By Dr Martin Scurr Editor
For the past three months, I have experienced a shaking right hand on occasions. My left hand is fine. I’m using a wrist support at night but it doesn’t seem to make a difference. People are starting to notice the tremor. What could be causing it? I’m 77 and reasonably fit.
Kay Thornton, Watford.
Dr Martin Scurr replies: There are multiple causes of tremor – the most common is essential tremor. This is a neurological disorder which typically affects the hands – but the head and body may also be involved – and while it’s not in itself dangerous, it does tend to get worse over time.
It can affect any age, but it typically occurs after the age of 40, though the cause is not clear.
Medication to help manage the symptoms is essentially aimed at calming down the nervous system and includes drugs such as beta-blockers or gabapentin.
Medication can also cause tremor and you mention in your longer letter that you are on the antidepressant sertraline, which can, albeit in rare circumstances, be a trigger.
However, a drug-induced tremor is unlikely to involve only one hand – plus, you say you’ve been taking that drug without side-effects for a long time.
Another possible cause of a tremor is Parkinson’s disease. In this case it often starts on one side, in the hand or at the wrist and the tremor improves with movement.
One thing to note is that loss of smell, or anosmia, can occur even years before a tremor is observed in Parkinson’s.
About 90 per cent of people with Parkinson’s experience some degree of this – although I note you don’t mention issues with smell.
My advice is that you must discuss the symptoms with your GP, perhaps requesting referral to a neurologist for an expert opinion.
When I last used hormone replacement therapy (HRT) aged 50, I had terrible depression and weight gain and had to come off it. Now my doctor has recommended using an oestrogen vaginal gel to combat poor urine flow. Should I try it again?
Name and address supplied.
Dr Martin Scurr replies: In a word, yes! Your GP has given you exactly the advice that I would have given.
You say in your longer letter that you are experiencing poor urine flow, meaning it takes a long time to empty the bladder.
Oestrogen, applied locally, helps improve the health of the tissue in the area and so improve flow. (Tissue changes related to the drop in oestrogen can result in the urethra – the tube which drains from the bladder – kinking to some degree.)
HRT can cause the side-effects you describe and, in your longer letter, you say this was the case – even when you switched to a locally-applied vaginal oestrogen gel.
However, your experience is surprising – I have never seen this in my own practice – and it may be that the preparations you used in the past contained preservatives or stabilising agents that you were particularly sensitive to.
Despite your previous adverse experience, I urge you to try an oestrogen gel again because if it’s successful and side-effect free, it’s likely to make a considerable difference.
If I’m wrong – and you do suffer an adverse reaction – then at least you can cease applications.
Perhaps it might be sensible to ask your GP to start you at a low dose, given your understandable concerns.