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

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 Recommendation

Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

The Doctor Reveals the Diagnosis

Sophia M. nailed it! Patty does indeed have the same condition that made Katherine Hepburn’s voice quiver in the movie “On Golden Pond”, Benign essential tremor was the obvious diagnosis to me from the get go, given Patty’s slow progression, tremor with activity, no rigidity of muscles, no gait issues and no cerebellar or spasticity issues. Also, her blood thyroid was fine. In addition, her family history with the father having shaking hands pointed to essential tremor since the condition is 50% genetic.

Plan/Treatment

Because Patty has high blood pressure, high normal pulse and no other problems, the doctor started with a beta blocker. Some patients feel a little tired or slowed down when first starting on beta blockers but the medication could be great.

The doctor’s second choice is Mysoline, a seizure medication that usually works. Sedation is minimal if at all once the patient is adjusted. It is really trial and error.

If Patty had anxiety issues making her condition worse she could use an occasional Xanax in a tiny dose, but she didn’t present with any more anxiety than just the worry about what her condition might be.

Bottom line, reassurance is the best medicine in this case.

Here is Patty’s take on her condition:

“Talk about massive relief! I privately thought I probably had Parkinson’s disease when I started to shake, but I never told my husband that. I did Google PD, but the information was very confusing. All I could get out of it is that there is no cure! So I prayed I had some thing other than PD. Imagine my elation when I found out that I had a benign condition – the same one Katherine Hepburn had! She went right on with her life, and I plan to do exactly that. My husband and my daughter are thrilled. So is my son-in-law. We told my grandsons, ages 9 and 11, that Mimaw has a cool shaky voice just like a famous actress. They like that! I do want to say, though, that you should not put off getting a checkup if you have something that worries you. I probably exacerbated my high blood pressure by worrying about Parkinson’s instead of finding out that I’m basically fine!”

Come back to thirdAGE.com next Thursday when we’ll introduce a new medical riddle!

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.