Whole lotta shakin' going on....

Here is the best all-around article I have found on the subject of tremor, courtesy of the Cleveland Clinic Continuing Education.

The technical jargon of tremor may be confusing at first.

Frequency is how fast you tremble.

Amplitude is how far you (or your body part) move when you tremble.

Hz (short for hertz) is a standard international measure of frequency.

This wikipedia article has a nice illustration of blinking lights at 0.5 Hz, 1 Hz and 2 Hz. Many 'weird neuro shit' tremors operate at 4-12 Hz but lights flashing above 4 Hz per  second (4 flashes per second) can cause migraine or even seizure in some unlucky people.

A low amplitude, high frequency tremor is the sort of not always visible tremor MS sufferers often describe as 'buzzing' or 'vibrating'. A high amplitude, low frequency tremor would be a slower pulsing, but more visible.

Tremors alone don't mean MS, as they can be a reaction to some medications, alcohol withdrawal (aka delirium tremens or 'the DTs'), or a benign condition known as Essential Tremor.

Until a tremor gets so extreme it interferes with your daily life - you have trouble writing or spill your food constantly or can't get your key in the door - it won't be medically significant.  It's a thing, it means that you are sick or you have a mild neurological condition (or both), but chances are you guessed that before the tremor came along.  The doctor is unlikely to say, "Ah hah! I note your tremor oscillates at 8 Hz and therefore my uncanny diagnostic instincts tell me it is definitely Essential Tremor and not multiple sclerosis as you have feared..."

My tremor, which is mostly invisible, gets worse when I'm very tired, sickening for something, or have had too much stimulant (coffee, chocolate or alcohol). Now that I'm used to it, I find it a useful 'final warning' that I'm overdoing it.

Yesterday, I ran a few blocks on an urgent errand for someone. At the end of that, the combination of adrenalin and unusual exertion caused my hands to shake far worse than usual and I couldn't unzip my bag, open mail or hold a cup of water without spilling. A pity, because I enjoyed the run itself, unaccustomed as I am to public sprinting...

Proprioception and gait abnormality

This year my physical stamina took a hit. A succession of minor injuries meant I couldn't exercise until I healed. Healing was taking forever, with one damn thing after another. My physio finally pointed out that "only some of the problem seems to be bio-mechanical... the rest seems to be...the other thing...".  The other thing being possible/probably MS.  (Unless that was code for conversion disorder?)

The physio is charming, caring and kindly, but I gained the distinct impression that treating someone who can't be completely cured is a bit of a 'downer'. Suspecting that was the physio's attitude was a bit of a downer for me, too.

So I researched neurological physiotherapy. For a physio who routinely treats those with moderate to advanced MS, Parkinson's and Aquired Brain Injury, I'm a good news story. It's also reassuring to be treated by someone who believes they can help.

My proprioception isn't what it could be, and my gait is abnormal. A quick google suggests that CNS lesions and Parkinsons are the front-runners if it's not a mechanical issue (hip, knee or ankle damage) or a genetic disorder. Well, duh. There is an element of mechanical issue, the 'usual' joint deterioration of a middle-aged person, and some learned 'guarding'.

If you watch me walk, you probably won't see a problem, but my neurophysio can see it.

Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.  (abstract)

Proprioception and locomotor disorders (google docs version)

Gait abnormalities in minimally impaired multiple sclerosis patients (abstract)

In plain English, brain lesions interfere with the pathways that determine some of the ways muscles work. Part of this can be caused by compensation strategies - your muscles stiffen up to literally keep you upright - which interfere with the normal proprioception.

The good news is that brain plasticity means we have the potential to be retrained in more beneficial ways. As long as we act early enough.

My exercises seem incredibly simple and 'easy'. Because they are working very specific muscles, and my brain, they are quite tiring - even the neurophysio finds them tiring - but if they increase my body awareness (proprioception) and the muscle strength of the weakened muscles, they will be well worth doing.

What's so only?

My most prominent MS-type symptoms are considered 'only' mild sensory symptoms.  Some come and go. Some are with me most of the time.

• Numbness or reduced sense of touch in some places. Odd changes in skin sensation: anything from a prickly feeling to actual pain (known in the trade as parasthesia). 
• Reduced or acute sense of temperature (thermoanasthesia). 
• Overly sensitive to light or sound (known in the trade as hyperesthesia). 
• Odd smells and tastes: sometimes the coffee is bad because the barrista isn't very good, and sometimes its just me (dysgeusia). 
• Below average balance (poor proprioception)

Tingling, tickling, itching, burning, numb, sensitive.  Really doesn't cover it.  Weird neuro shit is my term.

If you're a regular person, when something odd happens to your senses, you go to your Doctor because Something Is Clearly Not Right.  When you enter the twilight world of 'possible MS', 'findings suggestive of demyelinating disease', and other non-specific diagnoses, you eventually learn that no matter how freaked out you might be (initially), your doctor is unlikely to find your weird neuro shit 'diagnostically relevant'.

Your symptoms are also too vague to attract useful sympathy from your loved ones. They also tend to elicit encouragement to 'get out of yourself more', while the word 'psychosomatic' flashes from behind their eyes.  Or is that just me?

At this distance from my first MRI I understand that weird neuro shit is most unlikely to herald an inevitable decline to feeble invalidism on a couch. So I don't freak out on that account. Sometimes I even play with the sensory disturbance du jour.  There is a certain prurient interest in finding out how big your latest numb patch is, and testing how hard you have to poke your foot with a pin before you can feel anything. And don't get me started on how many times you can keep re-tasting that glass of wine your really, really, want to drink, to see if it's still disgusting.

The biggest problem with weird neuro shit is it undermines your confidence in your perceptions, your personal experience of the world, and that change is profound.

Try for a minute to imagine a world whether many, many small things are subtly "off" - but you're the only one who notices. Do you, or don't you, trust the evidence of your senses?

• When a meal tastes yukky, do you send it back or not? It could be just my funny sense of taste acting up. But if I ignore my own senses, and eat the dodgy meal, I could getting food poisoning.
• The stereo is too loud, and you'd like to ask your friend to turn it down, but last week at home you asked your partner to turn the volume down and it was only on 2...
• Is that a heat haze, or is it just my eyes going "googly"?
• Did I just get a static zap, or was that just weird neuro shit?

I reached a personal nadir recently, when I thought the shower was on the blink, because I wasn't getting hot water evenly across the showerhead. But when I stepped away to turn it off, my left arm felt hot water - it was only my right arm that thought the water was tepid.

Altogether, a fabulous recipe for self-doubt. I don't stress too much about weird neuro shit, I just make a note about it and it usually goes away again. But this second-guessing is a pain. And I'd like to know what's so 'only' about mild sensory problems.