INSIGHTEC FOR NEUROSURGERYINSIGHTEC provides a non-invasive, image-guided alternative for deep brain procedures such as thalamotomy and pallidotomy for essential tremor, tremor dominant Parkinson’s disease and neuropathic pain. This personalized treatment is done through an intact skull with no ionizing radiation, providing a real impact on patients’ quality of life.
MINIMAL HOSPITALIZATION and short recovery timeSHARP, ACCURATE
Lesions as small as 2mm, no penetrating trajectories, no implanted hardware, no ionizing radiation, less risk of infection
MRI guidance for targeting and thermal feedback, with immediate results
INSIGHTEC’s neurosurgery solution, Exablate Neuro, is the first focused ultrasound device approved by the FDA to treat patients with essential tremor. Exablate Neuro is a non-invasive, image-guided personalized thalamotomy, treated through an intact skull that doesn't require any ionizing radiation, incisions or implants.
What is Exablate Neuro?
High intensity focused ultrasound waves precisely target a focal point in the Vim nucleus of the thalamus, the tiny part of the brain that is thought to be responsible for causing tremors. The Exablate Neuro ultrasound transducer consists of 1024 beams that generate enough heat to ablate the targeted tissue during treatment. The result is an immediate and significant reduction of tremor for patients.
During planning and treatment for essential tremor, the patient is fully conscious and lying on the treatment bed in an MRI scanner. MRI provides high resolution visualization, patient-specific treatment planning and continuous monitoring of the procedure. Real-time thermal feedback allows the physician to control and adjust the treatment, ensuring that the targeted tissue is completely ablated without impacting adjacent healthy tissue.
This revolutionary, non-invasive treatment offers a life changing treatment to patients with essential tremor.
INSIGHTEC FOR NEUROSURGERY
Go back in time to experience Christmas in the 1800s
By Stephanie Turner firstname.lastname@example.org
Take a trip back to the 19th century when the Diann Shaddox Foundation for Essential Tremor presents Christmas in the 1800s.
The event will be from 5:30 to 8 p.m. Dec. 1 at the Aiken County Historical Museum, 433 Newberry St. S.W.
Tickets are $35 and include food and drinks. They can be purchased through the foundation's website and at 3 Monkeys Fine Gifts, 141 Laurens St. S.W.; Plum Pudding Gourmet Kitchen Store, 101 Laurens St. N.W.; and Aiken County Government Center, 1930 University Parkway.
Author and historian Kim Poovey will be decked out in her historical garb and share tales of the bygone era.
"She makes you go back into the 1800s," said Diann Shaddox, founder of the Diann Shaddox Foundation.
Musicians Jayne Williams, Patti Elmore and Matthew Osteen will sing carols while sauntering around the decorated museum.
Guests will be treated to food such as chicken, biscuits, pies, barbecue and cole slaw and beverages of wine, coffee, apple cider and spiced cider.
Chef Russell Gardiner, La Dolce Gourmet Bakery, Coffee and Tea Bar, Chick-fil-A, The Fresh Market and Starbucks will provide the refreshments.
Attendants are invited to dress up.
"It's ... like you will be going back and relive the 1800s at Christmas," Shaddox said.
For more information, visit www.diannshaddoxfoundation.org.
Stephanie Turner is the features reporter with the Aiken Standard, where she covers health topics, the arts, authors and restaurants. She graduated from Valdosta State University in 2012.
Because of the undeserved stigma attached to disabled workers, individuals with disabilities often face incredible odds when searching for employment. This is a sad truth, but one that can be overcome if you know your rights.
This guide was created to introduce disabled workers and job-seekers to the rights afforded to them by federal and state governments. In addition, we offer useful tips for finding a job, advice on staying gainfully employed, and guidance that can help you talk with an existing employer about making a reasonable accommodation for you.
Having any kind of disability does not preclude you from earning a living and supporting your family, nor should it. However, you may need to try harder than others to find employment that will adequately use your skill set without testing your disability or causing you undue harm.
Keep reading to learn more about your rights and responsibilities as a disabled worker, and best practices for moving forward.
What the ADA and Other Laws Mean to WorkersWhen anyone mentions the “ADA” in the context of disabled worker’s rights, they are speaking of The Americans with Disabilities Act of 1990, which prohibits the discrimination of persons with disabilities seeking employment while ensuring they have equal opportunity.
The ADA was created based on the basic principle that “physical or mental disabilities in no way diminish a person’s right to fully participate in all aspects of society,” with the goal of providing a “clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.”
Although the Americans with Disabilities Act of 1990 is long and cumbersome to read in its entirety, its main components can be summarized as follows:
Americans with Disabilities Act at a Glance
Americans with Disabilities Act at a Glance
This is Jerry Slea one our Millions Faces of ET, who lives each day with ET! Please help us fight to #EndET. "Here I Am" by Jerry Slea (c) 2016 Uplifted Heart Music
PHOTO CAPTION: The Diann Shaddox Foundation for Essential Tremor (DSF) is the recipient of the Holley Heating & Air's monthly Holley Community Fund donation for January. Pictured (left to right) are DSF executive director, Randy Miles; founder, Diann Shaddox; and Holley Heating & Air president, Lee Boylston. The Holley Community Fund is an ongoing program that donates to a different local nonprofit organization each month and is underwritten by Holley Heating & Air Conditioning, Aiken's leading provider of heating and air conditioning products. Millions of children and adults live each day with uncontrollable shakes from essential tremor (ET), the largest movement disorder in the world. It can begin at any age, from 1 to 100. DSF's mission is to educate and increase awareness about the people afflicted with ET — especially children — and provide medical research grants to find the cause and a cure for ET.
If you use H&R Block please download this form and take it in with you. The Diann Shaddox Foundation for Essential Tremor earns $20.00 for every new client we refer to H&R Block.
The Diann Shaddox Foundation for Essential Tremor is an approved charity for PayPal/eBay. Please add us.
The Diann Shaddox Foundation for Essential Tremor is an approved charity for PayPal/eBay. Please add us.Start selling for Diann Shaddox FoundationMake a donationThe Diann Shaddox Foundation for Essential Tremor is fighting the battle for ET a neurological condition that causes a rhythmic trembling of the hands, head, voice, legs, or trunk. Over 10 million Americans have ET. ET can begin at any age and doesn't discriminate with age, race, sex, or national origin. Awareness will stop the bullying, people losing their jobs, college students having their dreams disappear and end depression for people worldwide. DONATE #EndET www.diannshaddoxfoundation.org
Relaxation Tips for Those With Essential Tremor
In some people, too much stress simply results in irritability. In other people, too much stress can cause or worsen health problems, including Essential Tremor. Learning to relax is the key to reducing stress.
Below are a few relaxation exercises. Be sure that you have a quiet location that is free of distractions. Make sure that you are in a comfortable body position and a good state of mind. Try to block out worries and distracting thoughts.
WebMD Medical Reference
Johns Hopkins Medicine: "Essential Tremor."
International Essential Tremor Foundation: "Support Group Leader Training Guide."
Pal, P. Annals of Indian Academy of Neurology, July 2011.
Medscape: "Essential Tremor: A Clinical Review: Approaches to Treatment."
Reviewed by Neil Lava, MD on September 20, 2014
The Truth About Essential Tremor: It’s Not Just a Case of Nerves
The Truth About Essential Tremor: It’s Not Just a Case of Nerves
The Truth About Essential Tremor: It’s Not Just a Case of NervesThis prevalent cause of shakiness is often mistaken for Parkinson's.Tremors associated with essential tremor typically occur while the person is eating, drinking, writing, typing, brushing teeth or performing another movement-oriented activity.
By Stacey ColinoNov. 11, 2015, at 9:50 a.m.+ More
If your hand routinely shakes when you hold a drink, sign your name or tap a number into your cellphone, you may fear that you're experiencing signs of Parkinson's disease. But what you're more likely to have is essential tremor, a common neurological condition that causes an involuntary, rhythmic trembling of the hands during movement but can also affect the head, voice or legs. While it's often confused with Parkinson's, essential tremor is eight times more common and affects an estimated 10 million people in the U.S., according to the International Essential Tremor Foundation.
Unlike Parkinson's, which is a degenerative disease that causes someone to lose brain cells, essential tremor is not a degenerative disorder, explains Dr. Michael Rezak, director of the Movement Disorders Center at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois. "Essential tremor results from a malfunction of certain neurons, but you don't lose brain cells, and you don't lose gait or balance."
Despite its prevalence, it wasn't until 2013 that essential tremor was given its own specific diagnostic code, one that's distinct from other tremors, in the 10th edition of the World Health Organization's International Statistical Classification of Disease and Related Health Problems (ICD) code book. In medicine, the word "essential" means there's no known underlying cause for a symptom, which is the case for essential tremor. "When people hear it's essential tremor and not Parkinson's, that usually puts them at ease," Rezak says. "Essential tremor is the most common movement disorder out there, but we don't usually see people until it gets really bad. Most patients just learn to live with it."
Usually, the tremor that's characteristic of essential tremor occurs while the person is performing a movement-oriented activity – such as eating, drinking, writing, typing or brushing teeth – or when the hand is in a still but outstretched position (called a postural tremor). The severity can range from a barely noticeable trembling that's exacerbated by stress, anxiety, fatigue, excess caffeine or certain stimulant asthma medications to a severe, disabling tremor that has a significant impact on your ability to perform daily activities.
The late "actress Katharine Hepburn is an extreme example of advanced essential tremor – it affected her voice, head and arms, as well as her hands," Rezak notes. Playwright Eugene O'Neill also suffered from essential tremor. So does rocker J. Roddy Walston, of J. Roddy Walston & The Business, who became increasingly vocal about his condition in the band's 2013 LP "Essential Tremors."
The disorder affects men and women equally, and it's hereditary in more than 50 percent of people who have it. Though the average decade of onset is in the 40s, essential tremor can occur at any time, even in children. Debbie Lamb developed "the shakes" when she was in her late 20s but she didn't have a name for them until her second child was diagnosed as a baby in 2004 with "benign familial essential tremors." "It turned out that not only did I, her mother, have them, but my mother, sister, grandmother and niece all had them, too," says Lamb, now 50, a marketing executive in Vallejo, California.
There aren't blood or other medical tests that can definitively diagnose essential tremor. Instead, a neurologist makes the diagnosis on the basis of a detailed medical history and a neurological evaluation that's designed partly to rule out other possible causes of the tremor. In tough cases, a relatively new diagnostic imaging technique called DaTscan allows doctors to distinguish between patients who have a loss of dopamine, the neurotransmitter that's predominantly responsible for Parkinson's symptoms, and those who don't have a dopamine deficiency.
If your essential tremor is mild and doesn't bother you, it doesn't need to be treated. But you can take steps to mitigate the effects by avoiding caffeine and doing yoga or other relaxation techniques. Lamb relies on focused breathing exercises and meditation to reduce the severity of her tremors. A 2015 study from Australia found that doing resistance training also can reduce essential tremor and improve manual dexterity in those who have the condition.
It's often referred to as benign essential tremor because it isn't life-threatening, "but it's not that benign when it starts interfering with one's life and you can't work or eat soup," Rezak says. If it impairs your ability to function, the condition is usually treated with medications such as beta-blockers, anti-seizure drugs, anti-anxiety meds or Botox injections. There's a lot of trial and error to find a medication that works well for any given patient; sometimes drug treatment helps sufficiently, and sometimes it doesn't.
With or without medication, essential tremor is often a progressive condition. "As the tremor progresses, it can worsen or people can have breakthrough tremors on medication," explains Dr. Joseph Neimat, an associate professor of neurosurgery at Vanderbilt University Medical Center in Nashville.
Elsie Hamilton, of Englewood, Colorado, discovered this firsthand when her tremors got so bad over a 20-year period that she had to give up her career as a landscape, still life and portrait painter. Besides struggling to hold a paintbrush steady for detail work, on some days she had trouble keeping the brush between her fingers at all. In her personal life, when she was the slightest bit nervous in social situations, she would shake when moving a fork to her mouth or lifting a glass to her lips. For the last six years, Hamilton has been taking a beta-blocker for a heart condition, which helps with her essential tremor but doesn't eliminate it. "It can still be very embarrassing but I tell people up front and try to laugh it off," says Hamilton, now 54, president of the Lilly Brush Co., which manufactures and sells special brushes that remove pet hair from clothing and furniture. "My siblings, in-laws and two sons cover for me and help whenever they can."
For people with severe tremor that doesn't respond to drugs, surgical therapies and other treatments are gaining traction. With deep brain stimulation, a probe is implanted in the thalamus, the part of the brain that causes tremors, and a wire runs from the probe to a pacemaker-like device implanted in the chest. "We use the pacemaker to jam the tremor signal inside the brain," Neimat explains. "If the tremor gets worse, we can dial up the stimulation."
By contrast, a noninvasive procedure called Gamma Knife thalamotomy uses cobalt beams to deliver a precise dose of radiation to the thalamus to control these involuntary movements. In a recent study published in Neurology , researchers from France found that the Gamma Knife procedure improved upper limb tremor by 54 percent and the ability to perform activities of daily living by 72 percent in 50 patients with tremor.
Meanwhile, a new noninvasive MRI-guided high-intensity ultrasound technique, which uses concentrated ultrasound waves to selectively damage the part of the brain that contributes to tremors, is showing preliminary promise. "It's unique in that you don't need to cut the skin or insert something into the brain – and it's a one-time treatment," says Dr. Ali Rezai, director of the Neurological Institute at The Ohio State University Wexner Medical Center, where a clinical trial is being conducted on the technique's safety and effectiveness. "So far the results seem to be robust." The study will conclude next year, and doctors are hoping the technique gains approval by the Food and Drug Administration in short order.
The take-home message: While "this is a condition that can have a significant effect on a person's quality of life, it's very treatable," Neimat says. So there's no reason to suffer and shake silently or to hesitate to seek help for it.
Stacey Colino is a freelance Health + Wellness reporter at U.S. News. You can connect with her on LinkedIn or email her at email@example.com.
Essential tremor: Aiken resident lives with, raises awareness of disease
Stephanie Turner Email stephaniedturnerAS
Oct 11 2015 3:47 pm
Staff Photo by Stephanie Turner
Diann Shaddox was diagnosed with essential tremor in her early 20s. Today, she is the founder of the Diann Shaddox Foundation, which raises money and awareness of essential tremor, and is an author, with her first book “A Faded Cottage” also featuring the main character with the disease.
You’re out enjoying a meal with your friends, when you hear a clattering behind you.
Curious, you look over your shoulder to see another patron trying to grasp his fork with a trembling hand.
“Essential tremor (ET) is a neurological condition that causes a rhythmic trembling of the hands, head, voice, legs or trunk."
It is said to affect at least seven million Americans, according to a 2014 “Tremor and Other Hyperkinetic Movements” journal article.
“Everyone has some ... tremor. But these movements usually can’t be seen or felt. It’s Hopkins Medicine.
Diann Shaddox, an Aiken resident in her late 50s, discovered she had ET in her early 20s.
Her hands would start to shake while she was just doing normal tasks, she said in her biography.
“In the beginning, doctors told me to go home, (that) I was nervous,” she said.
Shaddox knew that wasn’t true, so she bypassed the doctors and went straight to a neurologist, who immediately knew she had ET.
Last year, Shaddox began the Diann Shaddox Foundation with Randy Miles as the executive director; Quaid Witherspoon, the protagonist of her 2013, debut book, “A Faded Cottage: A South Carolina Love Story,” also has ET.
“Essential tremor (ET) is the most common movement disorder. It is a progressive, often inherited disorder that usually begins in later adulthood,” according to John Hopkins. “Essential tremor is thought to be caused by electrical fluctuations in the brain that send abnormal signals out to the muscles.”
The gene that causes ET has not been identified, and how it’s inherited, if the person does inherit it, differs among patients, according the National Library of Medicine’s Genetics Home Reference.
In some causes, “they almost know it’s coming, because generation after generation have a pretty pronounced tremor,” said Dr. Michelle Lyon, Carolina Musculoskeletal Institute’s neurologist.
Staff Photo by Stephanie Turner Dr. Michelle Lyon is the neurologist at Carolina Musculoskeletal Institute
Since Shaddox’s father passed away before she was born and her mother died when Shaddox was a toddler, she isn’t completely sure how she got her ET, though she suspects it’s from a great aunt whose hands would shake.
“In most affected families, essential tremor appears to be inherited in an autosomal dominant pattern, which means one copy of an altered gene in each cell is sufficient to cause the disorder, although no genes that cause essential tremor have been identified,” according to the National Library. “Essential tremor may also appear in people with no history of the disorder in their family.”
There is no genetic test to detect whether or not you will get ET, Lyon said.
“Your health care provider will ask you questions about your health history and family history. He or she will also look at your trembling symptoms. Your provider will probably need to rule out other conditions that could cause the shaking or trembling,” according to John Hopkins.
ET is often confused with Parkinson’s disease, which affects less people and is more detailed in its symptoms than ET, according to Lyon.
Parkinson’s, for example, “generally involves slow movements (bradykinesia), rigidity (stiffness) and problems with walking or balance,” whereas those symptoms are abnormal in people with ET, according to the International Essential Tremor Foundation.
Living with ET
“This (condition) affects all nationalities, all sexes, all ages – all everybody,” Shaddox said.
In addition to running the Diann Shaddox Foundation and publishing “A Faded Cottage,” Shaddox has written time-traveling romance “Whispering Fog” and the historical “Miranda: Her Life’s Story,” with proceeds from her books benefiting her foundation.
The condition first affected her right hand before progressing to her left.
Shaddox can no longer write for extended periods; when she does write, the words are often scribbled.
“If you are right handed, don’t use your right hand; (then) write your name when you are tired, and just keep writing your name, until your hand gets tired. That’s kind of like ET,” she said. “Really simple acts can be horrifying.”
Trouble with writing and eating are often when people come in to get examined, according to Lyon.
“They are embarrassed to go out to eat at a restaurant because they are unable to hold the fork and cut the food,” she said. “I think a lot of people ignore it, until they get to that social situation.”
Shaddox often has to use her opposite hand to steady the one cutting food or putting on make-up and can no longer cross-stitch or play the piano.
Though her hands trembling are the more noticeable symptom, Shaddox’s head shakes back and forth, and she can feel her voice starting to tremor.
“I’ll take two (words) and make up a whole new word while I’m talking,” she said, adding that she also mixes up and forgets words.
The tremors tire her hands but do settle when the limbs are resting, and Shaddox can drive.
“My case is mild,” she said.
Stress, hunger, fatigue and anger can aggravate the tremors, according to the National Institute.
“My hands look like a bird’s wings flapping, when I get stressed,” Shaddox said. “It’s so embarrassing when you are sitting there, and people are staring at you when you are trying to write. You want to scream, walk out, because it’s embarrassing.”
ET has no cure but can be treated, according to Lyon.
Medicines prescribed can include tranquilizers, ones that “affect how brain nerves work” or are anti-seizure, according to John Hopkins.
When the condition is so severe and medicine doesn’t help, there are surgical options, Lyon added. Two are deep brain stimulation and thalamotomy, with the main difference is thalamotomy, which, according to the American Academy of Neurology, actor Micheal J. Fox underwent for his Parkinson’s, involves destroying a piece of the brain while deep brain stimulation does not, according to the International Essential Tremor Foundation.
MCT Graphic/”Minneapolis Star Tribune,” 2009 This graphic explains how deep brain stimulation, using a device similar to a heart pacemaker, can improve the quality of life for people suffering from Parkinson’s disease. The procedure is also used in more severe cases of essential tremor.
Shaddox no longer takes medication but does lift weights and tries to stay healthy.
When she does her public appearances, she might have some wine nearby, as the drink temporarily calms her, she said.
Shaddox has 16 more books she wants to publish and would like to see her foundation match the The Michael J. Fox Foundation for Parkinson’s Research’s scale.
Shaddox said the foundation’s An Evening in the 1800s with Kim Peevy that was scheduled for Saturday has been postponed but she will have a book signing in April.
“The foundation’s mission is to bring awareness, to educate,” Miles said.
If you are experiencing abnormal tremors, consult with a physician.
For more information on ET, visit www.diannshaddoxfoundation.org, www.aan.com, andwww.essential tremor.org.
Stephanie Turner graduated from Valdosta State University in 2012. She then signed on with the Aiken Standard, where she is now the arts and entertainment reporter.
Disability Benefits for Essential Tremor
If your tremor is so serious that you can no longer work because your hands shake too much or you have other disruptive symptoms, you may be able to get federal disability benefits. The Social Security Administration administers two programs: Social Security disability (SSD) and Supplemental Security Income (SSI). The medical eligibility requirements for both programs are the same.
First, your tremor must have prevented you -- or be expected to prevent you -- from doing a significant amount of work (making over $1,070 per month) for at least 12 consecutive months. Second, you must either prove that you don't have the ability to function at a sedentary job or that your tremor fulfills the requirements for Social Security's impairment listing for Parkinson's disease.
Determining Your Ability or Inability to FunctionTo decide whether there is any work you can do, the SSA will prepare a detailed report called a residual functional capacity assessment (RFC). An RFC is the most you can do on a regular and sustained basis (full-time work). The report will look at how your tremors affect your ability to do certain strength-related (exertional) activities like:
Considering Your Non-Exertional LimitationsBefore deciding that you can do the full range of activities to do sedentary work, the SSA should consider any "non-exertional," or non-strength-related, limitations that you have. Your RFC assessment should address whether your tremors, or your medications, cause any non-exertional limitations. Here are some examples of non-exertional impairments:
Examples of How Essential Tremors Affect the RFCHere are some examples of how the SSA may use a claimant’s RFC (including non-exertional limitations) to decide a claim for disability based on a benign essential tremor.
The SSA should use your medical records to compare your symptoms with the listing requirements for Parkinson’s to determine if they are “medically” equivalent. But it is often up to the claimant (or his or her lawyer) to raise this theory on appeal.
Here is an example of how the SSA might decide a case based on equivalence to a listing.
The Hidden Dangers of Medical Scans Medical imaging tests
The Hidden Dangers of Medical Scans Medical imaging tests are exposing more of us to potentially cancer-causing radiation. Here's when you really need that scan and when you should just say no Over the past ten years, Jill Nelson, 52, a health coach, personal trainer and counselor in Chicago, has received at least seven computed tomography (CT) scans and close to 30 sets of X-rays for a variety of health ailments—from two separate disk fusions in her spine to a worrisome-looking spot on her lung. That’s on top of the 10 or so mammograms she has had since age 35, plus dozens of dental X-rays. “With all that radiation, I’m surprised I don’t glow,” she says. “It makes me a little uneasy—in trying to get my health problems diagnosed, did I increase my risk of cancer?”
Jill’s concern is shared by a growing number of doctors and medical organizations, who are worried about the soaring use of medical imaging tests that rely on ionizing radiation. This radiation can damage your cells’ DNA, which may, over time, lead to cancer. The more you’re exposed to, the riskier it is. And thanks to the increase in CT scans—which typically emit far higher doses of radiation than traditional X-rays or even other imaging tests like mammograms—exposure has risen dramatically. In 1980, only about 3 million CT scans were performed in the United States. By 2013, that number had skyrocketed to 76 million.
Exactly how dangerous are all those zaps? In 2009, National Cancer Institute researchers estimated that the 72 million CT scansperformed in 2007 could lead to as many as 29,000 future cases of cancer. And a couple of years ago, when the Institute of Medicine looked broadly at the environmental causes of breast cancer, it concluded that one factor that’s strongly associated with risk of developing the disease is ionizing radiation.
That sounds scary—and it is. “Limiting exposure to medical radiation should be on every woman’s cancer-prevention list,” says Rebecca Smith-Bindman, MD, professor of radiology, epidemiology, biostatistics and health policy at the University of California, San Francisco. Yet the tests are widely overused, research finds. “About a third of CT scans are clinically unnecessary or could be avoided by using conventional X-rays or an imaging test that doesn’t use radiation, like ultrasound or MRI,” says David J. Brenner, PhD, director of the Center for Radiological Research at Columbia University Medical Center.
The challenge is figuring out whether the CT your doctor wants you to have is essential or not—a judgment call that is difficult for the average person to make. CT scans can, in fact, be lifesaving. “They’ve revolutionized medicine in almost every area you can imagine, including helping prevent unnecessary exploratory surgeries and diagnosing and treating cancers, heart disease and stroke, ” Brenner says. Price and time can also be a factor since CT scans are cheaper and faster than an MRI. (For a cost comparison of common imaging tests, go to health.com/scan-costs.)
Understanding the risks of medical radiation—as well as the real benefits—will better prepare you to make the best decision no matter when you’re faced with it. Here’s what you must know to avoid unneeded radiation.
When you receive a traditional X-ray, a small amount of radiation passes through your tissues in order to create a two-dimensional image of your insides in shades of gray. Air is black because it doesn’t absorb any X-rays, while bones are white because they absorb a lot, and organs are somewhere in between.
CT scanners, on the other hand, rotate around the body, sending numerous X-ray beams (and multiple times the amount of radiation) from a variety of angles. A computer processes the data to create three-dimensional pictures, providing a far more detailed view. “CTs allow us to see behind and around structures in the body in three dimensions with exquisite resolution,” Brenner says. As a result, they’re an indispensable tool in diagnosing all sorts of frightening health problems, such as finding small, early cancers (particularly in the lungs, liver and kidneys) or spotting internal injuries after a serious accident.
“They can detect differences between normal and abnormal tissue about 1,000 times better than a traditional X-ray,” says Richard Morin, PhD, professor of radiologic physics at the Mayo Clinic in Jacksonville, Fla. “Before CTs, if we suspected cancer in the abdomen or internal organs, we had to cut the patient open and do exploratory surgery, which could mean a weeks-long hospital stay. Now with a single scan we can confidently make the call in minutes, and the patient walks out the door afterward. If it’s an appropriately ordered exam, the benefit is far, far greater than any radiation risk.”
But the ease and accuracy of CTs has also fueled an alarming level of overuse. Have a headache that prompts a trip to the ER? Odds are good you’ll get a CT, even though current guidelines say that doctors shouldn’t perform imaging tests on patients with migraines or chronic headaches. Brain scans, whether a CT or an MRI, are worthwhile only if you have a headache with other worrisome symptoms, such as weakness or numbness on one side of your body, explains Brian Callaghan, MD, a neurologist at the University of Michigan. Even so, he and his colleagues recently found that about one in eight headache-related doctor visits result in a brain scan—and nearly half those patients are getting CTs, even though MRIs are more effective for peering into the brain.
“The goal isn’t to eliminate CTs but to use them more prudently,” Dr. Smith-Bindman says. “When my son did a head-dive out of a tree and was vomiting afterward, the ER doc recommended a CT scan to rule out a brain bleed, and I was happy to have the test. Five years later, when he hit his head skiing, it was pretty clear he just had a concussion, and the ER doc didn’t think a CT was necessary, so we didn’t get it. Doctors and patients need to step back a little and say, ‘Yes, this is a great test, but is it really necessary?’ If you have a CT when it’s not necessary, it won’t do any good—which means it can only do harm.”
X-rays and CT scans use so-called ionizing radiation, which contains enough energy to penetrate the body—and can damage DNA in your cells. Any damage that isn’t repaired can lead to DNA mutations, and those glitches in a cell’s programming center can, over many years, lead to cancer.
And we know that it does. “There’s not a single cancer-causing agent that has been studied more thoroughly than ionizing radiation,” Dr. Smith-Bindman says. Survivors of the atomic bombs in Hiroshima and Nagasaki who were exposed to even very low doses were more likely to get practically every type of cancer, from leukemia to lung cancer. Nursing mothers who were treated with radiation for breast infections—a common practice in the 1920s and ’30s—developed breast cancer at higher rates than those who weren’t. Those of us who’ve had more sunburns (caused by the sun’s ultraviolet radiation) are at higher risk of getting skin cancer. And the newest studies reveal that children who undergo CT scans of the head, abdomen or chest are more likely to develop brain cancer and leukemia over the next 10 years.
For reasons that are unclear, women seem to be slightly more sensitive to radiation than men. Children are more vulnerable than adults; not only do their growing bodies and rapidly multiplying cells put them at a higher risk, they also have far more years ahead of them during which they could develop cancer.
However, it’s important to note that our bodies are able to repair damage done to our cells by low levels of radiation. “If they weren’t, everyone who goes out in the sun would get skin cancer,” points out James Brink, MD, radiologist in chief at Massachusetts General Hospital.
The poison is in the dose, says John Boice, ScD, president of the National Council on Radiation Protection and Measurements and professor of medicine at Vanderbilt University. And the effects of exposure might be cumulative. “What may happen is that our bodies repair damage from small doses, but at higher doses our repair mechanisms are overwhelmed,” Dr. Brink explains. “And after that, subsequent exposure to radiation may propel the damaged cells farther down the path toward cancer.”
The actual danger to an individual receiving a scan (or even two or three) is relatively low. The overall risk of the average woman getting cancer at some point in her lifetime is about 38 percent; getting a single CT scan raises that risk to perhaps 38.001 percent, Boice explains. But since no one knows who is most likely to be affected, there is an element of radiation roulette at play.
What’s more, we’re marinating in low-level radiation every day. The average person in the United States receives about 3 millisieverts (mSv) of radiation per year (more if you live at a high altitude) from the sun and naturally occurring radiation in the environment, such as radon gas. To put medical radiation in that context, a dental X-ray is equivalent to about one day of natural radiation, while a single chest X-ray is equivalent to about 10 days. A mammogram adds up to about seven weeks of natural radiation—but even that level, doctors say, poses a relatively small risk, especially when compared with the danger of missing a malignant tumor already growing in your breast. A regular-dose chest CT, on the other hand, exposes you to about twoyears’ worth of natural background radiation, or 7 mSv. Some of the Japanese survivors of atomic bombs were probably exposed to between 5 and 20 mSv on the low end. The trouble is, we don’t fully know how much our bodies can handle.
The issue of medical radiation is now on most physicians’ and medical societies’ radars; just this fall, the American Heart Association called for doctors to learn about, and discuss with patients, the risks of radiation exposure from cardiovascular imaging tests. So it’s surprising—and concerning—how spotty regulations still are. For instance, dosages aren’t standardized across imaging centers, which means that one hospital or clinic may be delivering up to 50 times as much radiation as another facility, according to Dr. Smith-Bindman. “If machines are set too low, they provide blurry, unusable images, but the vast majority are set higher than they need to be,” she says. This is in part because it’s not a simple matter of pressing one button and lowering the dose. “There are formulas you need to use to set up a new protocol,” Dr. Smith-Bindman explains.
And because most older machines, many of which are still in use, don’t have warning systems to alert technologists when radiation levels are set too high, mistakes can happen. The most publicized CT-related overdoses occurred between 2008 and 2010, when several hospitals in California and one in Alabama seriously over-radiated more than 400 patients. The problem was discovered after patients reported losing their hair. Since then, new technology has been created to alert technologists if the dose is too high—and new federal legislation is in the works that would require radiology centers to adopt modern imaging equipment standards by 2016.
Still, the more common problem is that too many scans are being done in the first place, particularly in the ER, where doctors sometimes order CTs before they’ve fully evaluated a patient, Dr. Smith-Bindman says. But doctors in general have come to rely heavily on these tests. One reason: Many MDs today have a lower tolerance for ambiguity than ever before and have learned to trust images to give them definitive answers, even when other methods, including a risk-free physical exam, can provide the information needed.
In addition, physicians in private practice may feel financial pressure to recoup the cost of expensive equipment. “Research has found that if a neurologist, say, owns a CT scanner, the percentage of patients getting scans is higher than what’s typically done in a radiology clinic and much higher than in similar doctors’ practices without scanners,” Morin says. Add to the mix the possibility of being sued over a misdiagnosis, and you have a recipe for overuse.
Avoiding unnecessary medical radiation starts with speaking up and being your own best advocate (see 5 Questions to Ask Before You Have That Scan, page 117). At the same time, multiple industry efforts are under way to lower exposures from CTs. One initiative, Choosing Wisely (choosingwisely.org), helps doctors and patients understand which procedures and tests—including imaging tests—are unnecessary or commonly overused. Radiologists are leading the charge to make scans safer: Image Wisely, a program created by the American College of Radiology (ACR) and the Radiological Society of North America, is focused on optimizing the amount of radiation used in imaging studies and eliminating inessential CTs and other scans. The ACR has also created the Dose Index Registry in an effort to compare dosage information across facilities. About a third of the 3,000 or so scanning facilities in the U.S. are members, which means they get updates on the dosages other centers are using for similar tests, explains Morin, who was the founding chair of the registry. (For more on finding the best place to get a scan, go tohealth.com/safe-scan.)
Meanwhile, companies that manufacture scanners are developing new technology to lower the radiation doses. “They’ve fine-tuned the equipment so you can produce high-quality images with lower doses,” Morin says. Even so, when you need to get a CT scan, it’s always a good idea to ask if they can scan using the lowest dose possible, Dr. Smith-Bindman says. If you’re smaller or thinner, technicians can often get a clear image at a lower dose. (The bigger your body, the more radiation you require, since fat absorbs some of the beams.) Avoid unnecessary radiation from even low-level sources, like dental X-rays, which you probably don’t need every year unless you have ongoing problems with tooth decay.
The idea is not to refuse all medical radiation but to do your best to discriminate between what’s essential and what’s not. “I always tell my friends to say to their doctors who recommend CTs, ‘I’m happy to have the test, but I’d like you to help me understand why I really need it,'” Dr. Smith-Bindman says. “Medicine often doesn’t change until patients start asking questions. And when it comes to medical radiation, it’s time to start asking.”
1. “Will the outcome of the test change the treatment I’m likely to receive?” If the answer is no, the test may not be necessary, Dr. Smith-Bindman points out.
2. “Are there alternatives without radiation, like ultrasound or MRI?” In some cases, such as many abdominal CT scans, other scans work as well or better, Dr. Smith-Bindman says.
3. If you’ve just had a scan at another facility, ask, “Is there a reason to repeat the scan I just had?” Notes John Boice, ScD: “It doesn’t make sense to do tests twice, yet it does happen.”
4. If a CT scan is crucial, ask, “Is there a way to minimize the dose?” Doctors may be able to use a lower-dose technique, particularly if you’re petite.
5. After a CT scan, ask, “How much radiation was I exposed to?” Write it down so you have a record.
You probably don’t need a CT for… Question your doc if she recommends a CT for these health problems.
Concussion: Concussions can be diagnosed by symptoms alone. But it’s valid to do a CT if the doctor suspects a skull fracture or brain bleed, says Robert Cantu, MD, clinical professor of neurosurgery at Boston University School of Medicine.
Sinus infection: This everyday health problem can generally be diagnosed through symptoms and a physical exam, says the American Academy of Allergy, Asthma & Immunology.
Headache: If you do need a scan, MRI is the test of choice, unless a doctor suspects a stroke or brain hemorrhage, according to the American Headache Society.
Appendicitis in children: It’s best to use ultrasound first, then follow up with a CT if the ultrasound is inconclusive, according to the American College of Radiology.
Back pain: Most cases improve on their own within a month, so it doesn’t make sense to expose yourself to unnecessary radiation. If the pain continues, ask your doctor about an MRI.
How much radiation you get from…
Airport backscatter scan: .0001 mSv
Bone-density scan: 0.001 mSv
Dental posterior bite-wing X-ray series (two to four images): 0.005 to 0.055 mSv*
Two days in Denver: 0.006 mSv
Panoramic dental X-rays (standard single image): 0.009 to 0.024 mSv*
Cross-country flight: 0.04 mSv
Single chest X-ray: 0.1 mSv
Digital mammogram: 0.4 mSv
Average yearly dose from the sun and other environmental sources:3 mSv
Chest CT: 7 mSv
Virtual (CT) colonoscopy: 10 mSv
PET/CT (often used to diagnose cancer): 25 mSv
Smoking a pack a day for a year: 53 mSv
*Dose can vary based on the type of machine used.
Researchers in Toronto have recently shown that taking antioxidants before a scan can reduce the number of DNA breaks caused by the radiation. Published results are expected within the next six months. Says researcher Kieran Murphy, MD, professor of radiology at the University Health Network Toronto: “In light of what we’ve found, making sure you have a diet rich in antioxidant-packed fruits and vegetables could be beneficial.”
Introducing TremWatchTM the first in our series of wellness apps.
TremWatch(TM) provides a complete hand tremor measurement, and logging solution
10% of the proceeds from sales of TremWatch(TM) are donated to the Multiple System Atrophy Coalition. Please visit http://multiplesystematrophy.org to learn more.
TremWatch (TM) allows you to:
- Measure Tremors in your left and right hands
- Distinguish the direction your hand tremor is in (ie. does it tend to move more side to side, forward & backwards, or up and down)
- Compare differences & log data over time
- Compare multiple separate measurements side by side
- Frequencies measured from 0 Hz - 25 Hz (samples taken at 50 Hz)
- Graphs auto scale for smaller amplitude measurements
-TremWatch(TM) resizes to fit phones, tablets & other devices
- Export data for archival or use in other software
- Tremor Amplitude vs. Frequency for combined tremors
- Tremor Amplitude vs. Frequency in separate graphs for each direction X,Y & Z. This allows you to see if your hand movement is mostly sideways, forwards/backwards, or up/down.
- Tremor Raw Data (Acceleration vs Time)
- Multiple measurements can be seen as graphs side by side for comparison between each hand, measurement dates, etc.
* TremWatch(TM) is for educational purposes only and not for medical diagnosis or treatment. Please contact your health professional if you have any concerns regarding tremors.
Over 10 million people in the US deal with hand tremors - and a larger number world wide.
Tremors can be have many different causes, including Parkinson's disease, Multiple System Atrophy, Multiple Sclerosis, Orthostatic tremor, stroke, brain injury, and other neurodegenerative diseases. Other causes range from the use of some drugs (such as amphetamines, corticosteroids, as well as drugs for certain psychiatric disorders), alcohol abuse or withdrawal, mercury poisoning, over-active thyroid, or liver failure. Some types of tremor are inherited and run in families, others have no known cause such as Essential Tremor.
Tremors often begin years, or decades before they're noticed. However people don't have a good way to track what is going on, or what makes their symptoms worse.
If someone asks you: “How long have you had that tremor?” or “Has your tremor gotten worse?” It's very hard to say, because it's difficult to notice subtle changes over time.
TremWatch(TM) is for personal education and not for medical diagnosis*. It offers an easy way to track what is going on, learn more about their own responses. TremWatch(TM) helps you see how coffee, stress, lack of sleep, or medications seem to affect your tremors.
TremWatchTM is the first module in a suite of integrated wellness enhancement tools. A more advanced statistical analysis package is also in development. It will provide ongoing monthly charts of changes in tremor amplitude, frequency and other information. This tool will archive your data and run on multiple platforms.
A research version of TremWatchTM will be available for health professionals conducting studies. This version includes other features including real time encrypted data upload. If you are a researcher in this area, please feel free to contact us.
A handful of members from the Essential Tremor Support Group that meets monthly at Leisure World in Silver Spring made a trip to Capitol Hill to meet with Congressman Chris Van Hollen’s Legislative Assistant for Healthcare, Erika Appel, to discuss concerns over quality of life for people with Essential Tremor, a neurological condition.
E.T. can present with hand tremors, voice tremors, loss of voice, head tremors, and leg tremors. Prudy of Ashburn attended with her sister, Sara, of Derwood, in order to speak for Sara who cannot talk because of the condition. Sara began having a wavering voice years ago and as the condition progressed she lost her voice completely and faces not only social isolation but real danger from not being able to communicate. Another attendee was Thom who came with his wife Mary so she could speak to how it is for a family member supporting the person with E.T. Thom had Deep Brain Stimulation, brain surgery that involves a pacemaker placed below the neck that helps control the electrical signals and calm the tremor. Unfortunately for Thom, the electrical wire placed in the brain is close enough to the speech center to have impaired his speech which is slurred as a result. Charley, another member, lost his job last December when he was asked to take early retirement and suspects that his tremor may be in part to blame since he was an ESOL teacher who taught writing, which is of course quite difficult when your writing is illegible from the tremor. And lastly I attended, a 50 year old woman, and experience like many others the anxiety-like physical and psychological effects of the tremor and its negative impact on work and social life. As the condition progressively gets worse, I fear for my future in terms of unemployment [my excessive shaking at job interviews does not likely help me get the job] and disability [since the tremor is not bad at all times, I certainly would not qualify for disability, but in situations such as job interviews it is truly a disability].
Prudy spoke and gave some perspective on E.T. in the U.S. She recollected statistics from several years ago that approximately 1 million people have Parkinson’s Disease whereas E.T. affects about 10 million. Most in our group think people with the condition do not know they have it and attribute their symptoms to anxiety or nerves. It has been well-established that having an alcoholic drink helps many with this condition, that the octanol in alcohol helps diminish the tremor for a short time, and NIH has conducted research studies to isolate the octanoic acid from alcohol for use in pill form. These studies are years old, and there is frustration among this group that development of pharmaceutical octanoic acid is stalled. While there is the newer focused ultrasound treatment, and Sara mentioned she thought there were 9000 on the waiting list, we lamented over the lack of knowledge among neurologists about our condition, and about the complete lack of development of any drug specifically made to treat E.T. The few medicines that are prescribed were developed decades ago for other conditions like high blood pressure and epilepsy and happened to alleviate the tremor for only some people. It was encouraging that Erika Appel wanted to look into the condition further and wondered why a drug had not been developed if there is a market of so many people who have the condition.
Diann Shaddox Foundation for Essential Tremor Blog
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