There are five stages of Parkinson's disease, although the stages have nothing to do with the treatment of the disease as treatment is based on symptoms of the disease. It starts with the mildest symptoms and leads to severe ones.
1st Stage:
Very mild symptoms, generally on one side and sometimes not noticeable as they do not interfere with daily activities. That may be a tremor in one hand, a change in posture, walking, and facial expressions. In my wife's case, weakness in the right hand's grip with pain started. This was confused with just a grip weakness in the hand by both neuro and ortho physicians.
In this stage, the physician will begin a mild dose of Syndopa or Sinemet or any equivalent. In my wife's case, treatment was started a bit late as the doctors could not assess the disease as Parkinson's. The first time Dr. Sunil Pradhan of SGPGI started Parkinson's treatment with the initial medicines was on 23rd January 1995 and 27th March 1995 i.e., on annex 1 & 2. At this time, she did not need any assistance.
2nd Stage:
On 16th May 1996, Dr. Pradhan noticed tremors in both my wife's hands during our visit. So, it can be called the 2nd Stage, where symptoms slightly worsen as tremors or rigidity with posture and walking become noticeable on both sides. Her neck was seen as tilted on the right side. Daily activity will become harder to achieve, but the patient will still be able to do things themselves. The doctor may recommend an increase in the dose of Sinemet or its equivalent as it depends on the severity of the individual.
The main problem in my wife's case was that she was allergic to milk products and a protein diet which we were unaware of at that period. The Sinemet or its equivalent did not work sometimes. Actually, I was trying to get some permanent solution for the on and off period, in other words, some permanent solution for Parkinson's disease. Initially, the on position was very smooth when the dose of Sinemet was given to her. Her little finger of her right hand was up, and this was the sign when she had come in on position. In off position also, she was doing the things slowly but herself.
In the 2nd Stage, we were returning from Ghaziabad to Lucknow at night in the year 2000, waiting at the Railway station platform number one. An announcement was made that the train was coming at platform number three instead of number one. We were in a hurry to climb the stairs and reach platform three, where the train had arrived before we reached. With great difficulty, we reached the platform, and with my son's help, we entered the unknown compartment with half the luggage. We could locate our compartment in half an hour, which was so problematic that I cannot write in words.
I had to narrate this because Parkinson's patients should avoid traveling by train as nobody knows the circumstances you have to face. Another time also, when I was transferred from Lucknow to Siddharth Nager, I had to travel by train. The route was from Lucknow to Gonda and another train from Gonda to Siddharth Nagar by meter gauge. I had to increase the dose as a lot of walking was necessary.
3rd Stage:
It is considered the middle stage of the disease. Further loss of Balance, slowness of movement, and Falls are now common, but a person is fully independent for dressing and eating with slight difficulty. Many of the symptoms are like the second Stage, but the loss of Balance may be increased. Movement becomes slower overall. Medication with physiotherapy may be tried. In my wife's case, physiotherapy was started in May 2005, and perhaps this is when the 3rd stage started.
She had an attack of T.B. in 2002, and 8 to 9 months were required in the treatment where T.B. medicines were interacting with Parkinson's medicines. Some medications were increased to overcome the effect of T.B.; otherwise, she was doing day-to-day work herself. She did not need any caretaker. A few years back, when she had T.B., one of my friends, Mr. P.K Govil, had arranged a simple wooden chair in which four wheels were attached on each leg which was working comfortably. Afterward, a wheelchair was arranged by my elder son while returning from Pune in February 2012.
4th Stage:
This stage differs from the 3rd stage in the aspect of independence. People are unable to live alone and need assistance for daily tasks. They are unable to stand up from a wheelchair or a bed independently. Trouble in swallowing, voice very feeble, sometimes attendants have to feed tea, breakfast, and dinner. Posture becomes significantly stoop. This stage perhaps started after her brain operation I.e., after 1st October 2010.
5th Stage:
Most advanced and debilitating stage. The problems felt in the 4th stage continue to advance. Stiffness in the legs makes it impossible to stand from a chair or walk and requires a wheelchair or to be bedridden. Nursing is required round the clock for all activities. The person may experience hallucinations (seeing the things that are not there) and delusions (a belief that is not true). Swallowing becomes problematic and requires a Rytes tube. In my wife's case, this stage started in the middle of the year 2015.
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