Q: My right hand shakes, making my writing jittery. Lately, I've taken to eating soup with my left hand. I am 78 years old and my doctor calls it tremors. He doesn't think it's Parkinson's disease, but even so he tried me on some medicines for Parkinson's, which didn't help. Is there anything that can be done?
A: You probably have something doctors call benign tremor, or, less flatteringly, senile tremor. The tremor itself has nothing to do with senility. It is, however, associated with older age -- thus the medical term senile (from senilis, the Latin word for old age).
In its early stages, it's often hard to distinguish benign tremor from Parkinson's disease, which also causes a tremor as well as a slowing and rigidity of movement.
Both benign tremor and Parkinson's disease tremor are aggravated by anxiety and stress, and calmed by relaxation. Benign tremor is usually worse with precise movement (such as writing or eating soup); Parkinson's tremor is usually more noticeable at rest.
Less frequent causes of tremor are an overactive thyroid, alcohol abuse and certain neurologic disorders.
The cause of benign tremor is unknown, but in most cases it's hereditary. If you have benign tremor, you may notice that one or two drinks of beer, wine or liquor temporarily improves the tremor. However, a medication called propranolol (Inderal) is more useful in controlling benign tremor.
Q: I have terrible pain in my heels. My doctor says I have heel spurs, which he has treated with cortisone injections. These help a little, but is there anything else I can try?
A: A heel spur is a tiny tooth-like projection on the heel bone (it's named for the way it looks on an X-ray of the foot). Heel spurs in themselves are not the problem. Many people have them without symptoms, and many people have heel pain without spurs.
You probably have what's called plantar fasciitis, meaning a painful irritation of the muscles and tendons that attach to the bottom of the heel bone.
Plantar fasciitis is often caused by improperly fitting shoes, improper ways of walking or running, or wear and tear of the structures of the foot. Take a look at the heels of your shoes from behind. If they're unevenly worn on the inside edge, that's a sign of a foot problem that could cause the symptoms you're having.
Foot exercises may help. Try turning your feet in (soles facing each other) while sitting or standing. Also, do some gripping exercises, as if picking up a paper towel from the floor with your toes, to build up the muscles on the bottoms of your feet. Wearing sandals, such as Dr. Scholl's, that make you flex your toes when you walk, may also help.
You can try inserting a thick foam pad under your heel, but most of the shoe pads available in drugstores are too soft and compressible to work very well. Pads made by Spenco, available in many stores selling jogging shoes, seem to work better.
A podiatrist or orthopedic surgeon may prescribe special shoe inserts if your problem is persistent. They may also have you try a hard plastic heel cup, which molds the fatty tissues of the heel into a bigger, natural cushion that sometimes relieves the pain.
Anti-inflammatory medicines by mouth may also help.
If running brings on your pain, make sure you're using a good pair of running shoes, and ask your doctor about your running technique. You may have to cut back or temporarily stop running. Fortunately, plantar fasciitis, though sometimes recurrent, is usually a temporary problem.
Q: I've heard that yeast infectin (Candidiasis) can cause all sorts of symptoms, including fatigue, stomach problems, premenstrual syndrome and depression. How do you know if you have it? What can be done to get rid of it?
A: Two well-known varieties of yeast infection are thrush, manifestd by a white coating on the tongue or roof of the mouth, and a vaginal yeast infection known as monilia. Both of these are usually easy to treat. In rare instances, people with severe illnesses or those lacking natural defenses against yeast may develop serious, even life-threatening infections.
Lately there's been a theory outside traditional medicine blaming yeast infection for a myriad of troublesome symptoms. It's true that a yeast known as candida albicans may normally dwell on our skin and inside our intestines. The "chronic candidiasis" theory claims that this naturally occurring candida interacts with our bodily defenses to create harmful antibodies -- substances designed, in part, to attack microscopic invaders. Supposedly, this interaction provokes different bodily functions to run amok and produce chronic, often vague symptoms that don't respond to usual medical care.
Another theory is that candida produces toxins that are directly harmful.
In my opinion, the chronic candidiasis theory is unproven and attracts people who have been misled by unsubstantiated claims or who are driven to desperation by failure of traditional medicine to fully help them.
Until scientific studies legitimize the concept of chronic candidiasis, I recommend seeking other explanations for physical or emotional symptoms.