What's shakin'?: Essential tremors wreak havoc
During my first year in medical residency in Los Angeles, we experienced an earthquake that rocked my world. Well, actually at the time I was visiting my significant other at UVA, but when I returned to LA, I had the unfortunate thrill of experiencing after-shocks. (I always thought "after-shocks" occurred in family situations, like finally realizing your parents disowned you after being in denial for a few days.)
I was talking to a nurse in the LA clinic, and suddenly it looked like the nurse was dancing to KC & The Sunshine Band's "Shake Your Booty." Before I knew it, I was shaking along with her– and the whole clinic! Is that what having a tremor disorder is like?
There are many types of tremors. One of the most common types is Essential Tremor (ET– not to be confused with Steven Spielberg's cute little alien friend). About 10 percent of Americans have ET. Look at Katherine Hepburn– poor thing. She not only shook her own body but Spencer Tracy's world. ET has been called "Familial Tremor," but only 50 percent of people with ET have a close relative with the tremor. (Another case of being disowned?)
The incidence of ET increases with age, though if inherited from a family member, it can occur at an earlier age. ET can be very distressing to a person who relies on steady hands: surgeons, artists, manicurists, pick-pockets. A fine tremor occurs in ET; it's due to contracting flexor and extensor muscles affected by an unknown neurological problem.
The tremor occurs at rest and is usually worse with action, like shaving (ouch!), sewing (oops!), slicing foods (band aid!), and putting on mascara (doh!). The tremor is always there, but is worst when the movement is just about done– such as putting a key into the lock. You get the key to the hole, but then the shakiness makes it difficult to insert it easily.
The head is usually affected as well, which is why I hate seeing those celebrity bobbing head toys in people's cars. I think Ozzy Osbourne made millions on his bobbing head, unlike Lorena Bobbitt. The head can bob up and down like a "yes-yes" motion (very optimistic), or tremble side to side like a "no-no" motion (very pessimistic). A Queen would lose her crown. The head bobbing doesn't bother the person physically as much as the way it looks.
The voice can quiver like Belinda Carlisle singing, "I Get We-e-e-e-a-a-a-k." The chin can jitter like Tammy Faye crying with Jim Bakker in the '80s; legs can tremble like Elvis Presley's did. And the trunk of the body sometimes shudders like we did when we saw pictures of Liz Taylor with Michael Jackson at Liza's wedding. Chilling!
ET gets worse with stimulants and better with relaxants. Caffeine, decongestants, steroids, and albuterol (for asthma) can make a person with ET look like a person being electrocuted. Red Bull, anyone? Stress and anxiety can make signing divorce papers seem like making papier-mache. On the other hand, alcohol or valium can quiet a tremor– not that I am advocating that. You might be able to get the car keys into the lock, but then you're not sober enough to drive!
Beta blockers are not fraternity bullies. Beta blockers are a class of medicines that have been shown to be very effective in reducing tremors in ET. Propranolol is most often used, but it also slows down your heartbeat, which can be a problem. Also, an asthmatic can feel like they're breathing through a straw when they're on beta blockers.
There are other options to treat and deal with essential tremors. Just don't shake your baby, don't drink too many fattening milk shakes, shake a leg, and when you meet your opponent: shake.
Got a medical question? Dr. Hook wants to hear from you!