But there was another, equally important, reason for beginning a physical exam with the hands: taking the patient's hands in your own invites intimacy and trust, a nonthreatening beginning to an exam that will involve physical contact between physician and patient. An examination of the hands can also yield clues to a patient's state of mind or tell you something about their life that can provide an easy entrée to conversation. Are the patient's hands moist with sweat? If so, the patient may be anxious. Do they tremble? If so, Parkinson's may be suspected. Are they yellow with nicotine? Then the patient smokes. Do they reflect hours spent in the garden? If so, the patient may be put at ease with a question about his or her garden. My hands, too, reveal much. They are often red, often cold, and they often have a life of their own. My hands tell you a lot about my Parkinson's.
Another "small" problem related to the hands is what doctors call "micrographia," which is typical of Parkinson's patients. No matter how hard I try, the amplitude of my handwriting gets smaller and smaller as I write because my hand muscles fatigue.
This is, in fact, no "small" problem because with memory failing, I often leave notes to myself, ironically notes that I cannot later read. It's not unusual for me to write the same note six or seven times before I produce one legible enough to be read hours later. It takes me ten times as long to write a note as it once did. This is one of the daily frustrations that can quickly raise a high titer of anger. I have crumpled countless pieces of paper in frustration and thrown them at the wall. This is how Parkinson's chips away, bit by bit, at your humanity and the sense of normality that all seriously ill patients crave.
Sudden hypotension, usually lasting only a few seconds, is another symptom of my Parkinson's. Typically triggered by exercise or exertion of some kind, these sudden drops in blood pressure bring me to the brink of fainting. My peripheral vision disappears and narrows to tunnel vision as I begin to lose consciousness. Frequent hydration is a prophylactic, so I try to remember to drink six to eight glasses of fluids a day.
Eating is yet another ADL that has suffered the impact of Parkinson's. In addition to the mess I often make at my place, I have to avoid some foods that I once enjoyed because I can no longer manipulate my silverware well enough to cut a steak, for example, and I detest the notion that someone will have to cut up my food for me as if I were an infant or a senile old man. This can be especially embarrassing at a restaurant or dinner party. If it were not for the fact that Vicki has become a swift and very discreet monitor of the area around my dinner plate, it would often appear that a three-year-old child had been seated at my place. The more dramatic tremors associated with Parkinson's can be controlled with medications; yet the compromise of fine motor skills can turn a formal dinner into a management nightmare as I try to move soup from bowl to mouth without spilling it all over my shirt, or try to confine rice to the boundaries of my plate.