Dr James Le Fanu: 14 June
The sensation of fear is often associated with a tremor – which is bad news for nervous musicians as it can play havoc with their technique. The remedy, as many will know, is to take a beta blocker prior to a performance, which not only steadies the hands but minimises the sweating and palpitations associated with stage fright.
The types of tremor not brought on by anxiety are less tractable. They are not present at rest (thus distinguishing them from neurological disorders, such as Parkinson’s) but become apparent with movement. ‘My hands shake so badly when writing that I am embarrassed to do so in front of others,’ writes a reader from Surrey. ‘It is also particularly bad when pouring wine and I cannot carry a cup and saucer without rattling it.’
This is known as ‘benign essential tremor’, though its effects can be anything but benign, discouraging those afflicted from going out to restaurants and pubs. Even hand shaking can be an ordeal: a school teacher in her mid-30s reported how her hands shake so violently that men might reasonably suppose they are having a strong emotional effect on her.
This tremor is abolished by alcohol, which is clearly useful when going to a party, though a censorious neurologist once warned ‘this only too often serves as an excuse for habits of intemperance’.
Those troubled by another type of tremor have no problems when sitting or walking about but when they have to stand still – in a bus queue or at the supermarket check out – within a few seconds their legs start shaking uncontrollably and they have to lurch to regain their balance. This is known as ‘primary orthostatic tremor’ and may be misattributed to hysteria or some other psychological disorder.
This is particularly unfortunate as there is a highly effective remedy in the form of a shooting stick with a rubber tip. Whenever forced to stand in a queue, or even when doing the cooking, it is only necessary to open the seat and place one’s bottom upon it to abolish the hazard of toppling over.
THIS WEEK’S MEDICAL QUERY comes courtesy of a woman from Surrey in her early 30s troubled for the past three months with recurrent aches and pains, fevers, headaches and fatigue. The many investigations she has had include a positive test for glandular fever that her family doctor attributes to her having had the illness as a teenager. She wonders, however, whether it is possible for the virus to return or relapse and whether this may account for her symptoms.
It is indeed possible (if very rare) for the Epstein-Barr virus responsible for glandular fever to ‘reactivate’ and cause a recurrence of her symptoms – but this would not seem to be the situation here in the absence of the characteristic sore throat and swollen glands. That ‘positive’ test probably reflects, as the doctor suggests, the past episode of the illness. There must, however, be ‘something’ going on to account for the fevers and fatigue and were they to persist, it might be best to seek a specialist opinion to find out what is amiss.
drjames@lady.co.uk
The types of tremor not brought on by anxiety are less tractable. They are not present at rest (thus distinguishing them from neurological disorders, such as Parkinson’s) but become apparent with movement. ‘My hands shake so badly when writing that I am embarrassed to do so in front of others,’ writes a reader from Surrey. ‘It is also particularly bad when pouring wine and I cannot carry a cup and saucer without rattling it.’
This is known as ‘benign essential tremor’, though its effects can be anything but benign, discouraging those afflicted from going out to restaurants and pubs. Even hand shaking can be an ordeal: a school teacher in her mid-30s reported how her hands shake so violently that men might reasonably suppose they are having a strong emotional effect on her.
This tremor is abolished by alcohol, which is clearly useful when going to a party, though a censorious neurologist once warned ‘this only too often serves as an excuse for habits of intemperance’.
Those troubled by another type of tremor have no problems when sitting or walking about but when they have to stand still – in a bus queue or at the supermarket check out – within a few seconds their legs start shaking uncontrollably and they have to lurch to regain their balance. This is known as ‘primary orthostatic tremor’ and may be misattributed to hysteria or some other psychological disorder.
This is particularly unfortunate as there is a highly effective remedy in the form of a shooting stick with a rubber tip. Whenever forced to stand in a queue, or even when doing the cooking, it is only necessary to open the seat and place one’s bottom upon it to abolish the hazard of toppling over.
THIS WEEK’S MEDICAL QUERY comes courtesy of a woman from Surrey in her early 30s troubled for the past three months with recurrent aches and pains, fevers, headaches and fatigue. The many investigations she has had include a positive test for glandular fever that her family doctor attributes to her having had the illness as a teenager. She wonders, however, whether it is possible for the virus to return or relapse and whether this may account for her symptoms.
It is indeed possible (if very rare) for the Epstein-Barr virus responsible for glandular fever to ‘reactivate’ and cause a recurrence of her symptoms – but this would not seem to be the situation here in the absence of the characteristic sore throat and swollen glands. That ‘positive’ test probably reflects, as the doctor suggests, the past episode of the illness. There must, however, be ‘something’ going on to account for the fevers and fatigue and were they to persist, it might be best to seek a specialist opinion to find out what is amiss.
drjames@lady.co.uk