1.Rehabilitation of a Patient with Severe COVID-19 Using Extracorporeal Membrane Oxygenation:A Case Report
Daichi TSUKAKOSHI ; Shuhei YAMAMOTO ; Yosuke WADA ; Satsuki TERASHIMA ; Ryuji OSAWA ; Keiji MATSUMORI ; Shun ITO ; Yukio NAKAMURA ; Kohei NAGAMINE ; Shota IKEGAMI ; Hiroshi HORIUCHI
The Japanese Journal of Rehabilitation Medicine 2022;59(1):92-98
Coronavirus disease 2019 (COVID-19) has been spreading globally since 2019;however, comprehensive rehabilitation of elderly patients with COVID-19 pneumonia remains a challenge. A 76-year-old American woman with COVID-19 pneumonia was admitted to our hospital. Because her disease was complicated by acute respiratory distress syndrome (ARDS), she was treated with intensive care, including invasive ventilation and extracorporeal membrane oxygenation (ECMO). During and after intensive care, she exhibited physical symptoms such as weakness, pain, shortness of breath, and difficulty in movement and exercise. Furthermore, during approximately 3.5 months of hospitalization, she received swallowing and speech therapies along with physical therapy. These rehabilitation therapies enabled her to get home in the United States. Her rehabilitation schedule had to be carefully planned according to her symptoms and infectiousness of COVID-19. This paper highlights few important points regarding the difficulty in rehabilitation including that of physical function, mental health, and cognitive function of patients with COVID-19. Furthermore, this report provides a problem-solving approach for long-term rehabilitation in elderly patients with COVID-19 pneumonia.
2.A Case of Withdrawal Syndrome after Opioid Discontinuation Following Pain Relief of Bone Metastases
Ayaka ISHIKAWA ; Sayaka ARAKAWA ; Hiroto ISHIKI ; Koji AMANO ; Yuka SUZUKI ; Nami IKENAGA ; Shun YAMAMOTO ; Tairo KASHIHARA ; Tetsuhiko YOSHIDA ; Eriko SATOMI
Palliative Care Research 2023;18(3):159-163
Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.