14th Oct 2009.
The Wai-dan-gong Master
Mr. Lock Kuan Hun, a 59 year-old former mechanical engineer, had retired from his job for only two years when he started having mild symptoms of Parkinson’s. Back in 2000, he had noticed a mild left fingers tremor.
As the tremor did not affect his daily activities, he sought treatment only in 2002, when I first met him. As he was a newly-diagnosed Parkinson’s patient, I had a lengthy discussion with him on that day, and explained to him the initial treatment of early Parkinson’s. In view of his mild symptom, and the possible side effect of any Parkinson’s medication, I told him that there was no urgency in starting treatment with Parkinson’s medication at that juncture. Furthermore, as he was right-handed, his daily functioning was not really affected. He agreed with me, and managed to live a normal life without any Parkinson’s medication for a year.
When I met him again in 2003, his hand tremor had worsened. His body movement had also slowed down. At this stage, his daily activities had already been affected. As such, I advised him to start his treatment with Ropinirole, a dopamine agonist. I also explained the reasons why I chose Ropinirole, and not other Parkinson’s medications especially levodopa.
“As your symptoms are mild, you need only a mild medication such as dopamine agonist. Furthermore, initial treatment of Parkinson’s with dopamine agonists alone have been shown to be effective in relieving the symptoms of Parkinson’s for up to five years. Most importantly, dopamine agonists are associated with a lower risk of involuntary body movement (i.e. dyskinesia) compared with levodopa. Being the most powerful Parkinson’s medication, levodopa should be reserved for the later stage of illness when the symptoms have become more severe and interfere with daily functioning,’ I said.
During the first two months of Ropinirole treatment, his hand tremor and body movement improved. However, Mr. Lock suffered from sleep attacks.
“I was taking a short break from my gardening, and sat on the chair for barely a few seconds when out of a sudden, I dozed off without any warning. It probably lasted about ten to twenty minutes. When I woke up, I was fine and could resume my gardening as usual, as if nothing had happened to me. And when I watched my favourite television programs, the same attacks occurred within just a few seconds after I closed my eyes to relieve eye strain. Once, I even fell asleep while having lunch,’ he added.
At this stage, I discovered that Mr. Lock had been snoring ever since he was young. A sleep study confirmed that he had Obstructive sleep apnea (OSA). In view of the appearance of the sleep attacks soon after he was started on Ropinirole, I told him that the medication might have worsened a pre-existing sleep disorder (i.e. OSA). I explained to him the uncommon occurrence of sleep attacks associated with dopamine agonists, and suggested that he might need oxygen treatment for the OSA and discontinuation of Ropinirole. But somehow, for unknown reason, his sleep attacks subsided after a few months despite an increment in the dose of Ropinirole. As such, he continued taking this medication, till today.
Knowing that he had to do something for himself, and not just rely on Parkinson’s medications, he decided to learn Wai-dan-gong, an ancient Chinese exercise program which helps in maintaining physical mobility and balance. He mastered this ancient art quite fast and well. By 2005, three years after he was diagnosed to have Parkinson’s, he was already a Wai-dan-gong master.
The Wai-dan-gong master in action.
In September 2007, I received a phone call from Mr. Lock’s daughter, informing me that her father had become unconscious following a fall at Cameroun Highlands. He was walking out of the bathroom when he suddenly collapsed and developed a seizure. I advised her to bring her father to a Neurosurgeon in Kuala Lumpur. A CT brain scan showed that Mr. Lock had a blood clot (bleeding) in the brain. He underwent brain surgery on the same day, and almost completely recovered over the next few months.
However, by September 2008, his Parkinson’s had progressed. His body movement had slowed down further, while his head had become bent forward. I asked him to increase the dose of Ropinirole to the maximum dose and start taking Selegiline. He gradually improved over the next few months.
His physical mobility was fairly good – he could do gardening and drive for a short distance. In fact, a few months ago, he even drove me to a restaurant for dinner together with some other friends.
13th October 2008 – Mr. Lock is still going strong. He still drives his car for a short distance to bring his wife and friends out to a restaurant for dinner.
I met him again a few days ago at his home. He looked quite energetic and cheerful. He had a sustained and smooth response to medications. When I reminded him that he had actually done quite well, despite the progression of Parkinson’s and the head injury, he attributed his physical fitness to the Wai-dan-gong exercise. Even though he was no longer teaching Wai-dan-gong at this stage, he still practises it regularly at home.
Overall, I feel that his illness has been relatively well-controlled. Till today, eight years after his illness started, he is still not on levodopa (on average, most Parkinson’s patients would require levodopa by the fifth year of illness). At this stage, he does not have to worry about “wearing off’ phenomenon and dyskinesia.
He could also be right – the Wai-dan-gong exercise might have helped him.
13th October 2008 – Mr. Lock (third from right) enjoying dinner with friends at a restaurant in Subang Jaya, Kuala Lumpur.