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.
SYMPTOMS
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.
CAUSES
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.”
MANAGING PARKINSON’S
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.”
TREATMENT
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.”