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Parkinsonian Tremor - How have you dealt with it??

Discussion in 'General Issues and Discussion Forum' started by dgroberts, Sep 17, 2009.

  1. dgroberts

    dgroberts Active Member

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    This lady has just left the clinic room and has me stumped....

    Female 74yrs
    Dx Parkinsons
    Lymphoedema affecting left leg (has comp bandaging)
    Pt reports no other significant Hx.

    She presented for assessment nearly 8 weeks ago with painful apical lesions on the R4 and R5 digits. These were massively, grossly overgrown HD's mixed into OG nails and relly quite painful to touch.
    The massive problem here is the tremor. On touching the areas her feet just go wild and rotate all over the place, you cannot physically restrain them either and I'm a big strong bloke!

    So I sent her on her way and contacted the GP; we arranged for her to cluster her Parkinsons meds in the late evening and early morning just prior to treatment and went to see her at home thinking it might be a more relaxed setting. Same thing, I just couldn't do anything without fear of stabbing her or myself with the scalpel.

    So I went on my way. A week or so later we got back to clinic and used the podospray drill and with help from a colleague managed to get the lesions debrided and dressed reasonably well. This was 4 weeks ago.

    She came back in today with the same dressings on, she was told to remove them after 5 days. Her right foot is grossly oedematous, red, hot and has a tracking infection on the dorsum, going into the leg, not good.

    Managed, after much messing about, to get her a course of antibiotics (not from her GP, from a random passing one, long story). So I'm about to sit down and write to the GP again. Asking them to see her as an urgent case and explaining that we just can't do anything for this lady due to her tremors.

    This lady is a little incoherent, no family, seems to have no idea what meds she is on and when to take them, this has all been made clear to the GP.

    Long story that......:)

    Anyone have any hints, tips or experiences with similar patients. What did you do, what should I do????

    ps apologies for bad grammar and spelling, I fired this out between pt's.
  2. Hey DG

    Depending on how compis mentis she is and what kind of tremor she has, relaxation techniques (ie hypnosis) can be useful for this sort of thing.* As you've observed it tends to be less of a problem if the patient is more relaxed.

    Sounds like a tricky one!


    *For the patient also ;)
  3. Craig Payne

    Craig Payne Moderator

    I used to work in a neuro clinic that dealt mostly with parkinsons and MS patients.

    Here is what I did:
    1) Distract them; do not let them think about the tremors - that only makes them worse
    2) Decide what the worst problem is; leave the rest for another day in case you can not get any more done
    3) If its really really bad, arrange to have them initially treated under sedation; frequency of follow up often to do (2)
    4) Learn to shake, rattle and roll in time with them -- this is the most effective strategy!
  4. spike123horse

    spike123horse Active Member

    I have a lady patient with these tremors, & find that if I keep her talking, about anything, it distracts her for a while & tremors reduce. Alas, they return, but, with patience, I usually get the worst problems sorted, & sometimes the remainder aswell. Hopes this helps? Haven't tried hypnotherapy, but if it relaxes, then hopefully the tremors should subside
  5. spike123horse

    spike123horse Active Member

    Distraction by conversation, but my patient very 'with it', and enjoys a good chat, so relaxes & the tremors subside.
  6. cornmerchant

    cornmerchant Well-Known Member

    Hi dgroberts

    Have you ever had drilling to nails? If not I suggest you try it- not very comfortable at all in my experience. I have several Parkinsons patients, never had a problem with tremors, never use drill, talk to them all the time and debride careflully with a scalpel. It really does not matter if the nails are thick , that is not the problem, it is the calus/corns that need to be dealt with. The lady youare describing seems to have issues with dementia as well- third party in the room may help to reassure her.


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