Doctor Figure sitting on question mark

Solve the Medical Riddle: Her Hands Have Started Trembling, and Her Voice Is Shaky, 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. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations




During the first visit, the doctor did a complete neurological and general exam. She ordered laboratory tests and asked Patty to come back for a second visit to learn the results.


At the second visit, the doctor told Patty that the blood work had ruled out thyroid disease. The complete blood count, chemistry panel and thyroid functions were all normal.

The doctor noted that Patty’s tremors in her hands and voice had not gotten worse, and that her gait was normal. The tremor did get worse during the second visit when Patty tried to drink from a glass of water. That is exactly what had happened during the first visit. However, the tremor did not increase when Patty reached out her hand. That is also the same as what happened during the first visit.

Patty reported that her husband had said her condition had seemed to stay the same in the interim between the first visit and the second visit. Her daughter also didn’t notice any increase in the shakiness in Patty’s voice during their weekly FaceTime call . . .

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

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

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