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Mestinon Mestinon Under the Tongue - A Possible Emergency Measure for Myasthenic Difficulty in Swallowing Martin Sampson, M.D. Since 1984 we have learned of many instances where people in great Myasthenic difficulty were able to be tided over by the placement of Mestinon under the tongue. The first instance involved the niece of our Chapter's then vice president for Administration. The niece was not functioning well on her usual Mestinon dosage and was admitted to a hospital to determine the corrective treatment. She entered the hospital at 1:00 p.m. and was due for Mestinon at 3:00 p.m. However, the attending physician had failed to leave an order with the nurse to administer the child's Mestinon and no other physician was available. By 9:00 p.m. the child was in distress. She was choking on her own saliva and had to be suctioned. A nurse wanted to give the child Mestinon syrup but could not locate any in the hospital. At this point the child's mother - a Myasthenic herself - sensed her child's imminent danger and instinctively placed half a Mestinon tablet under her child's tongue. Apparently, the drug was absorbed rapidly from that site for the child began to recover and was able to swallow without difficulty within 15 minutes after the tablet had been placed under her tongue. Ruth Sampson, R.N., (former chair of our Chapter's Nurses Advisory Board and former secretary of the National Nurses Advisory Board) reported the foregoing in her milestone report entitled "Physical, Emotional, Social, and Family Interactions in Childhood Myasthenia Gravis," which was published as a book chapter in 1984. Another of our members, our Chapter's then treasurer had a thymectomy in 1984. About a week after the thymectomy she was back home and found that she was having difficulty swallowing and breathing despite her usual Mestinon dosage (taken by mouth). She realized that she was probably going into a Myasthenic crisis. She tried taking Mestinon syrup but was unable to swallow the syrup (which is frequently the case with those myasthenics who have swallowing problems). She then remembered Ruth Sampson's description of the above experience and placed a Mestinon tablet under her tongue. Her swallowing and breathing difficulties were diminished within 30 minutes after she put the tablet under her tongue and hence she was tided over until an ambulance was able to bring her to her local hospital. Our Chapter's Medical Advisory Board was apprised of the foregoing in 1984. The board, and particularly Dr. Peter Kornfield then in charge of the MG Clinic at Englewood Hospital, advised that we should publicize this information for the benefit of those who might in the future suffer pre-myasthenic-crisis symptoms - especially difficulty in swallowing. This was done and the results since then have been gratifying.
Date this page was updated: 08/16/2008 18:41 |
