Q: I have recently been diagnosed with early stage Parkinson’s. I’m taking Mirapex three times daily and propranolol twice a day. I’m having a total hip done soon due to cysts on the acetabular and arthritis. Should I be concerned about something going wrong under anesthesia or about the Mirapex due to the Parkinson’s?
I’m 62 years old, tall, slim and otherwise in good health. I had an X-ray and MRI already and would appreciate any information on Parkinson’s and hip replacement. Thank you.
A: As I am sure you are aware, Parkinson’s is a progressive nervous system disorder. It develops gradually and may cause stiffness, slowed movements, gait abnormality, tremors, changes in writing habits, rigid muscles in any part of the body, and more. Symptoms vary from person to person.
Specific nerve cells known as neurons in the brain break down and die. The symptoms that appear are because of a loss of neurons that produce dopamine. When dopamine levels decrease, abnormal brain activity results, leading to the specific symptoms an individual may have. While there is still much to learn about the disorder, age, sex, and genes are known to increase an individual’s risk factor for development. Extended exposure to pesticides and herbicides may also be contributory.
According to the BMJ (formerly known as the British Medical Journal), individuals who undergo surgery are at an increased risk because of the missing dopaminergetic medication during a period of perioperative starvation, an issue that can be further compounded if the absorption of drugs is impaired. Based on a 2010 study, the consequences of a lack of medication can vary dramatically from patient to patient. Some individuals are able to tolerate the lack, while others may become immobile. In some situations, missing dopaminergetic medication can precipitate a condition known as neuroleptic malignant-like syndrome and exhibit symptoms of fever, elevated concentrations of muscle enzyme, and more. Keep in mind this study is four years old and research often provides newer techniques and better outcomes.
Having said that, deep brain stimulation or DBS for short is a surgical procedure used to treat some forms of the disabling neurological symptoms of Parkinson’s, including tremor, gait abnormalities, rigidity, and movement issues and unrelated Parkinson issues of essential tremor and dystonia. At present, this procedure is only used for Parkinson’s patients whose symptoms cannot be controlled sufficiently by medication. DBS utilizes a surgically implanted battery operated device similar to a pacemaker to deliver electrical stimulation. It is targeted toward specific areas of the brain that control movement. The decision is best left to a patient’s surgeon who has complete knowledge of his or her full medical history.
Hip replacement surgery uses metal, ceramic or plastic parts to replace the ball at the upper portion of the femur to remove damaged cartilage and replace it with new joint material. Cemented joints are attached to existing bone with cement, while joints that are not cemented will be attached with the use of a porous coating designed to allow the bone to adhere to the artificial joint. With time, new bone grows, fills the opening in the porous coating, and attaches the joint to the bone.
General or regional anesthesia are commonly used for hip replacement. The choice will depend on your surgeon who will obviously take your Parkinson’s into consideration before making the decision.
If you and your physician agree the procedure is sufficiently safe with your medical history, be sure to follow his instructions to the letter to avoid issues down the road.
