Monday, June 29, 2015

What Causes Shaky Hands?

Tremor is an unintentional, rhythmic muscle movement, most often affecting the hands.  In some cases, tremor can be a sign of a neurological disease but the most common type of tremor occurs in otherwise healthy people.  Today's Health Tip will focus on this common type of tremor, known as "essential tremor".

Causes for tremor – There are a variety of causes for tremor, some serious, but most relatively benign or temporary. Neurological diseases including multiple sclerosis, Parkinson's disease, and stroke are some of the most serious causes. A number of drugs including amphetamines, corticosteroids, anti-depressants, thyroid replacement, and asthma medication can produce tremors.  While the exact cause for essential tremor is still being studied, there is some suggestion that it is related to mild degeneration of an area of the brain (cerebellum).
What does tremor look like?  Essential tremor is most likely to be noticed affecting the hands, but the head, voice, and arms may also be involved. The shaking involves small, to-and-fro movements which may not be noticed when the hands are at rest. A quivering sound to the voice may be present if the tremor affects the voice box.  Essential tremor is considered to be an "intention" or action-related tremor because it becomes worse with purposeful movements such as eating with a fork or reaching for a cup of coffee.  Some tremors, such as the one associated with Parkinson's disease, are more noticeable when muscles are relaxed.  In Parkinson's the tremor almost exclusively affects the hands or fingers and is known as a "resting tremor".
Is there a test for essential tremor? There is no specific test for diagnosing essential tremor.  For the most part the diagnosis is made by noting the characteristic movements and ruling out other potential causes.  Essential tremor occurs most commonly in middle-aged and older individuals. As a hereditary condition, there is a 50% chance that someone will develop essential tremor if one of their parents had the condition.  The possibility that the tremor could be due to a medication, excessive caffeine intake, nicotine stimulation or alcohol abuse should be considered.  Specific testing may be required if a medical condition such as an overactive thyroid, Parkinson's disease or multiple sclerosis is suspected. This could include blood tests and imaging studies of the brain, such as MRI scan.  With essential tremor, however, all of these tests would be normal.

How is essential tremor treated?  There is no cure for essential tremor.  So long as the tremor does not cause embarrassment or interfere with daily activity, no treatment is required.  For the most part, the condition can be managed with self-care measures such as:
  • Avoiding caffeine or other stimulants
  • Using Velcro fasteners for clothing instead of buttons
  • Using large handled utensils when eating
  • Using straws for drinking
  • Wearing slip-on shoes instead of lace-ups
Should the symptoms worsen to the point that treatment is required, there are medications as well as surgical procedures that may help.  The beta blocker, propranolol and an anti-seizure medication, primidone, have shown some benefit in essential tremor. Surgery is reserved for severe cases of tremor that cannot be controlled with drugs or other measures.  Surgical procedures include deep brain stimulation (DBS) and thalamotomy.   DBS involves the use of implantable electrodes to send high-frequency electrical signals to the thalamus, the region of the brain where the tremor originates. During thalamotomy, the site of origin in the thalamus is destroyed with a heated electrode.  Other causes of tremor respond to treatment of the underlying condition. For example, if an overactive thyroid is responsible for the tremor, treatment to reduce the level of thyroid hormone in the bloodstream will help.  When medications are responsible, stopping or substituting the medication is effective.

Anyone with the recent or sudden development of shakiness should discuss this with their doctor.  In all likelihood it will turn out to be relatively benign, such as essential tremor or simply too much caffeine.  Since a tremor could represent something more serious, such as Parkinson's disease, it important to confirm the exact diagnosis as early as possible.

Friday, June 19, 2015

Dodging Restaurant "Calorie-Bombs"

A restaurant dining survey performed by the market research group, Living Social, found that the average American eats out on 4.8 occasions each week.  Nearly half of these respondents described themselves as "meat lovers," 22 percent said that they had a "sweet tooth," and 19 percent were self-described "fast food junkies". With the common tendency that many of us have to overdo it or splurge when it comes to eating, we need to be especially careful when eating in restaurants.  While restaurants happily cater to our “guilty pleasures”, they seem to be less concerned about our waistlines and general health.  The following are several “traps” that we can allow ourselves to become ensnared in when eating out.  
  1. Beware the starters.  Eating bread or tortilla chips while waiting for your food to arrive can add hundreds of calories to your meal.  Sensible options are to ask the server to bring these items after your meal arrives, or take a piece of bread or a handful of chips and ask the waiter to remove them from the table. Don’t forget also that each tablespoon of butter (3 pats) spread on bread adds up to 100 calories.
  2. Calorie-dense side dishes.  French fries or onion rings are often an automatic choice when the server asks for a choice of side dishes. As compared to a baked potato, however, two-ounces of French fries pack a hefty 174 calories while the same amount of baked potato has around 52. A baked potato can be a sensible alternative, but adding sour cream, cheese, or butter can turn this very reasonable side dish into a calorie bomb!   Instead of French fries, onion rings, or potatoes smothered in butter or gravy, consider lower fat sides like tossed salad, vegetables, or broth-based soup.
  3. “Hidden calories” in beverages.  Can you imagine eating 8 to 9 teaspoons of sugar?  That’s the amount contained in 12 ounces of most soft drinks. When sugar is dissolved in soft drinks, however, it becomes much more palatable, as well as being dangerous to our waistlines. Alcoholic beverages are high in calories, too. The caloric content of most beer is in the 100 to 160 range for 12 ounces. By drinking water, unsweetened tea, or diet beverages these hidden calories can be avoided.
  4. All salads are not created equal.  Salads can be a healthy choice, but those with high fat dressings, fried chicken tenders on top, or cheese and bacon bits can be just as calorie dense as the main course.  When eating out always order the dressing on the side. While olive oil/vinegar based dressings do contain fat and calories, they are generally healthier than creamy dressings.
  5. Portion size out of control.  Over the years, the restaurant industry has increased the size of portions to coincide with the increasing American appetite. Just look at the options to “supersize” meals at many fast-food restaurants for just pennies more. One restaurant chain offers a twenty-four ounce steak which is the amount that most dieticians would recommended for six people!  Ask the server beforehand about portion size. If possible share an entrĂ©e or plan to take some of the meal home for a second meal.  And at all costs, avoid all-you-can-eat restaurants that simply encourage gluttony.
  6.  “Meal-killer” desserts.  A sensible meal can be turned into a calorie-fest based on what and how much we choose to eat for dessert. Most large desserts contain between 500 and 1,000 calories. Amazingly, the Ultimate Red Velvet Cake Cheesecake from the Cheesecake Factory is reported to contain 1,540 calories and 59 grams of saturated fat!  Usually a post-meal sweet-tooth can be satisfied with a bite or two of a dessert shared among several people. Or, choose a lower calorie option like fresh fruit or a scoop of sorbet.
Everyone splurges from time to time, and an occasional indulgence is nothing to be ashamed of.  But with more and more people eating out, along with the calorie-packed dishes that are typical on restaurant menus, it makes sense to be careful about what you order. Calories and weight gain are only part of the concern.  The same foods that contribute to waistline expansion often contain higher amounts of sodium and saturated fat, both of which can contribute to heart disease and stroke.

Monday, June 15, 2015

Everyone Worries, but When Does Worry Constitute a Disease?

Everyone worries or feels anxious from time to time.  Financial issues, conflicts faced at work, problems with relationships--- these are just a few of the events that can bring about anxiety.  In prehistoric humans worry, or its more exaggerated counterpart, fear, may have even provided some benefits. Triggering the “fight or flight” response activated mental and physical responses developed to address threats to survival.
Most people experience what could be called “normal worry”.  This type of worry is relatively brief and doesn’t interfere with work, relationships, or other activities of life.  One study found that people may experience this type of worry for up to 55 minutes a day. This is in contrast to someone who has an anxiety disorder in which worry can be present for several hours a day.  Anxiety disorders are characterized by excessive or irrational worry, usually present for several months or years.  Millions of people in the United States are estimated to be affected by an anxiety disorder.

One of the most common anxiety disorders is called Generalized Anxiety Disorder (GAD).  People with GAD obsess over their concerns, even though they may recognize that these concerns are out of proportion to reality.  GAD may also be associated with physical symptoms such as rapid heart rate, sweating, dizziness, headaches, shaking, shortness of breath, lightheadedness, and difficulty swallowing.

The exact cause of GAD is not fully known, but has been linked to a number of factors including brain chemistry, heredity, and precipitating stressful events.  Additionally, using or withdrawing from addictive substances such as alcohol, nicotine or opiates can contribute to the development of GAD.

There is no specific test to diagnose GAD.  Health providers make the diagnosis based on symptoms and physical manifestations.  Often, a physical exam or laboratory tests are required to rule out other conditions that can cause anxiety-like symptoms. Excessive thyroid hormone (hyperthyroidism), asthma, and the heart condition supraventricular tachycardia are three medical conditions that can produce similar symptoms as those seen in GAD.
Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy, also known as “talk” therapy.  The most common drugs used to treat GAD are in the anti-depressant or anti-anxiety classes of medications.  Anti-anxiety medications (e.g. Xanax, Valium, Ativan, others) are typically only used short-term because of their potential for causing sedation, adverse side effects when mixed with other drugs, and addiction.

Cognitive-behavioral therapy (CBT) is delivered by a mental health professional over several sessions. Major goals of CBT are to help someone with GAD to understand the relationship between thoughts, behaviors, and symptoms as well as to gain control of distorted views of stress-provoking events.  Many people with GAD also benefit from joining a self-help or support group in which problems and successes are shared with others.

Factors that should steer someone toward receiving professional help are when excessive anxiety or worry:
  • Interferes with work, relationships or social activities
  • Lasts for several months,  seems overwhelming or uncontrollable
  • Causes physical symptoms such as dizziness, rapid breathing or racing heartbeat
  • Produces psychological symptoms such as sleep disturbance, irritability, or problems concentrating.
  • Begins without an obvious cause  
“Do not anticipate trouble, or worry about what may never happen. Keep in the sunlight.” ― Benjamin Franklin