- Email: [email protected]
Poster 217: Hypothyroidism and Tube Feeds: A Case Report
S198
ance and disease progression. This case report suggests hyperthyroidism as an additional cause. Conclusions: Hyperthyroidism as a cause of increased muscle tone or overactivity has not been reported in the literature and potentially should be included in the differential diagnosis of such patients. Keywords: Rehabilitation, Muscle spasticity, Baclofen, Hyperthyroidism.
Poster 217 Hypothyroidism and Tube Feeds: A Case Report. Pari Azari, (Baylor/UT, Houston, TX); Carol Bodenheimer, MD. Disclosures: P. Azari, None. Patients or Programs: A 65-year-old man with coronary artery disease status post coronary artery bypass graft, hypothyroidism and poor wound healing presents to an acute inpatient rehabilitation unit after a prolonged hospital course due to deconditioning. Program Description: On admission to the rehabilitation unit the patient presented with decreased endurance, a stage III ulcer on the left calf, and a stage II ulcer on his left heel. He was placed on continuous tube feeds throughout his stay in the acute inpatient hospital and despite adequate feeding and vitamin supplementation, his wounds did not heal. On admission to the rehabilitation unit the patient had an elevated TSH of 33.290 despite having been on his normal dose of Synthroid. During his rehabilitation stay the patient was changed to bolus tube feeds and his TSH levels subsequently normalized. Setting: Tertiary care rehabilitation hospital. Results: Following the change to bolus feeds the patient was able to absorb the Synthroid and his TSH levels decreased. The patient’s hypothyroidism contributed to his poor wound healing, fatigue, and decreased endurance. As his thyroid levels normalized, his energy level improved and he increased time spent in physical therapy. But despite aggressive attempts to salvage his leg with wound care and nutritional supplementation, the wounds led to osteomyelitis resulting in an above the knee amputation. Discussion: Hypothyroidism causes many problems including poor wound healing, decreased endurance, fatigue, irritability, muscle cramps, weakness, and depression. The quicker the adverse effects are managed, the better the patient will improve medically and functionally. As physiatrists doing consults or working in inpatient units, we often see patients on continuous tube feeds. It is important for us to recognize patients with a history of hypothyroidism receiving Synthroid along with continuous tube feeds. To ensure proper absorption of Synthroid, it must be taken on an empty stomach. If we can recognize these patients early on then we can avoid the effects of uncontrolled hypothyroidism. Conclusions: In hypothyroid patients on continuous tube feeds, a break should be initiated in which the Synthroid is
POSTER PRESENTATIONS
given to ensure proper absorption of the medication to avoid the unwanted effects of hypothyroidism. Keywords: Rehabilitation, Wounds, Fatigue, Hypothyroidism.
Poster 218 Incidence and Identification of Intrathecal Baclofen Catheter Malfunction. Eric M. Dvorak, MD (Medical College of Wisconsin, Milwaukee, WI); John R. McGuire, MD; Mary Elizabeth S. Nelson, MSN, ANP-BC. Disclosures: E. M. Dvorak, None. Objective: Retrospective chart review of cases of intrathecal baclofen (ITB) pump/catheter malfunction and the diagnostic tests performed to identify the problem. An internal review was undertaken to develop a diagnostic flow chart in order to have a systematic method for identifying ITB pump and catheter complications. Design: Retrospective chart review. Setting: Tertiary care hospital. Participants: 160 adult patients currently followed in outpatient clinic with intractable spasticity and ITB pump implanted between 1994-2008. Interventions: None. Main Outcome Measures: Catheter malfunction was identified either by anterior/posterior (AP) and lateral thoracic/lumbar radiographs, fluoroscopic guided side port access, contrast dye injection followed by CT (fluoro/CT) scan or indium radionucleotide studies. Results: During the study period, there were 34 catheter revisions. All cases had radiographs, 21 had fluoro/CT studies, and 6 had indium studies. 4 cases had both fluoro/CT and indium studies. 11 cases (32%) were diagnosed by radiographs. 7 cases (21%) were diagnosed by inability to withdraw cerebral spinal fluid (CSF) from the side port. 14 cases (41%) were diagnosed by fluoro/CT studies. 2 cases (6%) were diagnosed by indium studies. Fluoro/CT studies demonstrated subdural catheter location in 4 cases. 2 out of 4 cases with both fluoro/CT and indium studies had normal appearing indium scans and an abnormal fluoro/CT study confirming subdural catheter placement. Conclusions: Based on the findings from this review, to determine cases of ITB catheter malfunction AP and lateral radiographs should be obtained first. If the radiograph is normal, attempt to withdraw CSF fluid from the side port. If unable to obtain CSF proceed to indium study, otherwise fluoro/CT study. Keywords: Rehabilitation, Infusion pumps, Implantable, Baclofen.
Poster 219 Incidence of Drug Abuse Over a 3-year Period in a Medicaid Population. Rachelle Valenzuela, BS (LAGS Spine & Sportscare, Santa Maria, CA); Francis P. Lagattuta, MD; Richard Martin, MD.
ance and disease progression. This case report suggests hyperthyroidism as an additional cause. Conclusions: Hyperthyroidism as a cause of increased muscle tone or overactivity has not been reported in the literature and potentially should be included in the differential diagnosis of such patients. Keywords: Rehabilitation, Muscle spasticity, Baclofen, Hyperthyroidism.
Poster 217 Hypothyroidism and Tube Feeds: A Case Report. Pari Azari, (Baylor/UT, Houston, TX); Carol Bodenheimer, MD. Disclosures: P. Azari, None. Patients or Programs: A 65-year-old man with coronary artery disease status post coronary artery bypass graft, hypothyroidism and poor wound healing presents to an acute inpatient rehabilitation unit after a prolonged hospital course due to deconditioning. Program Description: On admission to the rehabilitation unit the patient presented with decreased endurance, a stage III ulcer on the left calf, and a stage II ulcer on his left heel. He was placed on continuous tube feeds throughout his stay in the acute inpatient hospital and despite adequate feeding and vitamin supplementation, his wounds did not heal. On admission to the rehabilitation unit the patient had an elevated TSH of 33.290 despite having been on his normal dose of Synthroid. During his rehabilitation stay the patient was changed to bolus tube feeds and his TSH levels subsequently normalized. Setting: Tertiary care rehabilitation hospital. Results: Following the change to bolus feeds the patient was able to absorb the Synthroid and his TSH levels decreased. The patient’s hypothyroidism contributed to his poor wound healing, fatigue, and decreased endurance. As his thyroid levels normalized, his energy level improved and he increased time spent in physical therapy. But despite aggressive attempts to salvage his leg with wound care and nutritional supplementation, the wounds led to osteomyelitis resulting in an above the knee amputation. Discussion: Hypothyroidism causes many problems including poor wound healing, decreased endurance, fatigue, irritability, muscle cramps, weakness, and depression. The quicker the adverse effects are managed, the better the patient will improve medically and functionally. As physiatrists doing consults or working in inpatient units, we often see patients on continuous tube feeds. It is important for us to recognize patients with a history of hypothyroidism receiving Synthroid along with continuous tube feeds. To ensure proper absorption of Synthroid, it must be taken on an empty stomach. If we can recognize these patients early on then we can avoid the effects of uncontrolled hypothyroidism. Conclusions: In hypothyroid patients on continuous tube feeds, a break should be initiated in which the Synthroid is
POSTER PRESENTATIONS
given to ensure proper absorption of the medication to avoid the unwanted effects of hypothyroidism. Keywords: Rehabilitation, Wounds, Fatigue, Hypothyroidism.
Poster 218 Incidence and Identification of Intrathecal Baclofen Catheter Malfunction. Eric M. Dvorak, MD (Medical College of Wisconsin, Milwaukee, WI); John R. McGuire, MD; Mary Elizabeth S. Nelson, MSN, ANP-BC. Disclosures: E. M. Dvorak, None. Objective: Retrospective chart review of cases of intrathecal baclofen (ITB) pump/catheter malfunction and the diagnostic tests performed to identify the problem. An internal review was undertaken to develop a diagnostic flow chart in order to have a systematic method for identifying ITB pump and catheter complications. Design: Retrospective chart review. Setting: Tertiary care hospital. Participants: 160 adult patients currently followed in outpatient clinic with intractable spasticity and ITB pump implanted between 1994-2008. Interventions: None. Main Outcome Measures: Catheter malfunction was identified either by anterior/posterior (AP) and lateral thoracic/lumbar radiographs, fluoroscopic guided side port access, contrast dye injection followed by CT (fluoro/CT) scan or indium radionucleotide studies. Results: During the study period, there were 34 catheter revisions. All cases had radiographs, 21 had fluoro/CT studies, and 6 had indium studies. 4 cases had both fluoro/CT and indium studies. 11 cases (32%) were diagnosed by radiographs. 7 cases (21%) were diagnosed by inability to withdraw cerebral spinal fluid (CSF) from the side port. 14 cases (41%) were diagnosed by fluoro/CT studies. 2 cases (6%) were diagnosed by indium studies. Fluoro/CT studies demonstrated subdural catheter location in 4 cases. 2 out of 4 cases with both fluoro/CT and indium studies had normal appearing indium scans and an abnormal fluoro/CT study confirming subdural catheter placement. Conclusions: Based on the findings from this review, to determine cases of ITB catheter malfunction AP and lateral radiographs should be obtained first. If the radiograph is normal, attempt to withdraw CSF fluid from the side port. If unable to obtain CSF proceed to indium study, otherwise fluoro/CT study. Keywords: Rehabilitation, Infusion pumps, Implantable, Baclofen.
Poster 219 Incidence of Drug Abuse Over a 3-year Period in a Medicaid Population. Rachelle Valenzuela, BS (LAGS Spine & Sportscare, Santa Maria, CA); Francis P. Lagattuta, MD; Richard Martin, MD.