Tuesday, February 22, 2011

Operation - Where your the doctor

As a kid, I enjoyed playing the game Operation where you were the doctor. When Leah's teacher brought up her concerns with her minor shake, my husband said that he had a little shake and it really never bothered him, except when it came to playing the game Operation. He never did well when he played the game. Then, he mentioned that his grandfather had a shake and I asked is that why he became a mortician instead of a doctor or a surgeon?

What ever his grandfather's reasons for his career profession, our ET journey began the night of the parent-teacher conference. Although, we may not have realized it. The teacher's mention of our daughter's shake and the discovery of my husband's shake (that I really had never noticed before) gave us some pause. Then, the busy holidays began. My husband's lack of concern and his experience with this unexplained shake made me overlook my initial concerns.

A few weeks later, Leah's teacher asked me if I ever had Leah's shake checked out. With a bit of surprise, I said no. Since her father had it, I thought it was an inherited trait. This would later prove somewhat true as ET is inherited (Autosomal Dominant inheritance) but is categorized as a disorder. Mrs. Sarah's concern and her description of recent challenges Leah had faced that week with her writing made me make an appointment with the doctor. A bout of croup made the appointment occur later that day.

After a discussion about croup, I explained to the pediatrician Mrs. Sarah's concerns with her shake. After asking about Leah's family history, her father's shake and whether he had Parkinson's disease in the family, he began testing her. She was not the most cooperative. Actually, it was quite chaotic with Leah playing with her twin brother while we tried to discuss a diagnosis.  "Could it simply be an inherited family trait?" I asked. His response was less than reassuring as he explained she likely had Intention Tremor and handed me a referral to a pediatric neurologist. We had an appointment a week later.

A quick internet search of Intention Tremor provided plenty of concerns including M.S., brain lesions and brain cancer. At an appointment with the pediatric neurologist, she provided us with ET as the diagnosis, which was chronicled in the first Color Outside the Lines post. Yet, the neurologist explained that due to her age and the shake's presence at such an early age, Leah's case may progress at a faster pace or become more severe with age. Yet, essential tremor is not uncommon among children: 5% of new ET cases arise during childhood (Louis et al., 2005). With children, especially young children, it is easy to overlook, dismiss or simply rationalize the shaky writing as immature or undeveloped writing skills.

Simple activities can be challenging for my daughter. After a long day this weekend, playing with friends, eating too many treats and being exhausted from a long day, Leah tried to put the toothpaste on the toothbrush by herself. Her little hand shook from side to side (more vigorously than usual) as she attempted to aim, stop the shake and push the button to release the toothpaste. The combination of being tired, eating sweets, and attempting a new activity that required concentration was too much for her to control her tremor but she did not give up. I simply offered to do it for her. As she gets older, she may not be as receptive to help from her mother. Two days later, she would put the toothpaste on herself. Nothing will stop this little girl's determination.

Diet and tremor are not necessarily linked to tremor triggers, and yet, our neurologist stated that being tired and/or being sick would make her tremor worse. Also, the neurologist stated that the more a person tries to concentrate, the worse the tremor can be. We have noticed this to be true. When Leah writes new letters and numbers, the tremor is triggered. For the letters she has practiced, the tremor is less pronounced.

Interesting research lends hope for children like Leah. For now, Leah's tremor is manageable and her teacher is amazing, understanding and proactive. At times, you cannot even tell that she has any disorder at all. Katherine Hepburn never let her tremor bother her and in fact, it became a legendary aspect of her persona.

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