Even a small voice, as vocal projection shrinks.
Managers, colleagues, and clients may wonder: Can a person who shakes like this, teeters like this, talks like this, writes like this, actually do the job?
That's what happened to Christine Webb, a scientist at Merck & Co., the New Jersey-based pharmaceutical firm that sells two Parkinson's medications and is researching others. Webb was diagnosed with Parkinson's last year.
One of her experiments wasn't going well and she had begun the standard round of troubleshooting diagnostics. "My boss, gently and tactfully, asked if my condition could be contributing to this," she said.
To handle her delicate laboratory work, Webb, who is right-handed, learned to operate a pipette with her left hand. Her right hand is now too shaky.
"I knew there was no malice," she said. "He needed to know." Merck made an internal video about Webb, who said her colleagues have been supportive.
Webb is one of more than a million Americans who have Parkinson's. Each year, doctors diagnose from 50,000 to 60,000 new cases. The disease attacks neurons in the brain that produce dopamine, a neurotransmitter that controls coordinated muscle functioning. There's no cure, but medicine, therapies, and surgery mitigate the symptoms and slow the pace of degeneration.
Despite his serious condition, Fox's new show will be full of the type of comedy he is known for.
One scene shows a humiliating yet hilarious moment that drove his character to retire in the first place. Parkinson's made it impossible for him to control his rolling chair, so, live on television, he inadvertently pushed himself out of camera range and off the set.
Humor as ally
Humor has been key for Vito A. Cosmo Jr., 50, who has been struggling with Parkinson's since 2002 but was not diagnosed until the summer of 2012.
Cosmo, of Fort Washington, is a manager in the state and municipal tax practice for the Philadelphia office of Grant Thornton L.L.P., a major accounting firm.
In his job, Cosmo gives speeches to potential clients - with the tremor in his right arm very obvious.
"You probably notice I have a tremor," he said he tells them. "It's fine. In fact, if you don't like my speech, go easy on the evaluation, because I have Parkinson's.
"I try to defuse the situation with humor," he said.
Cosmo said he has nothing but support from his company. Colleagues take notes for him because his handwriting is bad. Fatigue is an issue, so sometimes he leaves the company's Center City offices early or comes in late.
"You can't use your disability as a crutch," said Cosmo, a board member of the Parkinson Council, a Bala Cynwyd-based organization that raises money for Parkinson's research, education, and quality of life issues.
Losing a job
But his experience at work couldn't be more different than that of Bill Quinlan, another board member.
"When I first got my diagnosis, I decided to keep it quiet," said Quinlan, of Doylestown, now 51. Although he had undiagnosed symptoms for years, he was diagnosed at age 42, only a few months into a new job at a major information technology company in Malvern.
For the next three years, he tried to hide the tremor and other changes. The strain of keeping his condition under wraps made him tired and less confident. Even so, he was promoted.
Six months later, his symptoms were so bad that he decided, after researching the Americans With Disabilities Act, to tell his company about his condition and to ask for legally protected accommodations - particularly speech-to-text software.
"A week later I was called into my manager's office. I thought we were there to talk about my request for accommodation," he said. "Instead they told me they were eliminating my position. They assured that it was purely coincidental, but I didn't believe them."
Hiring a lawyer yielded a better severance package, Quinlan said. His advice? "Be very cautious about disclosing to your employer," he said. "There are many companies who perceive it as a threat, whether they are afraid of insurance costs or what customers might think."
Tsao-Wei Liang, a neurologist at Jefferson University Hospital, said he's seen it go both ways for his Parkinson's patients, who seem, he said, wired to work. "It's rare that they want to leave," he said.
He weighs safety consideration - is it dangerous for someone to drive a forklift, or operate machinery, particularly if reaction times are slow?
And he isn't sure how to advise patients about what to do at work. For the most part, Parkinson's affects those older than 60, closer to retirement age. But 15 percent are under 50 when diagnosed, in the prime of their work lives. As boomers delay retirement, the Parkinson's dilemma on the job is likely to become more prevalent.
Liang said workers may be overly confident that they can conceal their symptoms, by sitting on their hands, or pretending they are nursing a shoulder injury.
"There's still a lot of stigma in the workplace when it comes to neurological issues," he said.
Tremors at rest
Slowness of movement
Trouble with balance
Loss of smell
Soft or low voice
Loss of facial expression
STAMP OUT PARKINSON'S EVENT
What: Three-mile walk to raise $300,000 to fight the disease
Where: Martin Luther King Drive
When: Oct. 12; 8 a.m. registration, 9 a.m. start
Who: 1,500 to 2,000 walkers
For more info:http://theparkinsoncouncil.org/walk2013 or call 610-668-4292