All of you, from time to time, need to have non-PD related medical care, from simple diagnostic tests, to routine procedures or major surgery. Some medical facilities are more PD savvy than others are and you are certain to encounter some health care providers who are unfamiliar with DBS or even PD. We have all heard stories, from friends or other patients, about simple health care encounters that have turned into PD nightmares due to lack of information. These kinds of experiences are easily avoided by educating your providers about your special needs. Your health care providers will love you for it, they are there to help, not harm you. “Forewarned is forearmed.”
This article will attempt to address some of the common challenges PD patients encounter in the health care setting, and how to proactively protect yourself.

What DBS is

DBS
graphic

Consumer
tips

Protecting
yourself

Programming

Drugs: This is a big one. There are drugs that a Parkinson’s patient should not have, and there are drugs that a Parkinson’s patient MUST not have. The following is a list of medications that are contraindicated in people with Parkinson’s disease. All of your health care providers should have a copy of this list, and when you go to the hospital, or outpatient clinic, request that it be placed in your chart. You can print this list, or your neurologist may be able to provide you with one. If you will be receiving anesthesia, make sure your anesthesia care provider reviews this list.
Tranquilizers: Haldol (halperidol Loxitane (lozapine) Mellaril (thioridazine) Mobran (molindone) Orap (pimozide) Primazine (promazine) Prolixin, Permitil (fluphenazine) Risperdal (risperidone) Serentil (mesoridazine) Stelazine (trifluoperazine) Thorazine (chlorpromazine) Taractan (chlorpothixene) Trilafon, Triavil (perphenazine) Zyprexa (olanzapine)
High blood pressure medication: Aldomet (alpha-methyldopa Moderil (rescinnamine) Raudixin (rauwolfia serpendina) Seraspil, Ser-Ap-Es, Diutensin (reserpine)
Anti-nausea medications: Compazine (prochlorperazine) Reglan (metachlopromide)
Misc.: Buspar (buspirone) Demerol (meperidone) Dilantin (phenytoin) Lithobid (lithium carbonate)

Most hospitals only carry generic Sinemet, and some patients have problems with this preparation. If you cannot use the generic, bring your own Sinemet in the original prescription bottle, and give it to your nurse. If you bring unlabeled medication, they will not accept it. Your physician may need to write an order for you to take your own Sinemet.

Dyskinesia: In the hospital setting, dyskinesia can be misinterpreted as agitation. Agitation is regarded as a safety risk to patients, so you may find yourself with unnecessary IV sedation, or even restraints. If you become dyskinetic on medication, communicate this to all of your nurses and health care providers, and demonstrate what you will look like when you are dyskinetic, so it will be correctly identified.

Surgery: Most surgery, major or minor, inpatient or outpatient, will involve the use of electrocautery. This will not damage the DBS, but some people who have had awake surgery with electrocautery have described a feeling of power surge during the cautery. The safest thing is to shut it off. Explain your DBS to the circulating nurse, and request that your cautery grounding pad be placed far away from your generators. Additionally, if you are having surgery above the chest, talk to your surgeon during the preop interview about using closed current bipolar cautery.

ECG and EEG: If you need to have an electrocardiogram or electroencephalogram, your DBS is likely to create artifact. If the technician is not familiar with DBS, he or she may not be able to complete the test. All you have to do is turn them off, so be sure to bring your access review device or magnet. If you shake badly with your stimulators off, you will need to ask your caregiver, or the technician, or both to immobilize your upper body for the duration of the test. It will only be a few minutes.

X-Ray, CT Scan and MRI: Regular X-ray, mammogram, dental X-ray, etc. are safe and you donít have to take any special precautions with your DBS. The same for CT. MRI is another story. If you need to have an MRI, your amplitude should be set to zero. This is because the magnet could turn the stimulators on and off. If there is no amplitude it won’t affect you. If a programming provider is not available for this, a Medtronic representative should be able to assist you. It is not recommended that patients with DBS enter MRI scanners with resolution above 1.5 Tesla. Provide this information to the MRI technician, and he or she will know what to do.

Dental Work: When you have invasive dental work, that is work that might cause bleeding, you should have a prophylactic course of antibiotics prior to the work. This is because the mouth is full of bacteria and, if it enters the bloodstream, could attack your hardware. This is standard procedure for patients with pacemakers, so if you tell the dentist that your device is similar to a pacemaker, he will know how to proceed. Some dental hygienists now use ultrasonic devices to clean teeth, and you all know about the warnings with ultrasonic therapies, so it’s good old-fashioned teeth scraping for you!

I hope this information is helpful to you, and I would encourage those who have had other health care experiences with their DBS or PD to share them, so we can all learn how to protect our PD patients.