Understanding Parkinson's with Dr. Sim Chun Yang
12:23PM Mar 8, 2021
Hi everyone, so welcome to our Homage series. My name is Bel, and I'm working with Homage. And together with me in this session today we actually have Dr. Sim. So Dr. Sim has work experience of 10 years with a specialisation in internal medicine, and he is also having pursuing a subspecialisation in neurology, so welcome Dr. Sim. Yeah. So in this particular series here today we will be covering a lot more about wanting to have a general awareness and better understanding about medical condition, Parkinson's. Yeah. So Dr. Sim, you know on our platform, given that we do have experience with Parkinson's patient. Some of the common questions we always receive from the families of, what are some symptoms that they should be looking out, you know, apart from tremors so that they will be able to play a role in early detection?
Thank you very much Ms Bel for the kind introduction. So, yeah, about Parkinson's. We know that Parkinson's is quite prevalent in Malaysia. So, this is a good question about what kind of symptoms that they get early on. There are actually a lot of symptoms. And a lot of people think that it's just a tremor alone but it's not really just about tremor. In fact, the main cardinal symptoms that you should get was - is bradykinesia, which means that they have this slowness in movement.
And that. But even before then, there are other symptoms that can precede this, what we call as motor symptoms, motor which is the tremors, the bradykinesia and rigidity. So even before these three cardinal symptoms of Parkinson's - one gets other things like constipation, you know they have problem passing motion. They have REM sleep disorder, meaning they sort of act out their - the dreams that they have with at night when they're sleeping. So then, other things like problem with smells, all these are very prevalent in person with Parkinson's. And these are what we call non-motor symptoms. And because. And most of the time people might tend to miss these kind of symptoms, they might not think too much of it, but actually it is already Parkinson's that is starting to manifest. And after a few years, they get the tremors, then they get bradykinesia. Even tremors, you might not expect to find in all sorts of- in all Parkinson's patients and so, but let's talk about the three main cardinal features of Parkinson's which is actually tremors, bradykinesia and rigidity. So tremors is what- what they get is they get this pill rolling you see that their first finger and second finger will roll about.
And usually, typically, about three to five movements per second and that's - that's the typical description of Parkinson's tremor, so you will see that not all tremors are Parkinson's. There are a lot of other types of tremors. Then the second thing would be bradykinesia where you see that you're - a person with Parkinson's starts to walk slow, and they start to talk slow, and even their thinking gets slower with time and it actually those, those are all the features of Parkinson's, because they don't have the important neurotransmitter hormones in the brain. They get loss, damage those- those area in the brain gets damaged so they produce less of those neurotransmitters so important to get the patient to to perform the usual activity as per normal so they get slower. As a result, and they get tremors as a result. So, then they also get rigidity. Rigidity is when you feel that the body becomes very stiff, and they. And this is where a patient with Parkinson's would fall, easily you know because they, they can't stop themselves from falling. They trip, they fall because their body are very hard, and they are also slow, so when they're hard and slow you expect them to fall a lot, and that's how they injure themselves. So those are the three main features of Parkinson's but on top of that those are what we call as motor symptoms but before - there are. Apart from the motor symptoms there are a lot of other symptoms that is non-motor as I mentioned, constipation, REM sleep disorders, your problem with your smells, and then you get your emotion problem, you get depression, you get hallucinations and urinary symptoms and all those
The emotional elements start to kick in lah in that sense you know because their lifestyles probably could have been abrupted or changed, like how you explained Doctor. Yeah, well that's very good symptoms that you shared because it's very common that you know, people always assume tremors is the only ones but I like how you brought up about smell and constipation as well because this, you know, very, to a certain extent, maybe misconceptions that we think, oh these are symptoms that could be overlooked.
Exactly. A lot of times people look at these kind of symptoms then they think that their motor symptoms is most important but actually there are a lot of other symptoms that a patient with Parkinson's can get and a lot of management revolves around the other symptoms, not only the motor symptoms. And they are equally important, you know, constipation, swallowing is all very important parts and parcels of how to manage a Parkinson's patients adequately.
I see. Thanks a lot for that sharing. The other very, you know, good education we want to be able to understand from you a lot better Dr. Sim is with regards to medication. So in general, we understand that you know with with various medical conditions, inclusive of Parkinson's medication then now plays a very important role in, you know, helping them to more importantly is to control tremors. Yeah. Could you share with us a bit more like you know the- the importance of keeping to a time period of adhering to the medications? Yeah.
Yeah. So medication is of course very important in Parkinson's, there are actually a lot of varieties of medications that we can start a patient on. One of the misconceptions about Parkinson's is that a lot of people are worried to take Parkinson's medications. Okay, you know, we heard about that? Because we know it is a general knowledge. I think a lot of people heard about this before that, when Parkinson's patients started on certain medication the medication would cause more side effects than good, alright. Which is why I don't know about you but I have a couple of friends in fact my uncle, who refuses to take medications because they know you know, to a certain degree that they heard about some news that the medication will cause some side effects. So, they are afraid of taking medications. So, one would sometimes give them medications they would just not adhere to it. So, which is why I. One important thing is that once a doctor has decided to start you on a medication usually a doctor has already taken into consideration the side effects of the medication, and the benefit that it gives.
So we decided, if you have decided- a Parkinson's patient has decided that they are worried about the side effects of the medication, you can always discuss with the doctor, and the doctor can always tailor a therapy that's just for you, right. We can take it slower, we can start you off with a milder medication with less side effects and then we gradually pick it from there, right. But at the same time, you need to know - a patient will need to know what are the side effects of the medication versus the benefits that it can give. So, obviously we have already thought about that. And the reason we start the medications, because it definitely helps the patient.
And, we both. Of course there are regimens, and there are ways how to start a new medication to avoid side effects. And, which is why. Usually we will start off with if patients are particularly young, we start off a mild kind of medication. But once the disease gets more and more advanced, you will need to take medication that we call as levodopa which is actually the neurotransmitter of the brain itself that the hormones - hormones in the brain that is lack of in the patient Parkinson's brain, right. Parkinson's patient's brain. And this medication, if taken them long enough could give you some side effects but if without this medication you cannot ameliorate your- your- the cardinal symptoms of your Parkinson's let's say that. The bradykinesia, your rigidity or tremors. So without this medication, there is no way to control it carefully. So, when you do not take the medications, and you have slow, you're slow, you're rigid, you will not be able to do your work as per normal- as per a normal human being. And then you will feel that you're very hard that you cannot- you cannot work, your thinking is slow. So you won't be able to do the normal activities and then it goes into a vicious cycle where you get problems with your muscles, you get muscle atrophy and then it gets weaker and then you will slowly, gradually lose your ability to walk. And that is what we do not want. That is much worse than taking the medications and expecting a possible side effects. So, so what Bel has said- mentioned about adhering to the medications is very important because this is to help you to continue with your daily activity, to get you to be like a normal person, to be able to do your activity- activity of normal daily living like a usual person, and to continue to preserve your ability to walk. And to do that. In fact, to go drive your car.
Yeah. It's because you don't adhere to the medication you know that the- your disease, Parkinson's disease is progressive and it'll get worse and worse with time. And it's because of the lack of hormone in the brain. So you will need to replace it. One day in the future into your disease, and it's better to replace it earlier on, because it gets you the possibility to maintain your normal lifestyle. And that is very, very important.
So I guess it's very important for families to, you know, really have a sit down with their doctors on understanding you know what the medications are for, and more importantly is to anticipate, if at all any side effects so that they will be able to keep you know as you advise doctor, you know, the fact that the medications are being introduced mainly for the sole purpose and the main objective is to enable the patients to slow down the progression of the disease, and also to be able to you know lead a normal life as best as possible and where possible as well. Yeah, that is so important for our families to know because we know you know medications with, not just with Parkinson's, with any other condition that with different patients may have different side effects as you have pointed out, which brings me to a very interesting question about what will be other medical conditions out there that tends to maybe mimic Parkinson's that is actually so that we don't misdiagnose in that sense. Yeah.
So of course there's a lot of misconceptions. A lot of people awareness about Parkinson's I tend to be generally quite low in the public, especially in Malaysia. So this is why we're having this session. So, some people they see that some people you get a little bit of tremor and you call it- you think that it is Parkinson's but there's not always Parkinson's. We have a lot of conditions that can cause you to have a little bit of tremor, but it's not necessarily Parkinson's and in that case there are medications to treat and it is a different kind of medication, different kind of management so things like essential tremors essential tremor typically last- runs in the family. You have your hands shakes, and so when you are trying to do certain activity. And that is, that is not Parkinson's you see. So these kind of things can be mistaken for Parkinson's. So it's always good to of course see a medical, expert opinion, whether or not you think that is Parkinson's, there are a lot of other kinds of tremors like. Like if you have some problems with your, the back of your brain you know you got some- or you have some stroke previously you might get some tremors but especially, particularly at the back of your brain. And these kind of tremors are different, so they don't get worse with time. They are not like Parkinson's, apart from that, there are of course, a lot of other types of diseases, conditions that a person might be mistaken for Parkinson's. Among which are some things like- like normal pressure, pressure hydrocephalus you know when you have abnormal collection of fluid in your brain, where it will cause you to have difficulty in moving and slowness as well. But this condition is usually- usually amenable to surgical treatment. They put in a- put in a shunt in your brain and you reduce the pressure in the brain, it actually gets you to be much- back to your normal self. So, the two. What's important here is that we need to recognise that there are a couple of conditions that could look like Parkinson's but not but they are not particularly Parkinson's and you will need to seek expert opinion. Because Parkinson's - even doctors might mistaken Parkinson's, because we know that Parkinson's actually a clinical diagnosis. Yes. Clinical diagnosis so you get these slowness in movement, rigid, stiff body and you get tremors. Then they'll say that this patient has Parkinson's but sometimes, as I said, there are a couple of limits that - that has tremors as well and sometimes when you're elderly, you do - you do become slower a little bit.
And people might easily mistake this for Parkinson's. So, um, generally, what's important is, once you go to a certain doctor to seek opinion. This doctor would - you would try to adhere to the - to go back to this doctor because most of the time, the doctor should already have in the back of their mind whether or not this is Parkinson's or not. And they will monitor your loved ones, and they will decide and see look back, if the diagnosis fits with Parkinson's in the future. So, what happens is sometimes a person might jump from a doctor to the next whensoever and think maybe this doctor made a mistake. But what they don't know, they don't understand is that they are actually as what Bel has mentioned Parkinson's mimics, that the doctor already, probably has already at the back of his or her mind. And then she is watching hard for other symptoms and whether this patient, this person might be Parkinson's or not. And if it's not, if it doesn't fit, he or she would change the diagnosis later on but it's just that it's important to continue to, to see the doctor, rather than to change and get a second opinion or third opinion. You know, that happens.
Consistency, I guess in seeking treatment
Yeah, it will lose the important progression, you know. The first doctor will not be able to know what happened in the future and the second doctor will not be able to know what happened initially.
What's important is to continue to see the doctor and you can ask the doctor whether it's really Parkinson's or not.
You mentioned a lot Dr. Sim about how you know, we started off about the symptoms and we talk about medications right, what would be you know some preventive measures that can be done at home in- wanting the family to, you know, allow a Parkinson's patient to lead as best as possible a normal life or to help them feel a lot more comfortable at home. What, what will be some of the recommendations or preventive measures as well, yeah?
Yeah, I think that's a good question. So as we know Parkinson's is actually a neurodegenerative disorder. It means that you get lost of a certain hormone in your brain, neurotransmitter in the brain and it progressive- it progressively gets worse and worse. And they- it's actually, there's no cure for it. What they do is, you give treatment to replace back the hormones that is missing in the brain. And that gets which- which gets less with time. But we know that, although we know that Parkinson's is progressive and gets worse and worse with years, with time. There are as Bel mentioned ways to- to slow down the progression of the disease, to slow down the progression of Parkinson's and what's been well-known is the fact that exercises is one of it, it slows down the progression of the- of Parkinson's and it helps the patient to walk. It makes the patient happier, actually makes the patient more, more confident to continue with their daily living- to continue doing activities. Because a lot of patients when they, the disease gets worse in the future, then they get lack of confidence. Then they prefer to sit down or lie down most of the time, and they will sit on the wheelchair or they will sit in a wheelchair, most of the time. And they are worried to walk because they are so slow and so rigid. And when they walk they are worried that they will fall, and that's that frequently happens to patients but what we can do is to encourage them to do exercises exercises like any types of exercises aerobic exercises, limb strengthening exercises, mobility exercises, which is to encourage the patient, show them how to to walk and accompany them, and probably give them what they do with the rods, how to support walking, and this will like limb strengthening exercises it will also preserve the muscle strength of the patient. And even though they are slow, they will still have the strength to walk. And about falls, there are also things to do, that you can help the patient with. For example, you could install railings at home, and modify the toilets. So that it's going to be converted to a sitting down toilet with hand railings. All these steps are to promote the patient to continue to do their activities as per a normal human being, and to encourage them to, to, to, to continue to function as per normal person. We do not want them. The last thing we want for them to lose their ability to walk, and to always sit on the chair or the bed. That is the caretaker's nightmare. So what- I heard about the what Homage can do would be to provide services to your- to the person's home, the patient's home and help you out with mobility of your loved ones you know Parkinson's patients. Because they need a lot of physiotherapy as well.
Yeah, that's very good sharing. So thank you so much Dr. Sim for your time and also you know sharing a lot of good tips for us to be able- for our viewers today to get a bit more information about Parkinson's. We do want to share with our viewers today that, you know, if at all any of your loved ones, or family members do present any of the symptoms that were shared in our series today, please, please do take note it's very very important as mentioned by Dr. Sim as well, to actually seek for early treatments or even get a diagnosis from the doctors. We sincerely hope for all our viewers, you would have gained more knowledge and understanding about Parkinson's and should any of you have any feedback, please feel free to drop us a comment. So thank you so much everyone and thank you so much once again Dr. Sim for your time today.
Thank you, Bel. Thank you, thank you for the opportunity to talk.
You're most welcome.