I’ve been interning at an ophthalmology clinic for Troy Tech’s diploma program. Today, we received an elderly patient with Huntington’s disease - a neurodegenerative disease that causes neurons to die in all parts of the brain, but especially the striatum and the basal ganglia. This particular patient had corneal abrasions that may have resulted from a previous shingles outbreak. Shingles is a viral infection; thus, she had been taking the antiviral drug valacyclovir, among other drops to treat her corneal abrasions. She had been having problems swallowing the large valacyclovir pills; thus, her caretaker was forced to turn 3 large pills a day into 12 quarter pills throughout the day, which was hard for her to swallow due to the decreased mobility in her pharyngeal muscles. On top of that, she had difficulty administering the two different eye drops used to treat her dry eyes and needed assistance for that as well. The ophthalmologist I worked with modified her treatment plan because of her Huntington’s disease, in order to tailor it to her needs and abilities throughout the day. Huntington’s patients suffer from a lessened muscle mobility, and they tend to start “freezing up” - losing more ability and motion - as a day progresses. The doctor’s modifications included: - Changing the antiviral medicine, valacyclovir, to a smaller pill, acyclovir, which would reduce the need to split large pills into quarter parts and cause the need to swallow more pills every day. - Eliminating the drop regimen due to its difficulty and ineffectiveness. - Application of a Prokera amniotic membrane bandage over the cornea to prevent scratching - Scheduling the follow-up appointment as early in the day as possible to avoid the patient freezing up. The doctor has said “ophthalmology is all about patterns, not measurements.” As such tailoring a patient’s treatment plan according to their common ailment but unique circumstances makes for a better patient care experience overall.
Credits to: Jacob Pan
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