Not just male doctors but female doctors too stepped up during the coronavirus pandemic at the cost of their own well-being and mental health for the welfare of the patients. While dealing with the pandemic for almost an year now, they have realised the need to take care of themselves is as crucial as it is to treat and care for their patients. The lady doctors gave us a peek into the issues they face while being on Covid duty and how they fight the fears at home.
The thought that by going for a job, I was potentially endangering my family at home, an ageing mother, and a small child, was terrifying
When the Covid-19 cases started rising in 2020, the fear and apprehension were palpable, it was in the air, and as much as we train ourselves to turn off the noise before we go home, it just wasn’t possible this time. The thought that by going to do a job that was an essential service, I was potentially endangering my family at home, an ageing mother and a small child, was terrifying. But we had a strong department and great co-workers who understood that as women, we now have the added responsibilities of online schools and housework, in addition to longer hours at work and emergency calls. Chores like cleaning, sanitisation, and cooking was sometimes overwhelming. It was at this time that another woman physician told me something that will stay with me: Imagine that life is like juggling two types of balls, some are rubber, and some are glass. Learn how to let the rubber ones fall as they will bounce back but hold on to the glass ones, take time and energy to keep them from breaking. For me, one of those glass balls was my mental health and peace of mind. I learned to identify small things that gave me peace. It was a small haven of normalcy where I didn’t have to think about Covid or the fear, apprehension, and sadness that came with being a first-hand witness to its effects on patients and friends in the hospital.
– Dr Lakshmi Vaswani, Assistant Pathologist, Bhatia Hospital, Mumbai
We can’t let our guards down and have to be vigilant
Doctors are at higher risk of contracting Covid-19. To reduce the risk of infection, patients are screened for temperature and signs of respiratory infection before they enter the OPD and they are tested for Covid before admitting them for an operation or a patient procedure. Doctors are wearing gowns, face mask, face shield and are sitting behind plastic screens to keep the person to person contact minimal. Hygiene is maintained and surfaces are cleaned regularly. There is always a risk of infection and we may carry it home and infect our family members.
I maintain social distance, wear a mask and use a hand sanitiser. In the hospital premises, overcrowding is avoided and patients are called on appointed time. After going home I change my hospital clothes, take a bath and then interact with my family. I have received the first dose of vaccine and elderly people also have started getting vaccinated so I hope that things come under control and we can relax a little bit but we can’t let our guards down and have to be vigilant.
– Dr Navneet Kaur, General Physician, Apollo Spectra Hospital, Nehru Enclave, Delhi
We are working hard for the welfare of the patients since last year to control the damage caused by the deadly virus
Coronavirus pandemic wreaked havoc worldwide. Even today, the world continues to battle the virus despite assumptions that “Covid is over”. When the crisis first spread, the frontline healthcare workers faced challenges and apprehensions. Besides coping with coronavirus, we were calming Covid positive patients and their families. We are working hard for the welfare of the patients since last year to control the damage caused by the deadly virus. It has been a war-like situation where the enemy is an invisible force. Along with attending patients we also updated their families via video conferencing.
In all this chaos, we needed to take utmost care of ourselves as the risk of catching the infection and infecting the family loomed over us. We worked straight for 14-15 hours while wearing PPE kits. Some of us had to even shift to solitary accommodations to ensure the safety of our family and take rest. To reduce the risk of transmission we had to quarantine ourselves. We took safety measures like sanitisation of the house, wearing a mask at home, and maintaining a safe distance from family. Many of my colleagues including me are Covid warriors, we kept on serving society and helping people get back on track.
The government, healthcare workers, and scientists showed their resilience in the face of the pandemic. Without the tireless work of the vaccine researchers, we wouldn’t be able to get a way out of the global crisis this fast. Slowly, the scenario is improving and we hope for the best. -Dr Manjusha Agarwal, Internal Medicine Expert, Global Hospital, Mumbai
Our only focus is to provide uninterrupted medical care to the patients
India is fighting the Covid-19 crisis for over a year now but the situation has improved when compared to the previous year. Doctors encountered challenges during last year like working day and night to control the damage wreaked by the pandemic. We needed to keep a constant check on the patients via telecommunication and video conferencing. Even doctors were under pressure and overwhelmed because of the spurt in the Covid cases. We were gruelling inside their PPEs and eating, drinking, or going to washroom seemed like a task. At times I used to blackout due to the continuous inhaling of my own CO2 in the PPE. Our only focus is to provide uninterrupted medical care to the patients. We feared that we would get infected which kept us away from our family for days.
We continued to give joy by delivering babies during the pandemic. I was fortunate to get good support from my husband and kids and that kept me going through the pandemic. We had to comfort the patient so that he/she doesn’t feel lonely and recover fully. We counselled the patients and helped them beat their postpartum blues. We also supported and took over a lot of our elder doctors workload to keep them safe as they were more vulnerable and being in the right age bracket of having experience but having a bit less vulnerability increased our workload.
I opt for double masking , avoid taking any equipment from the hospital to home, sanitise my hands and the house, and disinfect all the frequently touched surfaces at home. I also exercise and follow healthy eating habits to enhance immunity.
-Dr Surabhi Siddhartha, Consultant, Obstetrician & Gynaecologist, Motherhood Hospital, Kharghar
There’s a constant fear that what if we are bringing the virus to our homes and infecting our children
We have been adversely affected by the pandemic. As the coronavirus outbreak began to infiltrate our daily lives, doctors face daily risks and can’t even take a step back. The challenge is not only to cope with the virus but also to calm the patients affected by the virus. So, like anybody else, we also seek help from family and friends. When we are working, we ensure that we take small breaks in between to unwind ourselves and take a stroll inside the corridor of the hospital even as we adhere to all public health protocols since we are testing Covid samples too.
We have a highly motivated team that makes these tough times bearable. The chances of contracting the infection in us are more as compared to other people but we hardly pay attention to such thoughts and keep doing our work. When we visit home, there is a constant fear that surrounds us what if we are bringing the virus to our homes and infecting our children. That stress is always there. But now our kids have also become equipped with the situation and they don’t come near us till the time we don’t scrub ourselves.
-Dr Gauri Agarwal, Founder, Genestrings Diagnostic Centre and Seeds of Innocence
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INSOMNIA: IT’S TIME TO ADDRESS THE UNRECOGNISED BURDEN
Evolving lifestyle, unhealthy eating habits, adaptation to extended work-from-home routine and ever-transforming job culture have drastically influenced the sleeping patterns of Indians today. The risk potentials are such that insomnia- a sleep disorder in which a person faces trouble falling or staying asleep- is now emerging as an unrecognised health burden on the country.
According to a Wakefit.co report, the fear of insomnia increased from 19% last year to 24% this year, with Delhi NCR topping the list of cities where people are most worried about sleeplessness. Over 50% of Delhiites reported being anxious about suffering from insomnia. The 2021 report reveals that 42% of Gurugram residents complained about work keeping them up late at night. Last year, the corresponding number was 17%. Also, it is not surprising that people who used their phones just before sleeping was as high as 94 per cent in Delhi-NCR despite greater awareness about the perils of using electronic devices before bedtime. The report further says that the blurring boundaries between work and home have resulted in 81% of Delhiites feeling sleepy during work hours one to three times a week.
Insomnia is a condition that can be acute or chronic. It can also come and go. The condition can be termed chronic only when it happens for at least three nights a week for three months or more. It is further categorised into two types- primary and secondary. While the former is not linked to any other health condition or illness, the latter can bring trouble sleeping due to health conditions like high blood pressure, obesity, depression, anxiety, asthma, arthritis, cancer, pain, medication, or substance use like cigarettes or alcohol, and many others. Binge TV watching, particularly the addictive TV serials & web series available on several OTT platforms, an impulsive attachment to social media platforms and peer pressure of catching up with the “new normal” of sleeping late are some added reasons for insomnia.
The condition not only impacts physical health but causes major mental health problems with symptoms like inability to focus, anger issues, depression, irritability, daytime fatigue, night terrors or bad dreams, waking up too early or throughout the night or taking hours to fall asleep. Studies show that sad or sudden events like accidents or traumas like job loss, exam results, death of dear ones, financial distress, chronic health conditions, etc. are some of the major causes of insomnia. Furthermore, disturbed sleeping patterns due to jet lag, work shifts, bad lifestyle choice also catapult sleep disorders. Restless legs syndrome, an overactive thyroid, sleep apnea, chronic obstructive pulmonary disease (COPD) also cause difficulty in sleeping.
Today, insomnia can be diagnosed by doing a physical examination and by taking note of medical and sleep history. Patients are advised to carry a journal or a notepad for a couple of weeks to track sleeping patterns. In certain cases, special tests are also conducted at specialised sleep centres. While acute conditions may not require treatment, a doctor may prescribe sleeping pills for a very short time. However, it is always advised to not use over-the-counter drugs for insomnia which can cause side effects. Cognitive-behavioural therapy is also suggested.
Insomnia can be stressful but the condition can be easily managed by making simple lifestyle changes and adopting a healthy “Sleep hygiene”. These include going to sleep at the same time each night and waking up at the same time the next morning, avoiding the use of phones or electronic gadgets before sleeping, avoiding caffeine, nicotine or alcohol, regular exercises, avoiding heavy meals, etc. Patients who find trouble sleeping should try to make the bedroom comfortable, dark & silent with a controlled temperature. Using eye masks and earplugs work wonders in controlling disturbing factors like light or noise. Reading a book, listening to soothing music or taking a bath also helps in falling asleep.
Today, lack of awareness and poor knowledge about insomnia has brought negative consequences on people’s health and well-being. Insomnia is a common condition and can result from various issues. Anyone who is battling this condition should see a doctor or a counsellor who can identify the root cause and recommend a solution for overall recovery.
The writer is the Chief Neurologist at Artemis Hospitals Gurgaon.
HOW TO HELP YOUR CHILD FIGHT STRESS RELATED TO COVID-19
In crisis situations, such as the one Covid-19 has created, children are more vulnerable to get trapped with feelings of anxiety and stress. Depending on their age and their personality, the response to this situation may be varied. Some may become overly affected and some may withdraw, some may become anxious, angry or agitated and some may live in denial while others would accept it.
With the surge in cases again, we have come back to where we were exactly a year ago. Due to the critical situation, maintaining health precautions is extremely important, hence the board exams for class 12th have been postponed and schools closed again.
While we understand that with exams postponed and schools closed again, children may feel disheartened, the following suggestions will help to ease their stress and anxiety:
1. Encourage children to indulge in activities that help them relax like painting, dancing, power yoga, Zumba or anything else. Even better, if you can join them! This would not only help them reduce stress but also strengthen their bond. If you could not make the most of the previous lockdown, this is your opportunity to do it.
2. Remember this is going to be an emotional ride. Children may feel frustrated, angry or sad. There may be instances where they thunder at you. Support them through this emotional journey. Help them accept the situation and that they have a choice to make – either to get stressed or focus on studying consistently each day.
3. Keep your children closer to you. Have regular conversations, become liberal and let them speak their heart. This will ensure that they do not withhold the stress inside. What children most miss is being able to speak with their friends. Take this situation as your opportunity to build a bond of friendship with your children.
4. Establish a daily routine. While this may be hard, it is critical! When children go to school, having a fixed schedule and tasks to do keeps them focused. With more time at home and fewer tasks to do, children might start to worry about their future or studies. A daily routine will help them stay motivated! Create a routine where they also participate in household activities and get time to play, study and rest.
5. Be mindful of the environment you create at home. Avoid strained conversations when children are around. Evaluate situations and try to co-create solutions with your family.
6. Help your children to focus on building themselves – emotionally, physically and/or psychologically. The pandemic situation will get under control because nothing lasts forever. When it does, you must have lessons and experiences you have learnt during this time to share with the world. These are going to be unique to you and help you grow.
7. The most important tip for parents is to ensure their personal well-being. Unless your cup is over-flowing, you will not be able to fill your child’s cup. Ensure that you eat well, rest well and give yourself enough time to rejuvenate from the personal and professional life.
8. Lastly, children follow what they see. Instructing your children will not create a sustainable change. How you conduct yourself and deal with stress is how your child will learn to do the same.
Many of us reminisce back to our lives before the Covid-19 pandemic and hope for things to go back to how they were while we simultaneously try to adapt to the new normal. This is bound to take a toll on our children’s mental health. As parents, guardians or caretakers, it is vital we keep our children engaged, focus on their nutrition and exercise and ease the transition to the new normal.
The writer is a Life Coach and Image consultant.
A HANDY GUIDE TO BEAT THE HEAT
It’s wise to be prepared for the hot days and scorching temperatures. And to help you with that, nutritionists share tips to cool down your body and mind this summer.
The summer season is here and the mercury is going to rise rapidlywith passing days. The heat can affect your body in various ways and lead to heat stroke and other health issues. So, it becomes crucial to take care of yourself, be mindful of your food and water intake. Consume summer foods and drinks which are hydrating, electrolyte-rich, and cooling for the digestive system. Curd, onions, mint, watermelon, cucumber, fenugreek and coconut water are some of the best options when it comes to summer foods. The nutritionists share how you can keep your body hydrated and mind fresh in the hot weather. Celebrity & Sports Nutritionist Ryan Fernando says staying hydrated is the key. “Consume fruit-infused water and green tea lemonade. To prepare the fruit-infused water cut the orange, strawberry, papaya, mosambi, watermelon, apple or pears into cubes or slices and mix it in two litres of chilled water and leave it for some time as the fruit infuses its flavour into the water and you can enjoy better-tasting water. Green tea lemonade is a concoction of concentrated green tea mixed with sweet or salty iced lemonade. Don’t forget to add watermelon and cucumber to your diet as these have high water content,” he mentions.
Talking about how ACs impact air’s humidity, Ryan points out, “During summer, people use AC but it strips the air of all its humidity and water content. If you are in a room with the AC on and a humidifier is measuring the humidity, it will be below 40% but when the AC is not on it will be 60%. So when you sleep or work in an AC room, you are losing valuable water from your body. During the day if you are sitting with the AC on, keep a water bottle or jug near you to stay hydrated. Before sleeping keep a water bottle at the bedside table to sip from it in case you get up in the night or have a glass of water before going to bed. Also, you can keep a wet towel or use a humidifier to ensure higher water content in the room.”
SIMPLE WAYS TO INCREASE FLUID INTAKE
Staying hydrated with busy schedules is tough. We all know we need to drink more water but how much is enough? What if you don’t like the taste of water? Celebrity Dietician Shweta Shah replies, “The temperature is rising and you may be tempted with ice creams, sodas, juices but infused water with herbs, fruits, spices is a much healthier way to cool down your body. Detox water is not merely about good taste it’s much more than that. They not only energise you but helps in lifting mood, detoxify, and cleanse toxins. Lemon, mint, fennel, apple, cinnamon, cucumber, celery are some popular detox waters to beat the heat in busy schedules.”
Clinical Nutritionist Dr Megha Jaina believes it’s very important to keep yourself hydrated during summer as it can keep you mentally cool and physically refreshed. She says, “You can drink water-based beverages with every meal. It is recommended to consume fluids before you feel thirsty. Adding a slice of lemon to water may improve your immune system and promotes hydration.”
Dr Megha shares two healthy, easy and refreshing summer drinks:
Melon & Grape juice
Melon has a high content of water, which helps in hydrating our body.
Black Grapes are known for their antioxidants content.
Take one cup of muskmelon cubes, one cup of black grapes and two cups of water. Blend till smooth and the drink is ready.
Detoxifying Green Smoothie
Take one-third cup of spinach leaves, one apple, half teaspoon roasted jeera powder, juice of half lemon and one glass of water. Grind all and the drink is ready.
TIPS TO NATURALLY BOOST YOUR IMMUNITY
With the surge in Covid-19 cases, you should continue working towards strengthening your immunity. Whole food nutritionist Kajal Bhatia tells us some of the immunity-boosting foods you can have in summer. She says immunity and micronutrients are closely linked as they build gut strength and that’s what is needed for the body this summer. Kajal adds, “Increase the intake of plant foods especially antioxidant-rich fruits and vegetables in their whole form or smoothies, chutneys, salads dips etc. Fruits and vegetables rich in Vitamin C are great immunity boosters such as mangoes, grapes, papaya, kiwis, and dark green leafies especially spinach, lemons, bell peppers, and broccoli (if you don’t prefer taking broccoli raw saute or steam it).”
She emphasises increased liquid intake and consumption of fermented kanji and kombucha which are mineral-rich probiotic boosters. Foods rich in zinc and magnesium including sprouts, nuts, and seeds should be included in the diet.
Holistic nutritionist and founder of Saurasya Teas Vriti Srivastav, shares simple ways to boost immunity this summer :
Hydration: The very first step is to stay hydrated which most people struggle to keep up. In this pandemic time, we don’t want our organs to focus more on surviving in a dehydrated body than working on immunity. Drink at least 10 to 12 glasses of water. Also, prepare kadhas made from natural herbs and spices to boost immunity.
Eat natural to strengthen the gut: Your gut influences your immunity, emotional well-being, hormones and hence overall health. Consume a wide variety of nutrients by including colourful vegetables and fruits along with whole grains and pulses. The need for supplements arises today as all the processed foods and irregular lifestyle has hampered the absorption of nutrients in the gut. Squeeze fresh lime on your meals to add a dose of vitamin C. Give the gut a break from digestion by having an early dinner by 8 pm.
Here’s my mantra to a strong gut: fixed meal timings, eat natural, balance sleep-wake cycle, meditate and chant, exercise, hydrate, and include fibre.
ACUPUNCTURE FOR DIABETES: DEMYSTIFYING MYTHS AND FEARS
An insulin disorder that affects over 450 million people across the world, Diabetes Mellitus is one of the leading causes of death worldwide. In India alone, over 70 million people are estimated to be living with diabetes. Poor disease management and ineffective blood sugar control is a major risk factor for a series of life-threatening conditions such as cardiovascular, strokes and renal disease. In fact, diabetes is a major cause of vision loss, kidney failure, heart attacks, stroke and amputations. Worrisomely, the incidence of this lifestyle disorder has grown tremendously over the past three decades largely due to unhealthy lifestyles, increasing consumption of processed foods and a dramatic drop in physical activity.
Naturopathic interventions such as diet management, yoga, lifestyle alterations and acupuncture can play a significant role in controlling the diabetes pandemic. Adopting a naturopathic way of life not only helps patients keep their blood sugar level under control, but also help them reduce their dosage of allopathic drugs.
Acupunture as a diabetes control intervention
The widely used alternative healing practice of acupuncture dates back to more than 3500 years. This ancient Chinese practice is based on the belief that life energy also known as qi flows through our bodies through certain pathways, thereby regulating health and vitality. When the flow of this vital energy is obstructed due to some reason, the body experiences diseases. Acupuncture uses the practice of inserting pins and needles on strategic points on the body to remove the obstruction and revive the flow of energy through our organs. There are around 1000 acupuncture points in the human body.
Acupuncture is an effective therapy for diabetes, especially for type 2 diabetics. It helps regulate pancreatic function and control blood sugar levels in the body. The result is better glycemic control and improved overall health. A study published in the Journal of Traditional Chinese Medicines in 2019 found that when administered along with metformin drug, acupuncture treatment helped significantly reduce levels of both FPG and HbA1c – two critical diabetes indicators – in patients. The study, therefore, recommended the use of acupuncture as an adjuvant therapy among Type 2 diabetics.
Mainly two types of acupuncture practices are used to treat diabetes — electroacupuncture and wrist-ankle treatment. The former is the most common form of treatment in which needles are pierced at trigger points. Then a low-frequency electrical variation is transferred from one needle to another that helps fight insulin resistance. Wrist-ankle treatment is most effective in bringing down the sugar levels and focuses on deep stimulation of the trigger points.
However, several myths and misconceptions about acupuncture prevent many people from receiving its benefits. We demystify some common myths related to acupuncture here.
1. It’s painful
The mere thought of needles being pierced into the skin leaves many people petrified, but acupuncture isn’t as painful as you think it to be. The needles used for acupuncture are very thin and you feel very little or almost no discomfort while they are inserted. Many patients don’t even realise when the needles are being pierced into their body.
2. Doctors don’t recommend this
The World Health Organization and National Institutes of Health have recognised acupuncture as an effective therapy for treating not just pain but also several other conditions like diabetes. A number of modern medicine practitioners also prescribe acupuncture as an adjuvant therapy along with the regular medicines particularly to patients displaying poor glycemic control. A number of studies have found acupuncture to be effective in controlling blood sugar levels.
3. It has side effects
Acupuncture is absolutely safe when performed by a certified acupuncture practitioner. Side effects are almost negligible or only minor such as soreness, minor bleeding in some cases or dizziness. However, no serious adverse effect is associated with this therapy.
4. The treatment is expensive
Acupuncture is affordable and does not burn a hole in your pocket. On average, it costs around 1500 to 2000 Rs per session. Overall, the therapy may also help reduce dosage of diabetes drugs.
5. You get addicted to acupuncture
No, acupuncture is not addictive or dependence creating. The practice does help relieve stress and calm down people but it doesn’t create any dependence.
The writer is Sr. Naturopath at Jindal Naturecure Institute.
REMEDIES TO BOOST IMMUNITY IN CHILDREN
Over time, experts build a strong study of Rasayana – rejuvenation. They studied ingredients available in nature for well-being, immunity, and overall mental and physical health. Rasayanas are known to build the body to fight diseases of the mental and physical kind. These ingredients are also known to build immunity and protect the human body from infliction.
Here are remedies to boost immunity in your kids:
Golden milk: Children often fuss when drinking milk. Make it interesting for them and peg the usual haldi doodh or turmeric milk as Golden Milk. As you might know, Turmeric has anti-inflammatory properties and plays a crucial role in building immunity among children. It is also a staple in Indian cooking. As we use Turmeric in our daily cooking, an added supplement of Turmeric will positively impact your children’s health.
Ashwagandha: It is one of the many researched Ayurvedic herbs. It is known to help with numerous serious diseases and ailments. It also has anti-inflammatory properties, which contribute to preventing autoimmune disorders, among others. Research has proven that it improves the functioning of brain cells and common mental health issues. Ideally, give your children this magic herb through warm and sweet milk. You can also add it with Turmeric milk to combine both herbs.
Liquorice sweets: Liquorice or Mulethi is a herb that is commonly eaten as candy. You can find it at specialised stores or online. The candy is an acquired taste and has many health benefitting properties. The Glycyrrhizin – a saponin found in Liquorice is known for its anti-microbial action. Usually, this root is made into powder, mixed with honey and ghee, to improve immunity. It is a natural revitaliser and also effective as an anti-ageing remedy.
Vegetable juices with ginger: Give your children vegetable juice with a generous amount of ginger. Ginger is used in Indian cooking, but may not be enough, to impact immunity. Ginger is efficacious in curing coughs and seasonal flu. Its anti-microbial compounds help fight infections and boost immunity. Local stores also stock a large amount of ginger candy that can also be made part of your children’s routine.
Plant a Tulsi plant together: Tulsi, as you know, is a medicinal plant. It has healing properties and looks beautiful as part of the home decor. Involve your children in planting this plant with you, and together learn the importance of its medicinal properties. Use the plant leaves for wounds and burns. Show your kids how this plant can be used and also consume its juice daily. Allow your children to acquire the taste for it, and they will be build immunity to lead a healthy life.
Observe your children, as every human body is unique therefore, your child will also respond suitably to different remedies. Preventika an immunity booster by Zyropathy is a combination of Tulsi Leaf, Turmeric, Bael leaf, Sheesham, Gudmar leaf, Arjuna Bark, Mint leaves, Motherwort and more ingredients. It is a healthy option for balancing a child’s immunity. The herbal medicine helps strengthen the internal systems, ensures health and works against 19-various ailments.. Many other remedies and herbs help in building immunity among adults and children. Ensure to learn and include them in your daily routine to protect your family from external harm.
The writer is the founder of Zyropathy.
HOW TO MANAGE PARKINSON’S AMID COVID-19 PANDEMIC
Top healthcare experts and doctors share their inputs on all you need to know about Parkinson’s and ways to cope with this condition.
TIPS FOR MAKING YOUR DAILY LIFE WITH PARKINSON’S EASIER
• Have full awareness of their condition. Also, your caregiver must be equally educated about the same
• You can use the voice option in their phone for any work rather than text mode• Exercise regularly to maintain balance, go for massages, and movement therapies
• Take medications on time and listen to your therapist
• Simplify your tasks and set realistic goals
• Plan your tasks like exercising, chores, recreation in advance• Avoid extreme physical activity. Do not push, pull, or lift heavy objects (more than 10 pounds) that require you to strain
• Do not eat too many sugary foods and drinks as these can negatively impact your immune system. Opt for naturally sweetened food and reduce your sugar intake
• To help prevent accidents, install grab bars beside toilets, sinks, and in the tub or shower area depending on your need
—By Dr Rajnish Kumar, Sr. Consultant & Unit Head, Neurology, Paras Hospitals , Gurugram
ISSUES FACED BY PARKINSON’S PATIENTS DURING COVID TIMES
• Patients are unable to follow up with their neurologist; it is important that they continue to take their medicines regularly and if faced with worsening of symptoms or side effects related to the medicines they should try to contact the neurologist via telemedicine
• Patients with pre-existing Parkinson’s disease when affected with Covid-19 infection can have an exacerbation of the symptoms. They must be evaluated by a neurologist who can adjust the medicines and they should remain in touch with the neurologist whenever possible in person or if not via telemedicine
• Very rarely some patients with Covid-19 infection can present with features similar to Parkinson’s disease. These patients will need hospitalisation and thorough evaluation and treatment under the care of a neurologist.
April is Parkinson’s awareness month. It is the second most common degenerate disorder of the brain after Alzheimer’s disease that has devastating mental and physical implications on the patients who are left untreated otherwise. It is a progressive nervous system disorder that affects movement, says Dr Rajnish Kumar, Sr. Consultant & Unit Head, Neurology, Paras Hospitals, Gurugram.
Researchers suggest that Parkinson’s results from a combination of genetic factors and environmental factors such as exposure to toxins. It usually affects people aged 55 years and above.
—By Dr Prashant Makhija, Consultant, Neurology, Wockhardt Hospital Mumbai Central
DUAL CONCERN: PARKINSON’S & COVID-19 PANDEMIC
On the challenges posed by the pandemic in treating Parkinson’s patients, Dr Anil Venkitachalam, Consultant, Neurology and Movement Disorders, Nanavati Super Speciality Hospital, Mumbai said, “Like every vulnerable section of society, Parkinson’s patients and their treatment was hugely impacted by the pandemic. An increase in requests for home visits was a particularly challenging task. Due to the co-morbidities and risks of infection, the patients were restricted to their homes. Despite the risks involved and the unavailability of necessary instruments and diagnostic paraphernalia, we took all safety precautions and honoured as many home visit requests as possible.”
He adds, “The other challenge was the ‘loss to follow-up’ of our many patients. Several patients were on schedule H drugs such as anti-depressants or anti-psychotics etc. Due to movement restrictions, they couldn’t visit their physicians and renew the subscriptions. In the meantime, the pharmacies stopped honouring the old prescriptions or even new digital prescriptions and patients had to go on without medication for a long time. The hospital couriered hundreds of prescriptions to the patients so that they don’t stop the medication.”
Similarly, as February-March mark the financial year-end, many patients needed disability certification to avail the benefits announced by the government. Since they couldn’t get out of the house, the hospital team filled and mailed the necessary documents for the disability certification. Nanavati Super Speciality Hospital started online patient support group programs to offer holistic solutions and guidance to patients and caregivers.
“Parkinson’s may not affect the patient’s immune system directly. However, in few cases, such patients may have other health conditions which may increase the risk of contracting the Covid infection. They are strongly advised to follow Covid appropriate behaviour,” asserts Dr Guruprasad H, Senior Consultant, Neurology, Columbia Asia Referral Hospital Yeshwanthpu, Bengaluru.
What are the symptoms of Parkinson’s? Dr Rajnish replies the condition is characterised by four cardinal symptoms: tremor (trembling) mainly in hands, arms, legs, jaw, or head; stiffness in the limbs and trunk; generalised slowness of movements and stooped posture; and impaired balance and coordination. “Early symptoms of Parkinson’s are subtle and occur gradually. Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other,” he adds. Mental and behavioural changes sleep problems, depression and anxiety, memory difficulties (Parkinson’s associated dementia), chronic fatigue, severe constipation, difficultly in urination, persistent dizziness, altered sweating, excessive salivation, altered smell perception, and dramatic fluctuations in blood pressure are some of the prominent symptoms which may need treatment.
Parkinson’s occurs when nerve cells, or neurons, in the deeper areas of the brain called ‘substania nigra para compacta’, that controls the movement, tone and coordination of the body, become impaired and/or die. Normally, these neurons produce an important brain chemical known as Dopamine that helps send signals in your brain. When the neurons die or become impaired, they produce less dopamine, which causes the disease, informs Dr Rajnish. He points out that since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
DEBUNKING COMMON MYTHS
There are several myths associated with Parkinson’s. Talking about it, Dr Guruprasad says, “It is believed that everyone with the condition will have tremors, there is no treatment for Parkinson’s, and it is a mental disorder among others. It is a neurological condition and not everyone will experience tremors. Few patients may show other symptoms like balance issues. The advancement of technology has given way to new treatment techniques like deep brain stimulation with directional leads and pump delivered therapy for the management of the condition. Parkinson’s can be managed with medications and lifestyle changes.”
On how to manage this condition, Dr Guruprasad says, “Exercise, balanced diet, rest, speech therapy and physical therapies will aid in the management of Parkinson’s. The patients should follow Covid appropriate behaviour. Medications are the important factors to control physical and mental symptoms affecting the people with this condition. Taking the medications regularly, following an indoor physical activity regimen, and engaging in hobbies will be beneficial for them.”
Early detection of the disease and starting treatment is very essential, as it drastically changes the quality of life of a patient and arguably, also impedes the rate of progression of the disease. Although there is no cure for Parkinson’s, medicines, surgical treatment, and other therapies can often control the symptoms, informs Dr Rajnish.
Adding to it, Dr Prashant Makhija, Consultant, Neurology,Wockhardt Hospital Mumbai Central says, “Since Parkinson occurs due to progressive loss of nerve cells in the brain which produce Dopamine, the treatment is directed towards external replacement with Dopamine in the form of tablets or with medications that facilitate the action of internally produced Dopamine. The non-motor symptoms (such as sleep disturbances, constipation, memory as well as mood and behaviour changes) are symptomatically managed. Patients also require gait/balance training and speech/swallow therapy. Owing to the multiple issues the patients face, they need to be periodically evaluated by a neurologist who can titrate the medicines to provide them optimum benefit while minimising the adverse effects related to the medicines.”
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