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Neurology Now:
March/April 2006 - Volume 2 - Issue 2 - p 10-23

Ali's Fighting Spirit

Matthews, Wallace

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Author Information

Wallace Matthews is a Newsday columnist who has long covered boxing for major publications as well as NBC, CBS and ESPN. He also testified at the Senate hearings that led to the Muhammad Ali Boxing Reform Act.

For more information about Parkinson's and the Muhammad Ali Parkinson Center, see RESOURCE CENTRAL on page 54.

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Slowly and with great effort, Muhammad Ali eased himself onto a couch in a quiet corner of the museum that commemorates his remarkable life. His once-magnificent body, now withered by age and illness, was virtually swallowed up in the soft leather pillows. He seemed oblivious to the horde of photographers jostling behind an aluminum mesh screen for a shot of the former world heavyweight champion in repose.

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With his twin daughters, Rasheda and Jamilla, kneeling by his side, Ali gazed at a stained-glass skylight in the ceiling. He spoke to no one and no one spoke to him. He was once the most public figure the world had ever known, but these days his words, thoughts and dreams are strictly private property.

The sound and fury have been replaced by silence and tranquility. Muhammad Ali doesn't rumble anymore and he doesn't boast. The fastest man heavyweight boxing had ever seen now shuffles slowly, the once astonishingly handsome face a lifeless mask, the familiar voice stilled.

Muhammad is a man of few words now, Lonnie Ali, his wife of 19 years, had said earlier that day last November at the gala opening of the Muhammad Ali Center in Louisville. He spends a lot of his time quietly, reading and contemplating.

It has now been 22 years, and quite possibly longer, since parkinsonism began its relentless march through Ali's nervous system. He was diagnosed with parkinsonism, the umbrella term for movement disorders including Parkinson's disease, in 1984, three years after the last fight of his 21-year boxing career. Now, the increasing tremors in his limbs, the painful slowness of his gait, the reports of balance problems and the whispers of falls have led the neurologist who diagnosed him to suspect Ali may in fact suffer from full-blown Parkinson's disease.

Parkinson's is doing what none of Ali's opponents could: silencing him and stripping him of his incredible grace. Still, even at the age of 64, there remains a youthful, almost-childlike optimism about Ali.

If he could suddenly rediscover his voice, what advice would Muhammad Ali give fellow Parkinson's patients?

He would tell them what he tells me when we're alone and we're talking, says his daughter Rasheda. He'd say, 'Don't give up. Believe in yourself.'

Of course. What else could he say? If ever there was a consistent thread running through the golden fabric of Muhammad Ali's life, it would be his incredible self-belief.

No one believed this brash, skinny teenager born Cassius Clay could go to Rome and win the Olympic gold medal in 1960, but he did. No one believed a loudmouthed 22-year-old belonged in the same ring with the fearsome ex-convict Sonny Liston four years later, but Clay beat him so badly that the heavyweight champion quit on his stool after a mere six rounds.

Changing his name to Muhammad Ali and adopting the teachings of the Nation of Islam were widely viewed as career suicide. Refusing induction into the Army based on his religious objections to the war in Vietnam was supposed to be the end of everything. The resulting suspension cost him nearly four years of his athletic prime, but it wasn't the end of anything.

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And most people, even members of his own camp, were quite certain he would be injured, and perhaps killed, when at 32 he challenged George Foreman - a bigger, stronger, even-meaner Liston - for the heavyweight title in 1974. Of course Ali won, just as he promised he would.

Now comes perhaps the greatest test of Muhammad Ali's self-belief. This time, Ali believes that even if he can't beat Parkinson's, neither should Parkinson's be allowed to defeat him.

Muhammad has the strongest will of any fighter, of any individual, I have ever met, period, says Angelo Dundee, 82, who has guided the careers of more than 100 boxing champions and had trained Ali through every one of his 61 pro fights, right to the dreadful end of his career in 1981.

Rasheda Ali, who at 35 can scarcely remember her father without the symptoms of Parkinson's, sees the same quality. I wish I could take whatever it is in his makeup, she says. It's just amazing. Mentally, he's always been a very strong person in and out of the ring. He was able to accept it right away and deal with it. He looks at it as just another part of his life.

Or, as Lonnie Ali recently told us, Muhammad always says, 'Never look back, only ahead.'

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Anyone who's ever met Muhammad Ali has never forgotten that first encounter, and Stanley Fahn is no exception. He was captivated by Ali's personal magnetism, entertained by his repertoire of card and magic tricks, impressed by his cooperative demeanor.

But this was no social engagement. Stanley Fahn, M.D., was a neurologist at Columbia-Presbyterian Medical Center in New York City. In September 1984, Muhammad Ali came to him as a patient.

Three years removed from his final fight and five years removed from the heavyweight title, Ali was concerned about an array of symptoms. There was some shaking in his hands and an unmistakable thickening of his speech, which once had been as crisp and cutting as his signature left jab. There was an alarming slowness of movement in the man whose ring motto had been float like a butterfly and sting like a bee. And there was some unexplained fatigue; he could, and often did, nod off just about anywhere, sometimes right in the middle of a conversation.

After a weeklong evaluation period in which Ali and his entourage turned a wing of the hospital into their own private hotel suite, Dr. Fahn diagnosed parkinsonism. What's more, Dr. Fahn suspected that the head trauma inflicted on Ali throughout his boxing career could be the cause.

There was some evidence that he had taken some hits to the head and so forth, recalls Dr. Fahn, director of the Center for Parkinson's Disease and Other Movement Disorders at Columbia University. So there was concern on my part that he might have what we call post-traumatic Parkinson's, or 'pugilistic parkinsonism,' from damage to the brain and the brain stem.

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Despite his unmarked face and his mobile, gracefully elusive boxing style, Ali took a lot more punishment in his career than it appeared on the surface. In a show of machismo, he often lay on the ropes in training sessions, allowing his sparring partners to hit him in the head and body. And even in fights that he won, Ali took some vicious beatings, especially later in his career. He described the epic third fight with Joe Frazier, in which Ali retained his title after 14 brutal rounds, as the next thing to death.

Still, Dr. Fahn cannot be certain that Ali's condition was indeed caused by boxing or if in fact Parkinson's would have been his fate regardless of what career path he had chosen. An early Ali complaint of numbness in his lips and face, rendering him unaware of when food needed to be wiped away, indicated damage to the brain stem due to boxing, according to Dr. Fahn. But the steady progression of the disorder over the years, he adds, is more indicative of classic Parkinson's disease. The proof is only going to come at his autopsy, Dr. Fahn says, because the pathology is a little bit different between the two conditions.

In many ways, Ali's case remains unique among Parkinson's patients and among professional boxers. Although sleep disorders are common in Parkinson's, Dr. Fahn says it is rare to see them so early in the progression of the disease. Ali's age at the time of diagnosis, 42, placed him among the youngest of Parkinson's patients. The average age of Parkinson's patients is 60, with only 10 percent having had their onset before age 40.

There is evidence Ali was among that 10 percent, showing signs of parkinsonism when he was 38 years old. Looking back, I think the kid had Parkinson's his last couple of fights, says Dundee, his career-long trainer. I didn't know what was the matter with him and I used to give him hell, but nobody diagnosed him. I just remember the newspaper guys had to lean in real close to hear him.

Ali himself had noticed similar troubling symptoms in the late stages of his career - slowness, fatigue, slurred speech. He had been mistakenly treated for hypothyroidism while training for his 1980 knockout loss to Larry Holmes, his former sparring partner who had ascended to the heavyweight throne after Ali hung up the gloves in '79. Reporters covering that comeback fight and another ill-fated comeback fight in 1981 were shocked to encounter the normally loquacious and inexhaustible Ali sometimes conducting interviews from his bed, speaking barely intelligibly and seemingly too exhausted to sit up.

You could see back then that he was just not right, says Sports Illustrated senior writer William Nack, who covered many of Ali's most punishing bouts, none more so than the celebrated Thrilla in Manila with Frazier in 1975. He was mumbling and starting to slur, just a little bit. I remember thinking, 'Is he just tired?' Then I thought about all the times Joe Frazier had hit him and I realized he wasn't just tired.

Muhammad Ali's children never really knew the brash, loquacious, sometimes-outrageous firebrand named Cassius Clay. To them, the man who once divided a nation and electrified a sport existed only on videotape.

The father they knew was older, slower and quieter. Rasheda Ali was just 11 years old when she attended her father's last fight, a listless performance against the ordinary Trevor Berbick in 1981. I do remember seeing he was really slow, and he really did have the slurred speech quite a bit, she recalls. He was already showing the signs of Parkinson's, but I didn't really know what it was.

More than 20 years later, Rasheda Ali's 4-year-old son Nico asked her the question she never had to ask: Why is Poppy shaking?

Rasheda answered that question and others her kids had about their grandfather's illness by researching and writing a children's book on the disease and by advocating for Parkinson's causes.

The Ali family is fiercely protective of his privacy. But last fall, Ali's daughter Laila, 28 and a professional boxer, went public with details of her father's illness.

I feel like the disease is progressing, Laila Ali told the Los Angeles Times. I've noticed a change in him. It's painful for me because I would love to sit down and talk to my dad about the way he used to be when he was my age. I can't really do that. I can't share a lot of things with him. And he doesn't talk much these days, anyway. It takes him too much energy to talk.

He has his good days and his bad days, she went on. He's taking a lot of different medications, but sometimes his speech is so slurred you can't hardly understand him. But he definitely knows what's going on. It's his motor skills that Parkinson's affects. So it's like he's trapped inside his body. He can think, he has things he wants to say, but his lips sometimes just don't move to get it out.

Instead, Ali amuses himself and his grandchildren in much the same way he amused Dr. Fahn 22 years ago. He's still funny and he still clowns around a lot, Rasheda says. He loves magic tricks. He loves coloring and drawing pictures for the kids. Now he draws mountains for the kids, and airplanes. Even though sometimes you can't hardly hear what he is saying, he's dynamic in his body language and his face. There are other ways Parkinson's patients can communicate outside of speaking.

Recently, Rasheda took Ali and the kids to the movies to see the remake of King Kong. He just loved it, she says. Sometimes he gets bored and he doesn't always like to watch and he wants to move on to something else, but he sat through the whole entire movie. He ate all my popcorn and we just had a wonderful time.

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Still, the effects of Parkinson's are never absent. Sometimes he doesn't smile because of the masked face, Rasheda says. Because my kids know him so well, they don't freak out about it, but those who don't know people with Parkinson's might look at him and think, 'Oh, he's angry.' But he's not angry, obviously - it's just the freezing of the muscles in the face.

The most profound effects, though, have been on Ali's two trademarks: his voice and his movements. Like many Parkinson's patients, Ali shuffles when he walks and has problems with his balance and posture.

When I'm with him, says Rasheda, whose children's book is titled I'll Hold Your Hand So You Won't Fall, I just hold his hand when we walk.

For more than 10 years after his diagnosis, Muhammad Ali did something few would have expected of him: he largely disappeared from public view. Then, in 1996, the man who'd always kept promising to shock the world, and delivered on that promise so many times, had one more surprise left in him. The identity of the person who would light the Olympic caldron at the opening ceremonies of the Atlanta Games was a closely guarded secret. If the choice seems embarrassingly obvious in hindsight, back then who could've guessed that person would be Muhammad Ali?

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But suddenly there he was, standing on the platform, his left arm performing an involuntary dance while his right arm held the torch aloft.

It was an indelible image of the New Ali, the public face of a disease many sufferers prefer to keep private. At a stage of the illness when many Parkinson's patients begin to turn inward, Ali was coming out to embark upon a new journey.

Paradoxically, the more Parkinson's slowed his movements, the more mobile he became. The New Ali emerged as a globetrotting ambassador for peace. To the astonishment of many - and the consternation of some old friends - Ali and Lonnie, his fourth wife, began traveling the world to spread what Lonnie calls Muhammad's message.

He's had an incredible life, Lonnie Ali says. He went from a boxer to an emissary of world peace and love. It's part of the evolution of Muhammad.

Between last July and this February, Ali made extensive trips to Europe and Asia. Over a one-week period in July, he turned up at the major league baseball All-Star Game in Detroit and then jetted off to Singapore to support the U.S. bid for the 2012 Olympics.

Last September, he checked into Atlanta's Emory University Hospital for neck surgery to correct what was said to be a boxing-related spine condition. But by November, a sharp white scar bisecting his withered neck, he was fit enough to resume an itinerary that would have exhausted men half his age: receiving the Medal of Freedom from President Bush at the White House, spending a busy weekend in Louisville for the dedication of the Muhammad Ali Center, and then flying to Germany to attend a boxing match featuring his daughter Laila. Then in January it was off to Switzerland, where he was honored by the World Economic Forum and spent much of February with Lonnie.

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Anything Muhammad does, he decides to do, Lonnie Ali says in response to criticism that perhaps a man in her husband's condition should not be traveling so much. And anyplace we go, it has to be somewhere he wants to go.

In fact, Lonnie put Muhammad on the telephone during a recent interview to answer the question of whether his rigorous travel schedule is too much for him to handle.

He answered in a single hoarse but distinct word: No.

At the star-studded opening of the Muhammad Ali Center last November, the man for whom the museum is named made a dramatic, poignant appearance on the arm of his wife. He shuffled mutely, his walk a mismatched dance of constant but unrelated movements, his hips wobbling side-to-side, his arms shaking up and down as if attached to a jackhammer, his head bobbing front-to-back, his mouth working as if he were chewing the inside of his lips.

These dyskinesias, or abnormal involuntary movements, are often the result of medication administered to restore some measure of mobility to Parkinson's patients. Dyskinesia bothers the people looking at them but it doesn't bother the patient, who actually feels pretty good, Dr. Fahn says. Because they're moving about, they're not a prisoner in their own skin, they're able to move.

Like all Parkinson's patients, Ali has had to accept dyskinesias as a side effect of the medications he is taking. Unlike most Parkinson's patients, however, Ali keeps a schedule that often calls for public appearances, which makes proper timing and dosage of his medications crucial.

Early on, Dr. Fahn says, when I was first telling him all the problems he could have with the medications, Muhammad said, 'Look, I don't need to take it all the time. I'm pretty good. I can do most everything.' So I know that in the past he would often not take his medicines until he needed to make a public appearance.

That could explain Ali's good days and bad days. Both extremes have been witnessed firsthand by renowned photographer Neil Leifer, who took the famous shot of Ali standing over the fallen Liston in their 1965 rematch and has photographed him countless times since.

Assigned in 1992 to shoot a Sports Illustrated cover photo of Ali for his 50th birthday, Leifer found he had to button Ali's tuxedo shirt for him. And so lifeless were Ali's eyes that day that Leifer feared the candles on the birthday cake set up before him would burn down before he got the shot he needed.

Muhammad is the greatest photo subject who ever lived, and he loves the camera, Leifer says. But he was having a bad day and he was shaking. I had him point at the cake and used a strobe light to cancel out the shaking, and finally we got the shot.

Leifer estimates he has had 10 photo sessions with Ali since that day, ranging from difficult to incredible. On a bad day, Leifer might get two usable images out of each roll of 12 exposures. But three years ago, shooting for Esquire, he got 11 good photos out of 12, despite a period when Ali had to stop for a rest when the tremors became too severe.

Last year on St. Patrick's Day, Leifer photographed Ali at his Michigan farm and found him in fine form and spirits. Three days later, at lunch, Ali was listless. If there is a north and south pole of his condition, Leifer says, what I saw on Thursday was the north and what I saw on Sunday was the south.

Two years ago, Leifer and several others accompanied Ali on a flight to Frankfurt to promote GOAT, a 75-pound coffee- table book chronicling Ali's life that retailed for $3,000 (GOAT being the acronym for Ali's oft-quoted mantra Greatest of All Time!). To Leifer's astonishment, Ali spent most of the seven-hour flight out of his seat, entertaining the other passengers with his repertoire of card and magic tricks. Finally, the flight attendants had to ask him to sit down because they couldn't get the carts down the aisle, Leifer recalls.

Leon Gast, who directed the Oscar-winning Ali documentary When We Were Kings, was likewise amazed on that trip. Dining out with Ali on two successive nights, Gast watched him painstakingly craft a work of art on a napkin. He would start by drawing an overhead view of a boxing ring, add the ring posts, the ropes, two stick-figure boxers and a referee. Then he would meticulously start making little circles with his felt-tip pen on all four sides of the ring. He would work on this napkin through the course of an entire dinner, maybe two hours, Gast recalls. And when he was done, he had a beautiful overhead shot of a boxing scene with a crowd all around it. He filled the napkin right up to the edge on all four sides, and then he signed it and gave it to the waiter. Both nights. It was remarkable to watch.

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Still, it is difficult for some of Ali's oldest friends to see him in this condition. They had to lift him up from the chair so he could shake my hand, his old trainer Angelo Dundee says of their brief meeting at the museum opening. He couldn't really talk to me. It breaks my heart to see this kid this way.

Then again, as Laila Ali said last fall, He doesn't feel sorry for himself, so it's hard to feel sorry for him.

Muhammad Ali's 1975 autobiography closes with these lines describing the aftermath of what many thought should have been his crowning glory, the brutal third fight with Joe Frazier in Manila: The screams are so loud they sound far away. Then the crowd, pushing, shoving, reporters shouting. They want something from me. Something more. Some word or comment. But I'm too tired. Besides, I already told them. And I already told you. Didn't you hear me? I said I was The Greatest.

Ali had been saying that since 1964, when he overturned the boxing world as if it were a card table by defeating Liston. He said it so loud and so often that it became his nickname: The Greatest. He spouted off on so many subjects before, during and after training that Dundee took to sealing off Ali's mouth with duct tape for photo ops. Ali was known as much for his tireless mouth as for his fleet feet and flashing fists. Hence his original nickname: The Louisville Lip.

But over the years, Ali's incredible gift of gab waned as the illness took its insidious hold. And now, his powers of speech have declined so that he is virtually incapable of being interviewed.

His last televised interview was nearly five years ago, and it needed subtitles so viewers could understand his hoarse, garbled speech. However, Ali was still mischievous enough to feign sleep in the midst of the taping, causing the interviewer, David Frost, to momentarily panic on-air.

The last time I saw him, Leifer says of their 2005 photo shoot, he was difficult to understand, but he talked to me about his kids and he was able to get his point across. I think he gets frustrated that you can't understand him, but he's not shy about talking with people he knows.

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For the rest of the world, nearly every word attributed to Muhammad Ali is actually spoken by Lonnie Ali. While she acknowledges her husband has been slowed by age and illness, Lonnie says their life today is not all that different from when they first married in 1986. She says he exercises regularly in a gym on their property, including punching a heavy bag and occasionally even climbing into a ring to spar playfully.

Several years ago, he and Lonnie adopted a boy they named Asaad. Despite the seemingly hectic travel schedule they continue to maintain, Lonnie Ali says they have actually become more rooted to their Berrien Springs, Mich., home.

Muhammad is getting older, she says. And we're tired of being on the road all the time. We have a 14-year-old son at home and he's in school, so we don't like to leave him behind so much.

Other aspects of Ali's life have changed drastically.

Muhammad hasn't driven a car in 15 years, she says. He is no longer the type to pick up the phone and call friends the way he used to, but we converse. Don't get me wrong, it's not like he's sitting there espousing rhetoric, but his words still carry impact, they're still very important. You absolutely can understand what he wants, what he says, what he's thinking.

But Lonnie Ali is more than just the voice of Muhammad Ali. She is also his full-time caregiver, the one person who is absolutely indispensable in his life. She's with him all the time, Rasheda Ali says. It's a lot of work and she does a very good job at it. I tell her, 'You need to take a vacation, you need to rest and take care of yourself,' because I think a lot of caregivers take care of their loved ones and almost forget about themselves.

According to Rasheda, her father has never been embarrassed by his condition. Nor has he sought to hide its truth from the world. In fact, he lent his name to the Muhammad Ali Parkinson Research Center in Phoenix and serves as an ambassador for Parkinson's causes.

My dad's message is, 'I'm Muhammad Ali, I have Parkinson's, but I can still live and enjoy my life,' Rasheda says. I think a lot of people with Parkinson's need to see that because it is a debilitating illness and a real kind of painful and painstaking journey. But they can still do what they enjoy doing. I think he's a really great role model for people with Parkinson's.

Of the multiple legacies that define Muhammad Ali - three-time heavyweight champion boxer, civil rights activist, antiwar protestor, man of peace - this may turn out to be among his most important.

Some people look at Parkinson's as a crutch and some of them look at it as part of their life and experience, says Rasheda Ali, who puts her dad firmly in the latter category. Maybe his purpose in life was not to be the heavyweight champion, but to be so much more - and I think he's enjoying that right now. He says to me, 'My life has just begun.'

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