Shaky Hands I visit Pete every week at his assisted living center. One Wednesday, I
signed in at the reception desk and headed to his second floor room. The door
was open. His tremulous voice answered, “Come in. The door’s always open,
except when it isn’t.”
Pete sprawled on his bed watching the Travel Channel. Sweat stains dotted
the arm pits of his Denver Broncos T shirt.I maneuvered around his bicycle, wheelchair, and a half dozen boxes overloaded
with family pictures and bible commentaries.The room smelled of stale taco
shells and sweat. Unwashed laundry blanketed the wheel chair. A layer of dust covered
a computer that balanced on a wheeled stand. ”Hi, Pete. Feeling ok? “
“Yeah. But I’m out of mouthwash. And
management bozos decided residents have to buy their own toilet paper.” His
right hand jiggled when he reached for my hand. His grip was firm. “Could you
get me a glass of water?”
“Sure. “I turned on the faucet and filled his glass. When he reached for it,
water sloshed down the side.
Essential tremor (ET) is a
“shaky hand” condition that has no identifiable
cause. It is the most common type of upper extremity tremor and is frequent in people
older than sixty five. It may be present with other nervous system problems, including
dystonia (muscle spasm) and Parkinson’s disease. Tobacco, smokeless tobacco,
overactive thyroid, and alcohol or caffeine withdrawal can contribute to ET. Certain prescription medicines may worsten this condition. These
include some antidepressants (Valproic Acid), heart medications (Cyclosporine),
antidepressants (Valproic Acid, Lexapro), and antiviral drugs (acyclovir).
ET can affect the hands, voice, arms, head, and eyelids. It
rarely involves legs and feet. People with ET have difficulty holding or using
small objects. The condition starts in early middle age, but may be present in those
older or younger. Blood tests and brain imaging studies are often normal.
Treatment may not be needed unless tremors interfere with daily
activities. Getting enough sleep and caffeine avoidance are helpful. Severe
tremors can be managed by purchasing clothes with Velcro fasteners, using
button hooks, and cooking or eating with large handle utensils.
The most common medicines to treat ET include Propanolol, a
“beta blocker,” and Primidone, a drug used to treat seizures. Primidone may cause
drowsiness, concentration problems, nausea, and difficulty with balance and
coordination. Antiseizure drugs such as gabapentin and topiramate may diminish
tremors.
Botox injections to the hands have been used to reduce tremors by weakening local muscles.
Severe ET cases might need “stereotactic surgery.” This
involves high-powered x-rays focused on a targeted brain area. Sometimes surgical
implantation of a brain stimulating device can alleviate symptoms.
Conclusion: Pete’s doctor proscribe him Propanol, which lessened the
tremors. My goal is to motivate Pete to stay with a physical therapy program
three times a week and to take outside walks with his push-stroller. He’s my “buddy.”
For questions or comments, contact Dr. Clem at clementhanson.blogspot.com.
