So, now you know all about the Primary Motor Symptoms of Parkinson's disease. But, oh my goodness... there's so much more to talk about!A. MicrographiaThat there is a $20 Latin word for small writing. When I look back at all the crap I learned in High School, the one thing I am most grateful for is typing class. For a person with Parkinson's, writing by hand is a chore. I have always suffered from crappy handwriting. Now it is crappy - er.And it's more than just small writing for me. It's leaving letters out of words, it's wandering down the paper in a slant. My signature is practically illegible. But I kin type REEEEAL good, if you don't mind having to wait for me to make corrections.B. FatigueWhen I was going to and from my workplace in Bethesda, by the time I got to work in the morning I was already exhausted. So imagine how I felt when I finally got home at night. Fatigue is part and parcel, one of the rich colors in the tapestry we call Parkinson's disease.And I'm talking about a BONE weariness. If the problem is the medications not working, not only are you carrying your own weight around with each step you take, but you are moving with muscles that don't WANT to move. Muscles that RESIST moving. Muscles that would just as soon throw you in front of a moving subway train than take the staircase if the escalator isn't working.Now that I've retired at the ripe old age of 56, I don't suffer quite as much from the fatigue. But it turns out the fatigue has little to do, if anything, with the amount of physical effort I put forward in a day. Sometimes I can spend the morning watching TV and be in desperate need of a nap by 1 p.m.So if a Parky tells you he's sick and tired, he means it.C. DystoniaI used to get this a lot more before the DBS operation than I do now. But let's discuss.You're sitting there watching the same Law and Order episode on TNT that you saw three days ago when all of a sudden your foot wants to pretend it's a parrot's claw. It wants to curl up in a way that a foot was never meant to curl, so you can perch on a branch and eat cuttlebone. And it hurts like Satan's Eternal Torment.That's what they call "mild dystonia."Heavy duty dystonia, which I've never had, involves your body trying to turn itself into a pretzel. Here's a picture of a young guy with drug induced dystonia. Looks like fun, yes?A lot of the things I think of as "cramps" are probably, in fact, dystonias. The muscles in my neck, for instance, that cramp when I lie down. When I had a CT scan done not long ago and had to lay down on the hard exam table, my whole upper back tried to twist itself out of shape. I didn't care for it. Not at all.But thankfully, they don't happen often. And I think taking a nighttime Sinemet helps.D. Stooped PostureRemember Pope John Paul II in his final years?Yeah. That's the guy.That gentle slope in his back in this photo taken in 1997 is a direct result of his long battle with Parkinson's disease.I, likewise, have a similar slope.In fact, as I wrote earlier, I'm generally in a permanent state of stoopidery... unless I'm using my walker and make the conscious effort to stand up straight.Back in 2007, when I started taking my Parkinson's seriously again and my neurologist put me back on anti-Parkinson's meds, a friend of mine saw me in the hallway where I worked at the National Institutes of Health. She was staring at me."Have you gotten taller," she asked."No, why?""You look taller," she said. This friend knew I had PD, and I told her I had restarted the meds and maybe that was why I looked talker... I was standing up straight."You always had this 'walking into the wind' look about you," she said.Now, this far along in the progression, it's the least of my problems although I do feel the stress in the upper back muscles from time to time.E. Impaired Fine Motor Control and DexterityI have never been a poster child for the "Non-Stumblebum Society of America." But I've certainly noticed a drop in my ability to do fine work with my fingers. I used to be able to type without as many mistakes as I make now. And I think the micrographia we discussed earlier is part of this as well.Just don't ask me to do any surgery on you, and we'll all be fine.F. Impaired Gross Motor CoordinationPardon me while I look up just what they mean by that phrase.Ah! The reason I quit driving in May 2009. The reason I carried an "I have Parkinson's Disease" card in my wallet in case a cop ever pulled me over and wanted to give me a sobriety check.I cannot walk in a straight line.I cannot walk heel, toe, heel, toe.I cannot hold my arms out to my side, tip my head backwards, shut my eyes and touch my nose.The actual reason I stopped driving, however, had nothing to do with worrying about getting pulled over. It was because I was worried about being killed or killing someone else.In May 2009, Gail and I were on the way to the mall. I drove up the exit ramp and got close to the stop sign. There was a car in front of us. I put my foot on the brake. I also put it on the gas. The car lurched forward. Luckily I was able to stop us in time.This had been happening a lot lately, I told Gail, and enough was enough. May 20, 2009, I hung up the car keys.OK, what's next...G. Loss of Facial Expression or "Masking"I refer you again to some famous folks with Parkinson's. Muhammad Ali. The late Pope. That blank look on the face doesn't mean there's nobody home in there. In fact, although the lights may be out... everybody's home!Gail's used to it now. She has long since asking me what's wrong. I'm still capable of feigning expressions... but my neutral expression, my "Parky Face" if you will, is what you see here. Still cute as the dickens, mind you... but if you didn't know me you would think that I might be upset about something.Like I said... just another pastel in the rich, colorful tapestry that is our friend Parkinson's disease.H. Poverty of MovementThis was the thing that first got me noticed as a potential Parky. When the neurologist who examined me in November 1999 the morning after I was admitted with what they thought might be a stroke, he noticed I wasn't moving my right arm when I walk. Now, I don't move either arm when I walk. Now, if left alone, I am perfectly content to remain seated, perfectly still. My eyes get dry because I don't blink enough. Saliva gathers in the back of my throat because I don't swallow enough. This results in a nightly episode of throat clearing that makes my wife want to murder me.(There are many things that make my wife want to murder me, and I will do my level best to touch on all of them before we're done.)I. Problems Swallowing.The doctors call this "dysphagia." They charge you extra for that. It's a lack of coordination between your epiglottis - that little trap door that flaps down to cover your windpipe when you swallow - and the rest of your mouth.Want to know what that's like? Here's yet another practical demonstration you can try at home. (Have someone standing buy to call 9-1-1 in case things go south on you.)Grab a nice, cool glass of water. Take a nice sip. Now, try to force yourself to let just a few drops of that water trickle down your windpipe. Then, spend the rest of the evening coughing, trying to clear your throat.And it's not just liquid. I recall going to an Italian restaurant with Gail last year. I had a personal pizza, and a big string of mozzarella snuck past the epiglottis and went RIGHT DOWN MY WINDPIPE!I was able to hack it back up. But I was far from the most popular person in the restaurant.Once, back when I still drank (gave it up in July 2010), an entire mouthful of Port Wine went into my left lung. Shall we discuss how tender lung tissue reacts to alcohol? It's not pleasant. Not at all.It's an issue of coordination, I believe.This is connected, I believe, with our next contestant...J. Drooling.The way my neurologist put it, it's not that I'm making too much saliva. It's just that I'm not swallowing as much as I should be. The saliva gathers and pools and goes where gravity takes it. If I bend over, it will come out my nose. If I sit or walk with my mouth open, I will drool on my shirt.During one hacking spasm at the mall (not the same day as the near mozzarella mortality I mentioned earlier), I found myself standing in the middle of the passage way, coughing, wheezing, watching in horror as a long string of drool made its way, in taunting slow motion, from my mouth to the floor. It made a "splatting" sound that I'm sure they could hear at the opposite end of the mall.People were looking at me. With their EYES! The expression said, "Come, Matilda. Let us be off before that doddering old fool collapses and I have to perform CPR on him."Now, in the evening when I go into my usual mode of throat clearing, I've found a way to use drooling to my advantage. My neurologist gave me an atropine eyedrop solution to use for this. A couple drops under the tongue, and eventually the mouth dries up. But in the mean time, I breathe through my mouth and intentionally drool into a cup. When the passage of air causes my throat to dry out, then we're all better and Gail no longer lusts for my blood.K. Sexual Dysfunction.I may touch on this further when I discuss dyskinesia. But let me go on record as saying dyskinesia sex... it's not good.The meds, the disease, the combination thereof have robbed me of my libido which is fine with Gail who has been waiting for this since the day after our honeymoon. She loves me with all her heart. She just doesn't like... you know... touching me or anything.I exaggerate, of course. But loss of libido really isn't a problem when you're really, truly in love with someone. I love Gail as much - if not more - than when we were doing it on a nightly basis. Now we don't have to worry about finding the time or being in the mood or anything like that. It's behind us.And that's all you need to know about that.L. AkathisiaYour doctor will charge you an extra $30 for using that word. It means "restless leg syndrome" which I do not have. USED to have it before PD. Don't any more.But if you've ever had RLS, keep the feeling in mind. We'll get back to it when we discuss "dyskinesia."But for now, we continue with...M. SPEECH PROBLEMSNow, for most Parkies, this means their voice gets whispery, reedy, they have trouble projecting and being heard. I do not have that problem. I'm every bit as loud as I ever was. I think a lot of that comes from my training as a broadcaster. Most people speak from the throat. Ask anyone who has ever done any acting or broadcasting (I've done both). You have to speak from the diaphragm. I still do that. I've noticed that when I'm reading aloud, the muscles in my throat and my jaw and my tongue tire out quickly and I can't go on and on like I used to be able to. But loudness ain't the problem here.For me, it's this damn stuttering. No way would I be able to do a live radio show now. Even edited, there are times I sound like I'm slurring and talking slowly. And I guess I am.There are different categories for this, as far as I am concerned.There are times when I can't think of the word I want to say. Like last week when Gail asked if I wanted to go to Target with her and I said, "Yeah, cuz I need to get some new... um... things... for my... um..." and then I imitated the sound of an electric razor and the motions of shaving. Gail would be a great charades partner.Then there are times when I can think of the word, but I just can't make myself say it. This happens either when I'm under stress or for no reason at all, by itself or on combination with other symptoms.Last night, I was moving from the kitchen to the living room. I was carrying a bottle of club soda and a glass of ice in one hand, my nitey-nite pills in the other. As I got to the area where the linoleum turns into rug, Raven suddenly moved. She was getting out of my way. She's a good dog.My brain shrieked... "STOP!!!" I froze. Tight. Gail jumped off the couch and tried to steady me. I didn't need steadying. I needed her to take the glass and bottle. For some reason, I was feeling off balance and my dumbass brain was blaming it on the glass and bottle in my left hand."Take the... take the... take the... take the..."But then, the touch of her hand on my arm unfroze me. I was good as new, or at least as good as I get. I gave her a hug and a kiss and made my way to the recliner.But, as I said, this happens even when I'm perfectly relaxed. There are some scholars who think this and the phenomena of "freezing of gait" are related.Wouldn't surprise me a bit.