“Horner syndrome is also known as Bernard-Horner syndrome or oculosympathetic palsy.  Horner syndrome is a condition that affects the face and eye on one side of the body. It is caused by the disruption of a nerve pathway from the brain to the head and neck.  Typically, signs and symptoms of Horner syndrome include decreased pupil size, a drooping eyelid and decreased sweating on the affected side of the face. Horner syndrome may be the result of another medical problem, such as a stroke, tumor or spinal cord injury. In some cases, no underlying cause can be found.”

MAYO CLINIC

Signs and Symptoms:

Horner syndrome is a relatively rare disorder characterized by a constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the eye (enophthalmos). These are the four classic signs of the disorder.

The congenital, and more rare, form of Horner syndrome is present at birth but the cause is not known. Most often, Horner syndrome is acquired as a result of some kind of interference with the sympathetic nerves serving the eyes. The underlying causes can vary enormously, from a snake or insect bite to a neck trauma made by a blunt instrument.

“High blood cholesterol is one of the major risk factors for heart disease, causing heart attack and stroke.  According to the Centers for Disease Control and Prevention (CDC), heart disease is the number one leading cause of death in the U.S. More than one million Americans have a heart attack each year and about 500,000 die of heart disease.”

Meridien Research (https://meridienresearch.net/september-national-cholesterol-education-month/)

“In 2015–2018, nearly 12% of adults age 20 and older had total cholesterol higher than 240 mg/dL, and about 17% had high-density lipoprotein (HDL, or “good”) cholesterol levels less than 40 mg/dL.¹

Slightly more than half of U.S. adults (54.5%, or 47 million) who could benefit from cholesterol medicine are currently taking it.²

Nearly 94 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL. Twenty-eight million adults in the United States have total cholesterol levels higher than 240 mg/dL.¹

7% of U.S. children and adolescents ages 6 to 19 have high total cholesterol.¹

High cholesterol has no symptoms, so many people don’t know that their cholesterol is too high. A simple blood test can check cholesterol levels.”

Centers for Disease Control and Prevention (CDC) – https://www.cdc.gov/cholesterol/facts.htm

“Reye’s Syndrome, a deadly disease, strikes swiftly and can attack any child, teen, or adult without warning. All body organs are affected with the liver and brain suffering most seriously. While the cause and cure remain unknown, research has established a link between Reye’s Syndrome and the use of aspirin and other salicylate containing medications, over the counter products, and topical use products.

Reye’s Syndrome is a two-phase illness because it is almost always associated with a previous viral infection such as influenza (flu), cold, or chicken pox. Scientists do know that Reye’s Syndrome is not contagious and the cause is unknown. Reye’s Syndrome is often misdiagnosed as encephalitis, meningitis, diabetes, drug overdose, poisoning, Sudden Infant Death Syndrome, or psychiatric illness.”

Reyes Syndrome Foundation (https://www.reyessyndrome.org/blank-1)

“Sickle cell disease is an inherited blood disorder that affects red blood cells. People with sickle cell disease have red blood cells that contain mostly hemoglobin S, an abnormal type of hemoglobin. Sometimes these red blood cells become sickle-shaped (crescent shaped) and have difficulty passing through small blood vessels. When sickle-shaped cells block small blood vessels, less blood can reach that part of the body. Tissue that does not receive a normal blood flow eventually becomes damaged. This is what causes the complications of sickle cell disease.

Hemoglobin is the main substance of the red blood cell. It helps red blood cells carry oxygen from the air in our lungs to all parts of the body. Normal red blood cells contain hemoglobin A. Normal red blood cells that contain hemoglobin A are soft and round and can squeeze through tiny blood tubes (vessels). Normally, red blood cells live for about 120 days before new ones replace them.  People with sickle cell conditions make a different form of hemoglobin A called hemoglobin S (S stands for sickle). Red blood cells containing mostly hemoglobin S do not live as long as normal red blood cells (normally about 16 days).”.

Sickle Cell Disease Organization of America Inc. (https://www.sicklecelldisease.org/sickle-cell-health-and-disease/types/#)

“According to the Centers for Disease Control, each year in the United States, approximately 71,500 women are diagnosed with gynecological cancers. Each gynecological cancer has different signs and symptoms, as well as different risk factors. Risk increases with age.”

American Association for Cancer Research

(https://www.aacr.org/patients-caregivers/awareness-months/gynecologic-cancer-awareness-month/)

September is Gynecologic Cancer Awareness Month.

“The collapse of the Twin Towers created massive dust clouds that filled the air and left hundreds of highly populated city blocks covered with ash, debris, and harmful particles.  In Lower Manhattan, the plane crashes—which resulted in the collapse of the Twin Towers—created massive dust clouds that filled the air and left hundreds of highly populated city blocks covered with ash, debris, and harmful particles, including asbestos, silica, metals, concrete, and glass. Fires within the debris pile and the collapse of 7 WTC burned through the end of December 2001 with continued flare-ups in 2002, releasing carcinogenic combustion by-products. These contaminants remained in Lower Manhattan and parts of Brooklyn for an undetermined amount of time after 9/11. Responders, local workers, residents, students, and others had potential for acute exposures in the early days and continuing exposure from residual materials—indoors and outside—as well as exposure to toxic gases, smoke, vapors, and combustion by-products from continuing fires. ”

Centers for Disease Control & Prevention (https://www.cdc.gov/wtc/exhibition/toxins-and-health-impacts.html)

“Lewy body dementia (LBD) is a type of dementia in which Lewy bodies are present in your brain. Lewy bodies are clumps of proteins that build up inside certain neurons (brain cells). They cause damage to neurons in the areas of your brain that affect mental capabilities, behavior, movement and sleep.  Lewy body dementia is a progressive disease, meaning symptoms start slowly and get worse over time.

In people over the age of 65, LBD is one of the most common causes of dementia. The symptoms of LBD may closely resemble those of other neurological conditions, including Alzheimer’s disease and Parkinson’s disease.”.

Cleveland Clinic  (https://my.clevelandclinic.org/health/diseases/17815-lewy-body-dementia)

Behavioral problems are among the main reasons why dementia patients are placed in long term care facilities. Agitation with non-acute psychosis. Risperidone (FDA warning about cerebrovascular events) Olanzapine (Use with caution in diabetics) Quetiapine (Useful for patients with Parkinsonian symptoms) Ariprazole. Acute agitation. Haloperidol. Sleep disturbances. Melatonin, Trazodone, non-benzodiazepine hypnotics. Avoid antipsychotics in patients with Lewy body dementia. Ref: Charles D. Motsinger. Use of atypical antipsychotic drugs in patients with dementia. Am Fam Physician Jun 1;67(11): Ref: A. deLonghe. Effectiveness of melatonin treatment on circadian rhythm disturbances. Int J Ger Psychiatry 2010; 25:

Unfortunately at this present time there is NO cure or definitive treatment for Lewy Body Bementia. The disease has an average duration of 5 to 7 years. It is possible, though, for the time span to be anywhere from 2 to 20 years, depending on several factors, including the person’s overall health, age and severity of symptoms.  REMEMBER there is an approach in treating the symptoms.

LBD is a multi-system disease and typically requires a comprehensive treatment approach, meaning a team of physicians from different specialties, who collaborate to provide optimum treatment of each symptom without worsening other LBD symptoms.  It is important to remember that some people with LBD are extremely sensitive or may react negatively to certain medications used to treat Alzheimer’s or Parkinson’s in addition to certain over-the-counter medications just like other patients can do with with the meds they take for other diseases.   All meds have side effects.

Cognitive Symptoms

Medications called cholinesterase inhibitors are considered the standard treatment for cognitive symptoms in LBD. These medications were developed to treat Alzheimer’s disease. However, some researchers believe that people with LBD may be even more responsive to these types of medications than those with Alzheimer’s.  Remember Alzheimer’s disease are very similar to LBD symptoms.

Movement Symptoms

Movement symptoms may be treated with a Parkinson’s medication called levodopa, but if the symptoms are mild, it may be best to not treat them in order to avoid potential medication side-effects.  Many are also diagnosed with Parkinson’s disease before being diagnosed with this Dx LBD.

Visual Hallucinations

If hallucinations are disruptive or upsetting, your physician may recommend a cautious trial of a newer antipsychotic medication. (Please see WARNING below.  Of note, the dementia medications called cholinesterase inhibitors have also been shown to be effective in treating hallucinations and other psychiatric symptoms of LBD.

REM Sleep Behavior Disorder (RBD)

RBD can be quite responsive to treatment, so your physician may recommend a medication like melatonin and/or clonazepam.

Neuroleptic Sensitivity

Severe sensitivity to neuroleptics is common in LBD. Neuroleptics, also known as antipsychotics, are medications used to treat hallucinations or other serious mental disorders. While traditional antipsychotic medications (e.g. haloperidol) are commonly prescribed for individuals with Alzheimer’s with disruptive behavior, these medications can affect the brain of an individual with LBD differently, sometimes causing severe side effects (see below). For this reason, traditional antipsychotic medications like haloperidol should be avoided. Some newer ‘atypical’ antipsychotic medications like risperidone may also be problematic for someone with LBD. Quetiapine is preferred by some LBD experts. If quetiapine is not tolerated or is not helpful, clozapine should be considered, but requires ongoing blood tests to assure a rare but serious blood condition does not develop. Hallucinations must be treated very conservatively, using the lowest doses possible under careful observation for side effects.

WARNING:

Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome (NMS), which can be fatal. (NMS causes severe fever, muscle rigidity and breakdown that can lead to kidney failure.)

Medication Side Effects

Speak with your doctor about possible side effects. The following drugs may cause sedation, motor impairment or confusion:

• Benzodiazepines, tranquilizers like diazepam and lorazepam
• Anticholinergics (antispasmodics), such as oxybutynin and glycopyrrolate
• Some surgical anesthetics
• Older antidepressants
• Certain over-the-counter medications, including diphenhydramine and dimenhydrinate.
• Some medications, like anticholinergics, amantadine and dopamine agonists, which help relieve parkinsonian symptoms, might increase confusion, delusions or hallucinations.

NOTE: Be sure to meet with your anesthesiologist in advance of any surgery to discuss medication sensitivities and risks unique to LBD. People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium and may have a sudden significant drop in functional abilities, which may or may not be permanent.

Possible alternatives to general anesthesia include a spinal or regional block. These methods are less likely to result in postoperative confusion. If you are told to stop taking all medications prior to surgery, consult with your doctor to develop a plan for careful withdrawal but suggested as the last resort.

Non-Medical Treatments

Physical therapy options include cardiovascular, strengthening, and flexibility exercises, as well as gait training. Physicians may also recommend general physical fitness programs such as aerobic, strengthening, or water exercise.

Speech therapy may be helpful for low voice volume and poor enunciation. Speech therapy may also improve muscular strength and swallowing difficulties.

Occupational therapy may help maintain skills and promote function and independence. In addition to these forms of therapy and treatment, music and aroma therapy can also reduce anxiety and improve mood.

Individual and family psychotherapy can be useful for learning strategies to manage emotional and behavioral symptoms and to help make plans that address individual and family concerns about the future.

Support groups may be helpful for caregivers and persons with LBD to identify practical solutions to day-to-day frustrations, and to obtain emotional support from others.

End-of-Life

Planning for the end of life can be challenging and hard but a valuable activity for any family.  For some general guidance and some specific suggestions for families who face the burden of a disease such as Lewy body dementia.

Advanced Directives – a Caring Connections site with state-specific advanced directives can be helpful in having measures answered before weeks to days to hours before last minute decisions in medical care have to be made.

Caring Connections – home page of consumer Web site about hospice and palliative care managed by the National Hospice and Palliative Care Organization  This helps with weeks to days before pt moving on to the next world but in the most comfortable way possible.