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Solve the Medical Riddle: She Constantly Feels as Though She’s Swaying and Rocking, Second Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her symptoms and the doctor proceeded with the examination. That was step #1, S, of the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
O=Objective Findings
A=Assessment or Analysis
P=Treatment Plan or Recommendations

This week the doctor will move on to O and A in order to continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will move on to P to reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

The Doctor Looks for Clues to the Medical Riddle

O=Objective Findings

Last week, the doctor asked Judy to make an appointment for the following week with enough time so a comprehensive workup could be done.

O: Objective:
The doctor did a complete physical exam including checking for neurologic signs such as:

• nystagmus (rapid fine motor movement of eyes)
• tremor
• balance problems
• rigidity in muscles

All was normal. The doctor then used a tuning fork, a common way to test perception and hearing. A blood sample was sent to a lab to rule out anemia, chronic kidney disease, hypothyroidism (very common in postmenopausal women), as well as low B12 level associated with pernicious anemia that can cause balance issues.

A=Assessment or Analysis

The doctor did not feel ready to make an educated guess as to a diagnosis, preferring to wait for the results of the MRI and the bloods tests. However, based on her evaluation, she felt that a referral to a neurologist would be better than a referral to an ear, nose and throat specialist.

In the meantime, in order to give Judy some relief while she was waiting for a diagnosis, the doctor prescribed a low dose of Ativan (benzodiazepene) and Benadryl, a sedating antihistamine. Both drugs can help manage vestibular symptoms and could help Judy sleep.

To be continued . . .

Come back to ThirdAge.com next Thursday to find out what some people have guessed the diagnosis might be.

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