MEDS AND NEUROLEPTIC MALIGNANT SYNDROME

MEDS AND NEUROLELPTIC MALIGNANT SYNDROM (syndrome)
by stacys_aunt


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stacys_aunt
Female
MERIDIAN - MS
Member since Mar 2008
Mood: stacys_aunt is HOPEFUL
  



, 8 hours ago
I am a 51 y/o female, with hx of mvp and high blood pressure, which is well-controlled with Diovan 80. I'm also taking a multivitamin a day, calcium, vitamin C, one fish oil capsule twice a day, Vitamin A (8000 U.) capsule once a day; and Singulair or Zyrtec whenever I have allergy symptoms, or if I know I'm going to be around a lot of dust. I'm also about 50-60 lbs. overweight.
When I was about 27-29 years old, I started having chest tightness & pain, heart fluttering and light-headedness. It scared me, so I went to the ER, where they told me I was having panic attacks. The next time I went, they called it tachycardia. I was then sent to a cardiologist, who diagnosed me with mitral valve prolapse. He put me on Tenormin, which was later changed to Kerlone. I took it for about 1-1/2 years, before another cardiologist said I didn't need it; my MVP was very mild, he said, barely noticeable - so he took me off of it.I felt much better after that, not as tired. Since then, I have had very few problems, aside from having the same symptoms at times when I took certain NSAIDS (like Aleve or Naprosyn), or decongestants. There have been a few times that I have woken up during the night, feeling the same symptoms, plus feeling cold, even in the summertime, and trembling all over. I thought at first that my blood pressure was dropping at those times, but I had one of those "spells" once when my daughter was in the hospital, and I asked the nurse to take my blood pressure - it was 150/100. I know it sounds really strange, but since I've had so many of these "spells", I've learned that if I feel it coming on, I can get a book and start reading, and it will ease off. I guess it works by bringing my blood pressure down, or something(?).
Anyway, to get to my main point. I have recently been diagnosed with squamous cell carcinoma on the right side of my tongue. I will have surgery Aug. 11 at Baptist Hospital, Jackson, MS. When I went to the surgeon's office on July 25, he scheduled the surgery and ordered blood work, EKG and a chest X-ray. They did the blood work and EKG there. After the EKG, one girl said they "saw something" on the EKG; then she said that the girl who actually did the EKG said that I was "moving around"; I really wasn't!
My regular doctor here repeated the EKG, did a chest X-ray and surgical clearance exam. He said the EKG was "OK", didn't go into any detail. The surgeon had also wanted me to ask my regular dr. to order a doppler on my right leg, since I had a blood clot taken out of my shin Sept. 28, following a car accident Sept. 15, and there is still a hematoma on one side of the place where the clot was. My regular dr. said "We just did the doppler soon after the accident; I'll just send him that one." Also, the surgeon wanted me to talk to my dr. about getting back on the beta blocker, which I told him I didn't really want to, unless I really had to. My Dr. said "I think he's just being overly cautious". Is he? Or is my Dr. being "underly cautious"? I have had EKG's in the past that mentioned  something about a QT interval, and my dr. said it was nothing to worry about.
The reason I'm bringing all this up, though, is because all this makes me a little nervous about the surgery. My niece, who was "develpmentally delayed" and autistic, passed away suddenly this past March because of drug interaction; she was put on Geodon & Risperdal, by a nurse practitioner. The Dr. in ICU said her heart was just beating so fast & so irregularly that it just "gave out". I went to this MedHelp site and was told what probably happened was that the combination of the two drugs probably caused her to get Neuroleptic Malignant Syndrome. I read also that NMS can be caused from otherr drugs, such as Phenergan & Reglan; that really shocked me, because in at least my last 2 surgeries: hysterectomy in 2001 and Right mandibular salivary gland removal in 2002, I was given Phenergan and Reglan just before surgery! Scary, huh?!
But, the only problems I've had in the past few years with my MVP is the occasional "spells" I described above, and about a year ago, I started having "skipped', or maybe extra, heart beats, that "thumped" so hard that I could feel it in different parts of my chest, even up into my neck, and was having trouble getting to sleep at night. My dr. had a 24-hr. holter monitor put on me, and he said he could see the "skips" or extra beats, but just told me to cut out caffeine. I did cut down, but I didn't completely cut it out. When I called the surgeon's office to check on the EKG, the nurse told me to cut out the caffeine before surgery. So I'm down to 1/4 cup of regular coffee mixed in 3/4 cup decaf this morning, and will try all decaf by Friday.
The nurse told me to talk with the anesthesiologist Mon. morning (just before surgery) about my concerns with the Phenergan & Reglan; but I think I should talk to somebody about it before then! Of course, I don't want to throw up after surgery, either! Especially since my tongue will be so swollen! (The surgery will be Partial Glossectomy, Modified Neck Dissection (to look at/ poss. remove an 8mm. lymph node), Poss. Trachetomy, Poss. Tonsillectomy.
So, do you think I should be concerned about this? Shold I try to talk to the anesthesiologist further ahead of time? Do you think maybe my Dr. is being "underly cautious"? (Oh, yeah, I almost forgot; I always get antibiotics before dentist visits, even teeth cleaning, and "any invasive procedure", just as I'm supposed to, since I have MVP. But when I asked my Dr. didn't I need to be on antibiotics before the surgery, he said "No"; Strange, huh? The surgeon's nurse thought so. Even before this came up, I was thinking of changing doctors.I know I'm going to now, to one who won't dismiss my concerns.
Thanks for taking the time to read all this! I look forward to hearing from you soon.
                                                                                                                    Sincerely,
                                                                                                                    Beverly      

[dolfnlvr]

Hi there.  You have so many things going on, and I'm so sorry you've had to go through this.  Before I begin my response, I want to remind you that I am not a doctor, and that what you are about to read is my OPINION, based on years of experience and some very rudimentary health training (EMT certification and B.S. in Biology).  I do not want you to think that I am in any way giving you definitive advice.

Here goes....

Based on what you have written above, I do not think you need to be overly concerned about alot of what is going on.  Let's start with the MVP.  Mitral Valve Prolapse is probably one of the most overly diagnosed "conditions" in the medical community.  As few as 20 years ago MVP was considered a serious condition that warranted progressive treatment.  And that was true...THEN.  See, the technology used to identify abnormalities in the past were no where NEAR as sensitive as those that exist today.  As it turns out, something like 80% of the world's population has some sort of heart murmur that, years ago would have gone undetected, but show up regularly today.  What does that mean?  Well, it means that the heart is a pretty resilient muscle and that it is rare to find one that is 100% perfect.  In other words, there are multiple variations on a theme that are completely normal and healthy for THAT PERSON.  MVP, if it is pronounced, deserves close observation and preventative measures (antibiotics before dental work etc).  However, mild MVP is has been shown to have NO ADVERSE EFFECTS ON THE PATIENT and is not considered something that needs treatment at all.  Older doctors (sorry to say) that have not kept up to date on newer techniques and research often treat ALL MVP as though it were a problem, as they did years ago.  It's kind of like they are looking at an outdated textbook, but following it to the letter.  More modern doctors are aware that MVP, unless severe or pronounced is quite literally nothing to think twice about.  So, the fact that your cadiologist does not feel that you need antibiotics before surgery does not raise red flags for me.  

Now, the medication interactions is another story altogether.  One of the first things I will address is the situation with your niece.  Your niece was under the care of a nurse practitioner who prescribed some heavy duty drugs that, together, caused a rare but not unheard of side effect of severe tachycardia.  It is unfortunate that your family had to go through this horrible tragedy, and it is completely understandable that you have been made afraid by this occurence.  Here's the deal though.  Your niece was not (presumably) under face-to-face, one-on-one observation with multiple monitors and counteractive drugs nearby upon administration of the drugs that she took.  I would assume that your niece took the drugs, which  caused the arhythmia and was THEN taken for treatment.  You will be less than 2 feet away from a doctor whose sole purpose is to watch your vital signs, coloration, respiration and general appearance for the duration of your surgery.  If there is the slightest hint of trouble, your anesthesiologist will be prepared to administer treatment IMMEDIATELY.  While your anesthesiologist should be made aware of the family history of cardiac problems due to drug interactions your personal medical history is well known to him/her before he ever meets you.  An anesthesiologist is required to review your chart and be intimately aware of ANY possible complicating factors that may affect surgery outcomes.  So, a meeting shortly before the surgery should suffice.

While the internet and media are wonderful resources for keeping us informed, they often play up the least likely of circumstances and make them sound as though they are the norm.  All pharmeceuticals have side effects that can be dangerous for an individual.  But, with much research, doctors are well aware of the preceding risk factors that increase the liklihood of these complications and take strides to avoid use of potentially dangerous drugs with specific patients.  You are to be commended for your research efforts and persistence in acquiring the best possible medical assistance possible.  Especially having experienced conflicting diagnoses and treatments in your recent history.  I do feel that you are in safe hands and that your cardiac issues are being adequately considered in this situation.  I'm not 100% certain of the surgery and its ramifications, but as far as your cardiac health is concerned, I think you are in good hands.

Good luck, good health, and good day :-)

[dolfnlvr]

Bump.