It has been a while since i written here but i could not let the year finish without me saying one last note and thanking all of you for being part of my PD journey this year. i hope We all get to a new healthy start…
At least in this side of the world, we are just commencing the cold season in which many of us may unfortunately develop a cold. As you know having a cold is fraught with nasal congestion, stuffiness, runny nose among scratchy sore throat and other symptoms.
But after having a viral infection that wiped me out for more than two months and caused severe upper respiratory problems, I began to notice that sometimes the stuffiness did not respond to common decongestants rather improved with me taking my levodopa.
So, I thought i would address this issue which some of you might have experienced or are continuing to experience these nuances wondering why symptoms are persistent or coming and going more frequently? Just as I seem to wake up more congested in am when my medicine levels are lower and quickly clears after am doses kick in.
First, let me say that rhinorhea- ‘runny nose’ has been found to be much more common in PD patients believed to be up to 5x more common in people with PD not related to allergies or other contributing causes. this is believed to be a non-dopaminergic ( non-motor) symptom. although, still not very well recognized or studied and even less commonly talked about is actual nasal congestion- which I believe is dopaminergic mediated and appears as the levels of dopamine are weaning off. This why i believe many patients including myself have a thick nasal mucus pooling in the back of the throat which makes it difficult to swallow. this is not related to post nasal drip, allergies or infection.
The former symptom of runny nose can be extremely bothersome just the same causing frequent post nasal drip; for those who have already difficulty swallowing it can be even more trouble some causing chemical pneumonia, and frequent cough, or choking episodes. Because there is natural increased salivation with eating many might feel the need to avoid social meals. However, for increased salivation (sialorrhea) Botox is the best treatment in my personal experience because has no systemic side effects and effect last 3- 6 months.
There are many treatments for this problem with primary use of anticholinergics as a first line. I often used Levsin -(hyoscyamine). This pharmaceutical drug comes in liquid, pill and injection form which is extremely convenient. I prescribed frequently to my patients to reduce secretions. Although, it is an anticholinergic and can potentially cause confusion at small doses I did not experience this. However, if someone has dementia or hallucinating , this drug probably would not be best option. Another anticholinergic is one applied via a nasal spray (Atrovent- commonly used for bronchitis, copd) recently studied in a very small trial with good effects.
Of Note: Apokyne (apomorphine) has runny nose as a common side effect.
But, on the other hand nasal congestion is even less talked about. this does not respond to decongestants, antihistamines very well. It only improves with intake of dopamine medications. There is absence of literature on this subject. The only thing I found upon doing a literature search was a great deal of patient forums mentioning this problem and a small report on 26 PD in which authors concluded that “women over 60 were more likely to have this problem“.
However, if we look at pregnancy where levels of dopamine decrease and other hormonal changes like elevated levels of prolactin exist there is a tendency for women to develop nasal congestion which resolves after pregnancy. Interestingly, enough is during pregnancy that some women may fist develop signs of pd or have worsening of symptoms. Hence at least on the surface a tangible connection between low dopamine levels and increased nasal congestion. The nasal congestion is caused by excess blood circulation swelling the tiny vessels of the nasal mucosa leading to a stuffy nose feeling. Plus, remember that dopamine is a vasoconstrictor meaning they cause the blood vessels to decrease in diameter. But, if there is not enough dopamine circulating then vessels will dilate which really have same effect as blood rushing in widening tiny vessels causing a sensation of fullness and stuffiness.
If you have watery itchy eyes, sore throat, chills, fever, or increased sneezing then these are signs you are NOT dealing with nasal congestion from lack of dopamine/Parkinson’s.
You should seek medical attention especially if symptoms last beyond a week.
If you are told by your physician that there is no cause for your congestion as infections, allergies, and other irritants have been ruled out talk to your neurologist/MDS about adjusting your medications. but first pay close attention when this occurs, keeping a diary and also if there are other motor symptoms involved like increased stiffness, tremors and so on during this time make sit a lot easier to associate as pd being the culprit. Now, before i take any decongestants i make sure i take my medications which always resolves my congestion unless I have other symptoms.
In the meantime, here are a few home remedies you may want to try for your congestion.
- Use Humidifiers – but don’t forget to rinse with soap and water periodically to avoid mold and other bacteria from growing.
- Inhale steam or add some Vick’s vapor rub to hot boiling water and breath in.
- Use saline drops or saline gel (found in baby isle at stores)
- Stay hydrated- drink more fluid than usual during the cold season
- Use petroleum jelly or Vick’s vapor rub gently applying a very tiny dose in nasal passage a couple of times a day.
- Take Vitamin C
- Drink ginger tea- this not only helps with inflammation of mucosa but also stomach inflammation and helps nausea and increases digestion.
Happy Holidays everyone!
Many blessings and well wishes to all and hope to continue this journey with your support in the upcoming year!
All Rights reserved by Maria De Leon,MD