DEAR DR. DONOHUE: I would like to know what medicines other than Inderal might help my familial tremor. My head shakes most of the day. It began about two months ago and has increased rapidly. Does being stressed out or nervous cause the tremor? – R.P.

Familial tremor gets its name because it often runs in families. It has another name – essential tremor. That name indicates our lack of knowledge about its cause.

This tremor is the kind that occurs when a person makes a purposeful movement, like picking up a cup of coffee, threading a needle or bringing a spoonful of soup to the mouth. The tremor of Parkinson’s disease is different from this tremor. A Parkinson’s tremor is most pronounced when the hands are resting quietly in the lap.

You don’t mention a hand tremor. Familial tremor does not have to involve the hands. Sometimes its only manifestation is head-shaking or a quivering voice. Alcohol temporarily abolishes the tremor. All these points differentiate the tremor from that of Parkinson’s disease. Stress and nervousness make the tremor worse, but they do not cause it.

Propranolol (Inderal) is the drug that is the first choice in treatment. If you cannot tolerate that drug, Mysoline and Neurontin are alternatives. They are seizure-control medicines, but seizures are not why they are employed here.

A great help in tremor control is banning caffeine, in all its forms, from the diet.

Should medicines be unable to calm the tremor, brain stimulation can be tried. Here, a device similar to a pacemaker is implanted under the skin of the upper chest. From that device, wires are run to the brain’s movement center. Minute electric current can often stop brain signals that generate the tremor.

You and everyone who suffers from this tremor should contact the International Essential Tremor Foundation. The foundation provides you with the latest information on causes and control of essential tremor. The number is 1-888-387-3667, and the Web site is

DEAR DR. DONOHUE: I am a 50-year-old woman who has neurofibromatosis in the worst way. I have neurofibromas too numerous to count, and they cover me from head to toe. I have not known anyone else who has this. Do you know someone I could contact? – A.B.

I can go one better than that for you. Contact the National Neurofibromatosis Foundation (; 1-800-323-7938), and you will never again feel like the only person with this genetic condition. It affects about one person out of 3,000. That makes it sound like a rare disease. Divide that number into the population of the United States and Canada, and you come up with a surprisingly large population of patients.

Neurofibromas are soft growths of nerves and the material that encases nerves. They sprout from the skin and range in size from quite tiny to quite large and unsightly. They range in number from a couple to hundreds. They can also grow in or around internal organs.

Although the condition is present from birth, neurofibromas don’t usually start to grow until puberty. In infancy, however, a doctor can recognize trouble by finding coffee-with-cream-colored spots on the skin. Six or more are strongly suggestive of this illness.

I wish I could tell you that there is a medicine to rid you of these growths. I cannot. Surgical removal is the only answer.

DEAR DR. DONOHUE: I take furosemide (Lasix) to get rid of the water that swells my feet. I take 20 mEq of potassium twice a day. Am I taking too much or not enough? – P.F.

This is a question easy to settle. Your blood level of potassium can be checked by any laboratory. It’s a test that is done thousands of times every day.

Many diuretics (water pills; furosemide is one) flush potassium from the body when they flush excess body fluids from it. Yours is a normal dose.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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