Early symptoms appearing first in one upper or lower limb also commonly appear, sooner or later, in the limbs of the opposite side. The patient with an affected right arm, who diligently and courageously learns to compensate for his disability with his left arm, arises some morning to the grim discovery that his left hand has begun to shake. Correspondingly the patient whose efforts to compensate to a degree for an affected leg finds himself thwarted by the later appearance of signs in the "good" leg.
The emotional impact of these discoveries upon the patient is appalling and almost beyond description. It transcends grimmer realizations experienced later in the disease, because it is as yet uncushioned by resignation.
Once definitive symptoms have become established in the limbs, no fixed pattern of progression common to all sufferers can be expected. More than most diseases, Parkinson's Disease is individualistic, the details of its pattern depending upon varying individual characteristics and life situations. Thus the symptoms in a sensitive, intellectual patient may be predominantly emotional and subjective, consisting of vague fears, apprehensions, and "inward flutterings." Outwardly, such patients may appear to have Parkinson's Disease in extremely mild form. They may not shake violently, and they may not give evidence of more than slight muscular stiffness. Ironically, these patients may be suffering far more acutely than their fellow victims whose symptoms are more "on the surface."
A popular if somewhat crude expression has it that "those who keep everything inside feel worse than those who let it out." Nowhere is the truth of this more evident than in patients with Parkinson's Disease. Thus patients in this category, whose trembling and muscular crampings and sensations of panic are all "kept inside," do not consciously select these tendencies. There is evidence to prove, however, that these patients do choose this form of Parkinson's Disease subconsciously.
Sensitive individuals are by nature shy. The last thing in the world they desire is to be conspicuous. The ordinary manifestations of Parkinson's Disease being markedly conspicuous, such victims subconsciously strive to suppress them. As a result, the characteristic tremors may not be greatly apparent outwardly in the patient's limbs, trunk, or face, but may be extremely apparent to the patient inwardly as a constant and tormenting shaking of all the inner organs.
By the same token, patients of a more extroverted type of personality, those, for instance, who are by nature lovers of the outdoors, of athletics and sociability, often display appalling outward symptoms, but state that they feel relatively calm "inside." These patients suffer less acutely from an emotional standpoint than those in the first category. Although the outward manifestations of their disorder are severe, they are less inclined to self-consciousness and therefore do not go into the strict seclusion, as a rule, that serves as a refuge for the others.
Tragically enough, these differences are largely of academic interest, minutiae of degree, for no one knows better than the Parkinson patient in any category that he is experiencing a hell on earth.