Parkinson's Disease

Parkinson’s Disease: If You Have to Go into the Hospital

People ith Parkinson’s Disease may need to go into the hospital or have surgery. People with the condition and their caregivers should be well informed about how to ensure good management of Parkinson’s Disease while in the hospital.

While it is easier to plan in advance for pre-scheduled admissions to hospital for elective surgery’ (for e.g. hip replacement, heart, prostate or bladder surgery, emergency hospital admissions pose greater challenges (for e.g. hip surgery after a fall/fracture, pneumonia, infection, bowel impaction or stroke). Be aware that trips to emergency rooms for the management of increased dyskinesia or prolonged off periods are best avoided. These episodes will eventually resolve spontaneously and it is better to stay at home in a calm, safe environment.

We recommend you keep this fact sheet where you or a family member can find it should it be needed.

WHEN CONSIDERING SURGERY

Day surgery is generally not a problem for a person with Parkinson’s Disease. However, some procedures during which you would normally be awake, such as cataract surgery or some dental procedures, may pose a problem if your tremor or dyskinesia create too much movement. You should bring this to the attention of the surgeon before the date of the procedure is set. It is important to ensure that you know how your GP, surgeon and neurologist (if you see one) will coordinate the care of your Parkinson’s Disease with your procedure.

If surgery is recommended, discuss with the surgeon:

• Benefits & risks of the procedure
• Tests & procedures involved
• Expected outcomes and odds of success
• Potential complications
• Length of hospital stay
• Alternatives to surgery. Is there a more conservative approach?
• Alternatives to general anaesthesia
• Alternatives to admission

Then you can make an informed choice.

Pre-operative Medication

For surgery requiring a general anesthetic, your anti-Parkinson medication may be stopped the night before surgery. Alternatively you may be allowed to take an early morning dose of Sinemet with the least amount of water. Ask if it is possible to be first on a morning surgery list to avoid long periods without medication.

Parkinson’s Disease medication timing in hospital

• Ask your doctor to send your drug regimen and schedule with your hospital admitting orders before hospital admission. Also, bring your medications with you in the original bottles. Bring several copies of your list of daily Parkinson’s Disease medications and schedule to hospital. If, for example, you take your medication three times daily, write the times taken. Otherwise it mat be interpreted as taken every 8 hours.
• If you are on an experimental Parkinson’s Disease drug bring your own supply and a letter about the study.
• Discuss with your doctor the possibility of getting authorization to administer your own medication if you have frequent doses or as needed doses.

Contraindicated drugs & side effects

• Supply a list of all allergies to the hospital
• For pain control, People with Parkinson’s Disease tend to tolerate morphine better than Demerol. Demerol, pre-medication, and drugs used for anesthesia can cause severe confusion, which may take a few days to a few weeks to resolve even in people who are not normally confused.
• For post operative nausea, ask your physician and staff not to give you dopamine antagonist drugs such as Reglan or Maxeran (metoclopramide) or Compazine or Stemetil (prochlorperazine) for nausea. Gravol is a useful drug choice and can be given by mouth, suppository, and injection. (Domperidone only prevents the nausea associated with antiparkinson drugs).
• If you become confused post-operatively it could be drug or anaesthesia induced or the result of dehydration, constipation or an infection. Avoid all conventional anti-psychotic drugs such as haloperidol, respiridone, and olanzapine. Quietapine (Seroquel) is the only safe antipsychotic drug for Parkinson’s patients.
• For bladder or prostate problems, anti-cholinergic drugs often help relieve muscle spasms after surgery, but these can cause confusion, constipation and retention of urine.

Re-starting anti-Parkinson medication after surgery

In most cases you can restart your anti-Parkinson drugs as soon as you are fully awake, and able to sit up and swallow.

Anti-Parkinson drugs cannot be given during surgery. After some surgical procedures (for e.g. abdominal surgery) you will not be able to take anything by mouth. If this is the case you should ask about having a nasogastric tube inserted before surgery even if the surgeon does not usually insert one for your procedure. You must be able to restart your anti-Parkinson drugs as soon as possible post-operatively to ensure optimal mobility. Post-surgery, crushed regular levodopa can be given with water through tube. Other tablets and the contents of capsules can be administered via nasogastric tube. However, Sinemet alone is preferred for the first few days to minimize the risk of psychosis and nausea.

THE IMPACT OF HOSPITAL STAYS AND PROCEDURES ON PARKINSON’S DISEASE

• Parkinson’s Disease is already creating stress, so your body may be less able to cope with additional problems and adapt to the hospital environment.
• Stress reduces energy for healing and will make all Parkinson’s Disease symptoms worse. Use the stress management skills that work for you, such as breathing exercises, relaxing music on a walkman, and optimism
• Different diet, inadequate fluid, and lack of mobility can lead to constipation, which can be severe. Bring a bowel management protocol with you
• Do not be surprised if you aren’t always clear about what is going on. Different staff on different shifts and medical jargon can all create uncertainty. Ask questions and seek clarification.
• Medication complications can disrupt mobility and mental status, and delay recovery. Family caregivers need both a support system and a key hospital contact person.

Communicating your needs

Staff may not have much Parkinson’s Disease experience, so discuss these issues with the nurse:

• On/off fluctuations are not intentional
• The importance of taking Parkinson’s medications on time. Most hospitals allow nurses a window of time in which they can deliver medications. Delayed drug delivery can disrupt your Parkinson’s Disease and delay your recovery.
• Physical and mental slowness associated Parkinson’s Disease
• Speech problems may affect intercom use
• Hand dexterity may affect eating/hygiene
• Bed turns, transfers, and walking assistance may be required
• Hospital stays increase the risk of falling and fractures for those with Parkinson’s Disease.

Restoring Mobility and Rehabilitation during hospital recovery

• People with Parkinson’s Disease need to restore their mobility as quickly as possible to avoid complications such as pneumonia, deep vein clots, urinary tract infections, and increased rigidity.

• Physiotherapy should be ordered by your doctor following surgery for chest therapy to ease ribcage rigidity and risk of lung complications as well as body mobility exercises. There are inpatient and outpatient geriatric programs commonly used by patients needing assessment and rehabilitation services.

Discharge planning

If necessary:

• Ensure that you and your family understand the medical team’s follow up plans.
• Discuss the following with appropriate staff members: home nursing care, rehabilitation therapy and caregiver respite needs, and concerns arising about the need for ongoing facility care. The hospital social worker can provide links to community health resources.