January 19, 2017

Diagnosing my Parkinson's: Then and Now

A neurologist diagnosed my Parkinson's disease (PD) in the fall of 2009. I should have been diagnosed several years earlier, but I didn't -- and still don't -- have the typical tremor that makes PD easier to detect. About 35% of all Parkinsonians don't have the tremor.

My former internist gave me a physical every year. During our 2005 session, I mentioned I had lost my sense of smell. He said, “Don’t worry about it. That happens to a lot of people as they age.”

In 2006, I told him my kids thought my right arm had an unusually limited swing when I walked. Again, he said the symptom was common. No big deal.

In 2007, I told him I was having balance issues, and he referred me to a physical therapist. This PT was very good, and I met with him every week for nearly a year. He kept asking, "Have you told Dr. X about your right arm not swinging?"

In retrospect, I realize he had diagnosed my PD but didn't feel comfortable questioning my doctor.

My kids were becoming increasingly concerned and recommended I see a neurologist. 

The neurologist told me that no specific test exists to diagnose PD. But he did order some tests -- including blood tests -- to rule out other disorders that might be causing my symptoms. He also conducted a thorough neurological and physical examination.

Finally, he gave me a trial prescription for levodopa-carbidopa, the gold-standard medicine for PD. After a week or two on this med, I noticed that several symptoms had improved. Bingo! I had Parkinson's.

Last November, I reviewed a report that arranged PD symptoms into five stages, and I placed myself in stage three.

More recently, I found an article that uses a three-part analysis:
  1. Early stage symptoms
  2. Moderate stage symptoms, and
  3. Advanced stage symptoms
Again, I’d place myself in the middle (moderate) category of symptoms. But more and more, I can tell it’ll be a challenge to keep from slipping down into that third (advanced) stage.

Here’s the breakdown:

Early Stage Symptoms
  • Tremor on one side of the body when at rest
  • Arm swing on only one side of the body when walking
  • Muscle stiffness or aching
  • Slowness of movement
  • Small handwriting (microphagia)
  • Decreased facial expression
  • Depression (sadness or anxiousness)
  • Vivid dreams or restless sleep
  • Constipation
  • Feelings of fatigue

Moderate Stage Symptoms
  • Tremor on both sides of the body
  • Shuffling gait
  • Difficulty rising from a chair
  • Reduced speech volume (hypophonia)
  • Reduced speed and clarity of speech (hypokinetic dysarthria)

Advanced Stage Symptoms
  • Significant changes in, or freezing of, gait
  • Increased risk of serious injury from falling
  • Unpredictable response to medication
  • Assistance required for activities of daily living
  • Difficulty turning in bed
  • Slowness of thought (bradyphrenia)

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