Dear List-friends:

On Dec. 30, Margaret Tuchman passed on to us two messages from Dr. Ken
Janis, who wrote of his concern over the dearth of information about the
combination of PD and Anesthetic management. In the past, and currently,
list members have shared problems and horror stories relating to the
combination of PD and drugs used during surgery. Just now this is very
much on my mind. My husband waits for the results of MRI, bone scans, X-
rays, and the combined wisdom of neurologist, Orthopedist, and family
doctor, to find out if he will need surgery to alleviate whatever it is
that has so painfully, and suddenly immobilized him.

He has already stopped taking Eldepryl, but what about all the other
drugs he is taking? How will these interact with the drugs used? There
are a couple of other factors that have to be considered as well. His age
(76) is one. Many of the drugs used during surgery carry warnings that
the dose should be reduced for the elderly patient. Another factor is his
weight (122 pounds). Patients with relatively low weight and lean body
mass cannot tolerate the normal adult doses of many drugs. This is
considered by anesthesiologists, but it is not always easy to titrate
doses for these patients.

I recall that in 1945, when I had my first experience with a general
anesthetic, the nurse clapped a chloroform mask over my nose and I went
to sleep. With several subsequent surgeries, I gave no thought to the
process of anesthesia, being more concerned with the fellow with the
knives. Then, in 1987, for the first time, I received an itemized bill
for every item used in the process of removing my gall bladder. This list
included every drug used during surgery. What an eye-opener! Things
weren't so simple any more, and I imagine they have gotten more complex
since.

My list included atropine, Anectine, Tubo-cuarine, Demerol, Versed,
Lidocaine, Narcan, Sublimaze, and Vistaril. Each serves a specific
purpose. Some selectively deepen narcosis, others bring one back from it.
One is effective at blocking memory of peri-op activities. One is an
anticholinergic. Some relax muscles, others calm and tranquilize. Today's
Anesthesiologist is like the conductor of an orchestra, manipulating
various body functions while the surgical team does their work. All are
powerful, dangerous drugs. Their PDR entries include the usual numerous
warnings. I've never had any trouble with anesthetics, but I don't have
PD. If Neal has to have surgery, I would feel a whole lot better if more
data were available about how PD patients are likely to fare.

If it comes to surgery, my biggest problem will be to make sure everyone
concerned understands the problems presented by advanced Parkinsonism.
>From the messages shared here, I realize that isn't always easy.

Martha (CG for Neal, 76/11)