It's all in the smile

After my initial meeting with my GP, the referral letter included the comment "there appears to be possible early signs of Parkinson's mask". As I've previously said, this letter was hidden from me by the wife and I only came across it by accident shortly before I was due to see the neurologist.

At the time I was more irritated by the wife's subterfuge than I was concerned by its contents. But eventually, I thought I had better just check. 

Which means of course Dr Google

What is Parkinson's Mask? Well firstly it has a more scientific name; Hypomimia, it's when facial expressions become rigid or slow to respond and the individual can appear, unhappy or depressed or downright grumpy.

I felt relieved when I saw this, I am not a demonstrably emotional person in public situations, so I figured what the GP identified as possible early-stage Parkinson's mask, was simply me being me. Over the years both the wife and occasional friend have told me that I was looking like a miserable bastard, so would I smile a bit more!

I would try, but the result typically didn't convince, I'd still look grumpy, but with added grimace. It won't take much for readers to guess which one of the seven dwarfs I most take after.

Of course, some of my wife's friends put it differently when she referred the contents of the letter to them "don't worry, it's just his miserable Scot look"!

I could take offence.

Actually, and this is important to remember, and all joking aside Parkinson's Mask can have a dehumanising effect on how the individual is treated by others, including Caregivers and Medical professionals. With the face lacking the usual emotional cues, the individual can appear cold, aloof and unemotional and if the persons who are engaging with the individual don't understand the issues, they may believe the person to be unapproachable, rude or unfriendly. 

If the person is the patient's caregiver, it can cause serious problems.

And frequently nothing can be further from the truth. The mask can hide a warm individual, who loves to engage and enjoys company. And if this isn't understood and recognised an individual may become ever more isolated, and worse still shunned and cut off from society. 

Sadly PD victims have been known to be asked to leave restaurants and pubs, simply because of the lack of knowledge and understanding of those doing the excluding. They can't see beyond the face. Worse still some have been threatened, by individuals who have misinterpreted the unemotional 'stare' for unfriendliness and threat.

Parkinson's is isolating enough, without the fear of violence or the risk of humiliation by being refused entry to a restaurant or pub, 

So what can be done? Can this symptom be reversed and the face returned to normality?

Ignoring for a while smart-arse comments from 'friends' about it being impossible to see the difference in my case (revenge is best served cold, I will remember), I do facial exercises in an attempt to slow the degeneration and to keep my facial muscles elastic.

The appearance is one of a particularly gruesome gurning competition, where it seems I have every chance of sweeping the board. 

As I do these exercises driving to the gym, I'm hoping other drivers are concentrating on their road skills and not my strange facial contortions. Certainly, no one has ever asked me about them, but then, perhaps my permanent scowl puts them off from doing so!

The medication also helps, but even when you combine the two approaches, all it does is slow the decline. It is estimated that up to 70% of PD patients will suffer some level of masking, however as it would appear from what friends and loved ones say, I was already there before I developed Parkinson's.

Maybe then no one will notice it with me, they'll just assume I'm being miserable again, so perhaps it won't have a serious impact!

But if one day you are in a pub and an elderly man walks in, with a slightly stooped gate and a shaky right hand, looking miserable, don't get him thrown out, buy him a pint.

And no I'm not talking about me................... Cheek!