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Solve the Medical Riddle: Her Hands Have Started Trembling, and Her Voice Is Shaky, Third 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.

The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using 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

Last week, Patty learned the results of a complete blood test, a chemistry panel, and a thyroid functions test. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“The first thing that came to my mind was Parkinson’s disease. I have a friend who has early onset PD that started in his late 40s. I remembered that the hand tremor was that first symptom he noticed. I asked him about that. I told him that Patty didn’t have trouble drinking out of a glass of water in the doctor’s office and that her tremor didn’t get worse when the doctor asked her to reach out her hand. I was very surprised when my friend told me that Patty’s reactions would have been exactly the opposite if she had Parkinson’s. In other words, drinking out of a glass of water would have actually steadied her hand whereas reaching her hand out may have made it shake even more Who knew? Anyway, I’m pretty sure now that PD isn’t the diagnosis. I can’t wait to find out what it really is!”

— Lorna P.

“The doctor didn’t mention asking about whether Patty is a drinker. Since she’s his regular patient, she has probably asked her that before. Very often, self-reported alcohol use is not the whole story. Plenty of women are closet drinkers. I know, because I was one. I’m in AA now and I’ve been sober for ten years. My hands used to shake when I binge drank. They also shook when I first quit and was in withdrawal. Now they never shake! Maybe drinking is Patty’s problem.”

— Clarissa J.

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