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WHY AM I TREMBLING?

I have been trying to cope with trembling and shaking in my jaw

Tuesday August 31,2010

By Dr Rosemary Leonard

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Q: For some time I have been trying to cope with trembling and shaking in my jaw.

It seems to be increasing and I wonder if it could be because I am under a lot of stress at the moment. I am a carer for my husband who has kidney dialysis at home each day. I would like your opinion as the shaking is causing me much distress.

A: Occasionally, trembling can be a sign of an underlying medical problem such as an overactive thyroid. It can also be a side effect of some medications, as well as caffeine, so check how much coffee you are drinking. Much more rarely it can be a sign of a problem in the nervous system, such as Parkinson’s disease. That said, by far the most common cause is stress and anxiety.

Being a carer is very demanding. Often there is no let-up so you find yourself working 24 hours a day seven days a week, with no break and you have the added worry of your husband’s illness.

All too often carers’ needs get forgotten but it is important you look after yourself both physically and emotionally. Carers Direct is a support service set up by the NHS which provides details on getting respite help. There is also information regarding financial issues so you can make sure you are claiming all your allowances. Call 0808 802 0202 or visit www.nhs.uk/carersdirect

Q: FOLLOWING an endoscopy and CT scan six months ago, I was told I have a hiatus hernia and gastritis. I have been taking 20mg of omeprazole daily since and watching my diet. From time to time I get swelling above my navel to just below my breasts. This can last several days and feels tight and painful. I have read chiropractors can push the hernia back in place. Is this true and would it help me?

A: NORMALLY the stomach lies just below the diaphragm, the strong muscular sheet that separates the abdominal cavity from the chest. A small gap lets the oesophagus, the food pipe from the mouth, enter the stomach.

If this gap widens it allows the top portion of the stomach to push through into the chest cavity and this is a hiatus hernia. Surprisingly, this usually doesn’t cause any feeling of fullness in the chest and many people with a hiatus hernia are unaware they have one.

The main problem that can arise is reflux of acid back up the oesophagus, causing heartburn. There may also be associated inflammation, which is felt as a burning sensation behind the breastbone. The omeprazole drug you are taking treats these symptoms by reducing the amount of acid produced by the stomach.

Although some people find they can stop treatment after a few months, many have to continue taking tablets long-term. In severe cases an operation can stitch the stomach back into place in the abdominal cavity but this is rarely done.

Chiropractors work on bones and joints and can’t manipulate a hiatus hernia back into place. The swelling you describe could be due to excess gas in your stomach but it is unlikely to be due to your hernia. If your symptoms continue you should see your doctor. It may be you need to take a higher dose of medication for a short time.

If you have a health question for Dr Rosemary please write to her in confidence at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN or e-mail health@express.co.uk Dr Rosemary’s reply will appear in this column. She regrets that she cannot enter into personal correspondence and that, due to the volume of letters, she cannot reply to everyone.

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