During one of the meetings organized by the Malaysian Parkinson’s Disease Association (MPDA) four years ago, a young lady in her mid-30’s came to me. She introduced herself as Linda (not her real name), whose mother suffered from Parkinson’s Disease (PD). She learned about the MPDA meetings at Pantai Medical Center (Bangsar) from a local newspaper. She told me that she was concerned about her mother, Mdm. Rose (not her real name), whose health was failing.
Mdm. Rose had been a housewife who lived at a large bungalow at Damansara. Her husband was a high-ranking government servant who died many years ago. She stayed with Linda and two other siblings. She had been a very active housewife all along – doing all the household work such as cooking, washing clothes, cleaning up the house compound, etc. Whenever she had time, she would spent hours sewing clothes, which was one of her favourite pastimes.
Five years ago, Mdm. Rose started to have symptoms of PD such as slowness of movement and body stiffness. She had difficulty walking as well. Her family doctor treated her with one tablet of Sinemet twice a day. Initially she did improve and could still cope with her household work. Two years later, her illness became more serious. Her body movement was so slow that she could only walk a short distance inside the house. She spent almost all her time upstairs because she could not walk down the stairs on her own. As a result, she became depressed and demoralized. She also stopped visiting her relatives and old friends.
Linda also related to me how her mother was very sleepy during daytime. Mdm. Rose used to fall asleep when she was watching television. Sometimes, she even fell asleep when Linda was helping her to take shower in the morning. At night, she snored very loudly. During the early morning, she had hallucination. She told Linda that she saw rats running under her bed even though they were actually not there.
Upon knowing the seriousness and complexity of Mdm. Rose’s health problem, I arranged for her admission to University Malaya Medical Center (UMMC), Kuala Lumpur. I sat down at her bedside and reviewed her illness thoroughly. I found out that the dose of her Sinemet was way to low. Her family doctor was probably not aware that the dose of Sinemet had to be increased from year to year. I estimated that Mdm. Rose needed at least four tablets of Sinemet daily, and not just two tablets a day.
During the conversation, I noticed that Mdm. Rose was a very intelligent lady with excellent memory. She loved to talk about her late husband and how well he served the government. During this time, I noticed that she really missed her late husband. She had a very good command of English. Linda told me that her mother could sometimes make very sharp remarks when things were not right.
She had many other problems as well. Due to her immobility, she had put on weight and this has caused some difficulty walking. I referred her to the dietitian and prescribed her Zenical, a slimming drug. As part of the “PD Team” that we had in UMMC, she was also seen by the physiotherapists and rehabilitation specialists. They brought her to the gym for exercise almost daily. I asked a psychiatrist to start Mdm. Rose on a drug (Quetiapine) to control her hallucination.
This was not the end of Mdm. Rose’s list of health problems. One morning, while doing rounds at the ward, I heard a very loud snore that came from the other end of the ward (about 50 meters away from me!). I was shocked when I found Mdm. Rose snoring away while asleep. Her snore was so loud that her whole body was shaking. I tried to wake her up many times by tapping her shoulder and even pinching her. Despite this, she remained in her deep sleep. After making sure that she was not suffocating, I left her and continued my ward round. Later in the afternoon, the nurses told me that Mdm. Rose slept and snored until lunch hour.
Having any sickness, especially the snoring problem was not good news for anyone. Having said so, I have to tell you that I was very, very happy to discover that Mdm. Rose had a sleeping problem. Her problem was called Obstructive Sleep Apnoea (OSA), a sleep disorder which caused snoring, frequent awakening and thus, poor quality of sleep. Apart from PD, her OSA was the main reason why she was so tired and slow during daytime. She was treated with oxygen supply during her sleep at night.
Over the next two weeks, she gradually improved. She started to walk a longer distance. I was very happy when she could walk unaided and followed me from the 12th floor to the ground floor. She also slept well and the snoring was gone. During daytime, she was wide-awake and alert. During the last few days in the ward, she was always smiling when I went to see her. Once, I jokingly told her that she looked ten years younger than she used to be. She gave a very sweet smile that I would never forget.
As Mdm. Rose had improved a lot and regained her self-confidence, I decided to send her home. Art this stage, she had already started missing her home. She was discharged with a higher dose of Sinemet and several other medications.
One month after she left hospital, I brought a few colleagues to visit her at her bungalow at Damansara. It was indeed a very big house. There were four rooms; two on the ground floor and another two on the first floor. Linda showed us her mother’s room that was on the first floor. We advised Linda on how she could renovate her house to make it easier for her mother to move around.
One month later, I called Linda to find out how her mother’s condition was. I was very happy when Linda told me that her relatives were surprised to see her mother walking again. They thought she had reached the terminal stage of PD and would not be able walk anymore. Mdm. Rose was also back to her favourite pastime; sewing clothes. Nowadays, she spends many hours sewing clothes again.
Mdm. Rose owed it all to her daughter. Without her daughter’s love and initiative, she would not have recovered. Every time I thought of her, I fondly remember her amazing recovery. That helped to motivate me to do the same thing for other Parkinson patients. I was thankful that I met Mdm. Rose because she gave me a true meaning in my medical career. Her story was also very touching and proved to all of us that Parkinson patients could find a new life.