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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Beverly Adams on April 20, 2001, at 0:50:47
My name is Beverly ( or Bev ) and I am the main care giver for my Mother. The problem I have is with her.
I would like to thank you in advance for reading the "book" below. If you know anything about drug interactions involving Demerol, please read on.
Background:
Mom has Dual Depression and several Dystonias. She received BOTOX injections Dec/2000, Jan/2001, and Feb/2001. Three days after the last injection, she fell and broke two ribs in her back. The Emergency Doctor gave her Demerol injection and a perscription for a week's worth of 3 times a day. I can not remember the amount of the dose.
Needless to say, she does not remember anything of that week.
The problem is what happened afterwards. Before the ribs, Mom made a guttural noise associated with Oromandibular Dystonia ( the reason behind the BOTOX injections ). Right after the Demerol week, the noise disappeared and was replaced with singing. I have no problem with her singing. It just is the song she sings plays over and over inside her head. She can not stop it. With her dystonias and trying to sing she always hyperventilates.
My main worries are a drug interaction and if we can use MYBLOC ( stronger version of BOTOX ) and get a handle on her dystonia ( where her noise would have gone bye-bye ) we are still left with the singing. It sounds almoost complusive, but she does not have any obsessive thoughts which the singing would provide any type of relief.
Any ideas, suggestions, tips,...? Anything?
Thank you for your time.
Beverly
Posted by SalArmy4me on April 20, 2001, at 1:54:49
In reply to Demerol Interaction, posted by Beverly Adams on April 20, 2001, at 0:50:47
The effect of administering another botulinum neurotoxin serotype (e.g., botulinum toxin type A) at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin.
Posted by Sunnely on April 20, 2001, at 18:46:55
In reply to Demerol Interaction, posted by Beverly Adams on April 20, 2001, at 0:50:47
Hi Beverly,
I would like to offer my long-shot, 2-cent opinion. Is it possible that your mother is experiencing an unremitting "musical hallucinations" and repeating them by singing?"
Demerol can produce hallucinations, however, this problem should subside as the drug is eliminated from the system. I am not sure if the BOTOX injections, which she receives for her neurological condition (? Meige's syndrome), could have precipitated this problem or affected her hearing acuity leading to this problem.
"Musical hallucinations" are the hearing of tunes, melodies, harmonics, rhythms and timbres. They are common in females and are associated with age (among elderly females who have hearing impairment, 1/3 have been depressed), deafness, and brain disease (particularly epileptic focus such as temporal lobe epilepsy or temporal lobe tumor, or stroke). It can also be a symptom of salicylate (Aspirin) toxicity; reported with propranolol (Inderal) use; and seen in alcoholic hallucinosis. Finally, it can also be a prominent symptom of schizophrenia.
I think it would be a good idea to get a head CT or MRI and an electroencephalogram (EEG). Might as well have her undergo audiometry (hearing tests) to be sure. Also, check other medications (prescribed or OTC, any herbals) that she is taking.
If related to an epileptic focus, anticonvulsants, such as carbamazepine (Tegretol) are usually effective.
Just curious, how old is your Mom? Does she have hearing deficits or impairment? Aside from depression, does she have history of mental illness (e.g., schizophrenia).
+++++++++++++++++++++++++++++++++
> My name is Beverly ( or Bev ) and I am the main care giver for my Mother. The problem I have is with her.
>
> I would like to thank you in advance for reading the "book" below. If you know anything about drug interactions involving Demerol, please read on.
>
> Background:
>
> Mom has Dual Depression and several Dystonias. She received BOTOX injections Dec/2000, Jan/2001, and Feb/2001. Three days after the last injection, she fell and broke two ribs in her back. The Emergency Doctor gave her Demerol injection and a perscription for a week's worth of 3 times a day. I can not remember the amount of the dose.
>
> Needless to say, she does not remember anything of that week.
>
> The problem is what happened afterwards. Before the ribs, Mom made a guttural noise associated with Oromandibular Dystonia ( the reason behind the BOTOX injections ). Right after the Demerol week, the noise disappeared and was replaced with singing. I have no problem with her singing. It just is the song she sings plays over and over inside her head. She can not stop it. With her dystonias and trying to sing she always hyperventilates.
>
> My main worries are a drug interaction and if we can use MYBLOC ( stronger version of BOTOX ) and get a handle on her dystonia ( where her noise would have gone bye-bye ) we are still left with the singing. It sounds almoost complusive, but she does not have any obsessive thoughts which the singing would provide any type of relief.
>
> Any ideas, suggestions, tips,...? Anything?
>
> Thank you for your time.
>
> Beverly
Posted by kazoo on April 21, 2001, at 0:00:55
In reply to Demerol Interaction, posted by Beverly Adams on April 20, 2001, at 0:50:47
> My name is Beverly ( or Bev ) and I am the main care giver for my Mother. The problem I have is with her.
>
> I would like to thank you in advance for reading the "book" below. If you know anything about drug interactions involving Demerol, please read on.^^^^^^^^^^^^
Dear Beverly:
One drug combination you should be aware of is combining Demerol with NARDIL (an MAOI). Mixing these two drugs is FATAL.
Good luck with your Ma. I'm in a similar situation so I can identify, associate and appreciate your concerns and angst.
Regards,
(a compassionate) kazoo
Posted by Beverly Adams on April 21, 2001, at 16:24:32
In reply to Re: Demerol Interaction » Beverly Adams, posted by Sunnely on April 20, 2001, at 18:46:55
Sunnely,
Thanks for the tip. I'll look into it.
My Mom is 67 and has a brother who is paranoid schezo ( sorry, I don't know how to spell it ).
She is also taking Depakote twice a day among her many other medications. She takes Aleve, Advil, and Tylenol for her OTC.
Thanks again.
Posted by Sunnely on April 21, 2001, at 21:04:45
In reply to Re: Demerol Interaction, posted by Beverly Adams on April 21, 2001, at 16:24:32
Hi Beverly,
Although your mom's brother (your uncle) has schizophrenia, it is unlikely that your mother is having symptoms of schizophrenia at present, unless she has been diagnosed with one in the past. The onset of schizophrenia generally occurs in early life (late teens to early 20s for males; a bit later age for females).
The concordance rate for the development of schizophrenia among siblings (chance that a sibling will develop schizophrenia if another has schizophrenia) is approximately 9%, unless they are identical twins, in which case it rises to 48%.
I'm wondering why she is taking too many analgesics (pain pills). Both Advil (ibuprofen) and Aleve (Naproxen) belong in the category of NSAIDs (nonsteroidal anti-inflammatory drugs). Tylenol is another pain pill but of different class. I will be concerned about your mom's use of these meds. NSAIDs, especially in the elderly can cause stomach ulcer and bleeding. The elderly are also more sensitive to the central nervous effect of NSAIDs including confusion and hallucinations. Further, she is taking Depakote which has anti-platelet effect leading to increased risk of bleeding. The combination NSAIDs and Depakote makes her more vulnerable to bleeding. I believe there was also a study indicating that Tylenol can also increase the chance of bleeding. Finally, Tylenol and Depakote both can induce liver damage. With your mom's age, her liver (and kidney) function is probably already impaired (because of aging process). I think you should run by her doctor all these meds that she is taking.
If not done yet, I still say that your mom should undergo CT or MRI and EEG (and other tests such as a comprehensive metabolic panel). If your mom starts showing spontaneous bruising or any form of bleeding, you should notify her doctor immediately. This can lead to a potentially serious medical event such as stroke.
+++++++++++++++++++++++++++++++++++++++
> Sunnely,
>
> Thanks for the tip. I'll look into it.
>
> My Mom is 67 and has a brother who is paranoid schezo ( sorry, I don't know how to spell it ).
>
> She is also taking Depakote twice a day among her many other medications. She takes Aleve, Advil, and Tylenol for her OTC.
>
> Thanks again.
Posted by Beverly Adams on April 22, 2001, at 5:49:48
In reply to Re: Demerol Interaction » Beverly Adams, posted by Sunnely on April 21, 2001, at 21:04:45
Sunnely,
Thanks again for your info.
I will check out her mixture of OTC painkillers mixed with Depekote. She is scheduled to have a blood test for the levels of Depekote. I will see if the doctor will go for a metabolic blood test. I will also call our Neurologist and inform him of the worsening problem.
How is it getting worse? In addition to hearing the music, she is constantly singing it underneath her breath. Combined with her breathing problems caused by Meige's Syndrome ( you were right ), the singing makes her hyperventilate and get very short of breath just walking a very short distance ( ex: going into the kitchen from the living room ). She hasn't breathed properly for quite a few years. When she breathes out, she presses her stomach muscles out so bad, she now looks like she is about to deliver a baby any moment. When she is asleep, she sometimes can expand her stomach on the exhalation. I am afraid to leave her in case she falls again. She wears a whistle around her neck to call me if something happens.
Mom also has fibromyalgia, hypothyriodism, migraines ( which lead to the diagnosis of the dystonias ), and social anxiety disorder. I don't think I have left anything out. Did I mention controlled high blood pressure?
Thank you for taking time to give me the additional info and avenues to look down.
Bev
Posted by Beverly Adams on April 22, 2001, at 6:09:01
In reply to Re: Demerol Interaction » Beverly Adams, posted by kazoo on April 21, 2001, at 0:00:55
Compasionate Kazoo,
Thanks for your message and caring. I reread it and it helped me. Right now, I'm on a completely different sleep schedule than Mom. ( She's the one sleeping at night ) I know I'm getting fed up with what she is going through. I know she can't help it. I hear alot of "We gottas" or "You gottas". I'm fighting sevre depression myself ( I'm on medication, tisn't working ). We don't have any family where we live and the friends we have are older than Mom and going through some health problems of their own. We also live in a small town ( the largest employer is the hospital ) which doesn't have any services to help me.
It just kills me to see her like this. I feel helpless and discouraged. We seemed to have been close to some help with her dystonias and now I fear we've been handed a large backwards leap. I had to fight for three years to get her properly diagnosed ( it took migraines before a nuerologist diagnosed her with Meige's Syndrome or dystonias ). We even traveld up to Atlant and Emory, where we saw the Cheif of Neurology, who is also on the Foundation of Dystonias Scientific Board and who entirely missed the diagnosis suggested by another doctor at Emory in 1994.
The psych docotr she was seeing at home ignored the 1994 diagnosis, said she had Tourette's Syndrome and put her on Prolixin. It worked for her until we had a lung cancer scare with me two years ago. Where it took only 10mg of Prolixin to help with the noise, 50mg wasn't making a dent.
Enough of the soap box.
( a grateful ) Bev
Posted by mila on April 22, 2001, at 8:59:54
In reply to Re: Demerol Interaction, posted by Beverly Adams on April 22, 2001, at 6:09:01
dear Bev,
although you do not seem to be one of those people, it amazes me that many forget a simple truth: you cannot possibly be healthy in an unhealthy situation. You've got to take care of yourself, Bev. Have you considered taking a break? Something, just something should be possible to do for you to get some rest, to fly away from this relentless stress at home.
what is your escape, your private sanctuary? is there any possible way to provide yourself a normal amount and schedule of sleep?
gosh, this must be a very difficult situation you find yourself in...
love
mila
Posted by Sunnely on April 22, 2001, at 18:46:23
In reply to Re: Demerol Interaction, posted by Beverly Adams on April 22, 2001, at 5:49:48
Hi Beverly,
Thanks for further info on your mom.
Is it possible that is respiratory or breathing difficulty could be a form of respiratory dyskinesia? In your other post, you mentioned that she was on Prolixin (high-potency neuroleptic). This drug (and the other older neuroleptic, particularly the high-potency ones) have been reported to cause tardive dyskinesia (TD) and some form of dystonia, including the Meige's syndrome. Occasionally, a form of tardive dyskinesia called "respiratory dyskinesia," can occur. As you may be aware, the elderly (especially women), are highly vulnerable to TD induced by neuroleptics or antipsychotics. In most cases, TD symptoms are usually seen in the face and mouth area. However, occasionally, it can also affect the throat ("pharyngeal TD") and breathing as in "respiratory dyskinesia." Meige syndrome and other forms of tardive dystonia can ce-exist with TD.
A very good idea to have the neurologist re-evaluate her.
Please keep us updated. Thanks.
+++++++++++++++++++++++++++++++++++++++
> Sunnely,
>
> Thanks again for your info.
>
> I will check out her mixture of OTC painkillers mixed with Depekote. She is scheduled to have a blood test for the levels of Depekote. I will see if the doctor will go for a metabolic blood test. I will also call our Neurologist and inform him of the worsening problem.
>
> How is it getting worse? In addition to hearing the music, she is constantly singing it underneath her breath. Combined with her breathing problems caused by Meige's Syndrome ( you were right ), the singing makes her hyperventilate and get very short of breath just walking a very short distance ( ex: going into the kitchen from the living room ). She hasn't breathed properly for quite a few years. When she breathes out, she presses her stomach muscles out so bad, she now looks like she is about to deliver a baby any moment. When she is asleep, she sometimes can expand her stomach on the exhalation. I am afraid to leave her in case she falls again. She wears a whistle around her neck to call me if something happens.
>
> Mom also has fibromyalgia, hypothyriodism, migraines ( which lead to the diagnosis of the dystonias ), and social anxiety disorder. I don't think I have left anything out. Did I mention controlled high blood pressure?
>
> Thank you for taking time to give me the additional info and avenues to look down.
>
> Bev
Posted by kazoo on April 22, 2001, at 22:28:46
In reply to Re: Demerol Interaction, posted by Beverly Adams on April 22, 2001, at 6:09:01
> Compasionate Kazoo,
You, my dear, are the compassionate one!
I gave up my "life" to care for my father who died from brain cancer in 1996, and now I'm the caregiver for my mother; however, through it all, I've come to realize that there is no greater display of love and respect one can have for their parents than to care for them when they need it the most. After all, they cared for us. I have no regrets. God sees everything.
Kazoo
Posted by Beverly Adams on April 23, 2001, at 1:00:35
In reply to Re:Bev, posted by mila on April 22, 2001, at 8:59:54
Dear Mila,
Thank you so much for your concern. You are right, I am not healthy and know it.
I realized last night that, as crazy as it sounds, my sleep schedule is a coping mechanism. The time I spend awake, when she is asleep, I spend it for me doing things ( like this ) around the house.
Right now, this is the only way I can spend time with myself. After Kazoo, bless her ( I'm assuming here ) heart, let me vent last night, I feel much better now. All the anger and frustration I had been carrying around for a few days was gone. I even talked to Mom about it today. Knowing people, like you, are out there for me to talk with has helped me tremendously. I might try to get my baby brother to come down from Atlanta, with the explicit instruction he must bring down his two Golden Retrievers with him. I love them to death.
We are going ( hopefully ) to see her GP tomorrow and I'm contacting the three other doctors to see what they say. I'll let everyone know.
Again thanks so much for caring. Please take care of yourself.
Bev
Posted by Beverly Adams on April 23, 2001, at 1:13:42
In reply to Re: Demerol Interaction » Beverly Adams, posted by Sunnely on April 22, 2001, at 18:46:23
Hey Thar Sunnely,
Yes, I have read about TD. I did not know there was a respiratory one. I'll ask her GP about it and possibly getting her to see a RS. She needs help with her breathing and I want it close to home instead of 45 boring miles away. I am calling the three other doctors involved with her care, one of whom is a neurologist, and letting them know what is happening.
I know Prolixin is some very heavy duty stuff. It took me five years to get her off of it. She wouldn't leave her old Psychiatrist until the Neurologist said Meige's Syndrome. Then she came to realize he shouldn't have diagnosed a neurological problem for her without a corresponding neurological diagnosis.
I do believe she does have dystonias, because both her brother and deceased mother exhibit/exhibited some of the same symptoms.
I will keep you posted ( no punn intended ). Thank you so much for being there with all the other possiblitis you have given to me. It helps a great deal to have something to research instead of just doing nothing and being frustrated.
Take care,
Bev
Posted by Beverly Adams on April 23, 2001, at 1:21:00
In reply to No regrets » Beverly Adams, posted by kazoo on April 22, 2001, at 22:28:46
Dear Kazoo,
You are so right about taking care of our parents. Mom is supporting me as I am going back to school, at the age of 42, to get a second degree in Computer Information Systems with a minor in Computer Graphics. This will hopefully allow me to take care of her for the rest of her life.
By allowing me to vent last night, I was able to talk with Mom today and feel better about things. The anger was gone and I thank you.
My second mother, Mama Lou, told me the same wonderful message you sent me tonight. She is very protective of me and will fight anyone who says differently ( they will be beheaded ). I thank both of you so much.
Take care of yourself and I'm proud to know someone like you. Along with our parents, we are a preciouse item.
Bev
Posted by Sunnely on April 23, 2001, at 21:42:06
In reply to Re: Demerol Interaction, posted by Beverly Adams on April 23, 2001, at 1:13:42
Hi Bev,
Firstly, kudos to you for all your sacrifices and unselfishness in providing the needed care for your mom despite having major problems of your own.
Yes, there is such a thing as "respiratory dyskinesia" (RD). It consists of abnormal, involuntary movements of the respiratory muscles and clinically shows as an irregular respiratory rate, tachypnea (rapid breathing), and grunting. I believe you mentioned in your earlier post that your mom grunts or makes some funny noises while breathing. Aging (and presence of brain disease) appears to be a major risk factor for RD.
In one study, the prevalence (the number of cases at any given time) of RD is about 3.9% in patients with prior antipsychotic treatment. The prevalence rate is higher (17.5%) if accompanied by other symptoms of tardive dyskinesia (TD).
The diagnosis of RD is oftenly missed. When one talks of TD, most doctors, even psychiatrists, would immediately think of the classic TD (i.e., oral-buccal-lingual masticatory movement disorder or the mouth-and-tongue movement disorder). To make matters worse, RD can exist without the classic symptoms of TD. IMHO, in your mom's case, the long-term use of Prolixin is probably the culprit in the development of RD.
Good idea to have a respiratory specialist take a look at your mom. She may need a special test such as spirogram (a machine that records the rate, intensity, and pattern of respirations) and laboratory tests such as blood gases, among other things.
BTW, why was your mom on Prolixin for such a long time? Was she diagnosed with a major psychotic disorder such as schizophrenia? Just in case she needs antipsychotic treatment again, definitely avoid the older antipsychotics. The newer generation (atypical antipsychotics) such as olanzapine (Zyprexa) and quetiapine (Seroquel) are probably be the first choices. If she can tolerate clozapine (Clozaril), probably the best drug. However, use of this drug requires weekly blood count because of the risk of agranulocytosis (marked drop in white blood cell count) and aging is one of the risk factors for clozapine-induced agranulocytosis. Incidentally, there have been anecdotal reports of Clozaril being effective in tardive dystonia. Definitely avoid risperidone (Risperdal), although an atypical antipsychotic, Meige syndrome has also been reported with its use.
I included the following reference regarding RD (I'm sure there are more in the literature) for your info. Good Luck.
Hayashi T, Nishikawa T, Koga I, Uchida Y, Yamawaki S: Prevalence of and risk factors for respiratory dyskinesia. Clinical Neuropharmacology 1996;19:390-398.
P.S. I'm sure you know that Sunday, May 13 is Mothers' Day. Only the best for your mom.
++++++++++++++++++++++++++++++++++++++++++> Hey Thar Sunnely,
>
> Yes, I have read about TD. I did not know there was a respiratory one. I'll ask her GP about it and possibly getting her to see a RS. She needs help with her breathing and I want it close to home instead of 45 boring miles away.
Posted by Beverly Adams on April 24, 2001, at 0:05:15
In reply to Respiratory dyskinesia » Beverly Adams, posted by Sunnely on April 23, 2001, at 21:42:06
Dear Sunnely,
First of all, again thanks for the data. Mom's GP said she needs to see either the nuerologist or psychiaritist, whom are cousins. I called them also this morining asking what to do and if they would talk to each other about what is going on. We have appointments with the psychiaritist tomorrow/today @ 4:00. I will bring RD up to him and call the GP again about getting her looked at by a RS. I was going to ask him when I thought we would've seen him.
Mom was on Prolixin because of the noise ( grunting ). She has tried all of the drugs you mentioned including Haldol. Prolixin was the only one which seemed to help. We were told it would create a Catch 22 with the noise. Mom has even had ECTs. Helped for a little bit ( days ) and then back to "normal".
I'm going to check at my school ( in the same town as the cousins ) to see if they get the perioldical in which the article is. If they do, we'll stop by before going to the doctor and I'll make a few copies. I know he'll love it. ( Yea, right!! ) Tough, because my main concern are her and I.
I'm going to sign off right now so I can check.
Take care and have a good one! ( FYI, good one can be anything you want: day, hour, week, test, etc. )
Bev
Posted by tez on July 3, 2005, at 15:40:29
In reply to Re: Respiratory dyskinesia, posted by Beverly Adams on April 24, 2001, at 0:05:15
Hi Bev,
I have only just come across your mail posting. I have been diagnosed with Respiratory Dyskinesia after taking the anti-psychotic drug haloperidol (haldol).
RD is more typical in elderly women so it is certainly possible after anti-psychotic medication. Your GP will probably not be able to recognise the problem. You definitely need a respiratory specialist.
The condition is very rare and very often misdiagnosed. I have heard that it is 'incurable'. I take clonazepam which seems to help a little. This drug makes me very tired though.
There is very little information on it and I do not know of any support groups.
The following article may be worth reading (although I have not read it myself):
Successful treatment of respiratory dyskinesia with picoTesla range magnetic fields, Sandyk-R, Derpapas-K, International Journal of Neuroscience, March 1994, Vol 75, No. 1-2, p91-102.
You may be able to access this article on MEDLINE on the net.I wish you the best of luck. Make sure your mum does see the specialist.
If you have any further information I would be very pleased to hear from you. If you need any more info. please contact me.
Best wishes,
Terence> Dear Sunnely,
>
> First of all, again thanks for the data. Mom's GP said she needs to see either the nuerologist or psychiaritist, whom are cousins. I called them also this morining asking what to do and if they would talk to each other about what is going on. We have appointments with the psychiaritist tomorrow/today @ 4:00. I will bring RD up to him and call the GP again about getting her looked at by a RS. I was going to ask him when I thought we would've seen him.
>
> Mom was on Prolixin because of the noise ( grunting ). She has tried all of the drugs you mentioned including Haldol. Prolixin was the only one which seemed to help. We were told it would create a Catch 22 with the noise. Mom has even had ECTs. Helped for a little bit ( days ) and then back to "normal".
>
> I'm going to check at my school ( in the same town as the cousins ) to see if they get the perioldical in which the article is. If they do, we'll stop by before going to the doctor and I'll make a few copies. I know he'll love it. ( Yea, right!! ) Tough, because my main concern are her and I.
>
> I'm going to sign off right now so I can check.
>
> Take care and have a good one! ( FYI, good one can be anything you want: day, hour, week, test, etc. )
>
> Bev
This is the end of the thread.
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