What's eating James Parkinson (1817)

Remember times when we go for long road rides and stopped at the rest and treat areas for a rest? We would slot that RM1 into the massaging chair and let those tiny spicules (if I may say), massage our tired aching body.

Now imagine those 'spicules' in your muscles, tugging and pulling away with no control of your conscious mind.
Now, that's Parkinson's for you.

Eversince I watched the video on Parkinson's during lecture the other day, I felt terrible and close to tears thinking about what these patients go through in every day of their life. The video was an eye-opener. It revealed the life of patients afflicted with this degenerative disease and how they lived through it. This man, Richard, spoke about how he deals with it. There were instances when his body shook so much that it disrupted his posture. He cannot walk as fast and speak as fast, as all his movements are slower than usual. He has no facial expression, almost like a mask. He couldn’t enjoy his sandwich sitting on a bench, because before long the muscle tremors and violent shaking will move him off his seat, and he loses his ability in holding the sandwich. He goes for a walk down town feeling refreshed, but not until the muscles of his lower limbs goes into periods of rigidity and spasms at the same time causing him to have an unusual and frightening gait, at least to the people around him, so much so, they run away at his sight.

All this muscle over activity is not the only thing that bothers him. He cannot work, cannot drive, and cannot enjoy life to the fullest. He no longer has closed friends, his social life is a standstill, and as the disease progresses, he becomes incontinent and only has his wife to clean up after him. He can’t have a good night sleep, due to the overt neuronal activity in the brain. Before long, all he will be is a demented, depressed, bradykinetic piece of living zombie, waiting for the day when all the agony will come to an end.

To all my non-medical readers…

Parkinson’s is a debilitating degenerative disease of unknown cause some of the theories include:
-Genetic susceptibility
-Environmental toxins
-Oxidative stress
-Accelerated aging.

What actually occurs is a degeneration of a dopamine producing cells in the brain that causes all the symptoms, i.e.:
-Stiffness (rigidity)
-Tremors
-Akinesia (slowing of movement- bradykinesia)
-Postural changes
-Speech problems

As the disease progresses, the symptoms further intensify, they suffer from memory loss, and may become incontinent.

Parkinson’s patients have these tremors as long as they sit still, which is why they need to move often to relieve the symptoms a little.

Treatment?
Current first line treatments are drugs that replenish the dopamine in the brain (levodopa). Bu this drug only treats the symptoms. There is NO cure for the disease, although recent advances and research have some form of curative treatment. One fine example will be Pallidotomy, where electrodes are inserted into the brain at affected areas to improve the motor system. This is not a CURE per se, but it relieves the symptoms more effectively. US have been doing this for quite some time. It is a pretty risky procedure, but I am proud to say that there is a surgeon in Malaysia practicing this form of treatment, and success rate is high.

At the end of the day, despite all the treatment, what really is important is the patient’s emotional status. These patients suffer from insurmountable depression due to discrimination (to a certain extent) and also due to high dependence on their carers. They feel useless. Good thing is, there are many Parkinson’s Society and Groups, where these patients meet, share their problems and try to regain that little light in life that they have shinning through making friends and the like. With this, they are able to live a somewhat normal life again.

BUT, there is one thing missing in the whole picture of management and treatment of Parkinson’s disease, which I have never found in any medical books or journals.

THE CARERS.

Yes, the carer. When a Doctor treats a patient, the patient needs to be looked as a whole. This is where families come into the picture. These carers, who are more often than not family members, suffer the same EMOTIONAL turmoil as those of the patients, by virtue of being carers. They:

-Do not get sufficient sleep, as they need to keep watch and clean up after the mess of their loved one
-Get their social life into a nutshell as they need to be with their loved one most of the time
-Have an extra burden, in the sense that if the patient was the breadwinner of the family before the disease
-Lack of support from other family members (or even patients themselves)
-Inability to cope with the cognitive disability of patients (forgetfulness, etc)

The list may go on and on. What is vital here is not just the doctor’s role in educating the carers about Parkinsonism, but how to deal with the consequences of it that affects them. These carers also need to be seen as patients, and they need to be given the help that they need in ensuring the best for the Parkinson’s patient in their family.
At the end of this, it is not to say that Parkinson’s patients are troublesome, but we need to see this disease as a disease that not only affects an individual, but every single part that has a connection with this individual, first being the carers. One will only know the courage one needs to be a carer when they experience it them selves.

**Parkinson's was discovered by James Parkinson, in the year 1817 **