Page 13 - Boca Club News - August '22

Boca Club News, Page 13
Medical Matters: Essential Tremor

By Richard Nagler, M.D., a member Essential tremor affects seven million Americans metabolic problems, side effects from drugs, high alcohol
of Broken Sound Club and retired each year, the majority over age 40. In 50% of cases, it is levels and certain chemicals, all of which can cause
physician. After graduating from the familial due to a defective gene from one parent; for the tremors. CT and MRI scans can detect a stroke, and a
University of Pennsylvania and New others there is no known cause. This is not a serious or dopamine transporter scan can differentiate essential
York University’s School of Medicine, threatening disease. tremor from Parkinson’s.
Dr. Nagler served his internship and It is most important to differentiate essential tremor from Treatment is not necessary when symptoms are mild.
residency at Baltimore City Hospital Parkinson’s disease. The tremor of the hands in essential Beta blockers such as Inderal offer relief for some patients.
and Johns Hopkins. He followed that tremor occurs when using them, while in Parkinson’s it Anti-seizure medications such as Mysoline (primidone),
with a Fellowship in Gastroenterology happens when the hands are resting by the side or on the and tranquilizers like Xanax and Klonopin, are helpful
at Yale University School of Medicine, and was then Chief lap. In addition, Parkinson’s is associated with such other as is alcohol in moderation--especially for those whose
of Gastroenterology at Fitzimmons General Army Hospital features as stooped posture, slow movement, a shuffling symptoms are made worse with tension and anxiety.
in Denver. He returned to the Yale Medical School for one gait, loss of volume in speech with whispering, weakness Botox injections for head and neck tremors and to the
year as an Assistant Professor of Medicine before opening in the extremities, an unsteady gait and, in many cases, tongue may help with swallowing and speech, and can
his own successful private practice in Internal Medicine Lewy body dementia. last as long as three months. Focused ultrasound or high
and Gastroenterology. During that time, he also served for There are a wide variety of drugs associated with frequency focused ultra sound (HIFU) can target the part
ten years as Chief of Medicine at Huntington Hospital in tremors, which include certain cancer medications, of the brain that’s causing symptoms and destroy the cells
Huntington, N.Y. anti-seizure, anti-depressants, some asthma drugs, causing the tremors.
Essential tremor is a neurological disorder that causes amphetamines, antibiotics and antivirals, among others. Physiotherapy can improve muscle strength and
involuntary, uncontrollable rhythmic shaking, especially Individuals taking these drugs should be identified when coordination, and occupational therapy can help using
when performing simple tasks. The hands are the most evaluating tremors. heavier drinking glasses, wrist weights and wide grip
commonly affected, with tremors that can cause difficulty There is no specific test to diagnose essential tremor. pens. When symptoms are more severe and disabling,
drinking from a glass, even spilling the contents. Putting on A positive family history is important. Performance tests, brain stem stimulation is effective by placing long thin
makeup, shaving and tying one’s shoes may be difficult. The such as having the patient drink from a glass, holding their electoral probes into the Thalamus in the brain connected
head may shake from side to side or up and down. When the arms outstretched over the head, to write and draw a spiral to a pacemaker-like device implanted in the chest, which
tongue is affected, speech and swallowing may be impaired. are very helpful. Importantly, abnormal tendon reflexes, transmits painless electoral impulses that interrupt signals
There can be facial and eyelid twitches. The symptoms may loss of muscle strength and tone, the ability to feel certain from the Thalamus that cause tremors. Stereotactic radio
worsen in time and can become severe. They can be provoked sensations, poor posture and coordination, as well as an surgery, where high-powered x-rays are pinpointed to the
by hunger, temperature extremes, cigarettes, caffeine, stress, abnormal gait, are characteristic of other disorders. Thalamus, is another option.
fatigue and alcohol abuse. Blood and urine tests can detect an overactive thyroid,
Legal: Unintended Consequences

By Michael J Posner, Esq., a partner today states: Overruling Roe does not mean the overruling Ownership as Tenants in Common (TIC) means that each
in Ward Damon P.L. a mid-sized real of those precedents, and does not threaten or cast doubt on owner owns a distinct percentage as stated in the deed. If not
estate and business-oriented law firm those precedents.” stated, then it is presumed to be equal shares: two owners
serving all of South Florida, with However, Justice Thomas, in his concurring opinion mean each owns fifty percent, four owners mean each owns
three offices in Palm Beach County. in support of Dobbs, implies that the Supreme Court has twenty-five percent. TIC owners can freely convey their
They specialize in real estate law and not gone far enough to address other decisions that rely on interest without affecting the nature of the estate, and upon
can assist sellers and purchaser with substantive due process, such as the decision on Obergefell one owner’s death their interest passes to their heirs at law.
closing and financing of residential and other cases. A strict reading of his decision could mean Creditors can encumber a TIC interest, either voluntarily
and commercial real estate including support on the Supreme Court to overturn Obergefell on the through a mortgage, or involuntarily through a judgment. To
remote closings. They can be reached at (561) 594-1452 or same grounds as Dobbs, that gay marriage, like abortion, is create a TIC interest in Florida the deed needs merely recite
at mjposner@warddamon.com. a state legislative prerogative, not a protected right under the the grantee (buyer’s) name, and no statement of interest is
In a landmark ruling, Dobbs V. Jackson Women’s Health US Constitution. required.
Organization, the United States Supreme Court reversed the In the context of real estate law, the right to gay marriage Ownership as Joint Tenants traditionally meant that the
decision in 1973’s Roe v. Wade, which found that women meant that married gay couples were able to hold title as owners share equally in the ownership of the entire property. To
had a constitutional right to an abortion. In the majority tenants by the entireties. This is a special estate of ownership create a joint tenancy, four specific elements are necessary: (1)
opinion, the Court held, “It is time to heed the Constitution under Florida law that provides benefits not available to non- The joint tenants must own an undivided interest in the property
and return the issue of abortion to the people’s elected married couples. as a whole and their share must be equal; (2) the estates of the
representatives.” This will make abortion a state-by-state In Florida, the law recognizes three distinct estates for joint tenants must be for the same period of time; (3) the joint
issue. The decision has created the possibility of other multiple owners of property. Two are derived from common tenants hold their property under the same title; and (4) the
decisions being overruled, particularly Obergefell v. Hodges, law; and the third, tenants by the entireties (TBTE), is joint tenants all enjoy the same rights of possession.
which validated gay marriage. The majority opinion did seek distinct to Florida and about half of the states in the U.S. The The magic language to create this is estate is “joint tenants
to address that issue by stating, “I emphasize what the Court traditional estates are Tenants in Common and Joint Tenants. with rights of survivorship.” The main benefit of the joint
tenancy is that upon the death of one tenant, the property
passes outside of the deceased owner’s estate to the other
owner and no probate is required. Joint Tenancy does not
ARCHIVE GALLERIES the entireties, and creditors can lien and foreclose a joint
function as a creditor’s protection scheme like tenancy by
owner’s interest. Joint Tenancy is usually the best option for
owners with a common interest through family or for same
sex couples. After death, the recording of death certificate
and a non-tax (estate) certificate will generally clear title in
PAYS HIGHER PRICES FOR FINE ART AND ANTIQUES the surviving joint tenant.
A TBTE estate is created with the same conditions as a joint

tenancy, but is only available to married couples. The deed
• Oil Paintings • Sterling Silver • Collectibles must establish that the grantors are married, with words such
• Oriental Rugs • Objects of Art • Fine Crystal as “husband and wife,” or “a married couple.” The TBTE estate
• Tapestries • Sculptures • Orientalia has the same survivorship interest as the joint tenant estate,
• Fine Furniture • Bronzes • Tiffany Items but also adds creditor’s protection that only applies to married
couples holding title as TBTE. For example, a couple owns
• Service Plates • Porcelain • Clocks three rental homes in Florida in addition to their homestead.
If one spouse is sued, and a judgment is entered against that
spouse, the judgment will not attach or become a lien against
We Also Purchase Men’s And Ladies’ Items Including: any TBTE property. Thereafter, as long as they remain married
or the non-judgment spouse survives the judgment spouse, the
• Old Watches • Cufflinks • Smoking Items • Coins • Antique Jewelry lien will not attach against any TBTE property. However, if
• Designer Handbags • Fine Modern Jewelry • Vintage Costume Jewelry the parties get divorced, or the judgment spouse survives the
non-judgment spouse, the lien can then attach.
If Obergefell is overturned, gay couples will need to
One Piece Or Entire Contents Purchased carefully examine their real estate ownership. If the ruling
is retroactive, states like Florida—where gay marriage was
CALL NOW FOR A FREE CONSULTATION, NO OBLIGATION illegal—may mean all gay marriages are invalidated, thus
turning TBTE estates into tenants in common. Even if that
does not occur, any future purchases by gay couples should
carefully address ownership by including joint tenancy rights
CASH 561-498-7536 COURTEOUS in any future deed. Otherwise, a tenants in common estate
PAYMENTS IN HOME will occur, and when one “gay spouse” dies, the property will
UPON REQUEST SERVICE not go to the other spouse, but to his or her heirs, which is a
common issue for gay couples who never married and left
their real estate title as tenants in common.