The problems began with his voice, which mysteriously started growing fainter. Then came his handwriting, which began to shrink.
And when Carl Schuetz's gait became oddly halting, his then-wife asked why his strides were so uneven.
Schuetz, 63, of Timonium, had developed Parkinson's disease, a disorder of the central nervous system that causes ever-worsening symptoms ranging from tremors and rigidity to slowness of step. In time, it can lead to depression, impaired thinking, dementia and more. There is no cure.
But Schuetz, a graphic artist and yoga practitioner, has never been one to let external forces define him.
At a Timonium fitness club one recent Saturday, his voice was soft but steady, his movements disciplined, as he led fellow Parkinson's sufferers through 60 minutes of yoga exercises specifically designed for those who have the disease.
The men and women on the mats, each at a different stage of Parkinson's, watched him intently, straining and settling into increasingly challenging poses: the mountain, the kneeling hero, the supported bridge.
"In yoga, we try to breathe as we move and move as we breathe," Schuetz told them as he modeled the moves. "Breathe into the pose."
A few participants could only approximate the poses, known in yoga as asanas; one or two shook as they tried. Several found the correct position, their faces showing focus and strain.
Schuetz has always had a knack for reinventing himself. A Maryland Institute College of Art alum, he turned a graphic design education into a career as a web developer, teacher and software designer. His clients included NASA and the University of Maryland School of Medicine.
When he was diagnosed with Parkinson's in 2011, he took a proactive approach.
Plunging into research, he was dismayed to learn he would always have the disorder — but encouraged to find that new treatment approaches are helping patients manage and even significantly delay the onset of symptoms.
One was exercise, including yoga, which neurologists have come to believe can bolster a patient's balance, strength and emotional outlook.
Schuetz ditched his old career, earned certification as a yoga instructor, and set up shop to share his new expertise.
He's now the driving force behind "Yoga For Parkinson's," a weekly class at ACAC Fitness in Timonium. (A colleague also offers the class each Wednesday at the Bain Senior Center in Columbia.)
It's free, thanks to support from the two centers, from the Parkinson Foundation of the National Capital Area in Falls Church, Va., and from Yoga for Parkinson's, a nonprofit Schuetz founded in 2013.
"Parkinson's patients have enough expenses to deal with; we don't want to add to them," Schuetz says.
'The shaking palsy'
An English physician, James Parkinson, first described the condition he called "the shaking palsy" in 1817. But it wasn't until the mid-20th Century that scientists learned the disorder develops in conjunction with declines in the body's dopamine supply. Dopamine, a neurotransmitter, promotes movement and movement control.
Parkinson's disease can manifest itself in a range of motor-related symptoms — stiffness, tremors, poor balance, difficulty initiating movements — as well as non-motor symptoms, such as digestive problems, sleep disorders and sexual dysfunction. Left untreated, it grows worse over time.
Experts say a patient's sense of losing physical control can also lead to depression, feelings of isolation and other forms of emotional distress.
No one knows what causes Parkinson's, though it affects more than 1.5 million Americans, including about 60,000 who are newly diagnosed every year, according to the American Parkinson Disease Association. The median age of onset is 60, with up to 10 percent diagnosed before age 40.
"People think of Parkinson's as a disease of the elderly, but half of all patients are diagnosed during what you might call the prime of their lives," said Dr. Lisa Shulman, a neurology professor at the University of Maryland School of Medicine who specializes in movement disorders.
The disease can be difficult to diagnose — no standard lab test exists, and other disorders share some of its symptoms. Medications help by stimulating dopamine production, but they lose their effectiveness over time.
Some cases call for the surgical implantation of neurostimulators.
More recently, a consensus has developed that consistent exercise helps most patients in a variety of ways.
"There are more than a hundred studies investigating a large range of different types of exercise,´ said Shulman, who also is the co-director of the Parkinson's Disease and Movement Disorders Center at the University of Maryland Medical Center. "Based on the evidence, we're confident that exercise is an important intervention for improving symptoms and delaying disability in Parkinson disease."
Research done at the University of Maryland School of Medicine in 2011 suggests that instructor-led group exercise — in yoga, tai chi, zumba and more — works especially well.
Yoga is one of the more effective because it's "based on body stretching to preserve range of motion and enhancing mind-body connection to reinforce mindful movement of the body," Shulman said.
Schuetz's class is a blend of vinyasa yoga, which stresses flow between poses, and Iyengar yoga, which emphasizes holding the poses correctly.
He demonstrated the " tree" pose, which calls for a participant to stand on one leg, bend the other at the knee, and press the second foot against the calf of the first leg. As he executed and held the pose, he explained that he couldn't even begin to do it two years ago.
Such a triumph is no small feat for Parkinson's patients, he said, many of whom have grown used to taking minutes, not seconds, to perform such simple tasks as buttoning a shirt.
"The ability to do a balance pose uplifts and builds confidence, and that extends into other areas of life," Schuetz said.
In the back row, class member Marty Lefstein, 64, of Parkville, shook while holding a crescent lunge pose. Diagnosed 21 years ago, he said he'd reduced some of his many symptoms through medicine and surgery, but that yoga has helped affirm the improvements.
"If I keep at it regularly, doing it at home, it helps with my balance [and] helps calm me inside," he said.
Bob Falck of Cockeysville, 65, was diagnosed this year after noticing a tremor in one hand. He enrolled as a "preemptive measure," to delay any further progression, he said, adding that the custom yoga seems to be working.
"I was already an exercise fanatic, but this is helping me with flexibility and balance," he said. "I'm glad I discovered this."
Frank Pondolfina of Nottingham, 68, said the yoga class — together with other activities, such as dancing and gardening — brings effects that carry over away from the mat.
"I used to have tremors and shoe-shuffling in the mornings, but I have very little of either one now, and my posture improves throughout the day [after doing yoga]," said Pondolfina, who was diagnosed in 1977.
After an hour, Schuetz led the class through a relaxation regimen.
"Feel the cool air coming in through your nostrils and the warm air leaving your body," he said as they lay on their backs. "Let there be no worry lines, no creases in your foreheads. Receive the benefits of your yoga practice."
As recorded sitar music filled the room, Schuetz's charges gathered their belongings, said their farewells and left.
Yoga can't cure Parkinson's disease, Schuetz repeated, but even as the disorder disrupts the mind-body connection, yoga has been helping human beings strengthen that connection for thousands of years.
It has helped him to re-learn walking, writing, speaking and more, he said, staving off what would have been inevitable decline. He hopes to share that outcome with others.
"I'm going to be practicing yoga as long as I live," he said.