Tremors

He’s lived with the tremor for thirty years, since he was twenty-six. In those thirty years he has consulted several physicians. Whether he ever received any medication is an unanswered question. His attitude seems to be stoic, with the assumption that medicine has little to offer him. The tremor rocks his head back and forth. When he brings his chin to his chest the movement stops, and he can raise his head slowly before it resumes.

He’s convinced the agent that he used to clean jet engines, a supreme degreaser, is the cause. A toxic overdose from submerging his upper body in the solvent, on a regular basis, he believes is the culprit. Whether he is right or not is immaterial. The tremor haunts him, unrelenting. Sometimes while he lies in bed he feels his body shaking inside.

The doctor is certain he doesn’t suffer from Parkinson’s disease. His facial muscles are expressive, mobile. Actions are fluid. There is no slowness to him, if anything he does things quicker than normal. His voice is full volume, without hesitation. The tremor encompasses both hands.

On physical examination the muscles surrounding his joints are supple, his eye movements are normal, dexterity not compromised, though he complains his handwriting has degenerated. The doctor asks him to copy a spiral winding out from a point inside. The pen in his hand makes regular jolts as the tremor moves his hand. It’s the work of someone who has essential tremor. The same regular movement that made Katherine Hepburn’s head shake and voice waver.

An electrical engineer, he has the tenacity to draw his work at the computer. To accomplish this, he needs to subdue the tremor. He overcomes the tremor by pushing firmly downward. After three hours or so, his entire arm is aching.

Clearly, he’s ready for a change. The doctor prescribes Inderal, a beta blocker. He asks the patient to begin with one pill for three days then escalate to two pills for three days, than add the third pill for three days. After several weeks he’s to switch to a single pill of 60mg, that is a long-acting. The doctor asks him to call him in a month and report on his status, rather than give him another appointment. In the meantime, he requests a blood test, to look for heavy metal toxicity and an MRI of the brain, with contrast to rule out other more noxious diagnoses.

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