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Comments for Spasticity, Botox, and Phenol Injections

Swelling

Question: My Dad suffered from Parkinson Disease and stroke a few years back. He complained about pain when his right arm was stretched. It got progressively worse and held his hand to his chest all the time. His PD doctor recommended botox injections 2 months ago. After the injections his right arm was relaxed and stayed extended. The bicep was tight and he could not bend his arm. His hand from the wrist down was swollen 2 weeks after injections. The doctors did not know what to do. Then he had severe vomiting and diarrhea which might bring on dehydration. The swelling subsided by 90%. Ten days later the swelling is coming back.

Any suggestion?

Answer Some suggestions:
1. Elevate the hand/arm above the heart when sitting and lying down (prop it up on pillows and make sure the wrist is not bent
2. Compression glove - okay it with he doctor first, and it can be ordered online.
3. Manual Edema Mobilization - again okay it with a doctor then find an occupational therapist who is certified in lymphedema treatment - the therapist could also do wraps or get a compression glove if indicated.
4. Ice bath - submerge the hand in ice water for several minutes then remove (repeat several times a day) - be cautious with this one as stroke patients have decreased hot/cold sensation
5. Retrograde massage - gently massage hand starting at fingertips moving up arm - do not massage in the opposite direction (down the arm) as this can increase swelling

I think it would be a good idea to have the physician write a prescription for occupational therapy for edema management. The therapist could determine what techniques were appropriate and show your dad (or a caregiver) how to correctly perform the techniques.

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