Re: MG & Thyectomy

Posted By Tess on August 22, 1997 at 01:24:50:

In Reply to: Re: MG & Thyectomy posted by CCF MD on August 21, 1997 at 12:49:24:









OK, now for my response from a myasthenic:
Firstly, all the MG info you will ever need to find on the net is
linked
from the MG Links homepage at:
     http://pages.prodigy.com/myasthenia
It is constantly being updated, and will allow you to avoid
"advertising" sites for food supplements, etc., that are mostly
scams.
You will find a good "beginner guide" at my site at:
     My MG is not a sportscar!
     http://www.geocities.com/HotSprings/9943
Click on the "New Patients" page.
1) Is a thymectomy contraindicated in a 59 year old patient?
There is no reason that if there are no other reasons (i.e.
poor health) for contraindication that you cannot have a thymectomy
at a later age.  Some patients have received thymectomies over the
age of 70, but I wouldn't consider it until your father's health is more
stable.
Your physician should be looking at a combination of  autoimmune
suppressants and perhaps IVIg or plasmapherisis in order to
"boost" his health so he can get back to eating properly beforehand, if
possible.
2) Is MG common enough that a neurologist in a managed care
practice can adequately treat the disorder? Or would you recommend seeing
someone in a specialized clinic or university med. center?
    
NO to the first question!  Even most neurologists are not well versed in MG.  Call the Muscular Dystrophy Association office nearest you, or call the National office, and find your local office.  You can have your father seen by MDA neuros who are familiar with MG.  Otherwise, you MUST find a neuro who is well versed in MG, and is someone with whom your father will have a good rapport.  One is as important as the other.  It took me until I saw my SIXTH neuro to find  someone whom I could work comfortably with.
3) I've read some articles on Medline that suggest that the
thymectomy procedure that is done without opening up the sternum has been
achieving good results, any thoughts?
There are THREE procedures.  
1. Transternal (the open-the-chest approach) which is the classic form,
2. a cervical  or "necklace" cut (through the neck using a scope), and
3. a cut under the breasts ACROSS the ribcage (in which they go UNDER the ribcage, and the lung is collapsed) using a scope.  
Obviously the first technique has the better "vision" so it is more common.  The transternal approach is for that reason almost the only option if the thymus appears to be unusual and thymoma or thymic hyperplasia is suspected.
In thymectomy, the anesthesiologist and nursing staff must be WELL versed in MG not just thoracic surgery, as MGers must avoid certain anesthetic agents, and medications (anticholinesterates and pain therapy) should be self-administered during post-op.
4) Could a recurrent tooth infection play a part in the worsening of symptoms?
Most definitely!  It can exacerbate crisis if left untreated or improperly treated.   Also, your father's dentist should only treat him when he is strongest.  For most, that means first thing in the morning.   He should also watch which medications are used.  I do have info links for dentistry in MG, if you cannot find them.  E-mail me at ***@**** , as that page is not yet up, should you need them.
5) At what point would you suggest getting a second opinion?
Immediately.  No one should go through any major treatment for MG without a second opinion and a lot of preparation.     E-mail me if you like, and feel free to join, or have your father join, our mgmail support group.  Some pics of our members are on my homepage, on the "Hall of Fame" page.  Info about free
subscription to same is there as well.  OR we also have online chat forums,
listed on my "Chat" page.
Best wishes, and MGhugs,
Tess



My MG is not a sportscar!