WHAT I WHISPERED IN DEVIL’S EAR

My friend's highly inspirational words, “You have been an inspiration to me.  Despite your health problem, your spirit is high and so is your output!" influenced me beyond appreciation, beyond praise and beyond comparison, and forced a pen into my hands to pen down what I whispered back in devil's ear when the devil whispered "Storm is coming and you can’t withstand it."But I am a warrior, a soldier first, doctor, next.

The storm here is Parkinson disease, idiopathic or primary parkinsonism, hypokinetic rigid syndrome, paralysis-agitans , shaking palsy.

The eye of the storm is the substantia nigra as  described in Wikipedia  a basal ganglia structure located in the midbrain that plays an important role in movement control. Substantia nigra is Latin for "black substance", reflecting the fact that parts of the substantia nigra appear darker than neighboring areas due to high levels of neuromelanin in dopaminergic neurons.Parkinson's disease is characterized by the loss of dopaminergic neurons in the substantia nigra, that is why the diseased brain looks complete white.

The land fall of the storm also known  as typhoon, tarnado, cyclone and hurricane in different regions of the globe produces severe damages such as tremor, rigidity, bradykinesia(slow movement) and postural problems besides many other problems, you name it and the devil will raise it’s head :Tremor ,Muscular,Sleep,Cognitive,Speech,Mood,Nasal,Urinary and Facial disorders.

This storm is also not free from myths, and the people say if somebody kills cats he or she will get PD in later life .Quite funny ! !Another myth which needs evaluation is if one is having history of dog bite and anti -rabies vaccination he/ she may develop PD later. Co- incidentally , both are true in my case.!!

Until  2011 ,  the 6th decade of my life I was enjoying smooth sailing in the ocean of health  without having any clue of a storm building remotely .An absolute teetotaler but a strict non vegetarian with regular exercise cum yoga schedule developed occasional  twitching of muscles of right hand which were really tickling .When it became frequent I consulted a neurologist who ordered MRI scan of the brain along with other routine investigations .All the investigations were within normal limits.

While observing my walking he told me the likely cause of my twitching which concurred with my suspicion .Without wasting anytime started tablet Rasalect in minimal doses which miraculously lessened the twitching and improved the deficit in gait which was his first observation. And the horizon of health became little clearer with false hope of the storm being settled.

But it was otherwise .Then appeared tremor in the scene, and to fight that relevant weapon was engaged. Initial response was good as if half the battle was won .But PD is shrouded with mystery and like mythological warriors picked up missiles from nowhere and hurls at the victim. Same happened with me and gradually powerful anti-missiles one after the other fired with initial good response to just manageable effect.

At present, with all -out war against this devastating storm I am equipped with sophisticated weapons like Rasalect, Syndopa and Pacitane etc.Surgical strikes against emergency situations like high and low blood pressure, severe giddiness, severe imbalance and any respiratory problems are kept in reserve so also routine surgical interventions.

The famous people who have /had faced the fury of the storm

I have a form of Parkinson's disease, which I don't like. My legs don't move when my brain tells them to. It's very frustrating.

George H. W. Bush

Michael R Clifford, astronaut

The former United States Army officer and NASA astronaut, Michael R Clifford, spent over 665 hours orbiting the globe during his three space flights – one of them whilst dealing with Parkinson’s. The American astronaut hid his sickness for years, but eventually decided to share his story after realising that Parkinson’s had never stopped him from reaching his goals. In 2014, he collaborated on The Astronaut’s Secret, a documentary film about his career.

Michel J.Fox

God gave me Parkinson's syndrome to show me I'm not 'The Greatest' - he is.

Alan Alda, the award-winning actor, best known for his role in the long-running TV series M*A*S*H decided to let people know that has Parkinson’s to encourage others to take action, Alda posted on Twitter. “If you get a diagnosis, keep moving!”

Linda Ronstadt: Parkinson's Takes Her Voice, But Not Her Spirit.

When you know that the storm is imminent be calm and face it as :

And every now and then the devil will whisper in your ears:

Tremor

can occur at rest,

 in the hands, limbs,

 or can be postural .

small handwriting,

unintentional writhing,

Blank stare

Rigidity

stiff muscles,

 difficulty standing, difficulty walking,

difficulty with bodily movements,

 involuntary movements,

 problems with coordination,

 slow bodily movement,

 or slow shuffling gait

Sleep

Excessive,

daytime.

Nightmares

Hallucinations,

Sky with stars,

Fatigue

Dizziness

Restlessness

As if whole body

Burning with mild fire.

Amnesia, confusion,

 dementia, or difficulty thinking and understanding

difficulty speaking,

soft speech, or voice box spasms

anxiety or apathy

distorted sense of smell

 loss of smell

jaw stiffness

 reduced facial expression;

dribbling of urine or

 leaking of urine

constipation

Difficulty swallowing

Drooling.

Fear of falling.

Blank stare

Shaking , Shaking

And Pill rolling

All signs of

PD is coming.

Lead pipe rigidity,

Cog wheel rigidity

Gait …?

Slow and shuffling

And the storm is

Whispering  ?

Can you now withstand the storm  ???

And simple whisper back, “I AM THE STORM”.

World Parkinson's Day (on the birthday of James Parkinson, 11 April) and the use of a red tulip as the symbol of the disease.

[Dr. (Major) B. C. Nayak is an Anaesthetist who did his MBBS from MKCG Medical College, Berhampur, Odisha. He is an MD from the Armed Forces Medical College, Pune and an FCCP from the College of Chest Physicians New Delhi. He served in Indian Army for ten years (1975-1985) and had a stint of five years in the Royal Army of Muscat. Since 1993 he is working as the Chief Consultant Anaesthetist, Emergency and Critical Care Medicine at the Indira Gandhi Cooperative Hospital, Cochin]