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[Dysphagia] Re: Severe pharyngeal dysphagia
From: "Deanna Rolfe"
Subject: [Dysphagia] more on patient with severe phar.dysphagia
*** Some thoughts:
One would hope that he has been checked for digoxin toxicity - pretty standard but it can be surprising how often the obvious is overlooked. He is on 3 antibiotics and an antifungal so he would appear to be a very sick man. I would be inclined to give him a chance to surface first. .
Cordeiro MF; Arnold KG . Digoxin toxicity presenting as dysphagia and dysphonia. BMJ
1991 ;302(6783):1025
Case report of an elderly man with digoxin toxicity, a common adverse effect of this drug. He presented with both impaired vocal cords and dysphagia.
Kelton JG, Scullin DC. Digitalis toxicity manifested by dysphagia. Journal of the American Medical Association 1978. 239: 613-614.
Case report of an 89 year old man, prescribed 0.125 mg digoxin per day, increasing to 0.25mg per day. Developed inability to pass either liquids or solids through the esophagus. When digoxin was decreased, dysphagia diminished.
The amiodorone is of concern:
Most Frequent: side effects Amiodorone include:
CNS Toxicity, Constipation (which he is being treated for) Interstitial Pneumonitis,, Pulmonary Fibrosis (by any chance his respiratory problem?)
And, while it doesn't apply to this gentleman, those (many) with patients on calcium channel blockers should be aware that they are well known to cause parkinsonism and, in turn, swallowing impairment:
Here is one of many references:
Parkinsonism associated with calcium channel blockers: a prospective follow-up study. Clin Neuropharmacol. 1992 ;15:19-26
Garcia-Ruiz PJ, Garcia de Yebenes J, Jimenez-Jimenez FJ, Vazquez A, Garcia Urra D, Morales B.
Parkinsonism is a well-known side effect of some calcium channel blockers (CCB). Its long-term evolution, however, is unknown. To clarify this issue, we performed a prospective follow-up study involving 32 patients diagnosed with CCB-induced parkinsonism. After the baseline examination, the CCB were discontinued and serial evaluations were carried out according to the same protocol. Despite a global improvement, cognitive and mood disturbances subsided slowly, and tremor persisted in most patients. After 18 months of CCB withdrawal, 44% of patients had depression, 88% had tremor, and 33% still had criteria for diagnosis of parkinsonism. During the survey, only three patients were found to be fully recovered. The improvement of some clinical symptoms was related to age: Patients younger than 73 years recovered better than older patients did. Our data indicate that CCB-induced parkinsonism is not the benign condition previously thought, and suggest an age-related prognosis of this
entity.
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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