The annoying tremor that makes it hard to drink coffee, write your name clearly, or put on makeup. The shame of having a hand that shakes and you can't control. These are things that almost 10 million Americans with Essential Tremor (ET) have to deal with every day. There is no cure for this common movement disorder, but there are treatments that can help lessen the tremor and make your life better. Finding the right therapy, on the other hand, takes time and a personalized approach. This is where the Direct Primary Care (DPC) model comes in as a great partner.
Essential tremor is the most common movement disorder in the world. It is a neurological disorder that causes rhythmic shaking when a person moves on purpose.
Essential Tremor's Main Symptoms:
It is an action tremor, which means that it is most noticeable when you are trying to do something with your hands, like writing, eating, or holding a glass.
It usually makes the hands and arms shake, but it can also make the head shake (a "yes-yes" or "no-no" motion) or the voice shake.
A little bit of alcohol often makes it better for a short time.
This is not Parkinson's disease. ET is much more common than Parkinson's and doesn't cause other neurological symptoms like stiffness, slowness of movement, or a tremor when at rest.
The Purpose of Management: The goal is not to get rid of the tremor, but to make it less severe so that you can do more things and have a better quality of life.
Direct Primary Care (DPC) is a membership-based model that lets patients talk to their doctor whenever they want. The DPC model changes the game for people with chronic conditions like ET, where managing medications requires careful, slow changes. Here's why DPC is the best way to deal with your tremor:
A correct diagnosis and a plan that works for you:
Your DPC doctor has the time to get the right diagnosis right away.
A Full Neurological Exam: DPC's long, relaxed appointments give your doctor the time to get a full history and do a thorough neurological exam that will help them tell the difference between ET and Parkinson's disease or other, less common causes of tremor.
Eliminating Other Possible Causes: They can quickly check for and rule out other possible causes, such as an overactive thyroid gland or a side effect of another drug.
Careful, high-touch medication management:
This is where DPC really shines for ET.
The "Start Low, Go Slow" Method: Propranolol (a beta-blocker) and primidone (an anti-seizure drug) are the first-line drugs for ET. They work very well, but they need to be slowly and carefully adjusted to the right dose so that they don't cause side effects like tiredness or dizziness.
A Great Example of Titration: DPC is easy to reach by text, phone, or quick follow-up visits, which is great for this process. Your doctor can start you on a very low dose and then check in with you often to help you find the right dose for you over the course of a few weeks. This will help you find the dose that gives you the most tremor control with the fewest side effects. In a traditional system with long wait times for appointments, it is very hard to do this careful process.
A Comprehensive, Coordinated Approach:
Your DPC doctor is the one who calls the shots when it comes to your health care.
They can help you set up appointments for occupational therapy, where you can learn new ways to do things and try out tools like weighted pens or utensils to help you with everyday tasks.
If you have a small number of patients with severe, disabling tremor that doesn't respond to medication, your DPC doctor can help you get a quick and appropriate referral to a neurologist or neurosurgeon to talk about advanced treatments like Deep Brain Stimulation (DBS) or MRI-guided focused ultrasound.
Case 1: Linda, 70, has had a hand tremor that has gotten worse over the years. It makes it hard for her to enjoy painting, which is her favorite thing to do. Her DPC doctor says she has essential tremor and gives her a very low dose of propranolol. Linda's doctor helps her slowly raise the dose over the course of a month by checking in with her by text and phone every week. They find a dose that cuts her tremor by 70% without causing any problems, which lets her paint with a much steadier hand.
Case 2: David, 58, has an essential tremor that his medications are no longer able to control well, and it is starting to affect his job. His DPC doctor takes a long, relaxed visit with him to talk about what to do next. The doctor talks about the pros and cons of advanced therapies like DBS and focused ultrasound. Then, he sends the patient directly to a comprehensive movement disorder center so that the right experts can look at him.
Q: I have a tremor. Does this mean I have Parkinson's?
A: Not always. Essential tremor is much more common than Parkinson's disease. One big difference is that ET tremors happen when you're doing something (they're worse when you use your hands), while Parkinson's tremors happen when you're not doing anything (they're most obvious when your hand is resting in your lap). Your DPC doctor can usually tell the difference between the two with a full neurological exam.
Q: Is there a way to get rid of essential tremor?
A: No, there is no cure, but there are many treatments that work. The goal of management is to lower the tremor to a level where you can live your life and do what you want.
Q: Why do people with ET need to start taking their medications so slowly?
A: If you raise the dose of the main drugs, propranolol and primidone, too quickly, you may feel tired, dizzy, or foggy in the head. You and your DPC doctor can find the highest dose that gives you the best tremor control with the fewest side effects by starting with a very low dose and slowly "titrating" it up over the course of several weeks. The DPC model is known for having this close of a partnership.
DPC gives a clear advantage for this very common movement disorder by:
Being very good at safe and effective medicine Titration: DPC's model, which is high-touch and easy to reach, is perfect for keeping a close eye on the first-line medications for ET.
Giving a Confident Clinical Diagnosis: DPC's extra time for a full history and exam helps to correctly diagnose ET and tell it apart from other, more serious movement disorders.
Providing care that is coordinated and focused on the patient: Taking care of the whole person, working with therapists, and making sure that advanced treatments are only given when they are really needed.
You don't have to let a shaky hand ruin your whole life. Essential tremor has no cure, but there are effective treatments that can help you regain your confidence and ability to do things. The most important thing is to work with a doctor who is patient and can spend the time needed to get your treatment just right. Direct Primary Care gives you the steady hand and ongoing help you need to deal with your tremor and live your life with confidence.
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