Whole Lot Of Shakin' Goin' On

My hands shake a lot these days. The odd thing is that they don't shake with gross motor control, so you don't see it so much when I pick up a glass or pass a plate. They shake with fine motor control, so you can really see it when I do things like open a bottle top or peel an egg. It is another one of the oddities of ALS, that the fine motor control is what goes first.

The most difficult part of the shaking is that I drop things. Once again, it's not the big things that I drop. If I take the lid off of a bottle of soda, I can hold on to the soda just fine. It's the cap that goes flying. I can drive just fine but my hands shake when I try to put the key in the ignition. I spill almost every time I pour something; the container is safe in my hands, I shake and spill when I pour.

This kind of loss of muscle control is the beginnings of a more serious event, one that will end with the total loss of muscular control in my hands and arms. It is the equivalent of toe drop in my legs. It is not, however, the only kind of muscle challenge that goes with this illness. There are actually four different kinds of shaking going on.

The first, the one that I am talking about here, is a result of general loss of muscle tone. It is the weakening of my arms that causes my hands to shake, even though my hands themselves remain reasonably strong. This is a kind of spasticity occurring in those muscles I have which still function; it's the kind we all get now and again when we overwork a particular muscle or set of muscles. In other words, it's normal and we all get it.

The second kind of shaking happens mostly when I get up in the morning; it's called "clonus". It is a violent kind of shaking usually triggered by muscle extension or reflex action, like stretching when you first get up. It occurs across my upper body, most noticeably in my hands and arms, but also in my neck and head. Clonus is thought to be a result of damage to the upper motor neurons, something that clearly happens with ALS.

The third kind of shaking is simple muscle spasm, also known as spasticity. This happens most often during my Range of Motion exercises, what I call my stretches. When any of my weakened or dead muscles are stretched, they spasm. This means they contract and release rapidly, uncontrollably. Most spastic episodes happen when my care workers are pushing my muscles hard, particularly my hamstring muscles. Spasms also happen when I overwork any muscles on my own, such as when I try to hold something heavy for too long, such as a jug of milk or a box of wine bottles, as mentioned earlier.

Finally, the fourth kind of shaking is my old friend, the "fasiculation". This is the small contraction and release of muscles in those portions of my body under attack by ALS where there is still some level of muscle activity on my part. These mild muscle movements are a forewarning, telling me that bad things are happening. There were plenty in my legs before they died; they now happen in many parts of my upper body including my arms, my diaphragm, my eyelids, my cheeks, and so on. They are just wierd; they happen all on their own and I get to watch.

All in all, there are a lot of things that make me shake. So there's a whole lot of shakin' goin' on.