Dr. Vincent J. DePinto
From the OR to ET
I am 56-years-old and a retired surgeon. When I was 10-years-old in fifth grade, we dissected frogs, and I was immediately fascinated with anatomy. The circulatory system, the digestive system, the musculoskeletal system, the reproductive system—the designs and functions of living organisms seemed miraculous to me. It was at that moment that my dream to become a surgeon was born. To positively influence the function of a living human being with knowledge of anatomy and technical skill was my life’s pursuit. After four years of pre-med in biology and another four years of medical school, I embarked on my surgical training. I took great pride and worked very hard at my expertise in surgical fine motor skills.
I practiced my techniques incessantly to perfect my skills. I also studied my surgical anatomy diligently. Most surgical maneuvers are performed in a right to left fashion for a right-handed person. I am right-handed. At times, it is necessary to perform a maneuver from left to right which a right-hander performs in a back-handed fashion. I had a mentor during our training that encouraged us to practice these maneuvers with our non-dominant hand. This made it easier to perform surgical maneuvers in either direction. I worked very hard at this and became equally proficient with either hand.
When my training was completed, I began a career as a general, vascular and trauma surgeon. With the medical knowledge I had accumulated and the surgical technical skills I had developed, I became very successful. Many vascular procedures are performed under magnification. Many general surgical procedures are performed with minimally invasive video-enhanced techniques. Any shaking is exaggerated under these circumstances.
When I was about 50, I began to notice a slight tremor in my movements with my right hand. At first I think it was only noticeable to me as it was very fine. Being a proud surgeon, I was very sensitive to having a steady hand. At first I thought the tremor was just part of getting older, but as time went by, it became more pronounced. Interestingly it was only in my right hand. I had no tremor in my left hand. Because I was proficient in performing maneuvers with either hand, I compensated by predominantly using my left hand for the surgical maneuvers. In the interest of patient safety, I stopped doing the vascular procedures that required the most delicate of fine motor skills.
My right hand tremor continued to worsen. Some of my colleagues mentioned the tremor to me. I then had an evaluation by a neurologist. It was at this time that I was officially diagnosed with essential intention tremor. Again in interest of patient safety, it was at this time at age 54 I retired from surgical practice. I had a vague knowledge of essential tremor, but like most medical and non-medical people, I did not know the specific facts of this neurological condition. I felt like most people: essential tremor carried a stigma with it. I do not know if there is any history of this in my family as it is not something that is ever discussed. Like most people, I felt that it was something to try and hide, but in my profession it was a condition you had to accept and deal with.
I began taking Propranolol LA. It slightly dampened my tremor, but only minimally. I also tried the medication Mysoline, but the side effects of fatigue and disorientation were intolerable. I have noticed that my tremor is worsened by fatigue, stress and caffeine. Of course, fatigue and stress were common in my profession with the long hours of emergency night call and daily life and death circumstances and decisions. In retrospect, during my career I worked with a few surgeons who clearly had intention tremors, but again there was very little awareness that this was a distinct neurological condition that should be diagnosed, recognized and treated. It was very difficult to give up my surgical career, but it was the right thing to do.
Since my retirement, my tremor has slowly continued to progress. My handwriting is very poor. I eat and use other utensils with my left hand as so far it seems to be minimally affected, and I had become proficient with the use of my left hand. I also brush my teeth and shave with my left hand. I drink from a glass with my left hand. If I try and carry a glass of liquid in my right hand, I spill it. If I go through a buffet line, I place the plate on the table and serve myself with my left hand. Threading a needle or tying a fly on my fly-rod fishing pole is now impossible for me, and I ask for help with these tasks. In retirement, I have embraced golfing as my major pastime. My tremor affects mainly the finer motor skills of chipping and putting. I have compensated for this by using a belly putter and a “claw grip” with my right hand.
I have learned that it is okay to discuss essential tremor with people. I try to educate people that essential tremor is not a stigma, but a neurological disorder that effects ten million people in the United States. I educate them that essential tremor is not the same as Parkinson’s disease. I educate them that awareness is critical because as yet there is no cure for essential tremor. I have considered DBS (Deep Brain Stimulation) surgery for my condition, but have not committed to this step. I have seen the successful results of this surgery, but realize that it carries some risk, and is still not a cure for the condition.
I realize that having essential tremor precludes me from continuing a surgical career. However, there are options to deal with the condition in leading an otherwise productive and active life. I also emphasize awareness and education of the condition is critical to finding effective treatment and an eventual cure.