What can I do to stop my hands shaking?
MY PROBLEM is that my hand has shaken since childhood. Whenever I try to work, it starts shaking. Is there any treatment for this?
Prakash Sharma, by email.
SHAkY hands is a symptom of what is technically known as a tremor . Most people have some degree of tremor — you can see this if you hold a piece of paper in your hands: it will flutter very slightly. This is entirely normal.
But when it is more severe — and gradually gets worse over time — it is known as essential tremor. I believe this is your diagnosis.
essential tremor is sometimes known as familial tremor if the patient has a history of the condition in their family . The condition affects up to 5 per cent of people and is typically seen in hands and arms, though some people may find their head, trunk and legs shake, too.
The important point is that the condition will not lead to any other neurological symptoms. However, you do need to understand this is a lifelong problem — there is no cure.
If the tremor is mild and does not cause any real disability, then treatment is not crucial. But when the tremor is so severe as to be disabling , drug treatment can help minimise the extent of the movements.
For those who find stressful situations — such as performing in public — cause the tremor to get worse temporarily, it can help to take medication ahead of the event.
Typically, we prescribe propranolol primidone. P ropranolol is a beta blocker, which works by blocking the action of the hormones adrenaline and noradrenaline on muscle fibres.
Primidone is an anticonvulsant, thought to work by calming the nerve supply to muscles, as well as having an action in the brain.
Clinical studies have found each of these to be effective. In one study , the use of propranolol at a daily dose of 260mg reduced the extent of tremor by an average 35 per cent.
Some people may find that small amounts of alcohol reduce or abolish their tremor.
However,
this is not a suitable regular treatment — over time, increasingly larger amounts are needed to achieve the same effect.
This raises the risk of addiction and liver damage, as well as interfering with work and the ability to drive.
If a patient opts for continuous drug treatment, the tremor may worsen again after months or years. In this case, there are other options, including gabapentin and topiram - ate, which are anticonvulsants.
However, I would advise that a decision to move to this type of drug therapy should be guided by expert advice from a neurologist who has experience in the treatment of movement disorders as it is beyond the experience of most GPs. AFTER a routine visit to the optician, I was referred to an ophthalmic clinic where a series of tests was carried out, including having dye and drops in my eye.
The doctor then said that they would need to do a check every three months as I had freckles behind my eyes. To say I was dumbfounded is an understatement as the only freckles I have ever heard of are on the skin.
My GP did not know what they are or whether they are serious. Can you shed any light on this? I am 73.
Mrs Margaret Lomas, by email. THe term ‘freckle’ is not a medical word. It is not a diagnosis, but merely a label you have been given to describe one or more pigmented spots that were seen during an examination of the retina — the light-sensitive layer of cells at the back of the eye.
Pigmented cells on the retina are normal. However, these pigmented cells can move out of place and grow, like moles on the skin.
when they are found on the choroid — a blood vessel- enriched layer between the retina and the sclera, the tough outer wall of the eyeball — they are known as choroidal naevi (a naevus is the medical term for a mole).
About 5 to 10 per cent of Caucasian people have choroidal naevi — they are probably present from birth, but grow larger over time.
Let me reassure you that they are not an eye disease in themselves, and pose no threat to your vision. But on rare occasions they can turn cancerous, and this is why it is important to identify them and keep them under observation.
Your eye specialist will continue to monitor them, comparing them with baseline photographs that will have been taken at a previous appointment and looking out for any changes. If the appearance remains stable for the next year or two, the three or six monthly reviews will probably be replaced by an annual check-up.
It is unclear from your letter , and maybe you have not been informed, but it would be interesting to know the number of freckles and whether they are in both eyes.
There is a condition called dysplastic naevus syndrome, used to describe people who have many large and atypical moles on their skin.
Atypical moles are those that are benign but which do have some characteristics of malignant melanomas, such as asymmetry , irregular borders and multiple colours.
These people may be more prone to choroidal naevi, and often have several of them. But you have made no mention of your skin, therefore, I assume that this diagnosis does not apply to you. AFTER a gastroscopy last summer, I was told I had Barrett’s oesophagus. Right away I thought ‘cancer’. I have had acid reflux for five years and a hiatus hernia. I am 80.
Name and address withheld. I SeNSe the anxiety that the diagnosis has caused you, but let me reassure you that you ’re not in great danger of cancer .A gastroscopy is where a thin, flexible tube is used to look at the inside of the oesophagus and/or stomach.
The tube has a camera and can also remove tiny bites of the lining for examination.
Barrett’s oesophagus is where the cells that line the lower part of the gullet change, following repetitive damage from stomach acid.
These changes seem to be a defence mechanism to protect the delicate lining of the oesophagus. The concern is that these changed cells can be a precursor to cancer.
THe
aim of treatment is to control the acid reflux, stop - ping the damage caused by stomach acid. F or this reason, as you say in your longer letter, you are quite rightly prescribed lansoprazole every day , supple - mented by ranitidine at night, which reduce the amount of acid produced by the stomach.
You might also consider avoiding foods that can worsen reflux: fatty foods, alcohol, peppermint, chocolate and excessive tea and coffee. T ry eating your evening meal at least two hours before bedtime and avoid lying down after meals.
Your worry is cancerous change. But if this does occur it is gradual. only five out of every 100 people with the condition will develop cancer each year. You will have a further gastroscopy within the first year.
The worst-case scenario is that you could have early pre - cancerous changes, though it’s unlikely.
Your task is to take the medication and remember that progression to cancer is uncommon.