Help

[Guest guest]

:

Here is the MSA Booklet that I was talking about.

Takecare

Vera

MSA BOOKLET

What are some problems that can occur in MSA?

Light headedness and faints

Bladder difficulties

Constipation

Swallowing or breathing problems

Incoordination and Falls

LIGHT HEADEDNESS AND FAINTS

Blood pressure regulation difficulties due to autonomic disease

Medications: Sinemet, dopamine agonists

Other factorsWhat should be done for light headedness and faints?

Review all medications

Elevate head of bed by placing blocks under the bed legs

Increase fluid intake

Do not stand up suddenly; move feet and legs before arising and get up slowly

Do not remain standing in one place too long - sit down if you feel faint

Wear support hose or elastic stockings

Avoid alcohol, hot showers, excessive exercise (all dilate blood vessels which can increase light-headedness)

Increase salt intake (300mg 2x daily)Are there any medications that help with light headedness?

Domperidone (Motilium®)

Florinef® (fludrocortisone)

ProAmatine® (midodrine)

Ephedrine®

Salt pills

Lodosyn® (extra caridopa)

BLADDER DIFFICULTIES

What are the bladder problems?

Frequent visits to the bathroom (urinary frequency)

Urgency: sudden need to urinate

Dribbling and incontinence (loss of urine)

Incomplete emptying of bladderWhat are the causes of bladder problems in MSA?

In MSA patients, bladder problems are most commonly due to the underlying disease. Other conditions may aggravate bladder symptoms.

Bladder infection

Women may lose urine related to bladder changes from childbirth called stress incontinence which occurs with coughing, sneezing or laughter)

Although enlargement of the prostate gland is one of the most common causes of urinary difficulties in men, MSA patients should be aware that this is not necessarily so in them. You should have a thorough assessment of your bladder before assuming that urinary problems are due to prostate enlargement. Discuss this with your doctor. How do I deal with bladder problems?

Limit fluids at night and when going out

Avoid diuretics such as caffeine in cola, coffee, and tea

Exercise pelvic muscles by practicing starting and stopping urine stream

Have a commode or urinal at bedside

Use of cotton underwear with liners, incontinence pads or briefs

Condom catheter for men is an option

Cranberry juice reduces the unpleasant odor of incontinent urine

Levodopa may cause reddish-brown stain in urine (may need a test to eliminate the possibility of blood in urine

Consult urologist who will determine bladder capacity, ability to void, and need for medication or other treatments

Intermittent self-catheterization may be helpful for some patients. This option would need to be discussed with your physician.Are there any medications that may help bladder problems?

Ditropan® (oxybutinin )

Proscar® (finasteride )

Imipramine® (tofranil )

Detrol®

Urinary frequency or incontinence may respond to a peripherally-acting anticholinergic agent such as oxybutinin (Ditropan®) 2.5 to 5 mg at bedtime or propantheline (ProBanthine®) 15 to 30 mg at bedtime.

CONSTIPATION

What causes constipation in MSA?

Usually this relates to the underlying condition and associated changes in the autonomic nervous system (ANS). The ANS regulates movement within the gastrointestinal tract. As a result of disease, motility is slowed, and constipation results. Other causes of constipation include:

Inadequate liquid or fiber intake

Medications that slow gut motility

Decreased activity and exercise

How is constipation treated?

Establish regular eating and bowel habits

Increase bulk fiber:

Whole grain breads and cereals

Raw fruits

Leafy vegetables

Bran sprinkled over cereal

Lentils, split peas and barley

Increase fluid intake to 4 to 8 glasses per day

Daily exercise

Senna tea and prune juice

Hot beverages including hot water which has a laxative effect

Ensure with fiber can be used as a source of fiber

What are the medications that help with constipation?

Bulk agents: metamucil, citracel

Stool softeners: docusate (Colace®)

Mild laxatives (senokot, sorbitol, lactulose )

Cisapride (Propulsid®)

Avoid harsh laxatives or enemas

SWALLOWING OR BREATHING PROBLEMS

This may occur years after the onset of symptoms. One concern is that impaired swallowing may cause a reduction in overall food consumption resulting in insufficient caloric intake and progressive weight loss. Another concern is that food might be swallowed improperly, enter the lungs, and cause pneumonia from improper swallowing. In certain cases, a feeding tube may be placed into the stomach to provide nutrition without the risk of pneumonia.

What should be done for swallowing problems?

First, swallowing problems can be treated by common-sense measures, and occasionally an evaluation by a swallowing expert with a swallowing study is helpful.

What are the common sense treatments for swallowing difficulties?

Eat smaller, more frequent meals

Cut food into small pieces; chew slowly

Sip liquids after each swallow of solid food

Eat soft or well-cooked foods: chicken, ground meat, soup, stew, meatloaf, etc.

If problems with liquids, substitute with Jell-o, popsicles, ice chips, ice cream or use food thickeners (available through dieticians)

Keep food warm with plate warmers (never too hot or too cold)

Take small sips of liquids; use a straw

Use tall glasses which are easier to empty

Soft foods, e.g. yogurt and apple sauce can be placed further back on the tongue to ease swallowing

Swallow several times after each mouthful before the next bite

Eat 1/2 teaspoon of solid foods at a time

Do not mix solids and liquids in your mouth

Make sure dentures fit well

Sit up to eat; lower chin to chest when swallowing and if voice sounds "wet" swallow again

Take pills with a banana, apple sauce or other pureed fruit

Medication changes may improve swallowing function

Anticholinergic medications such as trihexyphenidyl and benztropine decrease saliva and may worsen swallowing

Family members should know the Heimlich maneuver

INCOORDINATION AND FALLS

Incoordination and/or unsteadiness with walking in MSA are related to changes in the cerebellum. Falls can result from incoordination and also from light headedness.

Are there things that can be done to help the incoordination and falls?

Prevention is very important, as falls may be common:

Make sure there is adequate lighting

Keep floor clear of clothing, furniture, throw rugs

Use of hand-held shower device

Have bench or chair placed in shower or tub

Use non-skid mats and grab bars

Steps and walkways should be in good condition and clear of obstacles

Railings on stairways

Furniture and appliances should be secure and stable

Place an answering machine and a telephone near floor level, or carry a portable phone

Raise beds, toilet seats, etc.

Bed rails for positioning

Plastic car seat covers make it easier to get in and out of car, but fasten seat belts to prevent from sliding down in seat

Do not wax bare floors or use throw rugs

Wall-to-wall carpeting may soften a fall

Wipe up spills immediately

Concentrate only on walking

Rolling walker with hand brakes, heavy duty wheels and a seat

Physical therapy - balance, strengthening

Lifeline Response SystemWhat about foot wear?

Wear properly fitting footwear

Make sure shoes are in good shape

If freezing is a problem, try leather-soled shoes as rubber or crepe soles tend to stick to the floor

Wear slip-on ice grips in icy weatherIf I fall how should I get up alone?

Rock onto your side

Push to a sitting position

Get on all fours and crawl to something solid

Firmly grasp it with both hands placed well apart

Bring the strongest knee up and move the foot forward

Press down with both hands and that foot

Lift hips and rise up