My wife, Doris (73,3), has moderate PD and congenital pulmonary
arteriovenous malformation (AVM). This latter condition was mild, until
recently it has resulted in severe hypoxemia. The condition is a congenital
shunt in her lungs so that much of her blood bypasses oxygenation in her
lungs with consequent arterial low oxygen gas content. Over her life time
her body has made miraculous adjustment allowing her to carry on normal
life. Recently the amount of blood going through the shunt has been
increasing so that the pulmonologist has insisted on 24-hour oxygen therapy
and some form of intervention. I want to say a word about the oxygen therapy
first and then the problem of further intervention.
Part of her parkinson disease has been insomnia and the restless leg
syndrome. Since she has been taking oxygen there has been a very sharp
decline in RLS, and a reduction in insomnia. One hypothesis is that the low
level of oxygen in her blood had compounded her PD symptoms and by the use
of oxygen therapy these had been reduced. Another hypothesis is that the PD
itself is caused (fully? partially?) by the poor blood that has been going
to the brain. (This latter hypothesis has been rejected by the pulmonologist
and cardiologist who are treating her hypoxemia, however it seems to me that
if environmental toxins may affect PD, poor blood may contribute as well.)
Query. Have others had to rely on oxygen for one reason or another
and has this affected their Parkinson symptoms. (During this recent period
we have not changed her sinemet regimen, and she is still subject to on-off
phenomena, but I think it is less severe, especially the dyskenisia.)
Our authorities recommend intervention, and on the basis of my
reading the medical literature I agree with them. There are two
possibilities - coil embolization by an intervention radiologist or surgery
by a thoracic surgeon. One of her physicians leans one way and the other
leans the other. I have read the medical literature and the depressing fact
seems to be that the radiation journals deal with experience with
embolization and the surgical journals report on surgical results and
methods. I have not found a careful comparison of the two. Unfortunately her
situation is quite rare which may account for an absence of comparative
literature. (Our choice will be made after an angiogram which will give us
more firm information about the character of the AVM.)
Query: Have others been faced with the choice of embolization versus
surgery in the lungs and have they found a resolution?
