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[back] The right support Anthony Thanasayan (The Star) - 21 Januray 2010

WHEEL POWER: The right support

A holistic approach is needed in treating those with Parkinson's disease.

MORE people are familiar with Parkinson's disease (PD) today than say, five or 10 years ago. However, when it comes to the medical challenges and social issues related to PD, it may well be a different story.

"Treating a patient with Parkinson's disease is like embarking on a journey," says Dr Norlinah Mohamed Ibrahim, head of the Neurology Unit at Universiti Kebangsaan Malaysia Medical Centre.

The associate professor, who is also a consultant neurologist specialising in PD and movement disorders, explains that the journey not only involves patients but also the caregivers, employers, NGOs, as well as healthcare professionals and providers.

The most challenging aspect of treating PD is to zero in on the disease, says Dr Norlinah. The next step is to initiate treatment. "Although there are medical guidelines on how to treat patients with PD, doctors must go beyond that in treating every patient who comes to them for help," says Dr Norlinah. Medical professionals need to be sensitive to the many issues faced by PD patients and what their caregivers are going through at every stage of the disease. "An executive in his early 30s came to see me about the tremor and slowness in his right hand which affected his ability to use the computer," explains Dr Norlinah.

"His right hand was also unable to swing naturally (a typical sign of PD) when he walked. He was fearful that his condition would cost him his job and render him unable to support his wife and children."

Dr Norlinah's examination revealed all the clinical features of PD.

"I knew that telling him that he had PD would have a big impact on his life, but he had the right to know. Today, five years later, this young man is doing very well even though he still experiences some difficulty with typing," says Dr Norlinah.

The patient came to terms with his condition and is now actively involved in creating awareness of PD.

Dr Norlinah believes in a holistic approach in treating patients with PD. She says the doctor must be familiar with the disease, the stages of its progression, and be on the lookout for complications that can arise.

Questions on how the disease affects patients and their families, and the daily problems in their living and working environment must be asked, says Dr Norlinah.

The disease's progression can make life difficult for the individual. Dyskinesias (involuntary twisting movements) is a condition experienced by many PD patients. It may affect various parts of the body and cause embarrassment, stress and even depression to patients. Caregiving also becomes more difficult when patients injure themselves during falls. Some have to stop working. Treatment becomes more challenging with frequent adjustment of medication.

As the disease progresses, patients may need to use wheelchairs. Others may experience memory loss and hallucinations. Some patients may develop paranoia and become aggressive and hostile to the family.

Dr Norlinah points out that with all these issues, community support and resources are needed to provide comprehensive care to patients.

"The Government can do its bit to provide extended community services such as respite services in nursing homes, meals-on-wheels, and financial support for the treatment and care of patients.

"For a start, authorities like the Welfare Department can officially recognise persons with PD as 'OKU' (orang kurang upaya or disabled persons). This is important when they become increasingly handicapped in terms of mobility, cognition and daily functioning in the later stages of the disease," adds Dr Norlinah.