Tremors

WHEN TO SEE YOUR DOCTOR

* You are experiencing a persistent tremor that is becoming more frequent and disruptive.

What Your Symptom Is Telling You

Singer Jerry Lee Lewis was right. There is a whole lot of shaking going on.

"We all have tremors. But most of the time they're so minor that we don't notice them," says Allan Naarden, M.D., a clinical professor of neurology at the University of Texas Southwestern Medical Center in Dallas.

A tremor is a shaking caused by involuntary contractions of muscles. They can occur in any part of the body, but usually they affect the neck, arms or hands. Most people will have noticeable tremors only if they're under stress, extremely tired, drinking excessive caffeine or taking medications that cause shaking as a side effect, Dr. Naarden says.

Some people have recurrent, serious tremors. The two most common causes are Parkinson's disease and an often-inherited disorder known as essential tremor. You can suspect essential tremor if the shaking occurs when reaching for a cup, tying a shoe or performing some other movement. Although bothersome, essential tremor isn't necessarily anything that puts your health at risk.

Other causes of persistent tremor include alcoholism, multiple sclerosis, tumor, stroke, an overactive thyroid and Wilson's disease--a rare inherited ailment that disrupts the body's metabolism of copper.

Symptom Relief

People with disabling tremors need medical and sometimes surgical treatment," says Joseph Jankovic, M.D., director of the Parkin- son's Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Houston.

Your doctor may prescribe drugs such as propranolol and primidone to control your tremors. But whether you're on medication or not, there are several ways you may be able to lessen the severity of your tremors--regardless of their cause. Here's how.

Shake the stress. If you feel tense or under stress and you find a way to relax, you may alleviate your shaking, says Erwin Mont- gomery, M.D., associate professor of neurology at the University of Arizona College of Medicine in Tucson. Biofeedback training, progressive muscle relaxation and other stress reduction techniques can help. Biofeedback involves using a monitor to help you learn how to let go of tension in your muscles. Ask your doctor to refer you to someone who can give you training. (For other methods of dealing with stress, see Anxiety on page 21.)

Stop after two. Caffeine can increase the intensity of your tremors. Limit yourself to two eight-ounce cups of coffee or Tuck in your tremor. Getting regular amounts of adequate rest may get your tremors to snooze, too, Dr. Ramseyer says. Set a reasonable bedtime and try to get the same amount of sleep each night. Most people need at least seven to eight hours a night.

Check the medicine cabinet. Over-the-counter cold and allergy medications containing decongestants like pseudoephedrine and prescription drugs such as epinephrine--a medication used to treat asthma--also can cause tremors in some people. Make a list of your medications and ask your doctor or pharmacist if any of those drugs could be contributing to your problem.

Managing Day to Day

Tremors are not easily controlled. But just because you can't control your tremors doesn't mean they have to control you. Here are a few simple forms of therapy you can do at home that may help you remain active.

Weigh it down. Wearing one- or two-pound cuff weights around your wrist or elbow when you're eating, cleaning or doing other activities may keep your tremor temporarily in check, says Anne Ford, manager of rehabilitation services at Walter O. Boswell Memorial Hospital in Sun City, Arizona. She suggests that you only wear the weights when you're doing an activity, since prolonged use of the weights can fatigue your muscles and actually worsen your tremors. The weights are available at most sporting goods stores.

Try special utensils. Extra-heavy forks, spoons and knives may make it easier to eat. You also might consider using customized plates that have a one-inch wall on one side. The wall will prevent food from sliding and make it easier to scoop up. These utensils can be ordered at most medical and surgical supply stores.

Bear down. Right before you're going to do a task, try sitting in a chair with your hands at your side. Grasp the seat or arms of the chair with your hands palm down. Then, keeping the elbows stiff, gently push your hands down against the chair for one to two minutes. "By holding in that rigid position you might fatigue the muscles and alleviate tremors for a short time," Ford says.