Patient Partners Share Their Story to Raise Awareness about Neurological Conditions

Patient Partner Maria Epiphania Dequina

Maria Epiphania Dequina had the following symptoms --seizures, poor memory, loss of bladder control and changes in cognitive abilities.

When the symptoms progressed, her family decided to go to the The Medical City for consultation upon the recommendation of some relatives. She was then referred to the Neurology and Neurosurgery Departments where cranial imaging was requested.

She was diagnosed with Normal Pressure Hydrocephalus (NPH),  a neurological condition which normally occurs in adults 55-years and older. NPH is an accumulation of cerebrospinal fluid (CSF) causing the ventricles of the brain to enlarge, in turn, stretching the nerve tissue of the brain causing a triad of symptoms.

Epiphania's daughter, Monica, said they were anxious the first time they learned about her mom's condition.

"Pero pag sinabing The Medical City, siyempre magagaling ang doctor, modern ang equipment, may pag-asa, nabawasan yung kaba (But when it's The Medical City, it means the doctors are good, they have modern equipment, so there's hope, it lessened our fear)," said Monica.

The following symptoms are considered hallmarks of normal pressure hydrocephalus--  difficulty walking, decline in thinking skills and loss of bladder control, the last two of which were experienced by Epiphania.

She was prescribed with anti-convulsive medications to control her seizures. Once her seizures were controlled, she underwent a ventriculoperitoneal shunt (VPS) last September 2017. VPS is a surgical treatment for hydrocephalus. The purpose of a VPS is to drain the excess fluid (CSF) from the ventricle. This is achieved by placing a tube into the ventricle (in the brain) which drains the fluid to the abdomen. There is typically a valve which prevents the fluid from moving in the wrong direction and only lets fluid drain when the pressure is too high.

The goal of a ventriculoperitoneal shunt (VPS) is to reduce the abnormally high pressure inside the brain. This is achieved by placing a catheter in the brain that allows drainage of excess fluid into the abdomen.

The patient experienced rapid improvement in her condition after the procedure. Currently, she has regained bladder control and has noted improvements in her memory, gait and speech.

"Ang laki ng naging difference. Mas maganda na ang response niya, mabilis na siya mag salita, memory niya bumbalik na din, dati kasi makakalimutin siya. Tapos mas magana na siyang kumain (There's a big difference. She responds well now, and she talks faster. Her memory is back. Before she was forgetful. She eats better now)," said Manuel, Epiphania's husband.

"Maganda na ang pakiramdam ko. Maraming salamat sa mga doctor. Kung wala sila, ewan ko na lang kung anong mangyayari sa akin (I feel better now. Thank you to my doctors. If not for them, I don't know what will happen to me)," added Epiphania.

References:

https://www.urmc.rochester.edu/neurosurgery/for-patients/treatments/ventriculoperitoneal-shunt.aspx

https://www.alz.org/dementia/normal-pressure-hydrocephalus-nph.asp

Patient Partner Yang Hoe Sung

Fifty-two-year-old Yang Hoe Sung from Seoul was in the country for a vacation when he suddenly felt left sided weakness and slurring of speech. His family immediately brought him to The Medical City (TMC) Emergency Department since it was the nearest hospital from where they were staying.

He was diagnosed with malignant infarction, an ischemic stroke which involves at least 50 percent of one hemisphere of the brain.

The patient underwent decompressive hemicraniectomy, a surgical technique, involving the removal of a bone flap to allow an outward swelling of the edematous brain.

After several days, he underwent a cranioplasty to repair the  bone defect in the skull, using his own bone flap.

Speaking through an interpreter, Yang said he is fortunate he was brought to The Medical City during his medical emergency. His surgeries were both successful and his family expresses gratitude to his doctors, namely, Dr. John Jerusalem Tiongson (Neurologist) and Dr. Louie Racelis (Neurosurgeon), and residents.

Yang said he is happy with the care provided to him by his doctors, nurses, and all the staff. He felt at home in TMC despite the language barrier. His doctors tried their best to explain his condition and the two surgeries he had− decompressive hemicraniectomy and cranioplasty − through an interpreter and by showing pictures and images.

Yang's friends and relatives, who are able to understand English, also helped in facilitating the communication between Yang and family and the medical staff.

"My doctors are the best," said Yang. He said he could tell that they are experts in their field.

Yang said he also appreciated the nurses who checked on him from time to time and invested a lot of time and effort for him to feel better.

When he goes home to Korea, he will tell his family and friends about his experience at The Medical City. He plans to return to TMC and bring some of his employees for their healthcare needs so they too can experience the kind of care and expertise TMC offers to its patients.

Patient Partner Alexander Sales

Alexander Sales' symptom started four years ago when he felt a tightening of the muscles in his left limbs. In the interim, there was a progression of the symptoms, described as having involuntary movements of his left upper and lower extremities. He also noted that his everyday tasks such as buttoning his shirt became harder to perform.

Initially, he and his wife Rina thought the symptoms he felt were  "pasma,” which he believed he got from his previous working environment. He was assigned to a department store warehouse.

His condition worsened over time to the point that he was already having difficulty moving the left side of his mouth.

Instead of seeking help from medical experts, they went to an "albularyo" and other faith  healers in Bicol, where they reside, and in nearby provinces.

His wife said all their efforts were futile as her husband's condition was not improving. In fact, she noted that it was getting worse. Due to this, Alexander started to feel depressed.

In November 2016, the couple went to visit some friends in Binangonan, Rizal who told them about The Medical City outpatient department clinic. Rina then encouraged Alexander to consult a doctor at TMC.

"Nag-aalala ang asawa ko sa mga gastusin. Pero maswerte kami dahil inaccommodate kami ng outpatient clinic at nirefer kami sa Neuro specialists. (My husband was worried about the expenses. We were lucky because the outpatient clinic accommodated us and we were later on referred to Neuro specialists)," said Rina.

Alexander had an MRI of the brain which revealed that he has Corticobasal Degeneration (CBD) which is a rare progressive neurological disorder.

Motor abnormalities that can be felt by patients with CBD include muscle rigidity and the inability to perform purposeful or voluntary movements as in Alexander's case.

In February 2017, Alexander was referred to Dr. Anthony Piano, a neurologist and a Movement Disorder specialist at TMC.

Alexander said Dr. Piano and the neurology residents were very patient and meticulous in explaining to them his condition and management options.

The doctors also encouraged Rina's active involvement in Alexander's care. They gave them instructions on how Alexander should take his medications. They also reminded her of Alexander's schedule for check up and treatment.

For their part, the Sales couple never missed a check up appointment and he religiously take his medications daily. They also saw  to it that they informed Dr. Piano about their observations or any remarkable changes in Alexander's condition.

"Maalaga sila at matulungin, kahit sa requirements para makakuha kami ng medical assistance sa PCSO. Handa sila laging tumulong. (They are very caring and helpful, even with the requirements to avail of PCSO medical assistance. They are always ready to lend a hand)," said Rina.

Both Alex and Rina are now well informed about CBD.

"Nung unang pagtuntong ko pa lang sa TMC, alam ko may pagasa na ko, lalo na nung nakilala ko si Dr. Piano (The first time I stepped in TMC, I already knew there is hope for my condition, especially when I met Dr. Piano),”Alexander said.

"My condition is improving, thanks to TMC and my doctors, and to the people who referred me to The Medical City.”

"There is hope. For me, The Medical City represents hope.”