot be performed without risk of serious injury to you. Give your doctors and surgeons the Medtronic contact information, 800-328-2518 (24/7), to call for guidance in the event that a surgery or procedure must be performed. Wear a medical alert bracelet if you have serious medicine, latex or tape allergies, and if you have DBS. IF you do have DBS, include the manufacturer’s phone number on the medical alert bracelet in case of emergency.

This is a lot to absorb, particularly if you never have to be hospitalized or have any of the suggested complications. Davis Phinney counts educating yourself about Parkinson’s disease as one victory, with the slogan, “Every Victory Counts.” I have used their information here, from the Fourth Edition, with permission.