essential tremors and surgery

[jot]

howdy,

a bit of background:
i was hit by a car 2 summers ago (don't worry, not a sob story ahead). it was funny cause i was on a bike i had bought about 45 minutes before (an awesome trek - no more) and was on the sidewalk, by some kid in a new camaro. hah wait that isn't funny - anyway because of that i got "essential tremors" (thats what the docs say at least) - the only long-term problem - so my hands shake quite a bit if i'm emotionally stressed (doesn't take much to trigger) or trying to concentrate on keeping my hands still (convenient). they said if i managed to lead a stress free life for the next 3 years or so they might go away (not bloody likely), but i have managed to control them mentally pretty well over a few years. i also take beta-blockers for 'em if i really want them still (they do calm down), but i avoid taking pills like the plague

so question:
i wanted to do surgery since forever and a day (before i knew what it entailed) but since then i figured it was out of the question, cause hell, i wouldn't want to be under my own knife. but i recently found out about a neurosurgeon with turret's syndrome that manages to control it during surgery (but it gets really bad once he "releases" control). are super steady hands a hardcore requirement (one would assume they are)? if i suck it up and take beta-blockers every 12 hours or whatever while on call, would it be feasible? since then i found something else i would really like to do, but wondered if it was still out of the question, and wanted to ask People Who Know. thanks.
-jot

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[CUarzt]

i apologize for not having the answer to your question and instead asking another...
im quite curious about this neurosurgeon to whom you refer. i dont want verification that he exists--i believe you--but im really interested in hearing his story.

as per your 'dilemma,' i would think that this ns would be proof of hope.

as a patient, i dont think id want a man with tourettes pokin' at my parietal lobe. following, i would assume that his patients are aware of this. if not, id think he had the moral responsibility to divest his syndrome.

once again, if the orig poster could shoot this guy's name my direction i'd be more than grateful....

just my $.02

 

[Samoa]

Propranolol 10mg before surgery will take care of an essential tremor.

 

[Rads]

Do what you want to do and don't worry about a tremor, people have done surgery with worse. If it really presents a problem and is bothering you, then you may want to go on long term beta blocker therapy. Otherwise, go for surgery you'll be fine.

 

[dr.evil]

I'll be starting my surgery internship in about 4 days and I can tell you that many of us going into surgery get shaky hands "when we're emotionally stressed or trying to concentrate on keeping our hands still". Anecdote ahead: When I was a 3rd year, the chief resident was letting me do a ton of a big belly case. I was very comfortable around him and could have threaded a needle with outstretched arms. THEN, the attending came in, made a comment about a 3rd year performing surgery, but instructed me to keep going as I was. Suddenly from nowhere I had the tremor from hell and I knew this guy intimidated me. The attending then smugly said, "NURSE, QUIT SHAKING THE ROOM!" That sucked bad.

Anyway, you can still do surg with a tremor, especially one controlled with beta blockers.

BTW, that attending wrote me a glowing letter of recommendation!

 

[BME02]

I have talked with a neurologist about this problem. There are many anti-anxiety drugs that work for people with essential or familial tremors. Not necessarily because the tremors are from anxiety, but the drugs seem to work. It depends on the severity of the tremors and your ability to control them. There is no reason to not pursue surgery.

 

[jot]

hey thanks - i automatically discounted it in my frosh year because of the tremors, and just thought about it again though i'm pretty set on the md/phd route. it really gives me something to think about though. i've mentally controlled them to not shake at rest anymore, but when my muscles are fatigued (its always a pain pippetting into gels!) or i'm stressed it flares up. i know i'd be fine with beta-blockers, but it seems ... unatural ... to be dependent on them all the time. what if one is on rounds for 30 hours straight or someting (hah i know that isn't supposed to happen anymore), and it wears off? seems risky. hmm - definately something to think about though, at least for the sake of satiating a childhood dream. thanks.
-jot

 

[CUarzt]

jot--id appreciate if you could give me the name of the nsurg to whom you're referring; i'd enjoy hearing his story.

if you dont know, please let me know...

 

[jot]

hey sorry i didn't respond - i heard it from a 1st year at upenn med - so maybe he works at CHUP, but i don't know his name. i will try to find out, i'm not sure if they advertise that sort of thing on a webpage though. will try to find out.-jot

 

[eagle26]

This topic is very interesting, cause it's somewhat relevant to me. I have a neuromuscular condition that sometimes causes problems. For the past few years, I have had numb fingertips. I have trouble with heat and cold as well as pinprick sensation. I'm a bit worried about being able to palpate. I'm pretty sure I can adapt, it's just one of those nerveracking things. I've already decided against being a surgeon due to the dexterity problems and my loss of sensation, but unlike the OP, surgery was never my passion in medicine. I have talked to someone who was disabled who happened to be a damn good ER physician. He gave me words of encouragement. If you want to go into surgery, don't let anything stop you. It may be more of an uphill battle, but you can do it. Keep the faith.

 

[Dr Sardonicus]

I forget his name, but I think I heard of the neurosurgeon you are referring to.

I think he was profiled in a book by Dr. Oliver Sacks entitled "An Anthropologist on Mars."

 

[CUarzt]

jot and dr sardonicus--i thank you both for the references.

 

[Nightengale]

Hi. I just found the SDN because I followed a (now defunct) link to a forum for medical students with disabilites.

I see its been over a year since anyone posted in this thread, but it's worth a try, right?

I'm a first year medical student and I have a tremor as well as a dystonia related to handwriting and similar activities. I am NOT considering surgery. I use a computer to type notes in class and almost any other time I need to write more than a few sentences at a time.

Anyway I was glad to find this thread and to know that I'm not the only medical student out there with less than 100% hands. The general sense I'm getting here is that my situation is something of a novelty and that I'm being a trailblazer.

I really should study anatomy now or I won't be any kind of med student anywhere.

Nightengale

 

[Neuronix]

A neurosurgeon with turett's here and I haven't met him yet? Strangeness. Anyways, you know you want to join the MD/PhD neurosurg fold jot.

(PS: It's CHOP, not CHUP... They actually aren't a part of Penn)

 

[Jamaican MD]

Jot, this is a great post. . .I also have a benign tremor, that is not extremely noticeable, but it does become VERY obvious when I'm nervous or stressed or under the influence of caffeine. My neurologist and I have tried many drugs, but nothing seems to work.

When I saw him last, I told him that I'm worried about applying/getting into medical school. I don't want to freak anyone out because I'm shaking. I know I'll be nervouse during the interview process, and I'll be sitting there just shaking away!

I'm a tech, and once, I was assisting a surgical resident putting in a chest tube. I was holding an amp of lidocaine, and as she insrted the needle, my hand started shaking. I was MORTIFIED! She just said, "Are you afraid I'm gonna stick you?" and chuckled, and I laughed too, so it made me feel a lil better. . .

I too am interested in surgery, but I always say, I'm to "shaky" to be a surgeon. But, I truly believe in mind over matter, and hopefully with drugs or concentration or prayer, I can eventually control my tremors.

Good Luck

 

[Habari]

heh - i completely forgot i made posts like this a year and many lessons about anonymity ago . nevertheless - i'm in med school now [in an md/phd program] - and still get the tremors occasionally. i know what triggers them [caffiene, distress, eustress, emotional spikes ...], and have learned how to ignore the tremors or eliminate the triggers for the most part [paying attention to the shaking excaserbates the problem in many cases] so i feel like i could manage to get through a surgery rotation. the problems arise when i'm learning something for the first time, and someone is watching [the basic set up of the rotation]; but i'm learning control them during that as well.

i've found that trying to thread a needle with time pressure simulates this to some degree and allows one to try and control the tremors - which has substantially reduced them.

finally a major change in the way i handle stress made the biggest difference. i was a little type A when i entered college - but this 'problem' necessitated changing that asap. it's certainly made med school much more palatable. i can honestly say that i have never been stressed by anything medschool has thrown at me, nor can i forsee anything until the clinics [i'm too unfamiliar to say].

dunno if that is helpful - hope things work out.

 

[dknykid1980]

just out of curiosity....especially since i'm learning about this in pharm right now...

how does propranolol or any beta blocker help your 'tremor' situation??

I understand that propranolol is a non-selective beta blocker, thus it'll dec tachycardia, lipolysis, myocard contraction..it'll also vasoconst and inc TPR (I'm assuming the reduced blood flow to the hands from the inc vasoconst and TPR is what's going to help this guys situation ???) or is it the general dec in CO and sorta hypotensive feeling that'll help him ????

-just curious

 

[carrigallen]

Originally posted by Habari
heh - i completely forgot i made posts like this a year and many lessons about anonymity ago .

Is this why you took down your website???? It sucks now, just mdphd stuff.

What lessons in anonymity did u learn...did several SDN girls start stalking you?

 

[DW]

Originally posted by carrigallen
What lessons in anonymity did u learn...did several SDN girls start stalking you?

well.....i dont know about stalking......

 

[Jamaican MD]

I have a question for you guys:

Since I have this tremor, is it something that I should "warn" interviewers at the start of an interview, or should I not mention it at all, and just shake away??

Jot, what did you do when you were applying?

 

[Nightengale]

I can't speak for interviews, because my tremor only appears after my dystonia, when I've been using my hands to write or hold things for awhile but I generally tell people up front. It did come up at my interviews because I typed the MCAT examination, so my score gets flagged as a "non-standard administration.

That's one reason I joined this thread - I'm curious if and what others tell people when they notice - people being interviewers, professors, classmates? I'm always torn between thinking that my hands are my business and my quest to educate the public (including and especially medical people - my last PCP had never heard of "handwriting dystonia," for instance.) For me, educating the public generally wins, especially as I have done some general disability advocacy as well.

At an interview, if you don't mention something obvious it can become the elephant in the room that no one talks about. So I guess my opinion is that a brief, self-assured explanation will show that you are more than dealing with your sitation, and will enable the interview to move onto other areas.

Nightengale