DEAR DR. DONOHUE: Will you explain what stage Parkinson’s disease starts with and how it progresses? My doctors have diagnosed me with it.

Right now, I have shaking and my writing is bad. – A.M.

The three key signs of Parkinson’s are resting tremor, muscle rigidity and bradykinesia.

A resting tremor is a shaking of the hand, arm or leg when it’s at rest, as when the hand is quietly supported in the lap. At first, it might go unnoticed or be nothing more than the index finger rolling over the thumb.

Muscle rigidity means that muscles resist movement. If you try to bend the arm of a Parkinson’s patient, you meet with great resistance. Rigidity makes fluid movement difficult.

Bradykinesia is slowness of movement. It takes Parkinson’s patients forever to rise from a chair. They walk with slow, shuffling steps. Dressing is a prolonged task.

Handwriting takes time, and the letters are small. (Your handwriting is much better than mine.)

The progression of Parkinson’s symptoms is usually quite gradual, and varies with each individual. Medicines and physical therapy slow their worsening and often suppress them. Life expectance is close to normal.

Most authorities stage Parkinson’s as mild, moderate or severe. The Hoehn-Yahr system of staging has five stages. Stage one consists of signs on only one side of the body and tremor in only one extremity. In stage two, signs are on both sides and the legs are often involved, but balance is good. The inability to walk straight signals stage three.

With stage four, walking is limited and muscles are very rigid. Stage five is the stage in which people are unable to care for themselves.

Not all Parkinson’s patients go through all these stages, and only a few ever reach the incapacitated level of stage five. Medicines can halt progression for long periods of time.

DEAR DR. DONOHUE: A colleague of mine fasts for five days once a year. She ingests nothing but water and a daily vitamin during this time. She does this to detoxify her body, especially her colon, which, she says, is where 90 percent of illnesses begin. Is this sort of fasting a good idea? What are your thoughts on this? – L.D.

I’m suppressing the urge to roll my eyes upward.

This isn’t a great idea. She’s not going to die by not eating for five days, but she’s not going to do any good either.

The body doesn’t need detoxification. Fasting doesn’t detoxify. What are the toxins she thinks she has?

The colon isn’t the source of 90 percent of illnesses. All of this is foolishness.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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