Dear Readers,

Paul G. is a 32-year-old bus driver in Kingston who is worried because of a tremor in his hands. He confides that he has always had a small tremor, which used to show when he was writing - for he doesn't have good handwriting - but his mother told him the doctors said this was due to her prolonged birth labour with him affecting part of his brain.

He has noticed recently that the tremor seems to be worsening. A doctor told him that he is undergoing some stress, which is causing the problem. Paul asks Lifeline if it really is stress causing his problem or if it could be some further problem in his brain.

There are a whole lot of different causes of hand tremor, some of which are self-inflicted and others which occur because of disease in the brain and body or due to "nerves".

Tremors refer to abnormal movements of the body, often affecting the hands, but can affect the head and other body parts. Some tremors are present at rest and lessen with activity, and others are just the opposite! A brain disease, Parkinson's disease, seen often in older people, although it occurs occasionally in young adults, causes a REST tremor. Other tremors occur when an effort is made to move the hand such as familial intention tremor, an overactive thyroid gland, and stress (fear).

Sometimes a mild tremor can be accentuated by stressful situations, chronic anxiety, fear, anger, or even joy. Intense emotions can be associated with tremors of the body!

Tremors are best evaluated by a specialist - a neurologist; however, the appearance of the tremor can help identify the cause.

Tremors that occur at rest: Often seen in Parkinson's disease, which mostly occurs in older people and is due to a deterioration of cells in an area in the brain called the "substantia nigra". Here, the hand will shake worse while in the lap than when moved to use it. This pattern of shaking can also occur when a person is taking certain medications such as anti-nausea medications and many used to treat more serious nervous disorders. Usually, further medication is available to counteract this side effect.

Tremors that seem worse when the hands are held out in the air or used to hold a cup. This can be due to an inherited tremor or an overactive thyroid gland. Some medications used for the treatment of asthma and seizure disorder can cause this also.

Tremors that occur when the hand approaches a target and can be due to injury of the cerebellum in the brain.

Where an underlying cause is determined and can be corrected, then the tremor will resolve.

Treatment may still be available even when the cause of the tremor is not determined. However, in these situations the neurologist should be consulted either privately or at the neurology clinics held in the larger regional hospitals.

Some tremors are reduced with the use of medications such as beta blockers or Gabapentine (Neurontin). These drugs are available only by prescription, and only a doctor can decide if this will be useful.

People with anxiety and stress who have tremors will find that anxiety-reducing medications will help to decrease or eliminate the tremors.

If the tremor is not thought to be serious, then it only really needs treatment if it is interfering with the person's functional abilities or causes undue distress.

Some lifestyle changes that can be made to help eliminate tremors are:

Eliminate Caffeine from the diet totally.

Stop cigarette smoking. Nicotine is a cause of shaky hands.

Reduce or eliminate alcohol. Alcohol consumption can cause serious tremor.

Check all medications being taken. Several medications can cause tremors and can be adjusted to reduce tremors.

Check blood sugar levels. Low blood sugar can cause shaky hands.

Reduce stress levels with meditation and relaxing activities.

Get enough sleep. Sleep deprivation is a cause of shakiness and hand tremors.

Include more vitamin supplements in the diet. Vitamins B12, B1, B6, and Vitamin E help maintain healthy nerves.

Prevent electrolyte imbalances. Magnesium deficiency can result in muscle spasms and tremors. Potassium also controls the activity of muscle and nerve cells.

Low calcium levels can cause tremors and shakiness.

If tremors persist, even after making the changes listed above then see your doctor for a check-up.

Write to:

Lifeline,

PO Box1731,

KGN 8

AJM

Itching before period

Dear Counsellor:

For some time now, I have been having intense itching before my period. My tummy hurts badly during and after the period. I also have a smelly discharge. I wonder if that could be a disease. My husband is a wild man, but I tell him to use condoms when he goes 'outside'. Can you tell me what could be the cause for the itching and discharge?

Concerned Wife

Dear Concerned Wife:

From what you describe it is highly possible that you may have contracted a sexually transmitted infection (STI). You need to visit a doctor immediately to be correctly diagnosed and treated.

If you are diagnosed with an STI, your husband and all other partners must be treated so that the infection can be controlled and reinfection prevented. You may also want to consider using condom whenever you have sex. You must take personal responsibility for protecting yourself. You cannot guarantee that your husband is using condoms when he has sex 'outside'. Let your health be your responsibility.

For more information on condom use, HIV/AIDS, and other sexually transmitted infections, call the AIDS/STD Helpline toll free at 1888-991-4444.