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Showing posts with label treatment plan. Show all posts
Showing posts with label treatment plan. Show all posts

Friday, September 29, 2017

Essential Tremor

Two months ago, I began shaking in my hands and would eventually have my legs give out, and spasm. It is terrifying, since I do not know what is causing it. I do not think it was a cause of hypoglycemia, because I would have this shaking before without hypoglycemia. I do not know if it related to gastroparesis or not, since the vagus nerve is damaged or even dehydration, or malnutrition. A friend suggested it was an essential tremor, so I wanted to do some research on it.



This is what happens to me:

http://www.youtube.com/watch?v=Y_PsBOodlB0&feature=youtu.be





According to the Mayo Clinic (http://www.mayoclinic.org/diseases-conditions/essential-tremor/home/ovc-20177826),

"Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces.

It's usually not a dangerous condition, but essential tremor typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although it's sometimes confused with Parkinson's disease.

Essential tremor can occur at any age but is most common in people age 40 and older.


Essential tremor signs and symptoms:

Begin gradually, usually on one side of the body
Worsen with movement
Usually occur in the hands first, affecting one hand or both hands
Can include a "yes-yes" or "no-no" motion of the head
May be aggravated by emotional stress, fatigue, caffeine or temperature extremes
Essential tremor vs. Parkinson's disease



Many people associate tremors with Parkinson's disease, but the two conditions differ in key ways:

Timing of tremors. Essential tremor of the hands usually occurs when you use your hands. Tremors from Parkinson's disease are most prominent when your hands are at your sides or resting in your lap.

Associated conditions. Essential tremor doesn't cause other health problems, but Parkinson's disease is associated with stooped posture, slow movement and shuffling gait. However, people with essential tremor sometimes develop other neurological signs and symptoms, such as an unsteady gait (ataxia).

Parts of body affected. Essential tremor mainly involves your hands, head and voice. Parkinson's disease tremors usually start in your hands, and can affect your legs, chin and other parts of your body.



Causes

About half of essential tremor cases appear to result from a genetic mutation, although a specific gene hasn't been identified. This form is referred to as familial tremor. It isn't clear what causes essential tremor in people without a known genetic mutation.



Risk factors

Illustration showing autosomal dominant inheritance pattern
Autosomal dominant inheritance pattern


Known risk factors for essential tremor include:

Genetic mutation. The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. A defective gene from just one parent is needed to pass on the condition.

If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.

Age. Essential tremor is more common in people age 40 and older.



Complications

Essential tremor isn't life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to:

Hold a cup or glass without spilling
Eat normally
Put on makeup or shave
Talk, if your voice box or tongue is affected
Write legibly



Treatment


Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your doctor.



Medications

Beta blockers. Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in some people. Beta blockers may not be an option if you have asthma or certain heart problems. Side effects may include fatigue, lightheadedness or heart problems.

Anti-seizure medications. Epilepsy drugs, such as primidone (Mysoline), may be effective in people who don't respond to beta blockers. Other medications that might be prescribed include gabapentin (Gralise, Neurontin) and topiramate (Topamax, Qudexy XR). Side effects include drowsiness and nausea, which usually disappear within a short time.

Tranquilizers. Doctors may use drugs such as alprazolam (Xanax) and clonazepam (Klonopin) to treat people for whom tension or anxiety worsens tremors. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.
OnabotulinumtoxinA (Botox) injections. Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.

However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If it's used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.



Therapy

Doctors might suggest physical or occupational therapy. Physical therapists can teach you exercises to improve your muscle strength, control and coordination.

Occupational therapists can help you adapt to living with essential tremor. Therapists might suggest adaptive devices to reduce the effect of tremors on your daily activities, including:

Heavier glasses and utensils
Wrist weights
Wider, heavier writing tools, such as wide-grip pens




Surgery


Deep brain stimulation might be an option if your tremors are severely disabling and you don't respond to medications.

In deep brain stimulation, doctors insert a long, thin electrical probe into the portion of your brain that causes your tremors (thalamus). A wire from the probe runs under your skin to a pacemaker-like device (neurostimulator) implanted in your chest. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.

Side effects of surgery can include equipment malfunction; problems with motor control, speech or balance; headaches; and weakness. Side effects often go away after some time or adjustment of the device."



According to WebMD (http://www.webmd.com/brain/essential-tremor-basics#1),

"Essential Tremor (ET) is a nerve disorder characterized by uncontrollable shaking, or 'tremors,' in different parts and on different sides of the body. Areas affected often include the hands, arms, head, larynx (voice box), tongue, and chin. The lower body is rarely affected.

ET is not a life-threatening disorder, unless it prevents a person from caring for him or herself. Most people are able to live normal lives with this condition -- although they may find everyday activities like eating, dressing, or writing difficult. It is only when the tremors become severe that they actually cause disability.



What Causes Essential Tremor?

The true cause of Essential Tremor is still not understood, but it is thought that the abnormal electrical brain activity that causes tremor is processed through the thalamus. The thalamus is a structure deep in the brain that coordinates and controls muscle activity.

Genetics is responsible for causing ET in half of all people with the condition. A child born to a parent with ET will have up to a 50% chance of inheriting the responsible gene, but may never actually experience symptoms. Although ET is more common in the elderly -- and symptoms become more pronounced with age -- it is not a part of the natural aging process."


According to the National Institute of Neurological Disorders and Stroke (https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet),


"What is tremor?

Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or happen as a result of another disorder.

Tremor is most common among middle-aged and older adults, although it can occur at any age. The disorder generally affects men and women equally.

Tremor is not life threatening. However, it can be embarrassing and even disabling, making it difficult or even impossible to perform work and daily life tasks.



What causes tremor?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. Most types of tremor have no known cause, although there are some forms that appear to be inherited and run in families.

Tremor can occur on its own or be a symptom associated with a number of neurological disorders, including:

multiple sclerosis
stroke
traumatic brain injury
neurodegenerative diseases that affect parts of the brain (e.g., Parkinson's disease).


Some other known causes can include:

the use of certain medicines (particular asthma medication, amphetamines, caffeine, corticosteroids, and drugs used for certain psychiatric and neurological disorders)
alcohol abuse or withdrawal
mercury poisoning
overactive thyroid
liver or kidney failure
anxiety or panic.


What are the symptoms of tremor?


Symptoms of tremor may include:

a rhythmic shaking in the hands, arms, head, legs, or torso
shaky voice
difficulty writing or drawing
problems holding and controlling utensils, such as a spoon.
Some tremor may be triggered by or become worse during times of stress or strong emotion, when an individual is physically exhausted, or when a person is in certain postures or makes certain movements."



Image Credit: http://lawrencechen.net/media/blogs/main/ET-factsheet-1.jpg?mtime=1330613603


According to LIVESTRONG (http://www.livestrong.com/article/533883-nutritional-deficiency-and-shaking/),

"Muscle shaking, also called essential tremor or muscle fasciculation, is an uncontrollable twitching of your muscles. Muscle shaking is most noticeable in the hands, but also occurs around the neck, eyes and legs. Muscle shaking and tremors are more common among the elderly and sometimes related to senility diseases, such as Parkinson’s and Alzheimer’s disease. Nutritional deficiency is a common cause of abnormal muscle tone and may lead to chronic shaking or twitching of your muscles. Consult with your doctor if your notice that you are unable to keep your hands steady.



Hypoglycemia

Hypoglycemia is defined as low blood sugar, which refers to the amount of glucose circulating in your bloodstream. Glucose is the primary fuel for your brain and needed by virtually all tissues to produce energy. Skipping meals is the most common cause of hypoglycemia, although it also occurs in diabetics who take too much insulin. A primary symptom of hypoglycemia is widespread muscle tremors and weakness, although other common symptoms include 'brain fog,' confusion, fatigue and lethargy, according to the book 'Functional Biochemistry in Health and Disease.' Eating refined carbohydrates or drinking fruit juice often quickly resolves muscle shaking caused by hypoglycemia.



B-Vitamin Deficiency

B-vitamins are needed by your body for metabolism, energy production, nerve function and conductance, enzyme synthesis and red blood cell production. B-vitamins are quickly depleted by stress, toxins and alcoholism, and deficiencies are common in people with poor diets and malabsorption issues, according to 'Metabolic Regulation: A Human Perspective.' B-vitamins most often linked to muscle shakiness because of their importance to nerve function include B-1 or thiamine, B-6 or pyridoxine and B-12 or cobalamin. Deficiencies in these vitamins invariably affect brain function and lead to other neurological problems such as reduced cognition, depression, numbness and tingling in the limbs and loss of balance. Red meat, chicken, fish, beans, nuts and green leafy vegetables are all good sources of B-vitamins.



Magnesium Deficiency

Minerals are also important for nerve function and normal muscle tone. Magnesium is especially important for the relaxation of muscles. Early symptoms of magnesium deficiency can include fatigue, irritability, insomnia and muscle tremors, twitching or shaking, according to 'Functional Biochemistry in Health and Disease.' Prolonged deficiency affects the electrical waves in your brain, heart and skeletal muscles and may be related to chronic muscle cramping and restless leg syndrome. If magnesium deficiency is the cause of your muscle shaking, then magnesium supplementation can lead to dramatic improvement within hours to days.



Dehydration and Electrolyte Imbalance

Dehydration occurs from not drinking enough water or quickly losing too much water from excessive urination, diarrhea or blood loss. Water loss is accompanied by loss of electrolytes such as potassium and sodium, which are salts of the body needed for normal muscle control and nerve function. An early sign of dehydration is muscle shaking or tremors, but muscle cramping, irregular heart beat, fatigue and reduced brain function can quickly follow if your body is not replenished with water and electrolytes. Drinking water devoid of minerals and electrolytes is not enough to return a severely dehydrated person back to health."



So, I guess it does occur during hypoglycemia, dehydration, vitamin deficiencies, or malnutrition. I love to learn new things and never heard of ET before.

Special thanks to my friend, Joette, for helping me and inspiring this article.



Wednesday, May 22, 2013

Regular GI Doctor Visit & Treatment Plan

The Follow Up Visit & Mayo Recommendations

Today, I found enough anger and determination to wage war in the doctor's office if he wouldn't listen to me or try to help me. I don't want to be written off by anymore doctors. So, I printed out the picture of before and after me, proving weight loss (picture below). I also brought the relaxation techniques that the Mayo psychologist gave me and explained what the Mayo doctor said about anxiety being the root of my problems.

I was able to show him all of my documents (I brought blog entries that he read too), including my weight loss:


The top picture is from 2011 and the bottom picture is from a week ago.

My GI doctor started laughing and told me that I had been on Celexa and Xanax for the past year and a half that he's been treating me along the way and he never witnessed me acting out of the ordinary, only being ill. He knows that I've been treated for and I've been managing my anxiety because he has the records, and like I said before, I've been under his care since he diagnosed me last year (March). Additionally, he read my blog entries that I brought and I told him that writing has always helped me overcome overwhelming things. I told him my blog had 19,000 views and he told me that was impressive. I explained that I document tests because there's not many resources online about them. He agreed with me and told me I was doing an excellent job.

After all of that, the GI told me that he doesn't think anxiety is the issue. He laughed at that diagnosis. Then, he stopped laughing and told me that doctor probably said that because he didn't know how to treat me and didn't want to deal with me anymore. Sadly, I think he's right. He apologized for sending me there. He said that he really thought I would receive treatment there since the Mayo Clinic has a reputation for having the best specialists for GI/GP issues.

He said to me that I will have to deal with this illness the rest of my life. I honestly was hoping to hear some good news about treatments. I know there's not a cure, but there has to be something they can do to decrease the nausea and vomiting so that I can get my life back.


I told my GI about my Mayo test THE pH PROBE. When I told him the results of that test, he was just floored. He was just sitting there in shock for a moment. Telling your GI that over a period of 24 hours that you had 56 recorded episodes, 44 of them vomit ... will bring strange looks to their faces. He gave me a look of pity and condolence all at the same time.


The Mayo doctor recommended a CHRONIC LIVER TEST as well as a PELVIC FLOOR TEST. The Mayo Doctors recommended exercise as well, cardio for 30 minutes. If I could exercise like I want to, I would be hiking. I told the doctor about my horse riding lesson planned for Thursday and he thought that was good enough exercise for now. I'm also doing yoga but it's hard to do when you're really nauseated all of the time. One of my fraternity brothers wants to take Yoga classes with me. I'm going to search around for beginning lessons somewhere so that we can go together. She'll be my motivation to kick my butt when I'm sickest to go. Yoga has always relaxed me. I used to take it at my previous college before because our student fees paid for it - so it was completely free to us. At my current college, you have to pay for it - but I'd rather pay to take it somewhere else. I told my GI doctor that I was worried about vomiting during a yoga session. This lead to the stomach surgery conversation.

My regular GI doctor asked about the status of the NISSEN FLUDOPLICATION. I told him that Mayo refused to do the surgery because I'm vomiting too frequently and too violently, that I would undo the surgery.

The Mayo doctor recommended for me to follow up with my regular GI doctor for extra tests. He wanted me to have a CHRONIC LIVER DISEASE and PELVIC FLOOR TESTING.




My Current Symptoms

I told him about my newest symptoms which include, but not limited to:

*Stumbling around while walking but no dizziness.

*Having blackouts of entire days that I don't remember. For example, I can remember Saturday but I have to look up what I did other days on Facebook.

*Dehydration.

*Cannot urinate unless I bear down really hard.

*Having issues sleeping because of frequent vomiting.

*Vitamin deficiencies in vitamin B-12, vitamin C, and vitamin D. All of the levels are extremely low.

NOTE: Vitamin B-12 injections are on back order.

*Seeing black spot.

*Becoming hypoglycemic because nothing stays down.

*In a LOT of pain - blood pressure is still high. The nurse said my heart was racing.

*Friday, my blood pressure was 184/93.

*I'm immune to acid reflux medications.





The Treatment Plan

My regular GI doctor didn't think the chronic liver test was an issue and refused to put me through it. He also gave me a B-12 injection in house, which helped my energy level a lot. He said that confusion, disorientation, memory loss, and all of those symptoms were from vitamin deficiencies and malnourishment.

Next, I talked to him about BOTOX THROUGH ENDOSCOPY. He agreed that was worth a try, and I'm scheduled for Botox on June 12th!

He is sending me to a pain management specialist to deal with my GP. He said there are pain patches and things they can give me since I have issues keeping food/liquids down.

He is also going to follow up on the Mayo doctor's recommendation of Pelvic Floor Testing.

Additionally, he is also going to schedule an appointment for me to get TRIGGER POINT INJECTIONS. I have had these done for my back my by my spinal cord stimulator. I didn't realize how tight the muscles were until they injected all of the trigger points. My muscles relaxed instantaneously. Every doctor makes up the trigger point cocktail differently, I learned through my stimulator doctor. Usually, it's lidocaine (numbing medicine), cortisone (steroid for inflammation), and some sort of muscle relaxer. It will definitely help some of the muscles I've hurt while vomiting in my abdomen.

The GI also said that if the symptoms I was having progress (seeing spots, etc), that I need to see a neurologist. I agree with that and will follow up after I give the B-12 a chance.