Earlier this year, my hand began to tremble, and then the shaking spread to my arm. An MRI scan led to a diagnosis of spondylosis. I’ve been given physiotherapy exercises, which have helped with the neck stiffness I also experience. Is the shakiness likely to go away?
A. Merriman, Northampton.
Dr Martin Scurr replies: Spondylosis is the medical term for age-related wear and tear in the spine. In your case, it is cervical spondylosis, which affects the joints and discs — the structures that cushion the bones — in the neck.
The condition commonly causes neck pain and stiffness. Wear and tear can irritate the joints and surrounding tissues, triggering inflammation and limiting movement.
Some people also develop symptoms in an arm or hand, including tingling or numbness, when a nerve in the neck becomes compressed. However, cervical spondylosis does not usually cause the type of tremor or shaking you describe.
The important question is whether the tremor appears when your hand or arm is at rest, or whether it occurs when you are moving it.
If the shaking happens during movement, it could indicate essential tremor. This is a common neurological disorder, thought to result from problems with the brain cells involved in controlling movement, and it most often affects the hands.
Essential tremor generally affects both hands, although it can be more pronounced on one side. Treatment usually begins with medication, including drugs that are also used to control seizures.
Holmes tremor can affect one hand and arm. It is present at rest and becomes more noticeable during movement. The condition can develop months after a minor stroke, which may go unnoticed (picture posed by model)
Another possibility is Holmes tremor, which affects one hand and arm. It is present when the limb is at rest but becomes more obvious with movement. Holmes tremor can develop after a minor stroke — sometimes so mild that the person is unaware it happened — and may not appear until many months later.
Other disorders affecting movement can produce similar symptoms.
I recommend asking your GP for a referral to a neurologist. Please write again and let me know what they conclude.
What’s behind my low blood pressure, which is around 105/55 and sometimes as low as 98/48, and my skipped heartbeats, which become worse when I’m exhausted? I feel faint, particularly first thing in the morning. I had a heart attack 20 years ago, followed by bypass surgery, and now take aspirin, ramipril, a statin and rabeprazole. The problem has been happening for several months. Should I be concerned?
D. Thomas, Cornwall.
Dr Martin Scurr replies: Blood pressure readings such as these might be considered healthy in someone in their 20s or 30s, and can also be normal in an older person — unless they cause symptoms such as faintness. When low blood pressure produces symptoms, it is known as symptomatic hypotension.
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In your situation, I suspect ramipril may be contributing. It is often prescribed for high blood pressure, and you may have become particularly sensitive to its effects.
Feeling faint in the morning suggests postural hypotension, in which blood pressure falls when you stand up. Mild dehydration after a night’s sleep may intensify the effect of ramipril.
The sensation of a skipped heartbeat can be caused by premature atrial or ventricular beats. In other words, either the upper or lower chambers of the heart beat earlier than expected. The ‘missed’ beat is usually the pause that follows this extra beat.
These extra beats are often harmless, but they can also result from damage caused by a previous heart attack, including disruption to the heart’s electrical system.
You should arrange an appointment with your GP for an electrocardiogram (ECG) and blood-pressure measurements taken both while lying down and after standing. If an ECG is not available at the practice, you should be referred to a hospital cardiology department.
Depending on the findings, treatment may involve changing the dose of your blood-pressure medication or stopping it.
Until you have been assessed, I would avoid strenuous exercise.
You mention in your longer letter that you have been taking salt to raise your blood pressure. I would not continue doing this until your heart has been checked. You should also have a blood test to assess kidney function. For now, keep taking ramipril unless your doctor advises you to change or stop it.
In my view… Patients will suffer when doctors strike
I was surprised by the announcement that hospital consultants are preparing to strike. With average annual earnings exceeding £150,000, along with access to an NHS pension, it is difficult to feel much sympathy.
Yet when I asked a group of consultants about the action, they simply rolled their eyes. None felt comfortable with striking, but all believed they had to stand together.
At the heart of the dispute is a demand from NHS consultants in England for pay parity with colleagues in Wales, where the final pay point is £16,000 higher. Welsh consultants also work a shorter 37-and-a-half-hour week, compared with 40 hours in England. Consultants in England are now seeking a 35-hour working week.
Consultants in Wales also receive almost twice as much time away from clinical work to carry out administrative duties and activities such as teaching.
Whatever your view of the strike, it is troubling to see the British Medical Association on one side and the Department of Health and Social Care — much of which appears to operate from home — on the other. You have to wonder where the adult supervision is.
In the meantime, patients will inevitably bear the consequences.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Replies should be taken in a general context. Always consult your own GP with any health concerns.