Text ◆ Leong Man Hock (gerontologist), “Ming Pao”
“I can’t control myself, my hands keep shaking, and even my feet are shaking. It’s really embarrassing.” Sister Liu, who is over 70 years old, trapped herself at home because her hands were shaking out of control.
Is hand tremor simply caused by age-related degeneration? Does age-related degeneration require treatment? Can hand tremors be treated?
(Hong Kong News) When Sister Liu and her husband Lao Huang walked into the clinic, I was a little surprised. I didn’t expect them to come all the way from Macau.
Sister Liu, who is in her 70s, often says that she is an authentic Macau native because she has never left Macau since she moved to Macau from Shunde with her parents at the age of 3. Friends often call her the “Master of Macau” because she can know all about Macau’s historical anecdotes, scenic spots, powerful figures, government structure, and economic system. For me, Sister Liu must be the “ground darling” of Macau cuisine.
Macau boss hasn’t sang or performed in 3 years
Sister Liu and I met at the Hong Kong and Macao Elderly Services Exchange Meeting and have been old friends for more than 10 years. Whenever I visit Macao for exchange activities, Sister Liu will always act like a host. She is warm and hospitable and will always take us to the most authentic restaurants. However, in recent years, I have not met Sister Liu in the collaborative elderly care work between Hong Kong and Macao.
The colleague who replaced her happily informed: “Sister Liu retired together with her husband! She is enjoying herself and is very happy. Sister Liu is a singer in the troupe. She performed in the community hall before and everyone clapped her hands. Dr. Liang, next time she will be there Please remember to come and support the performance!”
It is the greatest comfort to have an old friend living a prosperous retirement. So, when I saw Sister Liu, I couldn’t help but ask: “Sister Liu, how are you? Are you singing? When will there be a performance?”
Unexpectedly, before the conversation stopped, Sister Liu had already fired off a barrage of information about her current situation.
“Oh, Doctor Liang (Sister Liu always likes to call me this) asked me if I had performed! Three years! I haven’t sung a word in three years. Oh, it’s so miserable… No! It has nothing to do with the epidemic. Isolation limit During that time, I was stuck at home every day. Now that the epidemic has eased, I am in a worse mood than before. Not to mention going out to practice singing, even at home, I don’t want to say anything!”
My hands and feet were trembling when I walked on stage and I couldn’t stand steady.
“Oh, Dr. Liang, it’s not a problem with my vocal cords, it’s just that my hands are shaking and my feet are shaking! When I picked up the microphone, my hands were shaking so much. I shook it up and down and couldn’t aim it at my mouth. It was really sore. ‘. I just want a burrower! I also tried using an upright mic, but my feet just kept shaking.”
“I saw a doctor, and my family doctor recommended me to a government specialist, but I didn’t get better even after taking medicine. Alas, Dr. Liang, that’s not the key. The worst thing is that my wife and I went back to Shunde to visit relatives a while ago. We haven’t seen our relatives in three years. When we met, everyone turned out to be…sigh…”
Sister Liu’s emotions were ups and downs, and she stopped talking. I can only ask Lao Huang what happened. Lao Huang told: “Oh, it’s not a big deal, it’s just that everyone became concerned when they saw Xiaohua (Sister Liu’s nickname) and couldn’t help but greet her!”
He continued: “Oh, Xiaohua doesn’t like to hear it, but I still have to say it. In fact, I feel that Xiaohua has aged a lot since her hands started shaking two years ago; at first she only sang with the microphone in her right hand, and the shaking was more obvious. Xiaohua felt sour, so she decided not to sing and just stayed at home. But the condition got worse, she was shaking when walking and sitting. I encouraged her to walk more. After clearing customs, we went on a self-driving tour and returned to the countryside. Xiaohua walked She was so slow that she seemed unable to lift her feet and dragged her away. As soon as her brothers and sisters saw her, they naturally started to care about her. Once after eating, Xiaohua got up to go to the toilet. As soon as she turned around, she couldn’t stand upright and almost fell to the ground. Fortunately, I was alert at the time and helped her up immediately. In fact, there was another time when Xiaohua turned around and…”
Sister Liu couldn’t help but interrupt at this time: “Stop talking! The doctor said it’s degeneration. Doctor Liang, can the geriatric specialist treat degeneration? Can hand tremors be cured?”
Strokes, tumors, brain degeneration can also cause hand tremors
These are all good questions. What exactly does the scope of geriatric medicine include? Can age-related degeneration be cured? Does it require medical treatment? At the moment, it is difficult to explain everything clearly, or start with simple questions first.
There are many causes of hand tremors, the most common of which are physiological and psychological influences. Whenever people of any age are nervous, their hands will shake unexpectedly. This is a natural phenomenon. However, if your hand tremors become more frequent as you get older, it may be related to genetics, and people in the family may also have similar problems. However, this type of hand tremor is generally not serious and does not affect other body functions. If the patient feels embarrassed and cannot bear it, he or she can ask the doctor to prescribe medication to reduce the tremors.
Another physiological cause of hand tremors is hyperthyroidism. Patients are usually women between their teens and 30s. My wife also got sick when she was 30 years old. At that time, she was carrying a pot to pour tea, and it was all over the table. She was picking up vegetables with chopsticks, picking up one item and dropping another. Only then did she realize that her hands were shaking violently. After examination, it was confirmed that she had hyperthyroidism.
If the disease occurs in the elderly, the proportion of male and female patients is roughly the same, with no more females than males. Moreover, the symptoms are not as obvious as those of younger patients, and blood tests are often required to diagnose the disease. Hyperthyroidism is a treatable disease. If an elderly person notices symptoms of hand tremors, it is best to get checked out as soon as possible.
Of course, more serious diseases such as stroke, tumor, brain degeneration, etc. may also cause hand tremor symptoms. However, in addition to hand tremors, patients often have other symptoms that affect the functioning of the cerebellum, such as slurred speech, unsteady walking, etc., and rarely only present the single symptom of hand tremors.
Mistaken for old and infirmdelay in treatment
If the elderly experience symptoms such as hand tremors, slow movements, and muscle stiffness at the same time, they must not ignore Parkinson’s disease.
Parkinson’s disease is a common neurological disease among the elderly.
The age of onset is generally after 50 to 60 years old.
The causes can be divided into primary and induced, with primary accounting for the majority. The cause has not yet been unanimously determined.
Currently the only recognized factors are:
Reduced dopamine, a neurotransmitter, leads to impaired nervous system function.
As for induced Parkinson’s disease,
Causes may include long-term use of certain medications (such as anti-sickness pills),
Caused by brain trauma, encephalitis, multiple strokes, etc.
Patients around 50 years old are more likely to notice symptoms if they occur.
If you are older, symptoms are often mistaken for old age, frailty and slow movement.
If the patient does not mention it and the family does not notice it, treatment will often be delayed. The patient suffered from sequelae and became permanently immobile and even bedridden. Therefore, Parkinson’s disease should never be ignored.
“Doctor Liang! If you say so, do I suffer from Parkinson’s disease?” Sister Liu couldn’t help but ask.
I answered frankly: “The odds are high.”
The early symptoms of Parkinson’s disease are often preceded by hand tremors, which are more obvious on one side of the body. According to Lao Huang’s description, she also had a similar situation. Although she still has no major problems with her mobility, the danger of falling when she turned around twice is consistent with the later stages of the disease.
“To diagnose Parkinson’s disease, one must make inferences from the patient’s symptoms and medical records, and then confirm it with clinical examination, including movement speed, stability of starting and turning, resting and increasing hand tremors, muscle tightness, and changes in handwriting. , hoarseness of voice, etc. We can also use positron scanning to determine the status of dopamine in the brain.”
“Oh, Dr. Liang, if Xiaohua is really diagnosed with Parkinson’s disease, will she become dementia sooner or later?” Huang asked desperately.
Self-discontinuation of medication leads to recurrence of illness
“Of course not! Although Parkinson’s disease is also a degenerative disease, its pathology is different from that of Alzheimer’s disease. Most patients with Parkinson’s disease can maintain normal thinking, and their cognitive abilities are not much different from those of people of the same age. Although there is currently no cure method for Parkinson’s disease, but medication can effectively control symptoms. Generally, after taking medication, patients’ ability to move will improve, their tremors will lessen, and their daily life problems will also decrease.”
“However, medication needs to be taken for a long time, and discontinuing it on its own will cause the condition to relapse. In addition, physical therapy can enhance the patient’s mobility and reduce the risk of falls. As long as the patient follows a personalized rehabilitation exercise plan designed by the therapist, he or she will generally improve their muscles, muscles, and muscles. There have been improvements in joints, gait, transfer movements, and even skills in using walkers. Of course, there will be follow-up with occupational therapy and psychological counseling. At this stage, sister Liu must be examined before further treatment plans can be decided.”
Preliminary examination showed obvious indicators, and it was confirmed that Sister Liu suffered from Parkinson’s disease. The medicine also had an immediate effect and the condition was quickly relieved. I wrote a referral letter in the hope that she would receive follow-up treatment after returning to Macau. I firmly believe that with appropriate exercise training, Sister Liu’s muscles can be relieved and she can return to her normal life soon.
Sure enough, 6 months later, I had received an invitation: “Dr. Liang, I will hold a singing performance at the Macau Arena next month. I sincerely invite you and your wife to come with you. I have made a reservation at your favorite restaurant. We have a seat. You must come then!”
Now that Sister Liu is back after a long break, I want to go to Macau to support her!
New generation bracket with high durability
Question 1. How durable is the stent used in surgery?
Answer 1.With today’s technology, the quality of stents has been greatly improved. The stents currently used are drug eluting stents. The long-lasting and effective drug properties can prevent the stents from narrowing. Compared with the first generation stents, their materials are It is also relatively thin and light. In addition, patients control all risk factors, and its durability is quite high.
In theory, angioplasty has the same long-lasting results as heart bypass surgery, but the latter is slightly better. If a 35-year-old patient does not take care of his or her health as a young patient, blockage problems may still occur at the age of 60.
Some patients, in particular, require special stents. These patients may need a drug balloon to deliver drugs to the artery, a procedure used to treat smaller arteries. In complex arterial angioplasty, multiple stents are required. In order to avoid the implantation of more stents, the above method is used. But this depends on whether the patient is suitable.
90% of patients are discharged from hospital on the second day
Question 2. How long does it take to recover from complex coronary angioplasty?
Answer 2.Angioplasty is not an open surgery. Therefore, as long as the doctor plans and arranges carefully before the operation and the patient’s kidney function remains normal, the patient can generally be discharged from the hospital within 24 to 48 hours after the operation. Even with complex arterioplasty procedures, I will discharge the patient the next day if excessive contrast is not used.
Unless you are a kidney patient or have a long operation, you will need to stay in the hospital for two to three days for observation. 80 to 90% of patients go home the day after surgery. The recovery speed is also very fast, and you can return to normal life in about a week.