For too long, she struggled against tremors. Eventually, she could not drink from a glass without a straw, or cut her own food.
On this day, Marguerite Tiff works a meat-cutting blade, hands covered by nothing more than cellophane gloves, which is really to protect the food. Guiding the commercial blade, she shaves slice after slice, then delivers the shaved roast beef to a customer.
She beams and says nothing, but raises her arms, palms out. Her hazel eyes squint with a spreading smile.
Flash back to 2014. Tiff, 63, has a movement disorder, called essential tremor, characterized by rhythmic trembling of the hands, head, legs or trunk. It is slowly progressive, incurable, often hereditary, but treatable.
She was attending school to become a medical assistant, but had to put aside her hopes. “I was shaking so bad I could not give an injection,” she recalls.
Tiff was in her 30s when her hands developed a slight tremble. She eventually developed a pronounced tremor in both hands. Her head nodded yes and no constantly. She developed a voice tremor. She became functionally disabled.
“My grandchildren had to cut my meat,” Tiff says. “One of my granddaughters was going to have a baby and I wanted to hold that baby, but I was afraid.”
Medication did not help. Eventually Tiff was referred to Ashok Sriram, MD, MS, a neurologist and movement disorders specialist with Spectrum Health Medical Group. She had heard of a procedure—deep brain stimulation.
Could he help?
Tiff’s is the most common form of tremor, affecting up to 4 percent of the population older than 65. It occurs in largely healthy people and is not life-threatening. But it can be life changing and often runs in families.
Dr. Sriram has had success with deep brain stimulation, but deciding whether a person is a candidate requires careful review by a team of highly trained professionals.
Basic considerations: Tremors that are bothersome and get in the way of doing everyday things, and not responding to medications.
“Our philosophy is a patient-centered care approach, we should be rotating around the patient, not the patient rotating around all these different offices,” Dr. Sriram said.
Tiff was put through a two-day fast-track evaluation with seven professionals. It is a hallmark of Spectrum Health’s approach.
She earned approval to proceed with deep brain stimulation.
The devices work much like pacemakers. Implantable electrodes send high-frequency signals to targeted areas that control movement. Deep Brain Stimulator was implanted on one side of Tiff’s brain in February 2014 and the other in December 2014.
The hand tremors are all but gone, he said. “She has about 90 percent of head control.”
On this day at the Meijer Deli on 54th Street, Tiff is not thinking of that day. She is not thinking of the tears her daughter shed after the surgery.
She is carefully weighing the roast beef as it peels from her blade, and thanks her customer.
Then she raises her palms.
“See,” Tiff says. “No shaking.”