Congressional Briefing May 7, 2014

On Wednesday, May 7, we conducted a briefing to staff members of both houses of Congress. A representative from NIH also attended. The speakers were (1) Claudia Testa, MD, PhD, Associate Professor of Neurology, Virginia Commonwealth University, Associate Director of Clinical Research, VCU’s Parkinson’s & Movement Disorder Center, Joan Massey Chair in Clinical Parkinson’s Disease, (2) Sara Donaldson and Prudy Bradley, sisters with Essential Tremor (ET) that are part of a family in which all 12 siblings have or had ET, (3) Soren Lowell, PhD Assistant Professor, Department of Communication Sciences & Disorders, Syracuse University, and (4) myself.

Dr. Testa provided an overview of Essential Tremor (1) what its are effects – the problems its causes for those who have it, (2) what is known about ET, and (3) what we can do to help those with ET. Prudy and Sara then got up. Sara’s voice tremor is so bad, she can’t speak (she has a pen & pad of paper with her all the time). As a result, Prudy spoke for both of them and related how ET had impacted the quality of their lives. Dr. Lowell is currently conducting a study, funded by NIH, on the impact of Octanoic Acid on Voice Tremor caused by ET. I concluded the presentation by relating how I was fired from a senior management position as a direct result of my voice tremor.

There was real interest on the part of those who attended. A number stayed afterwards to learn more about Essential Tremor.

Peter Muller
Executive Director
HopeNET

Shaking On Capitol Hill

April 2, 2014 — A handful of members from the Essential Tremor Support Group that meets monthly at Leisure World in Silver Spring made a trip to Capitol Hill to meet with Congressman Chris Van Hollen’s Legislative Assistant for Healthcare, Erika Appel, to discuss concerns over quality of life for people with Essential Tremor, a neurological condition.

E.T. can present with hand tremors, voice tremors, loss of voice, head tremors, and leg tremors. Prudy of Ashburn attended with her sister, Sara, of Derwood, in order to speak for Sara who cannot talk because of the condition. Sara began having a wavering voice years ago and as the condition progressed she lost her voice completely and faces not only social isolation but real danger from not being able to communicate. Another attendee was Thom who came with his wife Mary so she could speak to how it is for a family member supporting the person with E.T. Thom had Deep Brain Stimulation, brain surgery that involves a pacemaker placed below the neck that helps control the electrical signals and calm the tremor. Unfortunately for Thom, the electrical wire placed in the brain is close enough to the speech center to have impaired his speech which is slurred as a result. Charley, another member, lost his job last December when he was asked to take early retirement and suspects that his tremor may be in part to blame since he was an ESOL teacher who taught writing, which is of course quite difficult when your writing is illegible from the tremor. And lastly I attended, a 50 year old woman, and experience like many others the anxiety-like physical and psychological effects of the tremor and its negative impact on work and social life. As the condition progressively gets worse, I fear for my future in terms of unemployment [my excessive shaking at job interviews does not likely help me get the job] and disability [since the tremor is not bad at all times, I certainly would not qualify for disability, but in situations such as job interviews it is truly a disability].

Prudy spoke and gave some perspective on E.T. in the U.S. She recollected statistics from several years ago that approximately 1 million people have Parkinson’s Disease whereas E.T. affects about 10 million. Most in our group think people with the condition do not know they have it and attribute their symptoms to anxiety or nerves. It has been well-established that having an alcoholic drink helps many with this condition, that the octanol in alcohol helps diminish the tremor for a short time, and NIH has conducted research studies to isolate the octanoic acid from alcohol for use in pill form. These studies are years old, and there is frustration among this group that development of pharmaceutical octanoic acid is stalled. While there is the newer focused ultrasound treatment, and Sara mentioned she thought there were 9000 on the waiting list, we lamented over the lack of knowledge among neurologists about our condition, and about the complete lack of development of any drug specifically made to treat E.T. The few medicines that are prescribed were developed decades ago for other conditions like high blood pressure and epilepsy and happened to alleviate the tremor for only some people. It was encouraging that Erika Appel wanted to look into the condition further and wondered why a drug had not been developed if there is a market of so many people who have the condition.

The next thing for HopeNET is the May 7th congressional briefing on E.T. sponsored by Congressman Moran’s office.

Lisa Gannon, Silver Spring Support Group Member

Personal Stories – Doris, age 77

Her age of onset was in her early 40’s. She tremored in both hands and after some time it seemed to go away but then came back in her head and then in her hands again. She was diagnosed in her late 40’s by a neurologist and sought a second opinion from a doctor at Johns Hopkins. She remembers the neurologist noting she complained of migraines, he asked if she drank coffee and was told she needed to wean herself off caffeine to see some improvement.

Doris’ son has ET and he had the exact same experience of it going away and coming back that his mom did. He is a welder by profession and feels the tremors when he puts his heavy helmet on. When Doris was in her mid-50’s she went to Hopkins because the ET started to worsen. It took her 6 months to get an appointment with a particular doctor. She started Propranolol at a low dose which worked but was depressed as a side effect, so she stopped. She tried Topamax and Mysoline, but both were not a good fit for her. Mysoline made her “out of it” and confused so she stopped. Doris is not taking anything now for her ET but does have Propranolol to take if she anticipates a stressful situation … such as an experience where her head shook badly when she went to make a presentation to the county about a building being constructed.

She has some Dystonia in her neck as was diagnosed with this movement disorder a few years ago. Because of the way her muscles contract she always sits on the right side near the back when people are assembled so she can look left and won’t distract people. It does not bother her that people look at her and her shaking, she’s gotten used to it. There have been occasions however when she has been asked something and she said ‘yes’ but her head was shaking ‘no’.

No one in her mother’s or father’s family that she knows of has ET. Her son however met his grandfather’s sister’s great granddaughter for lunch with Doris and they discovered this relative has it herself.

At an ET support group meeting she heard that if you have 4 kids (and Doris has 4 kids), 2 of them will probably have ET and as for the two that don’t have it, their kids will probably not have it either. Doris feels this supposition was dispelled when she met a couple in her support group who have one daughter with ET and one without it and the one without ET has kids who have ET.

Doris moved into her house 47 years ago and there was a problem with crickets in the basement, so she put down the pesticide Chlordane around the perimeter of the house. What she knew about Chlordane was that it stays .. you will probably never have termites [or in this case, crickets]. Chlordane has since lost approval for use in part because of its effects on the nervous system. She remembers the Chlordane splashing onto her Keds tennis shoes and that her kids slept in a bedroom in the basement; she wonders if it could have been a factor in the development of her ET and that of her children.

She has had balance issues in the last four years and goes to the pool for exercise. Her tremor occurs while she is carrying something, not afterwards, and also anytime there is an uncomfortable stress. Her tremor is constant whereas her daughter’s is more episodic and comes and goes away.

See also:

Charley
Sheila

Dale
Doris
Deb

Essential Tremor briefing date changed to May 7, 2014

The Essential Tremor briefing to Congress has changed. It will now be held in the late afternoon on May 7. Please contact your local Congressional office and encourage someone from that office to attend.

Find your representative: http://www.house.gov/representatives/find/

Find your senator: http://www.senate.gov/general/contact_information/senators_cfm.cfm

Meetings with the Legislative Assistants for Healthcare for Representative Eric Cantor & Senator Tim Kaine and members of Essential Tremor support groups in Richmond & Falls Church, Va. on January 24, 2014

We first met with Molly Newcomb, the Legislative Assistant for Representative Cantor. She stressed the Congressman’s support for health-related research. She also said that he was particularly interested in helping children. She said that financial commitments for the foreseeable future must be weighed against the overall fiscal picture in respect to the federal deficit. The personal stories told by each in the group, vis-à-vis, impact on quality of life, anxiety, social avoidance, etc., were well received by Molly. She seemed genuinely sympathetic to the plight of ET sufferers.

We next met with Kristen Molloy, the Legislative Assistant for Senator Kaine. I was surprisingly impressed with Kristen’s grasp and use of clinical nomenclature with respect to health care issues. She too was receptive to the life-experience stories shared by the group, and the occupational challenges that ET imposes. She agreed completely with the notion that ET, as with other conditions, needs to be examined/researched from a holistic vantage point. I genuinely believe that Kristen will continue to be a very sympathetic ear.

Michael McChord                                                                                           Falls Church Essential Tremor Support Group

Meetings with the Legislative Assistants for Healthcare for Representative Eric Cantor & Senator Tim Kaine and members of Essential Tremor support groups in Richmond & Falls Church, Va. on January 24, 2014

We first met with Molly Newcomb, the Legislative Assistant for Representative Cantor. She stressed the Congressman’s support for health-related research. She also said that he was particularly interested in helping children. She said that financial commitments for the foreseeable future must be weighed against the overall fiscal picture in respect to the federal deficit. The personal stories told by each in the group, vis-à-vis, impact on quality of life, anxiety, social avoidance, etc., were well received by Molly. She seemed genuinely sympathetic to the plight of ET sufferers.

We next met with Kristen Molloy, the Legislative Assistant for Senator Kaine. I was surprisingly impressed with Kristen’s grasp and use of clinical nomenclature with respect to health care issues. She too was receptive to the life-experience stories shared by the group, and the occupational challenges that ET imposes. She agreed completely with the notion that ET, as with other conditions, needs to be examined/researched from a holistic vantage point. I genuinely believe that Kristen will continue to be a very sympathetic ear.

Michael McChord                                                                                           Falls Church Essential Tremor Support Group

Congressional Briefing March 18, 2014

Today I received confirmation of the briefing we will make to Congress on Essential Tremor. It will be held on Tuesday, March 18. The speakers will be Dr. Fatta Nahab of the University of California, San Diego, Dr. Soren Lowell of Syracuse University and two sisters who have ET, one of whom has a very severe case.

This will obviously be a very important event. Please contact your Congressman and/or Senator and urge them or a member of their staff to attend.

Peter Muller
Executive Director
HopeNet

Find your representative: http://www.house.gov/representatives/find/

Find your senator: http://www.senate.gov/general/contact_information/senators_cfm.cfm

Personal Stories – Dale, age 52

Dale’s symptoms started around age 40 when he noticed a tremor when his hands were in motion. It was initially sporadic and he would shake more at times than at other times. By his late 40s the tremor had become worse, he noticed his fingers would tremor, and he believed anxiety and caffeine made it worse, but not always. His left hand was worse than the right. In Dale’s family his father had essential tremor and his sister has it mildly.

Dale saw a neurologist for a diagnosis at the age of 42 and was told it was benign essential familial tremor and it was nothing to worry about health-wise but it could be a nuisance. He was prescribed Primidone which did not work for him. Since then, for 8-9 years, he has been taking Propranolol. He was also prescribed medicine for anxiety which runs in his mother’s family and takes Clonoxopan as needed (hasn’t taken it for a couple of years).

He does not think his ET was a result of any trauma and does not have other movement disorders, but he did experience a softball injury and underwent surgery, had scarring, and then years later a seizure which indicated abnormal electrical activity, but he was told this was not related to his ET. He has no unexplained symptoms that could relate to ET.

Dale does get self-conscious and embarrassed when others see his tremor and while they might be understanding of the condition, they wonder if the shaking means he is nervous. He says his writing is a scribble. He’s been told exercise can help and alcohol can help but knows alcohol is not the solution. He experiences frustration but not depression, counting himself fortunate to look at the bright side of life.

He wonders why there aren’t medicines that really work .. the Propranolol he takes does not work completely.

Interviewed by Lisa Gannon
Silver Spring, MD Support Group Member

Other personal stories:
Charley
Sheila

Dale
Doris
Deb

Personal Stories – Charley, age 63

His onset of essential tremor symptoms was at 12 years old when he noticed he fumbled. His ET got bad quickly, he doesn’t know how extreme it was but certainly he cannot hold peas on a fork. His left hand is worse than his right but fortunately he is right-handed. As a teen and in college years he was an actor and was typecast as a drunk or anything that involved a spastic character. In later years, the past 5-6 years, his voice is quivering when he sings. One thing he found interesting is that he has to urinate frequently in the middle of the night , saw a urologist for this symptom and the urologist thinks it has a neurological cause and is related to the tremor.  He has been on Primidone but has also tried other things like Resveratrol which is naturally found in red wine. He found some red wines would work better like the sweet ones. Also, a shot of a mixed drink will work for a short time to alleviate the tremor.

Around 1990, Charley’s occupation was a house painter and one of his customers was a neurologist who termed Charley’s tremor “familial benign essential tremor”. Up to this time, Charley said there was no name that he knew of for the condition. Mentally the ET has had no real effect on him whereas emotionally at times he gets so frustrated that, as a teacher, he has avoided going to the teachers lounge to eat. He says to his new students as a way of introduction and explanation about his shaking that he’s not afraid of them, that he has this condition.

He shakes more when he knows he has to do something very dexterous (whether by himself or with others). The tremor is enhanced around others. Recently, at his third son’s wedding, he was convinced by others to take a few shots of alcohol beforehand since he knew he would be singing and speaking. As a result he was fine and not effected by tremors at the wedding. When Charley works out at the gym, if he works out like a bandit someone will come over, both during and after, and ask if he’s okay. Other times he notices the tremor is when he writes checks .. they are not legible and has had his signature rejected because it did not match.

In terms of what Charley has tried to alleviate the tremors, he took advice from a Hungarian doctor who focused on ketones in the body, and tried a long-term fast where he had nothing for 3 days, then water for 3 days, then raw fruit juice mixed with oil. He went as long as 48 days fasting. He also used Pat Robertson’s weight loss drink that he adapted for himself. He noticed that after maybe 7 days of fasting he lost his tremor.

For 19 years he has worked in the county school system and recently someone wanted to meet with him for accommodations, to make available a mobility device you can speak into which will automatically write what you say.

In Charley’s family, his mother-in-law had ET and wife’s sister’s son has ET and Parkinson’s Disease.

Interviewed by Lisa Gannon
Silver Spring, MD Support Group Member

Other personal stories:
Charley
Sheila

Dale
Doris
Deb

Personal Stories – Sheila, age 70

We are starting a new series of personal stories of people’s experiences with Essential Tremor, generally including age of onset, symptoms, neurologist’s diagnosis, medicine prescribed, alternative therapies tried, how people respond to their ET, how ET affects them mentally and emotionally, coping, and family history of ET.   The individuals interviewed below are from ET support groups.

Sheila, age 70
Sheila’s tremor started with a couple of episodes while living in Korea around 2006. She went to the emergency room – they did an EEG but symptoms had gone away by the time the doctor saw her.  She remembers trying to sleep and feeling the tremor start, without knowing why.  Seems when she gets urinary tract infections, it triggers the tremor. If she gets busy in the morning and can’t find time to eat, the tremor gets better. She saw a neurologist for the first time in 2010, and Propranolol was prescribed. Besides Propranolol she has had other prescriptions but has taken nothing that she’s been comfortable with.  She gets angry about the tremors sometimes wondering, “why is this happening to me” and feels sorry for herself. Her hands started trembling first then her lip started trembling … emotions  such as those caused by relationship conflict are a trigger for a tremor episode. She takes Clonazapam, prescribed for depression she attributes to the tremor.

Less than a year ago she was diagnosed with Parkinson’s and started taking medicine for that. She also takes Zanax which was prescribed for anxiety related to the tremor, and it is the only medicine that really has helped her tremor. She feels she’s been around the mulberry bush several times with doctors trying to see if something will work.

None of her friends or family has acted adversely to her tremor.

Next week’s story – Charley

Interviewed by Lisa Gannon
Silver Spring, MD Support Group Member

Other personal stories:
Charley
Sheila
Dale
Doris
Deb