Doctor as patient: The honeymoon is almost over

I recently ran into a dear friend. Her Parkinson’s disease is much more advanced than mine. She told me my writing made her laugh (you know who you are). I hope this one brings a smile to your face, too.As you may recall, my marriage to PD began three years ago, on my 71st birthday to be exact. At that time I was told by a fellow Parkie and squash partner that my honeymoon with PD would last about five years. That didn’t sound too bad, as my previous, and only other honeymoon lasted only three days. That was to Trout Lake near North Bay, Ont. and that was all the time I could get off of my medical rotation in Ottawa back in 1976.So 60% of the way through my honeymoon, how am I doing?Fortunately, very well. Better than I had anticipated. My right handed tremor occurs mainly at the end of the day, or with stress. Retirement is certainly not synonymous with the absence of stress. My left hand remains exempt from a tremor. Both arms still swing. I can get out of bed or the car, my parking is a bit erratic, and I have only had one life threatening fall, in addition to several unexplained tumbles on the squash court. I can still smile, though my handwriting is even more illegible than when I was a real doctor. If PD was only a movement disorder, as most medical and non-medical people still believe, that would be the full report. But it is much more than that. I am dependent upon Restorolax, which is much cheaper at Walmart as a generic. It goes wherever I go. I am reluctant to cross international borders with a white powder. My bladder is “overactive” to say the least. My mood fluctuates. I forget names and the whereabouts of my car keys and iPhone, though I can still rhyme off the Dodger and Yankee lineups from the early '60s! Sleep depends upon melatonin and Zopiclone, which sadly isn’t covered by ODB. CBD and CBT and CBC didn’t help. My voice is at times soft and weak, and not heard through the din of Tims. My pills sometimes feel like they are trapped in a pinball machine until they finally go down the right way. Naps are priceless. I can still smell the roses. For those of you who aren’t aware by now, the non-motor symptoms of PD can be more bothersome for many than the motor symptoms.I realize that all of this is compatible with getting older. PD feels like getting older on steroids. But I consider myself extremely lucky. My Sinemet, which I still take in small doses, is of benefit. But I attribute exercise to being the key to my current, though maybe my time-limited, success. In any case, I am reluctant to find out if I am wrong. And remember, PD also occurs in younger people, such as Michael J. Fox and Muhammad Ali. Yes, Ali, my idol, suffered with young onset PD.As doctors, we all espouse the benefits of exercise, for heart disease, diabetes, mood disorders, arthritis, obesity and everything else. The evidence seems particularly convincing for PD. I am blessed. I play doubles squash four or five times a week with a wide variety of partners, male and female, young and older, skilled and less skilled, but all enthusiastic and friendly. What we all have in common is forgetting the score and from which side to serve. I have dabbled in pickleball, but will defer that as long as I can. If you have PD or know someone else who does, any form of exercise may be of benefit. Dancing, Tai Chi, ping pong, walking, with or without poles . . . you name it, it helps.The other pillar of my retirement is music. Like many of you, I took piano lessons as a child at the urging of my mother, or your mother. When I quit, she told me I would be sorry. Well she would be delighted now as I have been taking jazz lessons for the past six years and play regularly in several retirement homes. I wish she could hear me. Brian, my teacher, provides both moral and musical support. My tremor and I have reached a mutual agreement that he will not bother me during my piano playing as long as I allow him to go rampant while I am slurping my hot soup.My repertoire encompasses Coltrane, Miles, Bill Evans, Rogers and Hart, Ellington, Gershwin, the Beatles and so many more. “You Make Me Feel So Young” is how I feel when I arrive each week to a venue filled with walkers, silver hair and varying degrees of cognitive impairment. Though it provides me with a realistic and disheartening window into my future, it makes me grateful for the present. I am often overwhelmed by David, a 97-year-old resident who plays circles around me at the keyboard, without depending on a single piece of sheet music. Admittedly, many do fall asleep while I play, but I am content if I see a head bobbing, a toe tapping, or hear a beautiful whistle in the background.Music takes practice, as did medicine. As does squash. As does anything worth doing. I miss the practice of medicine, but feel fortunate to have sidestepped the pandemic and the alarming slide of the attraction to be a family doctor. My heart goes out to those family doctors, both young and older, who feel demoralized by the current state of our profession. I feel like I was there during the golden years of being “just a GP.” Now, as a patient, I shudder at the thought of losing mine. I have been lucky to have a great community based neurologist. Driving down to the Toronto Western Hospital for deep brain stimulation still sits at the bottom of my bucket list.Giving up one’s medical license does not mean giving up on medicine. If you are like me, you will constantly run into former patients at Tims or elsewhere. You may transiently forget their names, but trust me, you will still have their CPP etched in your brain. Such meetings usually result in a hug, which would have been grounds for some discipline while in practice. Like many of you, I feel lucky and privileged to have been their family doctor and had an impact on their lives. Many of my squash partners still call me Doctor, and there is no shortage of requests for medical advice, which I diplomatically avoid rendering. “See your family doctor” I tell them. “He retired,” they respond. “Do you know anyone . . ?”While I sadly miss my Big Pharma CME dinners, I still keep in touch with medicine through the NEJM, the Medical Post, hospital rounds, webinars, podcasts, reruns of MASH, André Picard at the Globe and Mail, the recently quiescent OMA chat group, and monthly virtual get-togethers with a great group of similarly retired but engaged fellow doctors. I live vicariously with medicine without the overhead, lab reports, forms or dues.Though I am not an esteemed movement disorder specialist, I have given several well received talks to family doctors about PD. In my humble opinion, “they” and I in the past, are lacking in knowledge about this fascinating but relentless condition. It is a distinct advantage to be able to talk about the tremor and demonstrate it at the same time. Making a PowerPoint presentation is my equivalent of a hundred crossword puzzles. It goes without saying that friends and family are precious and indispensable.OK. Two hours to game time. I hope that by the time you read this, the Leafs are well into round two of the playoffs. Keon, Armstrong, Duff, Horton Mahovlich, Brewer, Bower. Don’t let me get started!So that’s where I stand. And to my dear friend with Parkinson’s, I hope I have made you smile once again.

Doctor as patient: The honeymoon is almost over

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