Another episode of Living with Parkinson’s: In which I regain my voice for a night

My nephew married a delightful young woman in Montana this past summer. The ceremony was very much a Montana affair: the bride rode down the aisle on horseback (it’s okay — it was outdoors), the flower girls wore matching white cowboy boots, and the officiant did the marrying from beneath the brim of a black Stetson hat.

At the rehearsal dinner the night before the wedding, the bride’s and groom’s friends and family members told stories about the couple. These were the kinds of stories you tend to hear at weddings, from early childhood memories to recent adventures — the kind that tend to grow longer and more convoluted in direct proportion to the number of drinks the speaker has downed prior to grabbing the mic. But, no problem: the stories were sweet and funny and spoke well of the betrothed couple.

I had no intention of telling any stories that evening. There was a time I enjoyed public speaking, a time that followed a decades-long period of hating public speaking. I was a shy kid from a family of shy-ish Irish-American folk not prone to spinning extravagant wedding tales.* My elementary school approach to being forced to speak in public consisted of turning red, staring a hole in the floor, and spluttering my message as quickly and quietly as I could.

Things improved somewhat through high school and college, mainly due to forced repetition, but I can’t say that I actually enjoyed talking to crowds until my book, Birth Day, came out in 2009, and I embarked on a brief publicity tour. My appearances at first were mostly in small, independent bookstores. (Once, in Utah, I spoke to an attentive audience of one.) But then, as interest in Birth Day grew, I was invited to speak to larger groups at meetings and conferences around the U.S. and Canada. As I grew more comfortable with speaking to large groups of strangers, I discovered that I actually enjoyed interacting with an audience. I was a man transformed: my inner “ham” emerged.

I discovered that the key to winning over audiences — and boosting my confidence in the bargain — was to hit them early in the presentation with humor. My go-to Powerpoint icebreaker was a “speaker disclosure” slide that was simply a picture of Dr. Mark “McSteamy” Sloan, the hunky plastic surgeon on the TV show Grey’s Anatomy, with my “disclosure” (“I’m not him…”) typed next to McSteamy’s left bicep.

I’d stand there, deadpan, and wait for the slide to sink in. The crowd would inevitably erupt — this being McSteamy’s early 2010s heyday — and then, when the initial hubbub died down, I’d offer to refund the registration fees of any disappointed Mc Steamy fans, which led to even more hubbing and bubbing. By the time things settled down I had both the audience’s attention and the confidence I needed to talk for an hour about the wonders and oddities of human birth.

My public speaking career hit its peak in 2013, when I was invited to deliver the keynote speech at the Western Australia Rural Health Association conference, the annual gathering of half the continent’s far-flung family doctors, in Perth. Peeking through the curtains offstage, waiting to be introduced, my heart sank. The audience looked pretty tough. Picture a few hundred sunburnt Crocodile Dundees packed into a steeply banked auditorium, backslapping and shouting greetings to colleagues they hadn’t seen in a year or more. It had all the earmarks of an “old home week” reunion, writ large. I suddenly regretted not ditching my McSteamy slide — had they even seen Grey’s Anatomy in the vast isolation of the rural Western outback? Would they stare uncomprehendingly at my strange American pop-cultural reference, hoot me off the stage, and then leave, en masse, in search of cold beer?

But it was way too late to make changes to my slide deck. So, I marched to the podium, shook the hand of the woman who introduced me, and launched into my talk. Up went McSteamy, and just as I’d feared, my wildly popular American slide was met with a wall of what seemed like puzzled Ozzie silence. A few awkward moments passed as I searched for a way to gracefully move ahead. Then, from a seat high up in the back, came a deep, booming voice: “We loove McSteamy!” The place went nuts and I knew I was good to go. Nobody asked for a refund.

I did a few more large-crowd speaking dates after Australia. Things naturally tailed off as readers moved on to other books, other authors. My speaking gigs became centered more on local community events, and teaching pediatrics and writing skills to family medicine residents. Then, a few years later, I began having problems with my voice — hoarseness and coughing, difficulty with enunciation and projection — early symptoms of what would turn out to be Parkinson’s. Speech therapy helped me fight back, but in the end, Parkinson’s robbed me of my public-speaking confidence. My large-crowd grand finale was at my daughter Claire’s wedding a few years ago, at which, in my father-of-the-bride role, I got to roast Claire and her new husband in front of 150 guests. I kept McSteamy out of things; the audience loved it anyway.

So, I had no intention of getting up and speaking at the rehearsal dinner — until I got up and spoke, that is. A few of the stories from friends and family had centered on the intense adolescent rivalry between the groom and his older brother, a rivalry that sometimes spilled over into actual fights. I suddenly recalled a vivid example of one of those near fights, but one that ended with a bit of a twist. Maybe it was a desire to soften the warring-sibs tales a bit, or maybe I just wanted to speak to an audience again, but suddenly — bing, bam, boom — there I was, up front, talking.

Long story short, my tale involved the groom in middle school, his budding high-school football star older brother, and my startled introduction to the “swirly,” defined by the Oxford English Dictionary as “a prank in which a person’s head is immersed in a toilet bowl while it is simultaneously flushed.” (The immersed head in this case being the future groom’s, inserted into the toilet by his brother.) Immediately post-swirly, the swirl-ee broke free of his tormentor, and amidst much bellowing and posturing it seemed that sibling blood might soon be let.

Just as straightforward as it looks…

My brother charged into the ensuing melee — this was obviously not his first offspring police action — and quickly separated his sons. In a scene that looked like something out of Animal House, he sat on the edge of the bathtub between his boys, one smirking to his right and the other, red faced and drippy headed, on his left. They sat in weary silence for a time. Finally, my brother tossed his younger son a towel and sighed. “You may not believe this,” he said, “but someday you two are actually going to love each other.” Twenty-five years later, I said in closing, that day had arrived.

I don’t know how my voice sounded — whether I was loud enough, or spoke too fast, or mushed my words into a congealed lump — and I really didn’t want to know. Some people laughed, some clapped, there were even a few “awww”s. On a warm, breezy Montana evening, eleven years removed from Perth and exactly four years since my diagnosis, I’d been heard, and that was enough.

Footnotes:

* My father was a big fan of wedding-speech concision. He often spoke admiringly of a distant relative, who, in his role as best man at his friend’s wedding, rose to cheer the newlyweds, raised his glass, and — perhaps in a nod to his blood alcohol level — completely forgot his speech. He stood blearily silent for a moment, then slurred/shouted “Ah, what the hell. Happiness forever!” and passed out on the floor. (“Now that,” Dad said, “was a toast.”)

You know you’re getting old when…

…your iPhone can’t recognize your face until you’ve had your morning coffee.*

* Couple of clarifiers:

1. Yes, this happened to me — this morning as a matter of fact. Rolled out of bed, tried to use Face ID to open my iPhone, failed twice. Then I made my coffee, and just as the caffeine made my eyes go ping!, I tried to open my mail again, and this time my (new? improved?) face did the trick. That is not a coincidence.

2. No, that’s not me in the picture — it’s my AI-guided image of a cranky old man with bed-head, holding a coffee cup and an iPhone, done up in the style of Van Gogh. (So, maybe it’s me after all…).

Things I can still do: Walking (and people-watching) in Golden Gate Park

If I were a musician (I’m not), the year was 1971 (it isn’t) and I was about to release a new album (again: no), this would undoubtedly be my album cover photo. It’s got all the requisite ’70s stuff: trippy perspective, weird tree-like structures and, there in the middle, a mysterious-looking guy in shades, doing… what, exactly? Just switch out the iPhone for a set of Panpipes and there I am: a be-hatted hippie in Golden Gate Park, tootling a Jethro Tull cover…

It’s a feature of aging: grieving the loss of youthful physical abilities. We watch in sadness as all that leaping and cavorting we took for granted back in the day slowly fades away. For those of us with progressive neurological diseases, the grieving can be that much sharper, as the losses come earlier and faster than we had expected.

Fortunately, the things I’ve lost so far haven’t been all that dear to me. Take swimming: I never enjoyed it much as a youngster, mainly because I was a chubby kid, not fond of the ridicule that came with peeling off my shirt to cannonball into a pool or lake on a stifling southern Indiana afternoon. I recently discovered, while stepping off a paddleboard in Hawaii and sinking like a rock, that – thanks to PD – I’ve lost even my chubby-kid swimming skills. (Fortunately, this happened in relatively shallow water. I mean, who falls off a paddleboard and drowns in the hotel lagoon?) So, swimming is out, but I figure, hey – if something’s gotta go, it might as well be something I wasn’t too crazy about in the first place.

But enough about losses! Today’s theme is the celebration of things I can still do well, and in that spirit I will point out that I’m still a pretty good walker. Once I’m up and moving – after I’ve slo-mo enticed my feet into shoes, extricated myself from the couch, and wobbled to my feet – I can go for miles, especially if there’s something interesting to walk to.

And for me the most interesting destination of all is San Francisco’s Golden Gate Park on a sunny day, now that the stretch of John F. Kennedy Drive that runs through the heart of the Park is vehicle-free. Out went the cars and trucks, in came the cyclists (bi-, tri-, uni-), baby strollers, rollerbladers, jugglers, dancers, toddlers on leashes, and exuberant exhibitionists. Golden Gate Park is a free-range Promised Land for people-watchers.

I spend at least three hours a week wandering the Park while Elisabeth takes an art class at the DeYoung Museum. Sometimes I cruise by the Conservatory of Flowers, sometimes I try to visit all ten of the Park’s lakes. And if I’m feeling particularly frisky, I hike on down to the Bison Paddock. (Yes, it’s really a thing.) But it’s the journey, not the destination, that makes for the best random sampling of Park people in their natural habitat. Here then, is a compilation of favorite observed/overheard moments from 2024 (s0 far):

  • A 30-something dad, feeding his infant twins on park bench, one baby on each thigh, a bottle in each of his hands. I say, “Looks like you’ve really got your work cut out for you.” He tilts his head back, nods to me with his chin, says, “Mmph.” Looks like he’d like to say more, but he’s got a pacifier stuck in his mouth. I nod, wish him luck, and move on.
  • I spot a woman holding her toddler horizontally in her arms. He’s face down, training pants at his ankles, peeing in the bushes by the side of the trail. Mom looks like she’s watering the greenery with him. When he’s done she shakes him a bit, making sure to get the last of the pee-drops onto the foliage, and says “You did it!” Kid says, “I do it!” about twenty times. Very excited. Mom pulls up his pants and off they go, “I do it! I do it!” echoing down the path.
  • +/- 6-year-old boy, very angry in a pedal boat on Blue Heron Lake*, moving about 0.1 miles per hour. “Daaad!!” he yells, arms tightly crossed. “You said these boats would be faaast!” Dad, a tad flustered: “You want it to go faster, just pedal harder!” Kid: “That doesn’t work! We’re still too slow!!” Dad: “Hey, if the boat’s too slow for you, get out and walk!” Kid looks down, speaks up: “Daaad! That won’t work either! It’s just water!
  • I’m walking back to 14th Avenue to move our car so we don’t get a ticket. I pass a very sad looking young woman slumped on a park bench next to an expressionless elderly woman who may be her grandmother. “So, I said to him,” she says to the older woman, “‘Look, you’ve got to tell me what your intentions are here.’” She breaks down sobbing; the old woman, who appears to be alive, doesn’t so much as blink. I come back ten minutes later, and they’re still there: girl still crying, unblinking grandma not registering much of anything. “I mean, he’s just…no,” the young woman says, sniffling. “He’s just so…no.”
  • I spy two mothers with toddlers off in a meadow. They’re not there together – they’re 50 feet or so apart – but their toddlers apparently have decided to throw simultaneous tantrums. They’re both screaming and choking and baby-swearing, faces down in the grass, pounding the ground. Mid-performance, one of the toddlers finally notices the other one, stops, sits up and watches, fascinated, maybe taking notes. His mother leans down, says something to him, and—Shazaam!— he realizes he isn’t quite done. Wailing again, he picks up where he left off. The mothers stare off in opposite directions, ignoring their little maniacs, waiting, waiting for the storm to pass. (There’s an old pediatric proverb about tantrums: “If you want the play to close down, stop buying tickets. This is clearly not the first tantrum rodeo for either of them.)
  • Two tech-bros jogging by. Blonde-bro: “Didn’t there used to be a statue around here?” Redhead-bro: “Dude, this whole place is nothing but statues.”
  • What’s the female equivalent of a tech-bro? “Tech-sis” doesn’t sound quite right, but at any rate, a woman on a bike, dressed to the nines in neon Italian bicycle ads, bears down on me while berating someone on her phone. I can hear her coming fifty yards away: “Vivisection!” she shouts. “No, vivisection!”she repeats even louder, staccato-spelling the word for the hapless assistant on the other end of the call. “It’s when you cut up something that’s alive, Jeff,” she snarls, whizzing by. (Advice to Jeff: Lock your front door tonight…)
  • Over by the entrance to the Rose Garden, I come across a small boy playing a big saxophone. By my pediatrician’s estimate, he’s somewhere between an average-developing 10 year-old and a late-blooming “tween.” An older man – His father? A teacher? – sits in a camp chair some distance away, sipping from a thermos, calling out encouragement and suggestions. They have an easy working style – the boy finishes a chorus of “Strangers in the Night” (seriously) and looks to the man, who sends the boy a thumbs-up in return. “Nice one, buddy,” he calls, and they both smile. 
  • One last JFK Drive sighting: All alone in the middle of the roadway, a young-ish man in a tight-fitting black body suit twirls and tosses a baton high overhead, the setting sun glinting strobe-like off the spinning shaft. His repertoire is quick and impressive: everything from horizontals and Figure 8s to cutbacks and flat flips and “three spins” with behind-the-back catches. Performing for everyone and for no one in particular, he neatly sums up the Day-in-the-Park vibe. (Full disclosure: I have no baton expertise. I just looked up “twirling tricks” on YouTube.)

That’s it for the Q1 2024 edition of “Mark Spies on People in the Park.” There are many parts of the Park I’ve yet to mine for people-watching purposes: the Tulip Gardens, the Windmills, the Japanese Tea Garden, the Beach Chalet, the Music Concourse with its 100+ year-old bandshell, the meadows, playgrounds, ballfields, etc., etc., ad infinitum. So, more to come, no doubt!

_ _ _

*Some readers may be a bit puzzled: Where is Blue Heron Lake?? You won’t find it on any maps of the Park (yet). That’s because, from the 1890s until January, 2024, Blue Heron Lake was known as Stow Lake, named for William W. Stow, a former speaker of the State Assembly and member of the Golden Gate Park board at the time of his sudden death in 1895. He was also one of California’s most rabidly antisemitic politicians, openly advocating for the forced removal of the state’s Jews and, failing that, imposing a tax on Jews “so high that [they] would not be able to operate any more shops.” A community effort in the 2020s succeeded in ousting Stow from his eponymous lake; the name “Blue Heron Lake” was chosen for the Blue Herons that nest on the island in the middle of the lake every spring.

Which exercise is best for PD? (Or: Do I really have to spend the rest of my life in spin class??)

It sounds a bit trite, but it’s true nonetheless: the best type of exercise when you’ve got PD is any kind of exercise you’ll actually do. Fortunately, just as Parkinson’s disease presents in a wide variety of ways, there is a wide, wide range of exercise types that can help you manage your Parkinson’s symptoms. Surely you can find something you like?

A great place to start is with Make Your Move, a reader-friendly, thoroughly researched publication of the Michael J. Fox Foundation. (See ‘Selected Resources’ list at bottom for additional links.) With clear text and inspiring first-person stories, Make Your Move can get you started on a personalized exercise path to taking control of your symptoms.

+++++

A picture is worth 1,000 words (even if the somewhat wordy graphic from the American College of Sports Medicine below already looks to have 999 or so…):

My motivation to exercise is pretty straightforward: On days that I exercise I feel more alert and engaged with the world. Sometimes I even feel like my old self (well, almost). And I sleep better, too, which gives me a big boost the following day.

Here’s my own (idealized) exercise regimen, adhered to as strictly as time, energy, and willingness on a given day allow:

Aerobic activity: Lots of walking and run-walking, aiming for 10,000 steps (+/- 4 miles) a few times a week. When weather and/or failing old-guy joints intervene, I supplement with an exercise bike.

Strength training: I usually lift weights twice a week at a health club. (I’m still fairly strong for an old coot, but that “fairly” is a pretty big qualifier…). I rotate upper and lower body exercises, and move quickly enough through my reps that my heart rate sometimes gets up into the high-intensity range. I keep lobbying my neurologist to let me count this as an aerobic activity, too, but she’s not budging. (“I know you love your weightlifting, Mark, but…no.“)

Balance, Agility & Multitasking: I cannot praise boxing, specifically the Rock Steady Boxing program, enough. It combines agility and balance with the joy of shouting at, and whupping the tar out of, a boxing bag. (Bonus feature: you don’t actually have to get hit.) Seriously, if you have PD and can find a Rock Steady program near you, sign up! I have similar praise for dance, specifically ballet, which I do once a week, and of which I have waxed poetic in past posts.

Stretching: Lordy, I’d love to stretch less often! I have problems with restless leg syndrome, which on bad nights can wake me up a half dozen times; stretching helps temporarily alleviate the weird, heebie-jeebie sensations that come with RLS. So, yes…I stretch.

Okay, up and at ’em! Hopefully this information will help get you started on a sustainable exercise program. And if (more like when) you fall off the exercise wagon, climb back on as soon as you’re able. Your Parkinson’s isn’t going anywhere!

+++++

Selected Resources:

Michael J. Fox Foundation, Make Your Move: Exercise for brain health and life with Parkinson’s (It’s free, after you register on the first page.)

Parkinson’s Foundation: Exercise

American College of Sports Medicine (with the Parkinson’s Foundation): Exercise Guidelines for Parkinson’s (A more in-depth look at the benefits of exercise.)

Rock Steady Boxing (Search for a gym near you!)

SF Ballet’s Dance Class for People with Parkinson’s (Completely free! If you don’t live near San Francisco, fear not – there’s a Zoom class every Tuesday that you can take from anywhere.)

Exercise and Parkinson’s: Beefing Up Your Brain

There’s a young man who’s been working out at my health club for a few months now. When I first saw him he was sapling-skinny, with scarecrow hair, owlish eyes, and black, square-ish, never-in-style eyeglass frames. I had sympathy for him—I took care of a lot of teen boys wrestling with body image issues in my pediatric career. Dressed in baggy sweats, he could have been the inspiration for one of those 1950s Charles Atlas bodybuilding ads—the 97-pound weakling who gets sand kicked in his face by the muscle-bound beach bully (1):

And sure enough, just like Atlas’s scrawny “Mac”, the young man at the health club soon transformed his body. His determination was a thing to behold, as he followed an exhausting routine of curls, bench presses, squats, pull-downs, and more, adding a bit of weight to the bars each week. His broomstick arms sprouted biceps that steadily grew; pleased with his own progress, the young man took to striking furtive poses in the mirror that covers the back wall of the weight room.

He’s now well on his way to becoming a true Charles Atlas “new man.” Where he once crept into the weight room, he now strides in with confidence. His t-shirt has gotten tighter in the chest and biceps. He’s weed-whacked his hair into a fashionable ‘do’. He’s even got new, au courant glasses. Woe betide the bully who inspired this transformation—he’s in for a good girlfriend (or boyfriend)-witnessed chin-bopping sometime soon:

A righteous ‘bop’

I’ve had to fight the urge to share my Parkinsonian learning with the young man. I’d like to tell him that all that iron he’s been pumping has made his brain stronger, too. Why, he’s got a zillion new neural connections all over his noggin – in the basal ganglia, the zona pellucida, the locus ceruleus, you name it! But he’s a twenty-something guy; who cares how good your brain looks at that age? I figure he’d just take me for a crazy old man. Which, I am.

+++

Here’s an old adage that I just made up: What’s good for the body is good for the brain. It’s true, if maybe not too catchy. When it comes to Parkinson’s, vigorous exercise of any kind, whether running, swimming, brisk walking, cycling, boxing, dancing, strength training à la Charles Atlas—basically, any form of exercise that gets your heart pumping—actually stimulates the growth of new neurons (brain cells) and strengthens connections between neurons in many parts of the brain. This makes for speedier and more efficient communication between areas of the brain, something of great importance to those of us with Parkinson’s.

But, really, there’s no anti-Parkinson’s magic going on here. Moving your body is good for all brains, not just the PD kind. The mechanisms behind the benefit are the same for the afflicted and the un-afflicted alike. It’s just that those of us with PD are starting in a neurological hole—we’ve been losing dopamine-secreting neurons for years, maybe even decades, before we’re diagnosed. Exercise can help you dig your way out a bit, or at least slow down the rate of decline.

How does exercise work its magic on the brain?

I learned back in high school biology that the adult brain was more or less a done deal, a mysterious, gelatinous blob that bossed around the body via an old-school scheme of stimulus and response. You were born with a finite number of neurons in your brain; our teacher told us, and once they’re gone, poof, they’re gone for good. I remember even then thinking that didn’t seem quite right—if head injuries or strokes destroyed brain tissue for good, I wondered, how did some people learn to walk or talk again afterwards?

When I reached medical school, I learned that, rather than a rigid, finished product, the brain was in fact plastic. (No, not in the single-use-shopping-bag sense; neuroplasticity is defined as the ability of the nervous system to reorganize itself, to change its structure, functions, or connections after injury or in response to external stimuli.) The brain has a remarkable—but not unlimited—capacity to heal itself.

The principle of neuroplasticity is critical to brain health in the neurotypical (aka, “normal”) individual and even more so in people afflicted with Parkinson’s disease. There’s currently no cure for PD—no way to undo the damage that’s been done by whatever the heck is causing the disease—and available medications provide only symptomatic relief. Exercise, though, can actually slow PD’s inexorable march. That’s why every newly diagnosed PD patient hears a nearly constant mantra from neurologists, therapists, and everyone else in PD world: You gotta get moving, bud! Movement is medicine! 

And they mean “get moving” quite literally, because body movement sends a signal to both the neurotypical and PD-afflicted brain to crank out increased amounts of a molecule known as brain derived neurotrophic factor (BDNF). BDNF in turn stimulates the growth of neurons in areas of the brain that are active. It’s nature’s way of building up the neuronal pathways that a healthy body uses most, while not wasting energy on those that are neglected. 

Of particular importance for people with PD, movement-stimulated BDNF production promotes the growth of neurons that manufacture dopamine, the neurotransmitter that controls and fine-tunes muscle activity and coordination. (Low levels of dopamine are responsible for the tremors, slowness, and rigidity characteristic of PD.) A virtuous cycle is thus created: body movement increases BDNF and dopamine production—especially in areas of the brain that control movement and balance—which in turn make it easier for you to move, which then stimulates the brain to produce more BDNF and dopamine…and so on.  It’s a variation on the old saying, “use it or lose it”: Use it (move your body!) and grow it (dopamine production).

What type of movement or exercise is best?

Good question! But this post has gotten pretty long, so how about I answer that one in my next post?

Stay tuned!

—–

Footnote:

1) Charles Atlas (1892-1972) was born Angelo Siciliano in Calabria, Italy. He emigrated to New York, in 1904, where as a teenager he became fascinated with the bodybuilders and strongmen at a Coney Island circus.

Atlas (he legally changed his name in 1922 after being told he resembled the statue of Atlas atop a Manhattan hotel), a late bloomer, described himself as the original “97-pound weakling” who got himself doubly humiliated one day when a muscle-bound guy kicked sand in his face at the beach as his girlfriend looked on and ridiculed him. Vowing revenge, Atlas whipped himself into muscle-man shape, a transformation that earned him a) the aforementioned revenge, in the form of a beach-bully beat-down; b) a job as a bodybuilder on Coney Island, c) a string of titles, including “America’s Most Handsome Man” and “America’s Most Perfectly Formed Man” and d) a lucrative side gig as a sculpture model. (Among many other artistic commissions, he posed for the statue of Alexander Hamilton that still stands outside the U.S. Treasury building in Washington, D.C.)

Charles Atlas is probably best remembered today for the wildly popular, full-page comic book advertisements for his eponymous body-building course. The story line in the ads hardly changed over the decades: a scrawny, dweeby-looking young man (typically named “Mac,” “Joe”, or “Jack”), dressed in ill-fitting, high-waisted swim trunks, sits with his shapely girlfriend on a beach towel, when, seemingly out of nowhere, a macho bully insults him (“Hey skinny! Yer ribs are showing!”), slaps him, and then kicks sand in his face, while Joe’s girlfriend snickers and further deflates his ego (“Oh, don’t let it bother you, little boy!”). Joe stomps angrily home, kicks a chair, vows revenge, then sends in a coupon for a free Charles Atlas booklet, and –lo!–two panels later he’s back on the beach with muscles popping out all over the place, bopping the bully in the jaw to the lusty approval of his fickle girlfriend (“Oh, Joe!” she coos as the bully skulks away. “You are a real he-man after all!”)

But a moral conundrum is left hanging in the air: Did Charles Atlas really make Joe a better man, or did he just create a new bully?

Another episode of “Living with Parkinson’s”: In which I visit the neurologist

Every six months, come rain, shine, earthquake, or wildfire, I go to see Dr. S, my neurologist.(1) This is ostensibly a follow-up visit, or so the honey-voiced appointment clerk tells me, to check on my Parkinson’s “progress.” She says this like I’m recovering from a broken leg, a bad case of hives, or maybe pneumonia—a self-limited medical calamity that’s expected to resolve in time. But Parkinson’s isn’t like that. It’s going to get worse, the only question is how fast. So, twice a year I check in with Dr. S to see whether my Parkinson’s is sticking to the speed limit or engaging in a bit of reckless driving.

Dr. S’s office is a 30-mile freeway trip from our house – down in Marin County, that legendary land of hot tubs, up-upscale shopping malls, and over-the-top estates tucked back in the redwoods. We will see none of that on our visit today, though; Dr. S’s office is a literal stone’s throw from the freeway.

After a half-hour of medium-bad traffic, Elisabeth noses the Kia into the neurology parking lot. For some reason Dr. S’s office shares a building with the county coroner’s office, a rather unsettling relationship I haven’t yet had the courage to explore. We enter the non-coroner side of the building, take our seats in the waiting room, and wait to be called. My health plan offers online check-in these days; this is my first attempt to use the service. As I understand it, having checked in by phone yesterday, all I have to do is sit and wait until, magically, a staff member will appear to take me to my doctor.

The lady at the registration desk notices me, eyeing me a bit suspiciously at first as I skip the line and plop into a chair. Patients come, patients go, while Elisabeth and I catch up on old People magazines. During a registration lull she waves, catches my attention, motions me to her window. “Sir,” she says. “Can I help you?” In my Parkinsonian head the words of explanation are all there, sorting themselves for an orderly exit, but my mouth can’t quite usher them out. I wave my phone in the air and point. “Already done,” I rumble-mumble. “Online.” The lady seems like she’s seen this before. “Let’s make sure about that.” She takes my card, types in my number. “There,” she says with a smile, returning my card. “Now you’re checked in.” I thank her and return to my seat, where Elisabeth waits, eager to update me on Prince Harry’s new life in California.

The door to the patient care area whooshes open. A young medical assistant calls my name. We follow her down the hallway and through the usual rooming-in procedures: weight, blood pressure, an oxygen saturation reading from the little E.T. thingie she clips to my index finger. Then come the questions: Any new allergies? (No.) Do I smoke? (No, for the thousandth time.) How many hours do I exercise a week? (Oodles, I want to say, but instead I throw out an estimate that seems to satisfy her.) Do I feel safe at home? (I shoot Elisabeth a sidelong glance, think for a moment about passing the medical assistant a “Help me!!” note, then think twice and say, “Safe? Sure.”) Her work completed, the assistant smiles sweetly and tells us Dr. S will be right in. And, a few minutes later, there she is.

Dr. S knocks at the door and enters, her hands glistening with freshly applied sanitizer. She is a slender woman with dark, kind eyes, and a warm smile that I only see from time to time – it all depends on the clinic’s Covid masking requirements du jour. Her presence is reassuring; there’s a comforting routine to these appointments. 

We start with a bit of chit-chat, announcing the next-springtime arrival of our first grandchild. Dr. S seems genuinely happy for us. She asks about my recent ear surgery ( a minor, and unsuccessful, attempt to fix a eustachian tube problem). I tell her that the ear problem is making it difficult for me to carry on a simple conversation – my voice was soft to begin with, then made softer by Parkinson’s, and now, thanks to the loud vibration of my eardrum when I speak above a certain volume, it’s even worse. “Wow, that sounds like it’s really impacting you,” she says, and I nod. She makes a note to herself. “I’ll get in touch with your surgeon, so he knows how much this is bothering you.” And I know she will. Dr. S is one of the most empathic doctors I know.

She moves on to my Parkinson’s symptoms. Have I fallen since our last visit? Any new tremors? Am I depressed? Sleeping well? How about heartburn? Nausea? Constipation? She doesn’t ask me about seeing or hearing things that aren’t there this time – hallucinations are not uncommon as Parkinson’s advances. Either she assumes I’d tell her, or maybe (probably?) she got sick of my bantering: “But if I can see them, how would I know that they’re not real?” Such a funny guy.

Now comes the neurologic examination, a series of hoops and hurdles designed to see how well my sometimes meandering description of how I’m doing correlates with objective reality.

Dr. S starts with my hands. She tells me to make a modified “okay” sign: thumb and index finger making a flattened “o,” with the other three fingers extended above them. (If you have a flashlight and a wall handy, you’ll see that this makes a passable shadow-animal profile of Wile E. Coyote’s head.)

Sorta-kinda like this guy…

“Okay now, do this,” Dr. S says as she opens and closes her “o” (i.e., Wile E.’s mouth), rapidly tapping her index finger on her thumb. I do that; my Wile E. looks like he’s babbling now. I think I’m doing pretty well, speed-wise, until I look at Dr. S’s shadow animal – the graceful fox from the old Disney movie, The Fox and the Hound, I think – babbling about twice as fast as mine. (Bibibibi versus bah-bah-bah, if you’re taking notes.) She calls a halt to this cartoon standoff a few moments later.

Next, we move on to what I call the “dying-fish-flop” test. (I know it has another, more clinical sounding name, but hey, I’m retired: I’ve already forgotten more medicine than I ever knew.) Dr. S puts her hand on her thigh and flip-flops it back and forth, palm-up/palm-down, and invites me to follow suit. I do, and once again I’m struck by the difference in speed between us. Her fish looks like it has a decent chance of flopping off her lap, out the door, across the hall and back into the river from whence it came. Mine gives a resigned gasp, gazes heavenward, and prepares itself for the grill.

Dr. S runs me through a number of other tests. I touch the tip of her index finger, then my own chest, then back and forth like this until she’s satisfied that my finger won’t wander off willy-nilly and poke me in the eye; I tap my toes on the floor; I cross my arms, Aladdin-like, and stand up from my chair as quickly as possible. There are other parts to the exam – she smacks me a lot with a rubber-tipped hammer, for one thing – but I get exhausted just trying to describe them. Through it all – the Wile E. Coyote, the dying fish, the genie-levitating thing, the hammering and the rest, Dr. S concentrates, her face – or at least her eyes, since she’s still wearing a mask – inscrutable.

“Okay,” she says, when she finally runs out of hoops for my hands and feet to jump through. “Let’s go out in the hallway.” Ha! I know what comes next. She may not seem like the violent type, but I don’t let that placid exterior fool me. As soon as we get out of the exam room, Dr. S is going to try like heck to knock me over. I pull on my shoes (a glacially slow process these days) and follow Dr. S into the hallway. Elisabeth smiles and flashes me a quiet thumbs up.

“Turn and face the wall,” Dr. S says, like a kindly-voiced cop about to cuff a robbery suspect. “I’m going to pull you backwards, hard.” She shows me her outstretched left arm, the one that, she assures me, will catch me if I fall. (A bit of perspective here: I’m tall, with a fair amount of leftover muscle from my athletic youth. Dr. S is eight or ten inches shorter than me and slightly built; I doubt she played football. I’ll know I’m in trouble the day she manages to floor me.) She tugs on my shoulder a few times, but comes up short in our quasi-sumo match. I’m still standing.

We re-enter the exam room; Dr. S returns to her stool while I settle into my chair. She smiles and tells me she’s pleased – I’ve had little disease progression since our last visit. We do a quick review of my plan, make a couple of minor adjustments, and then we say our goodbyes. “See you in six months,” Dr S says. “Bring pictures of that grandbaby!” “Thanks,” I reply with a smile. “I’ll definitely do that.” Someday Dr. S will have to give me bad news; for now, though, I’ll take her “(almost) no news is (pretty much) good news” summary to heart.

Neurology is a much more physical specialty than I realized, what with all the pushing, pulling, and hammer swinging. If, God forbid, Dr. S ever keels over from exertion in the middle of examining me and passes on to that big neurology waiting room in the sky – the one where online check-in actually works – I’ll know just what to tell the inquiring TV reporters as they gather around me for comment.

“At least she was doing what she loved,” I’ll say. (“Which was trying her best to knock me over,” I’ll keep to myself.)


  1. “Dr S” isn’t my neurologist’s real name. Heck, it’s not even her real initial…