Dear PDIEN:

I'm a subscriber to the Parkinson's Disease Information Exchange Network,
and I'd recently (July 6 or 7) posted PDIEA about a serious
constipation-related problem that my mother, who is 89 & has PD, is
having. I see that my original posting has been reposted in today's
(August 1) PD Digest.

QUICK SYNOPSIS OF BACKGROUND:

Late March, first time in her life, Mom -- always healthy & active (even
with PD, which was under medication-control) -- had a congestive heart failure.
Entered hospital for 10 days. There was prescribed Norvasc, Lasix,
Nitro-Dur patch. Also continued on her regular PD meds of Sinemet 25/250,
Sinemet-CR 50/200, Bromocriptine 2.5mg. On 11th day, came home, stayed
on these meds, was doing fine.

About 1 & 1/2 weeks later, we went to her neurologist because she'd been
experiencing 40-minute leg-tremors in the middle of the night over the
prior several weeks. He prescribed 2 bed-time Bromocriptine tablets
(beyond her large amount of this & the other meds during daytimes) and
said, when asked, that there would be no side effects, don't worry.

Over the next 3 & 1/2 days, Mom's abdomen became increasingly distended
and painful, and she felt increasingly & badly constipated in her abdomen.
We then saw her primary doctor, who sent us immediately to the hospital
(LIJ), where the drs & nurses found that 1/3 of her colon was impacted, and
they attributed this problem (which was very serious) to the
Bromocriptine.

4 days in, after they'd tried a high colonic, she got a heart attack, was
intubated and moved to the ICU, and they totally stopped ALL PD
medications (for perhaps the next 2-3 weeks; they controlled
high-breathing-rates/PD tremors by using sedatives such as Ativan and
sometimes Morphine).

1 & 1/2 days later, she was doing decently enough (though still impacted)
that they chose that night to do 3 high colonics, which partly worked. But
the next evening (6pm), she began to suddenly turn pale, said "I don't feel
so good", got jitters; a nurse, in then trying to suction Mom's lungs,
then accidentally punctured (I learned later) a lung -- and pow! Heart
Attack!

Mom nearly died right then & there. They immediately intubated her (i.e.,
breathing-machine), IV'd her, used dopamine, etc.. The whole ensuing night
was touch and go. But, thank God, by Morning her numbers sprang to
near-normal, she awoke and had pulled through.

Around that time-frame, she contracted pneumonia. So though the doctors
tried many times over the next 12 days to wean her by lowering the
vent-settings, it didn't work: Every so often, suddenly her breathing rate
would shoot to the 40s or 50s per minute, simultanous with tremors
kicking up. So they did a tracheostomy. Eventually, after many more weeks,
she recovered miraculously, and was released, after 2 months, to enter a
great rehab center (Burke).

During perhaps the last 3-4 weeks at LIJ, the LIJ neurologist re-started
her, cautiously, on Sinemet 25/100 three times a day, and later increased
it a touch.

Was the PD the cause of the rapid-breathing or was it vice-versa? The
doctors were not sure; they suspected that the PD was the effect and not
the cause. Also, during this time in LIJ, they found (fortunately) that
her intestinal tract had become partly UNblocked and so surgery was not
necessary. But they did every so often give her Propulsid or Lactulose, as
her bm's were otherwise perhaps several days apart.

At the rehab center, where she stayed for almost 2 weeks, Mom was doing
wonderfully, even though on a reduced level of PD meds (3 & 1/2 or
4 Sinemet [25/250] a day, as opposed to her pre-illness regimen of 3 or
sometimes 3 & 1/2 Sinemet [25/250] a day, 3 halves of Sinemet-CR [50/200]
a day, and eight Bromocriptine [2.5mg] a day). She was energetic, lively,
got herself around in a wheelchair (with help), active in events, etcetera,
and cheerful too. (Note: During those 2 months in the hospital, she lost a
lost of weight & muscle, going down from a normal 105 lbs to 83! But at
the rehab center she was beginning to regain weight & tone.)

Now my mother -- who was doing very well prior to late-April, without
problems -- is unfortunately in significantly worse shape than when I
transmitted that first post. Her slow-digestive-tract problem is still
a real problem, but more has happened, and I suspect that some of it
relates to her Parkinson's or reduced-level of Parkinson's medications,
combined with the impact of potentially-fatal pneumonias (including
staph-pneumonia) from which she is now terribly weakened and slowly
recovering.

If you also can offer suggestions about the following additional things
happening to my mother, I'd appreciate it.


NOW THE 8/1/96 UPDATED SITUATION (Can anyone offer any help?):

(Note: I may reiterate a few items here of what you've just read above,
but perhaps it will knit together this way.)

While now again in the hospital (a differnt one, in upstate NY) for the
past 3 weeks, and slowly, and with difficulty, recovering from potentially
deadly staph-pneumonia, she again has this bm problem -- hasn't had a bm
in 6 days as of this morning.

She's terribly weak, debilitated, can barely speak (they extubated
her yesterday), and continues to be on a far lower dose of Sinemet
than she'd had in her healthier days pre-April 22. (Prior to that time,
which was when she was admitted to a LIJ for what turned out to be a
Bromocriptine-induced near-paralysis/obstruction of the intestinal tract,
she'd beeen functioning very well on a daily regimen of Sinemet 25/250,
Sinemet-CR 50/200, and Bromocriptine 2.5 mg (See above); but
within 4 days of her entering LIJ for that intestinal problem,
she got a heart attack, then 2 days later got another (in part induced, I
suspect, by a nurse puncturing a lung while my mother was having a breathing
problem), and they had her on *zero* PD meds for about 2-3 weeks from that
point.

Then they re-started her on tiny doses of only Sinemet (25/100).
Bromocriptine -- which was what many of the doctors & nurses there said
was likely the cause for the intestinatal-tract problem and which Mom's
neurologist had INCREASED just a few days before she had to enter the
hospital, was now "off limits" (and it still is). At some point, they also
started with Propulsid, and sometimes Lactulose; these took awhile to
work but at least they worked.

At LIJ, by the way, she also picked up serious pneuomonia, such that, from
the moment of that 2nd in-hospital heart attack, she remained intubated
for nearly 2 weeks, after which they put her on a tracheostomy; she
finally, toward the last couple of weeks, & miraculously recovered so well
that they removed the tracheostomy tube and soon (after 0xygen masks) she
was breathing well on her own, and was admitted to an excellent rehab center
in upstate NY.

In that rehab facility, they also continued every so often with Propulsid,
Lactulose, and they also used Senokot. Mom's intestinal tract, though
working, was still slow. At the rehab center, they also raised her
Sinemet-only dosage to 3 & 1/2 or 4 whole Sinemet 25/250 per day, and Mom
tolerated it decently. The last day she was there in early June, they were
just about to (or did) increase the bed-time dose to either a whole
Sinemet 25/250 or a 1/2 of a Sinemet-CR 50/200.

She was recuperating wonderfully there. But after about 2 weeks, on July
7th, they said she'd had a heart attack, and zipped her over to White Plains
Hospital, where it was decided that she'd had a heart attack plus, in only
1 lung, pneumonia. So she was admitted to the ICU, intubated, and a week
later extubated, and 6 days later re-intubated (life-or-death emergency, they
said); and, as her dr. says she's now licked the staph-pneumonia, was
again extubated yesterday. The hospital has continued her rehab-center
amounts of regular Sinemet 25/250 (but on a more flexible schedule that more
seems to match when nurses are available rather than the strict
every-4-hours-during-daytime schedule set by the doctor).

But Mom is very weak, and finally, I think, becoming (after all this
torture -- she can hardly make herself understood, despite her urgent
efforts to speak and commiunicate her meaning) frightened and possibly
sometimes disoriented. She can no longer enunciate, her face is usually
much less expressionless than it used to be before all this (though she
does still show some expression at times), and her right hand (she's a
righty) has also shown weakness and reduced control as contrasted to what it
had been just a couple of weeks ago. It also appears that her hearing has
been reduced (but whether that's an effect of the illness, of the
antibiotics, of PD, or even of earwax or the environment or what, I don't
yet know; the doctor says he'll have an ear-nose-throat specialist & their
infectious diseases specialist, who knows about the antibiotics, look into
these things).

I've asked her doctor there about the possibility that these problems may
be a result of the PD meds (or lack thereof), or of the PD itself (which
was NOT a problem before all this), or of these factors combined with the
impact of her antibiotics (including, among others, vancomycin &
fluconazole) and the illness itself. He says he'll have a neurologist look
into it.

So here we now add all the above to the BM problem: As of this morning,
this will now be the 6th day in a row that Mom has not had a bowel
movement (even though she was given a combination of Milk of Magnesia &
Cascara the day before yesterday).

So now I really can use helpful advice!

Thanks in advance,
SJS
[log in to unmask]
8/1/96