Case No. 1 – Mr. Sim
The first case of MSA or Multiple System Atrophy who walked into our Chin’s Qi Tuina Holistic Centre was the father of my son’s classmate in school. He had been diagnosed by specialists and doctors in having this dreaded incurable disease, and his condition has been deteriorating ever since.
When he came to our Holistic Centre, he was shuffling in very slowly with his wife supporting him. His voice was barely a whisper, and his lack of speech coordination resulted in barely understandable garbled speech. When the doctor tested for knee reflex, his knee hardly moved. His physical coordination was also very poor resulting in trembling some of the time.
He had to sit down or lie down due to “no energy”, and could not swallow solids. Even swallowing liquids was a problem as it sometimes went down the wrong way. He had no appetite at all. He was skin and bones having lost a lot of weight, and his skin colour was an unhealthy sallow yellow.
He has a job as a supervisor, and his health condition was getting in the way of his job execution. Everywhere he needs to go, someone has to support him, drive him and look after him all the time.
We started him on his Qi Tuina treatment immediately, coupled with a diet programme, and an ancient form of Qi Gong exercise twice a week for 3 weeks, then tapering it down to once a week.
Mr. Sim had to practise the Qi Gong exercise at least 3 times a day, and follow the diet to the letter, along with Qi Tuina sessions twice a week for the first 3 weeks.
To people who knew what challenges Mr. Sim had to deal with, his wife, son, relatives, close friends and colleagues, they were amazed to note his improvement over just 3 weeks.
He could swallow solids again without any problems, and had a “great appetite” according to his wife. You can hear his voice across the room when he talks, and he has command of his physical and speech coordination just like a normal person. He walks faster than his wife now.
He has more than enough energy & strength to perform his supervisory job, and can stand and walk for long periods of time. His knee reflex has gone back to normal, and he can finally drive himself around, and move around without anyone to support him. He has gained some weight and his skin colour is much better with a pinkish tinge. He has fully regained his mobility and independence.
We are continuing to treat and monitor his progress, once a week, and he has been living normally without any support or help from anyone since he recovered from the ravages of MSA. We continue to regress his MSA which though is not curable, is regressable and can be managed to ensure the MSA does not adversely affect the afflicted person’s life.
Mr. Sim and his family are very happy with his progress and his continuous good state of health, and has agreed to be a reference for other MSA patients.
Case No. 2 – Ms. Doris Wong
Ms. Doris Wong comes from a large family, and resides in Melbourne, Australia. She was diagnosed in Australia as having MSA, and to her with young kids, it felt like a death sentence without any hope. She was even embarrassed to let her family and siblings know that she contracted MSA.
As fate would have it, one of our patients who come to us for help with arthritis told her about Mr. Sim and the work we do, and she came with her sister, Irene (who has Rheumatoid Arthritis), to see us at Chin’s Qi Tuina Holistic Centre. She was home in Kuala Lumpur on her annual holiday away from Melbourne as luck would have it.
Her speech was slurred when she came, and very soft. Her sister Irene was holding her up on one side while she shuffled into the clinic very slowly. She had very little energy and must either sit down or lie down. Doris had a problem swallowing solids, and had a problem with physical coordination and trembled at times.
She had to come almost every day for her Qi Tuina treatment and to learn the ancient Qi Gong so that she can practise it on her own when she gets back to Melbourne. She also had to follow a diet we prescribed.
After 4 weeks of treatment, she now walks faster than when she arrived into Kuala Lumpur, and instead of Irene holding her up to help her walk, she is now holding up Irene to help her walk (Irene has Rheumatoid Arthritic knees and ankles)! Her voice is much louder and her speech is clear. Her siblings claimed that she has improved tremendously, and can now converse normally just like before.
Doris has learnt the whole Qi Gong set and on her last day in Kuala Lumpur in January 2017, came for a last session with us. She has also agreed to give us a testimonial, so I have listed her case down here.
Both Mr. Sim and Ms. Doris Wong can be contacted if anyone suffering from MSA needs to speak with them for their advice and support. Call, message or whatsapp me at +6-012-2895716 or email me at email@example.com
We are ecstatically happy to have helped two fellow human beings live a normal life although they have MSA, which is incurable. We are now helping a third person to do the same, but she is already on a wheelchair and may take more work and effort from both us and our patient to be successful. But I am confident we can do the same for her, if she is resolute enough to fight her MSA.
For appointments to treat MSA, please go to Chin’s Qi Tuina Holistic Centre. Clinic hours and a booking link can be found there, as well as all contact information.
What is multiple system atrophy?
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by a combination of symptoms that affect both the autonomic nervous system (the part of the nervous system that controls involuntary action such as blood pressure or digestion) and movement. The symptoms reflect the progressive loss of function and death of different types of nerve cells in the brain and spinal cord. Go to Multiple System Atrophy to read in detail what MSA is all about.
Symptoms of autonomic failure that may be seen in MSA include fainting spells and problems with heart rate, erectile dysfunction, and bladder control. Motor impairments (loss of or limited muscle control or movement, or limited mobility) may include tremor, rigidity, and/or loss of muscle coordination as well as difficulties with speech and gait (the way a person walks). Some of these features are similar to those seen in Parkinson’s disease, and early in the disease course it often may be difficult to distinguish these disorders.
MSA is a rare disease, affecting potentially 15,000 to 50,000 Americans, including men and women and all racial groups. Symptoms tend to appear in a person’s 50s and advance rapidly over the course of 5 to 10 years, with progressive loss of motor function and eventual confinement to bed. People with MSA often develop pneumonia in the later stages of the disease and may suddenly die from cardiac or respiratory issues.
While some of the symptoms of MSA can be treated with medications, currently there are no drugs that are able to slow disease progression and there is no cure.
MSA includes disorders that historically had been referred to as Shy-Drager syndrome, olivopontocerebellar atrophy, and striatonigral degeneration.
What are the common signs or symptoms?
The initial symptoms of MSA are often difficult to distinguish from the initial symptoms of Parkinson’s disease and include:
- slowness of movement, tremor, or rigidity (stiffness)
- clumsiness or incoordination
- impaired speech, a croaky, quivering voice
- fainting or lightheadedness due to orthostatic hypotension, a condition in which blood pressure drops when rising from a seated or lying down position
- bladder control problems, such as a sudden urge to urinate or difficulty emptying the bladder
Doctors divide MSA into two different types, depending on the most prominent symptoms at the time an individual is evaluated:
- the parkinsonian type (MSA-P), with primary characteristics similar to Parkinson’s disease (such as moving slowly, stiffness, and tremor) along with problems of balance, coordination, and autonomic nervous system dysfunction
- the cerebellar type (MSA-C), with primary symptoms featuring ataxia (problems with balance and coordination), difficulty swallowing, speech abnormalities or a quavering voice, and abnormal eye movements (“cerebellar” reflects a part of the brain involved with coordination)
MSA tends to progress more rapidly than Parkinson’s disease, and most people with MSA will require an aid for walking, such as a cane or walker, within a few years after symptoms begin.
Additional symptoms of MSA include:
- contractures (chronic shortening of muscles or tendons around joints, which prevents the joints from moving freely) in the hands or limbs
- Pisa syndrome, an abnormal posture in which the body appears to be leaning to one side like the Leaning Tower of Pisa
- antecollis, in which the neck bends forward and the head drops down
- involuntary, uncontrollable sighing or gasping
- sleep disorders, including a tendency to act out dreams (called REM/ (Rapid Eye Movement sleep behavior disorder)
Some people with MSA may experience feelings of anxiety or depression.
What causes MSA?
The cause of MSA is unknown. The vast majority of cases are sporadic, meaning they occur at random. A distinguishing feature of MSA is the accumulation of the protein alpha-synuclein in glia, the cells that support nerve cells in the brain. These deposits of alpha-synuclein particularly occur in oligodendroglia, a type of cell that makes myelin (a coating on nerve cells that lets them conduct electrical signals rapidly). This protein also accumulates in Parkinson’s disease, but in nerve cells. Because they both have a buildup of alpha-synuclein in cells, MSA and Parkinson’s disease are sometimes referred to as synucleinopathies. A possible risk factor for the disease is variations in the synuclein gene SCNA, which provides instructions for the production of alpha-synuclein.
How is MSA diagnosed?
Making a diagnosis of MSA can be difficult, particularly in the early stages, in part because many of the features are similar to those observed in Parkinson’s disease.
After taking a clinical history and performing a brief neurological examination, a doctor may order a number of tests to help make the diagnosis. These tests might include autonomic testing (such as blood pressure control, heart rate control), assessment of bladder function, and/or neuroimaging such as an MRI (magnetic resonance imaging) or PET scan. An MRI of the brain may identify changes which might suggest MSA or rule out other causes of the observed symptoms.
A PET scan (positron emission tomography, which allows doctors to see how organs and tissues are functioning) is sometimes used to see if metabolic function is reduced in specific parts of the brain. DaTscan can assess the dopamine transporter in a part of the brain called the striatum and can help physicians determine if the condition is caused by a dopamine system disorder; however this test cannot differentiate between MSA and Parkinson’s disease. Individuals with MSA typically do not have sustained improvement in their symptoms with levodopa (a drug used to treat Parkinson’s disease), a finding that often supports the diagnosis of MSA.
How is it treated?
Currently, there are no treatments to delay the progressive neurodegeneration of MSA, and there is no cure. There are treatments to help people cope with the symptoms of MSA.
In some individuals, levodopa may improve motor function; however, the benefit may not continue as the disease progresses.
The fainting and lightheadedness from orthostatic hypotension may be treated with simple interventions such as wearing compression stockings, adding extra salt and/or water to the diet, and avoiding heavy meals. The drugs fludrocortisone and midodrine sometimes are prescribed. In 2014, the U.S. Food and Drug Administration approved the medication droxidopa for the treatment of orthostatic hypotension seen in MSA. Dihydroxyphenylserine helps to replace chemical signals called neurotransmitters which are decreased in the autonomic nervous system in MSA. Some medications used to treat orthostatic hypotension can be associated with high blood pressure when lying down, so affected individuals may be advised to sleep with the head of the bed tilted up.
Bladder control problems are treated according to the nature of the problem. Anticholinergic drugs, such as oxybutynin or tolteridine, may help reduce the sudden urge to urinate.
Fixed abnormal muscle postures (dystonia) may be controlled with injections of botulinum toxin.
Sleep problems such as REM sleep behavior disorder can be treated with medicines including clonazepam, melatonin, or some antidepressants.
Some individuals with MSA may have significant difficulties with swallowing and may need a feeding tube or nutritional support. Speech therapy may be helpful in identifying strategies to address swallowing difficulties.
Physical therapy helps maintain mobility, reduce contractures (chronic shortening of muscles or tendons around joints, which prevents the joints from moving freely), and decrease muscle spasms and abnormal posture.
Individuals may eventually need assistive devices such as walkers and wheelchairs. Occupational therapists help with home safety and learning new ways to address activities of daily living such as dressing and eating.