It is both happy and not happy

Hello everyone, it has been a while.

In my last post, I mentioned that I would be taking a break because the tremors in my right hand were severe, making it difficult to type. Now that my diagnosis has been confirmed and I am able to alleviate some of the symptoms with medication, I think I will start up again little by little. I don't know how long I can keep this up, but I would appreciate your support until that day comes.

Well, let me start by telling you the story so far. This is an article, but it is also a record for myself.

In the latter half of 2020, I began to notice tremors, mainly in my right hand. At first, it was thought to be drug-induced Parkinsonism caused by Latuda, a new antipsychotic I had started taking around the same time to treat my bipolar disorder. I tried two types of anticholinergic drugs as symptomatic treatment, but they had no effect at all. After a while, it was decided that Latuda was not effective for my bipolar disorder and it was discontinued, but the tremors did not subside at all.
It was just a case of mistaken identity.

For the time being, I left it alone until August 2023. At that time, I could still stop the tremors if I tried, and I thought that a little shaking in my hand (compared to bipolar disorder) didn't really matter. However, after three years, I suppose I got concerned, and my psychiatrist told me to go see a doctor, so I went to a nearby neurology clinic.

Waiting in the examination room was a relatively young female doctor (hereinafter referred to as the "Queen") who, despite not wearing a mask or fishnet stockings and (naturally) not carrying a whip, acted like a queen (everything was from a condescending, commanding tone). She said,

I'm sure you've already guessed the punchline, but there was one more complication, so please bear with me.

My housemate is (barely) a medical professional. At that time, they were extremely rare and "voluntarily" introduced me to a neurologist they trusted at their workplace, so I took a bus even though it was far from home. This was in April 2025. A middle-aged male doctor who looked like a veteran (hereinafter referred to as the "Veteran"; he didn't seem like a "Master") said,

Come to think of it, I still had the energy to write articles like this back then.

Entering the latter half of 2025, tremors also appeared in my right leg. It's not noticeable when I'm standing or walking, but when I cross my right leg over my left, it repeats a movement like tapping out a rhythm with my foot. As for my hands, it became almost impossible to operate my smartphone with my right hand.

What was even worse was the pain in my right arm that started about two months ago. At first, I thought it was a frozen shoulder and went to an orthopedic surgeon, but they took an X-ray and said, "There are no abnormalities in the bone," and that was it. They prescribed painkillers and compresses, but it didn't improve, and after that, the pain spread throughout my entire right arm. The forearm (from hand to elbow) isn't the shoulder, is it?

Finally, my psychiatrist got motivated and introduced me to a decent university hospital. If you were going to do that, you should have done it five years ago.
I went to the hospital right away.

When I opened the referral letter and looked inside, the receptionist who spotted it scolded me severely, saying, "Referral letters are treated as private correspondence, so they become invalid, and you could be charged with a crime (I assume she meant the crime of opening a letter under Article 133 of the Penal Code)." It's embarrassing to be scolded at my age. But unfortunately, she was wrong. There is no legal problem. However, it might lower the credibility of the document and be a hassle, so I recommend that everyone not open them.

My first impression of the female doctor (it's rare for me to write "doctor") was that she seemed very serious. She looked as young as a student, but seemed competent. After checking my walking ability, cognitive ability, etc.,

The other test wasDaTscan(also known as brain DAT scan. Is it a trademark?). This method is a test that provides information about Parkinson's disease and dementia with Lewy bodies. As a test reagent, it uses a radiolabeled compound containing iodine-123 calledioflupane, and these things are generally expensive, so this test cost 27,000 yen (30% co-payment).

After finishing all the tests, I went for another consultation on 12/9.

As soon as I entered the examination room, my eyes were drawn to the brain DAT scan images. Even to an amateur like me who had only looked them up online, they were typical images that were immediately obvious. On the left side—the side that controls the right side of the body—the part that should have been glowing in a comma shape (the striatum) had become a round shape that was one size smaller.

It seems one more condition is required to diagnose Parkinson's disease, and that is confirmation if a drug called levodopa is effective.
Levodopa is a precursor in dopamine biosynthesis and is converted into dopamine by decarboxylase in the body. By the way, the reason dopamine is not administered directly is that it cannot cross the blood-brain barrier and therefore cannot enter the brain, which is the target site.

I went for a consultation early in the new year. There was no need to ask the doctor for the diagnosis; since the tremors stopped immediately after taking the medicine, it was confirmed as Parkinson's disease.

Hey, 'Queen' and 'Veteran,' you claim to be specialists in neurology, right? I believe Parkinson's disease is your field of expertise, so what is the meaning of this?

Parkinson's disease causes various symptoms due to a decrease in dopamine, a neurotransmitter in the brain.

It is a progressive disease, and although it is slow, taking years, the quality of life definitely declines. Furthermore, the medication I am taking now will also stop working, though the speed of this varies from person to person. As someone like me who has already stuck one foot in the grave several times, I would have preferred it to be fatal, but it seems my life expectancy is only a few years different from the average.
Since patients with bipolar disorder have a life expectancy that is on average 10 to 20 years shorter than the general population (there are various theories) due to significantly higher suicide rates and the risk of comorbid lifestyle-related diseases, I thought this was convenient. However, when I think about it, my parents and both sets of grandparents lived well past the average life expectancy, so I have a slight anxiety that I might come from a long-lived lineage.

Furthermore, cognitive ability also seems to decline early. To be honest, this is what I fear the most.

I started getting lost a few years ago. Actually, I don't have many memories of getting lost since childhood. I think this is because I originally had a strong 'habit' (likely from the hunting era) of moving while drawing a bird's-eye view in my head, and because I often acted alone in my daily life (which means I don't have many friends), that ability was naturally trained. Also, I dislike sports (though I did a little martial arts in my student days), so I have never read the original text, but I feel like I have thought about the famous line, 'If you give up, the game is over right there.'

However, I feel like the number of times I get confused and cannot reach my destination no matter how much I walk has been gradually increasing. Among the allocentric (map-like) and egocentric (smartphone map-like) abilities necessary for spatial awareness that I learned from the articles of a noter I always read, the latter is clearly declining. When I move or change direction, I immediately lose track of the positional relationship between myself and my target or landmarks.

It's nostalgic to think about how I used to joke with girls, saying things like 'I have a built-in biological GPS' or 'The stars guide me.'
Using the map function on my smartphone was nothing but a humiliation.

My ability to multitask has also dropped significantly, and my visual cognitive ability has declined. Because 'I can see it with my eyes, but it takes time to identify what it is' and 'if I skim through it at my usual speed, I miss necessary information,' the pattern of decreased work efficiency → it's a hassle → giving up has increased.

I thought these things I had been feeling for the past few years were due to aging or the influence of the medication I take for my mental illness, but when viewed from the perspective of Parkinson's disease, they all seem to be 'typical' symptoms.

I don't know how fast the disease will progress in the future, so it is unclear how long I will be able to write. Well, everyone is the same in that we don't know what the future holds. Until that day, thank you for your support.

Bonus:
Looking into it carefully now, it seems that drug-induced Parkinsonism is generally characterized by a lack of asymmetry in symptoms, so perhaps that possibility could have been ruled out at that point. I have accused Latuda of a crime it did not commit. I would like to sincerely apologize and correct this here.