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Parkinson's and Pancreatitis
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capegirl2 posted:
Hi, all.....

My mom has been diagnosed with PD for about 10-11 years, of course, not knowing the true beginning. The actual diagnosis was "Parkinsonium Symptoms with Dementia."

Based on that, she has been taking Sinemet for the PD, Aricept AND Namenda for memory.

The disease is, without question, advancing. That said: with a history of stomach issues, she has recently been complaining of terrible stabbing abdominal pains, lasting about 3-5 minutes, 1-3x/day. We finally took her to the ERIC and based on pancreatic enzymes at 1284, they admitted her. The following morning, the hospital doc called to tell me having never seen anything like this---- her enzymes plummeted to 84 --- he was releasing her.

She went to the ER a week later with what she thought was chest pains and left arm pain. BP was hugely elevated (mom had regular high AND orthodontic BP along with an aortic aneurysm); by jthe time she got to the ERIC, her BP was SO regular, the EMTsaid he wouldn't even bring her in. Too late, so they took her into ER and was released for 3 days.

Here's the brass tacks question: ever since her stay at the hospital the 2nd time, she has been WAY MORE confused than ever before! She's begun hallucinating about passed relatives, seeing them, believing they're there. She has lost the ability to speak without slurring most of the time. She feels alone, and can't seem to discern reality a lot of the time. Prior ronthisnhospital stay, she had many, many "clear" days - we'd laugh and joke....even about the memory issues, et al.

Can someting like this happen virtually overnight? I am making a gastro appointment ASAP, but have read about instances where pancreatitis can make a PD sufferer seem completely off.....the hallucinations, paranoia, etc. my mom has always loved and respected most everyone in her life, but the other morning I called her just in time to hear her tell one of her awesome caregivers to "shut up!" I was and still am appalled!

She has had repeated and closely spaced UTIs but nothing as of about a month. She also suffers from psoriasis.

No fever, blood pressure all over the charts. Here is a list of the remainder of her meds:

Mom's Current Meds: (11/2010)

Sinemet 25/100mg.   3x/day Pkns. Tekturna  300 mg.   1/2 tab 2x/day Atenolol  50mg.  1x/day. BP Folb Acid. ?mg.  1x/day Aspirin. 81mg. 1x/day. BP/Prevention Aricept. 10mg.  1x/day  Pkns/Mem  Namenda. 5mg. 1x/day.  Pkns/Mem  Amlodipine. 5mg. 1x/day BP XXXXXXXXXX NOW PRN Lisinopril. 40mg. 1x/day Lexapro. 10mg. 1x/day. Depr/Anxiety.  XXXXXXXXXX Simvastatin. 20mg. 1x/day  Cholest Trazadone. 50mg. 1x/day. Sleep Boltz  XXXXXXXXXX Tylenol 500mg. PRN  Zoloft 50mg (repl Lexapro) 1x/day. Noon/Sleep/Mavica. XXXXXXXXXX

Since all of this, we have stopped Xanax as a sleep aid and now use low dosage (0.25) of Ativan.

We are left wondering if this quick change has to do with a meds mix, the "supposed" miraculously disappearing Pancreatitis, BP meds ..... We are at a complete and total loss. Just had her to her interest : all liver, kidney, chol., white blood count are within normal range. Her doc says her pancreatic enzymes are still a bit elevated but nothing he's concerned about, saying he ran the two tests one runs for pancreatitis. Today we had her see her neuron and he did another Czt scan of which the results should be in 1-2 days.

If this is the real beginning of the end, I get that. I just can't leave all other options unturned without an answer; that would be a complete disservice to mom.

Sorry I took so much time, but I am open to any and all input.

Thanks so much in advance,

capegirl2
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capegirl2 responded:
So sorry about all of the typos - this iPad was on auto-suggest/correct and I typed too quickly to see it/them. Some corrections:

ERIC = ER Orthodontic = Orthostatic "Mom had....." = "Mom HAS......." Interest = Internist Neuron = Neuro Czt scan = CT scan
 
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worn1 responded:
Dr Stacy
please read and respond. I can respond to her mothers attitude but not to the clinical problems.
capegirl2
Your mother is tired of being poked,proded and getting no sleep. Being a patient in the hospital these days is no cake walk. It use to be sleep at night was the most important thing. Now it is get the patient well enough to release the patients as soon as possible. Your mother has most likely been awaken several times during the night for vital signs blood tests medications. Some hopital do not have the most courteous staff at night ie noisy and fail to answer calls from the patients. I would be irritable also if I had to spend any amount of time in the hospital as a patient. I have worked nights in both military and civilian hospitals. Managed care has caused the medical community to concentrate on the almighty dollar instead of the patient. There are a few of us dinasours around who remeber what it was to take care of patients. so it your mother was rude Do not be offended. She has reason to be rude.
 
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capegirl2 replied to worn1's response:
Thanks for the reply.

We received the results from the MRI from the neurologist today: no change from a year ago.

He DID say that if pancreatitis is present, it wreaks havoc with a PD patient and that I need to get mom to a gastro "immediately." They may or may not be able to do anything but at least there will be SOMEthing to lay a finger on. He said it can quickly cause Encepolopathy which could totally be triggering these outbursts and nastiness and advancing the dementia.

For anyone who suspects this in a friend or loved one, I will post when I get some kind of feedback or labs from the gastro appt. I made for this Friday, expecting no real answers till the following week.

FYI: our neurologist also said that with dementia, try to keep your loved one otherwise healthy enough to stay out of the hospital; that with each stay, the dementia WILL worsen and yes, it CAN happen virtually overnight, IN hospital.....

Thanks again for your input. Will repost next week.

capegirl2
 
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worn1 replied to capegirl2's response:
capegirl2
glad to hear you are getting the answers you need. It sounds as if you have a great neurologist.
w
 
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DUKE MEDICINE
Mark A Stacy, MD replied to worn1's response:
Hi, capegirl2
I apologize for my long delay, but glad things have been defined and a treatment plan is in place.
 
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capegirl2 replied to Mark A Stacy, MD's response:
Thank you both for your thoughts. I wish I could say that things are looking up. Unfortunately, as you both most probably know, and as our neurologist shared, there may be nothing that can be done, ASSUMING we even get an encepholopathy diagnosis, the worsening dementia will remain.

As the sole child living close enough to deal with all of this, I am HUGELY concerned with our caregiver situation. We have an awesome CNA who works at a facility but lives in with my parents Monday morning through Wednesday afternoon, and a second caregiver who works the remainder of the week. As much as they both adore my mom, they have both voiced how difficult it is becoming to care for not only mom and her worsening dementia, but my stepfather, who has been pretty independent, has recently begun barely eating, has been in the hospital so he is now very weak, and they're having to deal more and more with both parents.

I am afraid that I will lose one or both. Dealing with a fixed income, it will be over-the-top rough to replace them from a loving/caring standpoint who my mom loves in return, not to mention they're both working for a really good amount of a salary.

And as much as the health issues are, of course, my main concern, this is constantly in the back of my mind, swimming, and causing an amount ofnstressmI a finding increasingly difficult to deal with.

Thanks again....just getting this out is somewhat cathartic.



capegirl2
 
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susiemargaret responded:
hello, C --

WORN1 asked me to take a look at your post; i appreciate the faith in me (see PS1)!

one thing i need to clear up -- is your mother's diagnosis parkinson's disease with dementia, http://www.webmd.com/parkinsons-disease/default.htm , or parkinsonian symptoms with dementia (also called parkinsonism), http://rarediseases.info.nih.gov/GARD/Condition/10251/QnA/27090/Parkinson_disease.aspx ? these are two different things. for the purposes of this post, i am assuming that her diagnosis is parkinsonian symptoms with dementia; if i am incorrect, however, please write back and i will give it another shot!

i also could not tell whether she is taking all of the meds listed below or some currently, others in the past. finally, i could not tell which ones are PRN ("as needed"). for the purposes of this post, i am assuming that she is taking all of the meds listed below and that she takes all of them regularly. please correct me if i'm wrong!

the main issue, if i am understanding it correctly, is whether what appears to be your mother's worsening dementia could be a product of her various meds or of pancreatitis, or whether it is simply -- "simply," hah! -- an inevitable part of her parkinsonian symptoms with dementia.

from your post, it looks like your mother is taking the following meds regularly --

-- aliskiren/tekturna for high blood pressure (PS2),

-- amlodipine/norvasc, a calcium-channel blocker for high blood pressure (PS3),

-- atenolol/tenormin, a beta blocker for high blood pressure and chest pain (PS4),

-- lisinopril//prinivil/zestril for high blood pressure (PS5),

-- trandolapril/mavik for high blood pressure (PS6),

-- aspirin//easprin/ecotrin/empirin as an anti-inflammatory and blood thinner, and for pain (PS7),

-- acetaminophen//tylenol/panadol for pain (PS8),

-- simvastatin/zocor for high cholesterol (PS9), and

-- folic acid, a B vitamin for vitamin B deficiency, stroke, kidney disease, liver disease, and bowel problems, among other things (PS10).

i see that i am about to run over the word limit, so can you meet me at my subsequent post?

-- susie margaret

PS1 -- i am not a medical person; i welcome, solicit, and indeed beg for correction, amendment, or replacement of any inaccuracies in this post.

PS2 -- webMD info on aliskiren/tekturna is at http://www.webmd.com/drugs/drug-147671-aliskiren Oral.aspx?drugid=147671&drugname=aliskiren Oral&source=2 .

PS3 -- webMD info on amlodipine/norvasc is at http://www.webmd.com/drugs/drug-5891-amlodipine Oral.aspx?drugid=5891&drugname=amlodipine Oral&source=2 .

PS4 -- webMD info on atenolol/tenormin is at http://www.webmd.com/drugs/drug-11035-atenolol Oral.aspx?drugid=11035&drugname=atenolol Oral&source=2 .

PS5 -- webMD info on lisinopril//prinivil/zestril is at http://www.webmd.com/drugs/drug-6873-lisinopril Oral.aspx?drugid=6873&drugname=lisinopril Oral&source=2 .

PS6 -- webMD info on trandolapril/mavik is at http://www.webmd.com/drugs/drug-12430-trandolapril Oral.aspx?drugid=12430&drugname=trandolapril Oral&source=2 .

PS7 -- webMD info on aspirin//easprin/ecotrin/empirin is at http://www.webmd.com/drugs/drug-5093-Aspirin Extra Strength Oral.aspx?drugid=5093&drugname=Aspirin Extra Strength Oral&source=2 .

PS8 -- webMD info on acetaminophen//tylenol/panadol is at http://www.webmd.com/drugs/drug-892-Acetaminophen Extra Strength Oral.aspx?drugid=892&drugname=Acetaminophen Extra Strength Oral&source=2 .

PS9 -- webMD info on simvastatin/zocor is at http://www.webmd.com/drugs/drug-6105-simvastatin Oral.aspx?drugid=6105&drugname=simvastatin Oral&source=2 .

PS10 -- webMD info on folic acid is at http://www.webmd.com/vitamins-supplements/ingredientmono-1017-FOLIC ACID.aspx?activeIngredientId=1017&activeIngredientName=FOLIC ACID .
what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
 
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susiemargaret responded:
hello again, C --

this is the second part of my post in response to your inquiry about possible causes of your mother's worsening dementia.

your mother is also taking --

-- lorazepam/ativan for anxiety and insomnia (PS11),

-- sertraline/zoloft, an antidepressant (PS12),

-- trazodone/desyrel for depression and insomnia (PS13),

-- donepezil/aricept to improve memory, awareness, and ability to function associated with dementia related to alzheimer's disease (PS14),

-- memantine/namenda to improve memory, awareness, and ability to function associated with dementia related to alzheimer's disease (PS15), and

-- carbidopa-levodopa//sinemet/atamet for parkinson's disease or parkinsonian symptoms (PS16).


i ran an interactions check on http://www.drugs.com , a website i trust, and will try to summarize what i found without ending up with an encyclopedia! first i'll deal with an interaction that could be contributing to your mother's worsening dementia, then i'll list some other interactions that you might want to be on the lookout for.

the combination of sertraline and trazodone can cause serotonin syndrome, a potentially life-threatening condition associated with too much serotonin in the bloodstream. it is characterized by changes in mental status, including confusion and hallucinations, and fluctuating blood pressure and gastrointestinal problems such as cramping, nausea, vomiting, and diarrhea. this is considered a major risk.

i am not a medical person, and i do not second-guess drs. nonetheless, the symptoms of serotonin syndrome match your mother's symptoms so closely that i think you may want to ask her dr if this is a possibility. keep in mind, however, that the fact that this may be a possibility does not mean that it is a certainty and therefore that you should do this as diplomatically as you can! i believe it would be extremely unwise to say that some woman on the internet suggested this idea; it would be better to say it was the result of your own research, which is absolutely true in that you reached out to us for help. in addition, you could easily duplicate the checks on interactions that i did.


oh, dear, i see i am running close to the word limit again. can you meet me at my subsequent post? i hope it will be the last!

-- susie margaret

PS11 -- webMD info on lorazepam/ativan is at http://www.webmd.com/drugs/mono-5244-LORAZEPAM - ORAL.aspx?drugid=8892&drugname=lorazepam Oral&source=2 .

PS12 -- webMD info on sertraline/zoloft is at http://www.webmd.com/drugs/mono-8095-SERTRALINE - ORAL.aspx?drugid=1&drugname=sertraline Oral&source=2 .

PS13 -- webMD info on trazodone/desyrel is at http://www.webmd.com/drugs/mono-89-TRAZODONE - ORAL.aspx?drugid=11188&drugname=trazodone Oral&source=2 .

PS14 -- webMD info on donepezil/aricept is at http://www.webmd.com/drugs/mono-9218-DONEPEZIL - ORAL.aspx?drugid=14334&drugname=donepezil Oral&source=2 .

PS15 -- webMD info on memantine/namenda is at http://www.webmd.com/drugs/drug-77932-memantine Oral.aspx?drugid=77932&drugname=memantine Oral&source=2 .

PS16 -- webMD info on carbidopa-levodopa//sinemet/atamet is at http://www.webmd.com/drugs/mono-41-CARBIDOPA%2FLEVODOPA - ORAL.aspx?drugid=3394&drugname=carbidopa-levodopa Oral .


what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
 
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susiemargaret responded:
hello again, again, C --

this is the third part of my post responding to your inquiry about your mother's worsening dementia.

the remaining interactions that i found do not seem to match your mother's symptoms, but she is taking so many meds that can reduce blood pressure that i am concerned about their cumulative effects. i list these below.

the combination of amlodipine and atenolol can reduce blood pressure and heart function. this is considered a moderate risk.

the combination of atenolol and lorazepam can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of atenolol and trazodone can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of atenolol and carbidopa-levodopa can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of lisinopril and lorazepam can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of lisinopril and trazodone can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of trandolapril and lorazepam can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of trandolapril and carbidopa-levodopa can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of trandolapril and trazodone can reduce blood pressure and cause a person to pass out. this is considered a moderate risk.

the combination of amlodipine and carbidopa-levadopa can reduce blood pressure. this is considered a moderate risk.

the combination of lisinopril and carbidopa-levodopa can reduce blood pressure. this is considered a moderate risk.

the combination of amlodipine and trandolapril can reduce blood pressure. this is considered a minor risk.

the combination of amlodipine and lisinopril can reduce blood pressure. this is considered a minor risk.

in contrast, the combination of amlodipine and aspirin can increase blood pressure. this is considered a moderate risk.

the combination of atenolol and aspirin may decrease the effectiveness of the atenolol in reducing blood pressure. this is considered a minor risk.


there are several other combinations that have the potential for detrimental effects. i list these below.

the combination of lorazepam and sertraline can depress breathing. this is considered a moderate risk.

the combination of lorazepam and trazodone can depress breathing. this is considered a moderate risk.

the combination of amlodipine and simvastatin can increase the concentration of simvastatin in the blood; this can lead to myopathy, which is muscle pain, muscle weakness, and atrophy. this is considered a major risk.

the combination of simvastatin and carbidopa-levodopa can cause peripheral neuropathy, which is tingling, pain, or numbness in the hands and/or feet. this is considered a moderate risk.

the combination of aspirin and sertraline can induce bleeding, including gastrointestinal bleeding. this is considered a moderate risk.

the combination of aspirin and donepezil can induce gastrointestinal bleeding. this is considered a minor risk.

the combination of lorazepam and carbidopa-levodopa can decrease the effectiveness of the carbidopa-levodopa. this is considered a moderate risk.

in theory, the combination of carbidopa-levodopa and memantine can enhance the effectiveness of the carbidopa-levodopa; however, the clinical significance of such an enhancement is unknown. this is considered a minor risk.

the combination of sertraline and donepezil can increase the concentration of donepezil in the bloodstream; however, the clinical significance of this increase is unknown. this is considered a minor risk.


let's go to what i fervently hope will be my final post!

-- susie margaret
what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
 
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worn1 replied to susiemargaret's response:
Good morning susie margaret:)
I should have been more specific concering the area of research. . The area of research I was thinkng about is the other area of your expertse. After reading her last email I thougt of your research in the area of resoruces available to help. Also you usually have some ideas that help.

Thanks again
W
 
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worn1 replied to susiemargaret's response:
Susie Margaret all I can say is wow. You put it together and in simple terms t boot.

W
 
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lovedogs1955 replied to worn1's response:
Capegirl2, I don't know where you live so I don't know if the same agencies exist under the same names as where I live.

It sounds like your parents are living in their own home an d that you have caregivers coming in to them. Since I am a disabled RN, CCM (Certified Case Manager) and I specialized in Geriatrics, I have some base to speak from. First of all, have you been in contact with your local Office on Aging for guidance/assistance? In my County, this office works within the local communitiy services branch of our County government. Second, your Health Department should have some specialized nurses or Social Workers who can go into their home and conduct a thorough physical/mental/environment assessment and then make recommendations based on their findings. And the last thing I can think of this morning (I find it hard to think clearly for very long these days!), see if you have any Geriatric Case Managers working nearby. They are angels in disguise and can help you navigate through the healthcare maze.

Hope this helps. Good luck.
 
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susiemargaret responded:
hello again, again, again, C --

this is the fourth and final part of my post responding to your inquiry about your mother's worsening dementia.

you mentioned that your mother might get a diagnosis of encephalopathy (PS17). for other readers, encephalopathy is a catchall term for any degenerative brain disease. it manifests as an altered mental state, which can range from progressive memory loss and personality changes to dementia, eventual loss of consciousness, and death.

treatment for encephalopathy depends on the underlying cause; some common ones are infection, metabolic problems, physiologic changes, and trauma. altho less common, acute pancreatitis can also cause encephalopathy. when related to pancreatitis, encephalopathy can come on very quickly, so if your mother does have pancreatitis, it is possible that her worsened dementia is one consequence.


i sympathize completely with your distress about your father's deterioration. i hate to suggest this, and i'm sure you hate thinking about it, but if neither of your parents can care for themselves, it may be time to consider options other than his and your mother's staying at home with full-time caregivers. do you have brothers and/or sisters with whom you can discuss this? aunts and/or uncles?

i hope this helps. i send you caring thoughts and hope you will keep us posted on how you and your family are doing.

-- susie margaret

PS17 -- an excellent article on encephalopathy is at http://www.medicinenet.com/encephalopathy/article.htm .
what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
 
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susiemargaret replied to worn1's response:
hello, W --

oh! well, just in case we do need an encyclopedia, we have one! i've also done a response with a list of resources.

-- susie margaret
what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.


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