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Solve the Medical Riddle: She Suspected That Her Husband Was a Closet Drinker, First Week

By Marie Savard MD

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.

We’ll start this week by letting you know what the patient told the doctor and how the doctor proceeded with the examination. Next week, a specialist will 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 specialist will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

 

The Patient’s Wife and the Patient Report His Symptoms

 

Elaine, age 55,noticed that her 60-year-old husband often had alcohol on his breath at all times of the day. She was afraid he had become a closet alcoholic but he insisted he had never had a drop to drink before the evening. Although Elaine wanted to believe him, she knew by his erratic behavior and slurred speech that something was wrong. She convinced him to see their family physician for a check up.

 

As always in ThirdAge Medical Riddles, the doctor uses 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, we’ll learn what Elaine and her husband, Sam, told the doctor:

Elaine: Lately I’ve been smelling alcohol on Sam’s breath at odd hours of the day, sometimes even in the morning after breakfast. Not only that, but he often slurs his words and when we’re watching TV, he starts slumping in his chair. I suspect he is secretly drinking. However, I’ve never found any beer or wine or liquor hidden in the house and I haven’t seen extra empty bottles in the recycling bin. I’ve read that older people sometimes can’t hold their liquor as well as they once could so maybe that’s what’s going. He has always had one or two small bottles of beers before dinner with no problem. Could he be getting drunk on that much alcohol now? Still, that wouldn’t explain why he is often drunk in the morning!

Sam: I swear I’m not a closet drinker! I don’t deny that I feel dizzy and drunk even in the morning sometimes but I have never touched a drop that early in the day. As my wife said, I do have a couple of beers in the evening. I’ve been doing that for years. Actually, I tried going a week without the beer as a test but I still felt drunk! Believe me, I am not lying. I hope you can help me because I’m afraid I might get pulled over for drunk driving and then fail the breathalyzer test even if I haven’t been drinking. Or worse, I could get into an accident and hurt someone else. And I might even lose my job if my boss smells booze on me. I’m telling you, Doc, I’m scared. I know there’s something wrong with me! I sure hope you can find out what it is.

SUBJECTIVE EXAMINATION

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