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Suggest Treatment For Left Sided Paralysis In An Elderly Person
Question: My 86 year father suffered a right sided CVA causing left sided paralysis 3 months ago.
For the past two weeks he has been suffering motion type vomiting.
His GP has ceased Omeprazole & charted Nexium.
Prior to this vomiting he couldn't stand the smell of food & has not eaten much at all since.
As a consequence my father has lost 20 kilos.
Dad is currently taking Mirtazipine 30 mgs nocte.
On top of this my fathers other underlying co-morbidities are Parkinson's disease for which he is taking levadopa t.d.s nocte dose was reduced because of nightmares he was experiencing.
Dad is also taking lyrica b.d. For neuroleptic pain in his left leg. With burning sensations in his left foot. The lyrica is a little helpful relieving those symptoms.
Dad is also on Targin 5/25 mg nocte only.
Plus he has regular paracetamol t.d.s.
Parkinson NSW Australia suggests STRI's for antidepressants.
I'm thinking dad needs something to reduce cholinergic neurotransmitters.
My research is suggesting tricyclics anti depressants & Imipramine hydrochloride.
I'm a registered nurse & whilst a know & understand a little I'm not sure about these medications.
I would like to make sensible suggestions to his GP for his consideration without overstepping my mark.
I wish to be polite as this young GP is so very polite.
Can you give me some advice.
I'm thinking my father will become so malnourished, he will go into organ failure.
In one sense I wish for dad to live with some level of comfort, I also wished that this CVA had taken his life so he doesn't have to suffer like this.
I'm hiring a specialised wheelchair which has a tilt so I can take him out of the nursing home. Dad is a returned serviceman from WW11 & I like to take him to our local RSL club. But this motion sickness & continual nausea & heightened senses of smell are preventing me from giving him some quality of life.
I don't know ... the torture for him & his wife, my brother & I plus his grandchildren is immense.
Either he goes soon or we try to make some of his days left a good experience.
Dad was a type 11 diabetic but because of his poor food & fluid intake the meteor in medications were ceased.
ECG fine, pathology fine, u/a n.a.d.
Complex problem ... perhaps we are looking at end of life care in the near future .
XXXX
Registered Nurse for 30 years.
For the past two weeks he has been suffering motion type vomiting.
His GP has ceased Omeprazole & charted Nexium.
Prior to this vomiting he couldn't stand the smell of food & has not eaten much at all since.
As a consequence my father has lost 20 kilos.
Dad is currently taking Mirtazipine 30 mgs nocte.
On top of this my fathers other underlying co-morbidities are Parkinson's disease for which he is taking levadopa t.d.s nocte dose was reduced because of nightmares he was experiencing.
Dad is also taking lyrica b.d. For neuroleptic pain in his left leg. With burning sensations in his left foot. The lyrica is a little helpful relieving those symptoms.
Dad is also on Targin 5/25 mg nocte only.
Plus he has regular paracetamol t.d.s.
Parkinson NSW Australia suggests STRI's for antidepressants.
I'm thinking dad needs something to reduce cholinergic neurotransmitters.
My research is suggesting tricyclics anti depressants & Imipramine hydrochloride.
I'm a registered nurse & whilst a know & understand a little I'm not sure about these medications.
I would like to make sensible suggestions to his GP for his consideration without overstepping my mark.
I wish to be polite as this young GP is so very polite.
Can you give me some advice.
I'm thinking my father will become so malnourished, he will go into organ failure.
In one sense I wish for dad to live with some level of comfort, I also wished that this CVA had taken his life so he doesn't have to suffer like this.
I'm hiring a specialised wheelchair which has a tilt so I can take him out of the nursing home. Dad is a returned serviceman from WW11 & I like to take him to our local RSL club. But this motion sickness & continual nausea & heightened senses of smell are preventing me from giving him some quality of life.
I don't know ... the torture for him & his wife, my brother & I plus his grandchildren is immense.
Either he goes soon or we try to make some of his days left a good experience.
Dad was a type 11 diabetic but because of his poor food & fluid intake the meteor in medications were ceased.
ECG fine, pathology fine, u/a n.a.d.
Complex problem ... perhaps we are looking at end of life care in the near future .
XXXX
Registered Nurse for 30 years.
Brief Answer:
Read below
Detailed Answer:
I deal mostly with stroke patients and I know the dramatic change it can bring to the lives not only of the patient but of family members as well. I often hear people saying that perhaps it would've been better not to survive at all and I understand your position. The fact that he has a neurodegenerative disease such as Parkinson's certainly doesn't help in hoping for any improvement. Long standing diabetes usually means a less likely improvement as well.
Regarding antidepressants I am afraid I disagree with you about tricyclics. They are not preferred in the elderly because of their higher potential for side effects (anticholinergic effect may worsen nausea and vomiting). That is why SSRIs are chosen instead, not because they are more effective but because they are safer.
As for nausea and vomiting. That is difficult to address because medication to reduce nausea may cause somnolence and dizziness, others like metoclopramide worsen Parkinson's. However an over the counter antihistamine such as meclizine or dimenhydrinate may be tried (commonly sold for motion sickness). Also I wonder about how necessary Targin is. Oxycodone may have nausea and vomiting as a side effect at times as well.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I deal mostly with stroke patients and I know the dramatic change it can bring to the lives not only of the patient but of family members as well. I often hear people saying that perhaps it would've been better not to survive at all and I understand your position. The fact that he has a neurodegenerative disease such as Parkinson's certainly doesn't help in hoping for any improvement. Long standing diabetes usually means a less likely improvement as well.
Regarding antidepressants I am afraid I disagree with you about tricyclics. They are not preferred in the elderly because of their higher potential for side effects (anticholinergic effect may worsen nausea and vomiting). That is why SSRIs are chosen instead, not because they are more effective but because they are safer.
As for nausea and vomiting. That is difficult to address because medication to reduce nausea may cause somnolence and dizziness, others like metoclopramide worsen Parkinson's. However an over the counter antihistamine such as meclizine or dimenhydrinate may be tried (commonly sold for motion sickness). Also I wonder about how necessary Targin is. Oxycodone may have nausea and vomiting as a side effect at times as well.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your advice.
I guess I'm clutching at straws a little, but watching all of this unfold is extremely painful for everyone.
I will forward this onto his GP. I pray he is not offended.
The GP is ruling out any infective processes today re: urine & stools.
He has been so patient, the care staff too have quite a handful as well, with my fathers needs & do not fault the care they provide.
Again thank you.
Regards
XXXX
I guess I'm clutching at straws a little, but watching all of this unfold is extremely painful for everyone.
I will forward this onto his GP. I pray he is not offended.
The GP is ruling out any infective processes today re: urine & stools.
He has been so patient, the care staff too have quite a handful as well, with my fathers needs & do not fault the care they provide.
Again thank you.
Regards
XXXX
Brief Answer:
You're welcome
Detailed Answer:
Your GP is doing well to check for possibility of infection. At times in the elderly there may not be evident symptoms. He seems to be a careful doctor.
Hope things work out for the best.
You're welcome
Detailed Answer:
Your GP is doing well to check for possibility of infection. At times in the elderly there may not be evident symptoms. He seems to be a careful doctor.
Hope things work out for the best.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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