Huntington's Chorea

[saribeth]

Hi all...I have a pt with Huntington's and he has developed these episodes of "coughing" that last for 3 hours plus and go into the wee hours...he does cough up small green mucous plugs (no fever) but minimal and then it is just clear sputum...one doc says Robitussin, the other says Claritin immediate dissolve tabs q 24h...I am thinking it is muscle spasms similar to the extremity movements...he is on 1.5mg of Haldol at bedtime...he responded fairly well with lorazepam 1mg..tossed around scopolamine patch?? Any ideas or insight into how we can prevent the episodes from beginning??????? thanks a bunch...(he has diminished breath sounds!)

[doodlemom]

If they're green, could he possibly have a respiratory infection that has not yet gotten bad enough to run a fever? What about a long acting narcotic before bed? I've had a couple of Huntingtons patients and I remember they needed scope patches for drooling - but it sounds like this stuff is very thick and scopolomine may just make it thicker and harder to cough up. If he is able to swallow tablets, you might try some mucinex to thin his secretions, which will last longer than the robitussin. Does he have a hx of allergies? If he does, maybe the claritin will help. Whatever you do, try one at a time to see what works. Good luck.

[Carlos Casteneda]

Dont know if its too late but a few things we use

scopolamine patches + saline nebs if secretions become too thick

Atropine eye drops sublingualy

positional changes chairs with tilt in space used to obtain very upright position (obviously depends of severity of movement)

beds with cardiac chair facility

but we still sometimes struggle

best wishes

Julian