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Dear Mary, I'll answer your post the best I can, though it's not possible to give individualized counsel without a great deal more information. > Her husband, ~ 83 yrs old, went from nursing home to hospital with > pneumonia. Anticipating release from hospital to return to nursing home, she > was told her husband must have a tube inserted (in his nose I think) to > prevent aspiration pneumonia and because he is unable to use the mechanism > that closes the lungs off in order to get foods and liquids where they > belong. Aspiration pneumonia is, unfortunately, not uncommon in people with PD. Awhile back, I offered an article on acid reflux for this very reason. It's not well recognized, even though aspiration pneumonia is one of the more frequent causes of hospitalization of people with PD. In this case, I doubt the tube would be placed nasally, with the feeding going to the stomach; it appears the esophageal sphincter has weakened and would allow stomach contents to come upward and be aspirated into the lungs. It's more likely the physician would order a "PEG" (percutaneous endoscopic gastrostomy) -- a small incision is made in the abdominal area, and a sort of 'button' is placed in the incision. When a tube feeding is needed, the tube is inserted into the 'button' and the liquid supplement goes through the tube. Instead of going directly to the stomach, in this man's case it will probably go into the small intestine, to avoid the possibility of aspiration pneumonia. I am very much in favor of PEG placement for those at risk of aspiration pneumonia, also for those who cannot maintain weight. It helps the individual avoid dehydration, nutrient depletion, and unwanted weight loss, as well as aspiration pneumonia. It is also very discreet -- the 'button' remains covered by clothing, so that the individual can move about freely; the tube feeding can take place whenever desired, and proper timing of medications and feedings can be maintained. It also allows for use of liquid Sinemet, which can be very useful for those with delayed stomach emptying (some people have been known to pass an entire Sinemet undigested, generally due to slowed peristalsis), as it allows better and quicker uptake of levodopa. > They want to do this right away and she wants to know more about if this is > the best and/or appropriate thing to do. Also what information can be found > about this situation. > Can you shed some light on this? Thanks! Mary I hope I've answered your question, but if not, let me know -- I'll try again. It's a complex subject. > Separate issue--PS > After the meeting Kathy put her husband, Dick, on the supplement program, > increased his water intake, reduced his protein, and timed his medications > differently. The next month he was back at the support group meeting for the > first time in months. He is able to move better, the medication works > better, and she is thrilled! I am thrilled, too!! Many, many people would get longer on time, and less dyskinesia, if more dietitians specialized in understanding of PD. I've completed a manual for dietitians that will be published next month, and I hope this will make proper nutrition care more widely available. My very best to you, you're doing a great job as SG facilitator!! and my very best to the caregiver and her husband. Kathrynne -- Kathrynne Holden, MS, RD Medical nutrition therapy Author: "Eat well, stay well with Parkinson's disease" "Parkinson's disease: assessing and managing unique nutrition needs" http://www.nutritionucanlivewith.com/