Health

Despite Dr Dabla’s classic case and Dr Razdan’s clinical trials, Kashmir remains clueless about Parkinsonism

Termed as an elderly disease with 1 percent prevalence rate among 60-plus age group in the world, Parkinsonism still awaits a major study to understand its graph and grip in the Kashmir Valley. On eve of World Parkinson’s Week, as ailing Kashmiris continue to frequent Dr. Sushil Razdan’s Jammu clinic, it’s the classic case of Dr. B A Dabla that merits attention amid the crippling state of healthcare in the valley.

Two private clinics instantly turned crowded with ‘derailed minds’ when the military offensive began in Kashmir during the nineties. One clinic operated outside the Sir Syed Gate of Kashmir University, where conflict-battered community would be taken in droves — mostly the torture and trauma victims. Run by Kashmir’s celebrated clinical psychiatrist Dr. Mushtaq Margoob, the clinic created its own significance in a strife-stricken zone.

Another clinic became operational outside the Jawahar Tunnel, in the sweltering planes of Jammu. Run by a migrant Kashmiri Pandit Dr. Sushil Razdan, the clinic witnessed, according to the doctor, “80 percent of mentally disturbed patients” from the conflict-ridden valley.

These two clinics catered to the different mental disorders in the backdrop of the war-torn situation in the region.

As a norm those days, persons with tremors, shakes and faint attacks would be forced to hit the highway amid hostile convoys to reach Jammu and seek Dr. Razdan’s help. In that patient overload, some were losing their wits to a neuro-degenerative disease.

The doctor’s own study sometime back had revealed that the incurable disease occurs when a person loses specific brain cells called neurons. And once that happens, patients tend to lose cognitive, intellectual and memory capacities.

Why it happens, nobody knows.

But when it happens, neurologists can only treat its symptoms, before patients even stop responding to their treatment as well. In that case and stage, they’re passed through deep brain stimulation, to restore some sane status quo in their fading brains.

This is exactly what happens in Parkinsonism — the debilitating disease, about which, Dr Razdan had conducted the first and the only research in Kashmir, some 33 years ago. In absence of a new research, Kashmir lacks fresh insights about the disease, which often cripples and trembles lives.

Some 9 years ago, when a cheerful homemaker from Srinagar was diagnosed with Parkinsonism, it reduced her to a miserable being from a lively person.

Lying lifelessly on a bed inside her Sakidafar residence in Old City, Azra recalls the day when tremors first shook her. She was watering her vegetable garden. The water hose had slipped out of her hands when sudden trembling began.

Her low tone and severe fatigue are symptoms of her disease. A change in voice to a lower, quieter tone is what happens, as Parkinsonism progresses. That’s why mental specialists call it a “monster”, which only grows with time.

That day, Azra had confused those tremors with some nervousness. She took a rest, thinking it would calm her “tired” body down. She was wrong. She only turned jittery. Then, a quick visit to SKIMS Neurology Department followed. And shortly, the doctor whom she remembers as a “gentle soul” revealed the cause behind her nervous state—Parkinsonism.

Among other things, the neurologist had found that Azra’s smelling power had started diminishing a decade before the tremors would set in.

But what was the correlation between then and now, she could never know. However, what was clear to her, now, was that a part of her brain was dying—silently, without giving her any clue about it.

At Srinagar’s Government Medical College, senior neurologist, Dr Irfan Yousuf Wani, says Parkinsonism often starts with a sudden loss of smell — the sign which is not taken seriously by patients and often gets overlooked.

“And this first sign could emerge ten years before Parkinsonism rears its ugly head in a person,” Dr Wani says. “Although it mainly affects elderly people in their sixties, young people can also become its victims.”

He’s right.

Dr. Irfan Yousuf Wani

Azra was just 35, when tremors appeared. And since then, she has only grown feeble and fragile. “I was only told that there’s something wrong with my head,” she says, in her frail voice. “That’s what a doctor told me. He was a nice guy, trying to help, but I was driving myself insane.”

What gave her sleepless nights was the nature of her disease. It had started messing up with her brain, which was slowly giving up on her, for some unknown reasons.

Soon, she would notice rigidity and pain in her fingers. That pain—that excruciating pain, as she recalls it—would then travel up through her wrists and her arms. And then, tremors would occur all over the body. And because of those “wild” tremors, she finally lost her graceful walk — forever!

Some twenty four years before Azra would turn shaky and rigid, Dr. Razdan had studied some similar cases in Anantnag’s Kuthar Valley. That belt would send some “unsound” patients to city health centres. And to ascertain the prevalence and pattern of various neurological diseases, the celebrated neuro-physician went there in 1986 along with his team of doctors and conducted house-to-house survey in a rural population of 63,645.

“616 cases of major neurological disorders were detected, yielding a prevalence ratio of 9.67/1,000 as of November 1, 1986,” the study findings noted. “The prevalence ratios for various common neurological disorders were: epilepsy 2.47/1,000; stroke 1.43/1,000; paralytic poliomyelitis 2.18/1,000; mental retardation 2.09/1,000; deaf mutism 1.63/1,000, and cerebral palsy 1.24/1,000.”

Persons with these conditions constituted 92 per cent of all neurological cases, Dr. Razdan noted in the study. It included Parkinsonism, with 14/100,000 prevalence.

Dr. Sushil Razdan

On the face of it, Parkinsonism prevalence was zilch. But since the study was confined to a certain south Kashmir pocket, it could never give away the pan-Kashmir picture.

However, Kashmir never saw any new research, despite patients like Azra regularly turning up in SKIMS’ Neurology department. In absence of fact-finding, even neurologists seem to have no clue about its prevalence in the valley.

“We can’t say whether its number is increasing or decreasing,” Dr Wani continues. “Since Kashmir lacks specific clinics, census on the disease, so we just can’t tell. We only treat patients on the basis of their symptoms.”

Among a wide range of causes leading to Parkinson’s disease symptoms, include neurodegenerative conditions (like in case of Azra, where her neurons are mysteriously dying), drugs, metabolic diseases, toxins and neurological conditions, Dr Wani says.

“About 7 percent of people with Parkinsonism develop symptoms as a result of side effects of medications, majorly due to neuroleptic antipsychotic drugs and rarely because of antidepressants,” the doctor says. Its symptoms can also occur “when people become habitual of taking stomach medicines without consulting a doctor”.

Meanwhile, after diagnosed with the incapacitating disease, Azra would find it hard to cope with the initial diagnosis.

“I was constantly worrying about how long it would be before I could no longer walk,” she voices what neurologists usually say about Parkinsonism: It worsens with time.

Two years after her diagnosis, Azra had started getting dyskinesias—extra movements. “Suddenly my arms would flap like wings, leaving me humiliated in front of everyone,” she recalls. “It turned me into a loner. I stopped visiting my relatives. I became more and more stiff and experienced wearing off of my medication.”

Doctors mainly prescribe Levodopa as the main drug to treat Parkinson’s symptoms. It helps patients in mobility, but it also induces involuntary movements, which at times make patients behave, as if electrocuted!

And this is where, Azra says, it’s extremely frustrating to live with Parkinsonism.

Back in the day, when some of these cases began reaching Dr. Razdan’s Jammu clinic, nobody had anticipated that a well-known person would become the “poster boy for Parkinsonism” in the valley.

The name was late Dr. Bashir Ahmad Dabla, Kashmir’s great sociologist. He was among hundreds of Kashmiris streaming down from the mountains to visit Dr Razdan’s Jammu clinic. But for neurologists treating Parkinsonism, Dr. Dabla was a wonder case, says Dr Abdul Wahid, a renowned Kashmiri doctor, who shares Old City’s roots with Dr. Dabla. Both grew up as neighbours and friends in Nowhatta locality.

Dr. Dabla

“My very good friend and JK’s eminent neuro-physician, Dr. Sushil Razdan, would tell me that Dr. Dabla was a rare patient whose mental alertness and physical preparedness defied the debilitating disease,” Dr. Wahid says.

This defiance became celebratory after trembling and rigid Dr. Dabla would regularly attend Kashmir University’s Department of Sociology, which he had made as a reckoning research center.

But after fighting the disease, Dr. Dabla finally lost the battle in the early fall of 2015.

Since then, the disease he once fought has been continuously making Dr. Razdan’s Jammu clinic a crowded space. With rising footfall, however, Parkinsonism in Kashmir awaits a fresh fact-finding, the one which could tell upon the society’s mental underbelly.

 

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