Expert Queries

Q. My mom is suffering from Parkinsons and my father is a diabetic cum heart patient and the only carer. Can you please suggest a good physiotherapist in Delhi? — Pushpanjali, Delhi

A: You can contact AIIMS Delhi as you can get very good physiotherapist references from there. One of our recommendations is Dr Harpreet Singh Sachdev, Senior Physiotherapist, AIIMS. You could contact the department and find out more physiotherapist leads if he is not available.

– Dr Nicole D’Souza

Q. I am a Central Govt. Pensioner (aged 64 yrs) & residing in Delhi. I have been diagnosed as having Enlarged Prostate and taking Urimax 0.4 mg. capsule since July 2016. My questions are: 1. How long I have to take URIMAX Capsule? 2. Is this medication meant for improvement of my medical problem? 3. Any side affects of prolonged use of the capsule. 4. At what interval I have to go for Ultrasound for improvement, if any, in my enlarged prostate. – RC Goyal, Delhi


Dear Sir,

There is lot more information needed about the medical condition to be able to answer your questions. Please approach your consulting doctor with your queries as he being fully informed about the medical condition will be best placed to answer them.

Dr Ali Poonawala

Q. My father aged close to 80 has been diagnosed with Parkinson’s disorder for at least 10 years. As of now the most troubling issue is the loss of balance. Just today he lost his balance four times. We are in consultation with a neurologist. But he says there are no medicines for freezing and loss of balance with Parkinson’s disorder. While we are facing with other issues like trembling, poor gait, constipation, these issues are in tolerable level. I am looking for some kind of solutions, either permanent or temporary or even some sort of solution which could reduce the issue of falling and make him independent. It could be a moral consultation or physiotherapy or any alternative or traditional medication, etc. – Narayanan

Answer: Prevention of falls is critical for people with Parkinson’s as it can lead to fractures and hospitalisation which greatly affects their quality of life. For both Freezing phenomenon and problems with balance, it is important to understand the situations in which they occur and to evaluate what triggers them. This can be done by a qualified physiotherapist.

Freezing phenomenon in Parkinson’s can be overcome with certain cueing strategies. There are 3 main types of cueing strategies – Visual, Auditory and Movement. Visual strategies could be the use of strips on the floor, laser light etc. Auditory includes rhythmic beats, use of a metronome etc. Movement includes marching or stepping back etc. Which strategy works the best varies from person to person. A physiotherapist will be able to identify which strategy to use and then can train the person to effectively use the strategy.

In order to effectively improve the balance, first the causative factors and the level of balance impairment need to be identified. Based on this a therapist can decide whether restorative, compensatory or adaptive strategies need to be applied. Some of the strategies and techniques are strengthening of the leg muscles, improving posture, reactive strategy training, balance exercises, functional exercises, maintaining a falls diary etc. Assistive aids may also be prescribed to reduce freezing (laser cane) and prevent falls.

Dr Nicole D’ Souza

Q. Is there any early symptoms of Parkinson’s disease. What precautions are to be taken to prevent or slow down the onset of PD – Anonymous Reader

Answer: There are a few signs and symptoms which could indicate that one could have Parkinson’s. If you do experience any of the following signs or symptoms then it would be advisable to consult a Neurologist who would be able to tell you if it’s Parkinson’s or just a simple deficiency.

Some of the early symptoms are

Bradykinesia – your movements may have become slower than usual. It may take you significantly longer to do things than before.

Tremors or shaking of the hands, legs or lips/chin

Micrographia – change in your handwriting. The size of the letters becomes smaller as you write.

Masked face – your face may always seem to have a blank expression or you may not blink your eyes as much as others do resulting in a “staring face”.

Rigidity or stiffness in your hands and legs or body.

Change in your walk – you may walk with smaller steps or may shuffle. You may not swing your arms while walking or drag your legs.

Change in the volume and/or clarity of your voice – your voice may have become softer than before and people may ask you to repeat yourself frequently.

Other early symptoms may be loss of smell, a bent or hunched posture and constipation.

There is no clear evidence which tells us what needs to be done to prevent Parkinson’s or slow its onset. However there has been anecdotal evidence which suggests that leading a healthy lifestyle is the key to keeping Parkinson’s at bay. This would include exercising regularly, eating a healthy diet (high in fibre, more vegetables and fruits and less red meat and dairy products), sleeping properly and keeping active both physically and mentally. Products containing caffeine and those rich in antioxidants are also said to slow the onset of Parkinson’s.

— Dr Nicole D’souza


Q. What will be the best  option for diet/routine if the parameters are the following for a person who is 64 years of age.  Total cholesterol==119, HDL=38, LDL=104, Triglyceride=124,LDL/HDL ratio=2.7 – Umashankar, Gujarat

A. The parametres are well within control. Adherence to a balanced meal consisting of complex cereals, wholegrain pulses, low fat diary and liberal fruits and vegetables would be a good choice.
Dr. Priyanka Rohatgi

Q. My wife is 58 years old. She has medium built and diabetes. From the last few months she has developed pain in the left hand (below the shoulder) and it is experienced while lifting the hand, restricting her hand movement. This was noticed after she fell down in the kitchen some 5 months ago. She underwent a saragem acupressure heating for a month but there was no improvement. Please suggest some treatment option to cure. – US Khare, Gujarat

I recommend that you visit an orthopedic doctor in your area who could examine your wife’s arm and advise appropriate treatment. I can’t comment on the nature of your wife’s pain and treatment without examining her and hence its advisable you take her to a doctor as soon as possible. Also I request you to refrain from further acupressure, massage, etc., until you get it checked by the doctor. Hope this is of help to you.
– Anjali Sivaramakrishnan

Q. I am 74 years old. Six months after cataract surgery, my vision started becoming hazy. I have been advised to postpone yag laser because of a major retinal detachment and having a silica buckle in one eye and many cryos done in the other. Is there any latest development in these areas which can improve my vision without the risk of becoming totally blind? – Pankajam Balasundaram

A. If the retina is attached in the operated eye and the other eye which has had cryo does not have any retinal tears, nothing to worry. A periodic retina check up is all that is needed and the risk of permanent loss of vision is almost nil. You can have the yag laser in the operated eye now and the cryo eye 1 year after cataract surgery with minimal risk.
– Dr. Mahesh P Shanmugam

Q. I am 62 years old. From last 2 years I’ve been getting occasional dizziness spells and shaking of the body. After repeated visits to various specialists and diagnostic tests including a MRI, I was diagnosed to be suffering from vertigo. Doctors prescribed medicines like Vertex and Vertizac but while they would briefly control my dizziness they gave me splitting headaches. Also the dizziness would resume in 15-20 days, even while sleeping. Now for last 6-8 months I have been taking homeopathic medicines which tend to give me relief. I would like to understand what may be causing this at this stage of my life and if there is a permanent cure for it. Are there any natural remedies that will help? – MM Chawla

A. Vertigo can have various causes. The most common ones are inflammation of the inner ear and positional vertigo, which very commonly occur as we age. For positional vertigo, we normally suggest some exercises which help in reducing symptoms. Vestibular sedatives (the drugs that you have been prescribed) tend to reduce the symptoms, but should be used for short durations and by tapering down the dosage. If your MRI has been reported as normal, then I presume there are no structural or other major causes of vertigo. Finally, as an allopathic practitioner, its very difficult for me to comment on homeopathic/naturopathic remedies.
– Dr. Anoop Amarnath

Q. I  have Parkinson’s problem in the left hand. I’m 62 years and 8 months . I have controlled diabetics type 2.  How you can help me to overcome tremors in the left hand? I am also worried it may spread to the right hand. If you have any regular clinic I will visit you. – AJ Prakasam

A. The nature of Parkinson’s is such that it progresses slowly over time. Hence, I understand your concerns. However it is important to note that Parkinson’s may not progress at the same rate for each. At this point, I suggest you exercise everyday, maintain good health and take your medications regularly and do not worry about the progression of the tremor.

The tremor in Parkinson’s is responsive to medications, and I suggest you consult your neurologist for the same. Additionally, some strategies like relaxation, deep breathing or meditation can also help. When the tremor bothers you, you can perform any action like touch each finger with your thumb, make a fist or squeeze a ball. This will temporarily reduce the tremor. Hope this is of help.
–  Anjali Sivaramakrishnan

Q: If a spouse, after having made a will, deliberately puts it in a place where the partner can see it and the partner gets to know that he/she has been cut off from being the beneficiary of the assets, what course of action can be taken? – Name withheld

A: The choice of making the contents of a will known to the spouse, either intentionally or otherwise is a matter of choice of the maker of the will. Whether such act is done with ulterior motives or not is irrelevant. As a will comes into effect only after the death of the maker its earlier disclosure either intentionally or otherwise is not controlled or regulated by law. Nor can any right be claimed under the will until death of the maker occurs. In respect of the absolute and self acquired properties of the maker of the will he/she has an absolute right to bequeath such properties to any person of his/her choice and the spouse cannot claim a legal right to or in such properties .Hence as long as the maker of the will is alive no right to initiate any action in respect of the will accrues in favour of the spouse.

— Shiv Kumar