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Topic Tooth extractions (11 stubs) on a 76 year old Parkinson's patient Go to previous topic Go to next topic Go to higher level

By ToothExtraction On 2014.02.22 01:30
I'm wondering if it's reasonable to force a 76 year old, non-compliant, end-stage Parkinson's patient to have 11 tooth stubs extracted/scraped out in one shot for abscess prevention. Pt is in the home setting; takes levodopa every 2 hours & has major motor side effects. Pt is stubborn and non-cooperative and intolerant to discomfort. I would not push one of my elderly parents to go through such an ordeal; if an abcess does eventually surge it can be dealt with accordingly. having such an invasive procedure can very well result in massive infection with a patient that doesn't follow orders.
All comments appreciated.
Thanks

By jaxrock On 2014.02.22 08:07
Personally, I would not want my husband to go through something like that.
Our doctors have been very conservative with suggesting any treatments that might be painful, futile in the long run.

I don't see the point of such treatment at this stage.

Just my opinion...
Good Luck

By ResistanceFutil On 2014.02.22 09:50
Is the patient in Hospice? The Hospice doctor or RN would be the best person to advise what would constitute palliative care in this situation.

http://www.pdf.org/pdf/fs_parkinson_role_of_hospice_09.pdf

By LOHENGR1N On 2014.02.22 11:42
We Parkinson's patients do not do well recovering from anesthetic. it takes much longer to exit our systems and will make our symptoms present worse while it is in our systems. This could if in hospice and final stages make it a situation he won't recover from the effects. Myself being a patient, prefer to handle dental problems as they arise forgoing preventive care or oral surgery. (for the above mentioned problems).

I would include in assessing the procedure recovering from anestetic time and trouble from such, making sure the doctors know of this problem and potential results. As these problems are not widely known in the medical field as a whole and must be pointed out.

By pickles On 2014.02.22 11:51
We are scheduled to have two teeth removed in the coming weeks and I'm curious to know more about anesthetic recovery and parkinson's. Lohengrin if you can forgive my earlier outbursts/rudeness I would be grateful to hear more about this. <3

Pickles

By jaxrock On 2014.02.22 11:54
I agree...the effects of anesthetic can be horrible for a PD patient...I've witnessed it!
I've had to bring up that fact on many occasions to different doctors.
Cataract surgery was handled differently on my husband because I mentioned the risk to his eye doctor.
Other suggested treatments have been put off as well. Including dental work.
It's a matter of my husband's quality of life at this stage.
I wouldn't want to see him suffer any more than he already is.
Again, just my opinion

By LOHENGR1N On 2014.02.22 16:20
pickles, no worries. With the anestetic mental cloudiness can carry on for weeks and even months. Increased motor symptoms also. If you go under to have a tooth removed you,re probabilly a bit loopy for the rest of the day, with P.D. we,re loopy for a few ddays maybe more. So in the case of this thread , elderly take longer say weeks instead of days so add P.D. and you could be talking months instead of daays . Also if cloudiness lingers a doctor could not noting problems with anestitic and P.D. may say dementia is developing then you,re adding meds same with motor symptoms increased medication then in a few months we're over medicated BUT the doctors think well the increase is working see! I hope this helps and keep asking questions. I'm not upset or mad lol even if I werre...which I'm not I answere questions and give my views trying to help my fellow patients lead aas good a quality of life as they can. (still on a tablet and it isn't tremor friendy better quit here for now, sorry about the typos folks)

By jcoff012 On 2014.02.22 17:03
I brought up a similar dental situation about six months ago...Carl had been toying with getting braces on his bottom teeth for years (BAD underbite, making eating difficult, even before PD dx)...After discussing the entire process with three doctors and his regular dentist, then two sessions with an orthodontist, he decided to go through with the braces without any anesthetic. *He will be 66 in two weeks.*

Sometimes, he is in great pain, other times it doesn't seem to bother him...He feels it will be worth it...I was and still am torn by the whole process...I hate seeing him go through the pain, but, as I have said in other posts, he is his own man and wants this...We had to wade through four kids' sessions with braces until we could afford this!

I truly think he wants to make as many health decisions as possible, and he has his own bucket list...this is number five on his list...he has to have them on for another year, then it is over...

Still torn, and to answer your question as best I can, I would say that the only way to make an informed decision is to do as you have done...come here, ask those who have gone through surgeries, and then ask for your doctor and dentist to confer...Carl's did...they discussed it three times...once while he was in the orthodontist's office. Questions were asked and answered, a printout of pros and cons was given to him and it was up to Carl to come back or not...He chose to go through it...To each his own.

Whatever you decide, I am glad you asked before making such a difficult decision...hugs and good luck, Jane

By ToothExtraction On 2014.02.22 17:09
I appreciate all the feedback, thank you!
I'm one of the caregivers for this person and I think that the stubs should be left alone and dealt with individually whenever a problem arises. My co-worker, the main caregiver is the one who is pushing for this to be done and I think it's booked for next Friday. As far as I know the dentist will freeze each area individually, since the patient doesn't want to pay the extra three hundred and some dollars for the IV sedation, and extract all 11 stubs in one visit...I think this is absurd and have already discussed it with my co-worker, but she thinks this is the way to go...
A great day to all

By Grammy7 On 2014.02.22 23:55
My husband had a detached retina operation as out patient surgery in Feb 2012. He did awful with the anesthetic. They admitted him to the hospital for 6 days, then 30 days in rehab. Came home with 14 weeks of home health care and never walked by himself again. The day of his surgery he showered, shaved, dressed and walked into the hospital. I wish he never had the surgery. He is now very advanced in as assisted living facility. He's either in bed or his wheelchair and is on pureed foods and sleeps a lot. I blame the anesthetic for his fast decline.

By jcoff012 On 2014.02.23 00:06
Oh, Grammy, that touches my heart...I am so sorry...I wish I could say something to you that would help. Bless both of you in your journey. Thank you for posting, as for many of us, this is an avenue upon which we have yet to travel. If you need us, you know we are here. Hugs, Jane

By JulieB On 2014.02.23 19:27
Grammy, I'm so sorry for what this did to your PWP. I'm sending a virtual hug to you....

I had no idea about the possible effects of anesthesia on a PD patient, and will keep that in mind from now on. Quite sobering. xox

By Mary556 On 2014.04.10 11:57
does this caution apply to both general anesthetic and local anesthetic?
TIA. you guys are the best.

By Freespirit On 2014.04.10 13:24
I'm not certain about the local anesthesia, but it sure is a gamble with general. My husband was so "affected" the last time he had it (a few years back now) that we have decided NO MORE. He is an older man who also has advanced prostate cancer. We choose to preserve what mind he has left intact and let the cards fall where they may. Not the right choice for everyone, of course, but it was for us.

By carman96 On 2014.04.10 21:32
My husband's Neuro said absolutely no general anesthetic. He has had some dental work like crowns and bridges, but they used novacain. I hated to put him through it but the dentist said it's important that he can chew well. So that made sense. Also I didn't like that he still had metal fillings, which supposedly can leak mercury. My husband did well and didn't complain too much about the dental work.

By Mary556 On 2014.04.10 22:57
Thank you, Freespirit. I'm sorry for your dear husband having that setback, and for all those who have experienced a decline following anesthesia. My Mom had a dentist visit today and this question was asked. I didn't know how to answer.
General anesthetic is not a risk we want to take either. Something changes to upset the fine balance and then you wish you could go back to the way things were before.
It is invaluable to learn from the input of those who have walked this road before us, to be well-advised and spared another heartache. But this learning came at a cost for someone else.

Carman, thank you, too. One of my mother's teeth has a borderline crack and there has been talk of a crown. Thankful that we do not need to cross that bridge yet. It is reassuring to know that your loved one did well.

God bless all of our PwPs and caregivers.

By parkinit On 2014.04.11 08:28
There are so many things wrong about tooth extraction at this age with Parkinson's. The setback with no hope of full recovery, the anesthesia, the unnecessary act given the "big picture of things." I do hope you share all these comments with the other caregiver.

My father did not have pd, but went under anesthesia several times later on his life for cancer. My mom said, " I hate these surgeries because we lose a little bit of your dad every time he goes under." With PD, YOU LOSE A LOT OF THE PERSON EVERY TIME THEY GO UNDER.

By moonswife On 2014.04.11 10:55
Tooth Extraction we had a similar issue. My husband is hardly at end stage, but knew anesthesia would be a problem. His Dentist and Neurologist conferred and found a teaching Oral Surgeon (from USC) who was will to do extractions with local anesthetic only. Was fine. Now has been fitted with dentures and eats regular food again. Enjoyed ribs last week for the first time in years. Good luck.

By carman96 On 2014.04.11 15:51
I think the original poster has been put in a bad situation. I assume that the family has given the primary caregiver responsibility for health decisions. How awful for them.
I had a friend who was one of the caregivers for a wealthy woman who's family never visited. They hired someone to make health care decisions and hire caregivers. My friend enjoyed taking her out to lunch and doing special things for the woman. She was eventually fired and was devastated that her lady and friend was basically kept a prisoner with uncaring caregivers. Sounds like a scary movie.
Of course it sounds ridiculous to us to put the poor patient through all the extractions. But the person that posted has no say apparently in the final decision. Terrible position to be in but since she is not a family member it sounds like nothing can be done.
It's just a terrible situation altogether


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