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

“I was 22 in 1981 when I saw ‘On Golden Pond’, a film for which Katherine Hepburn won an Academy Award for Best Actress. She was terrific, and I remember thinking how amazing it was that she perfected that quivering voice as part of her role. Well, guess what? She wasn’t acting! I’m 57 now and I have a voice tremor just like Hepburn’s in that movie! My dominant hand also shakes, and the other one shakes a little. My doctor is the one who told me that my diagnosis, essential tremor, is what Katherine Hepburn had in real life rather than just on the screen. Wow! Anyway, I hope this is what Patty has because it’s not serious. Yes, people sometimes look at me funny. Who cares? I’m not going to die from this, and I can still drive. I’ll bet Patty’s grade school teacher had essential tremor, too. If so, she should have leveled with her students to allay their fears and keep them from making fun of her behind her back. Just my humble opinion or IMHO, as my grandson says.”

— Sophia M.

“Maybe the culprit is simply too much caffeine. Patty remembers that her father’s hand shook when he was drinking coffee. Is she a big coffee drinker? If so, may just cutting back on cups of Joe will cure her!”

— Rhonda K.

“Maybe Patty has dyskinesia, or intentional tremor. I’m wondering why the doctor didn’t mention asking her to toucher her nose and then his nose. That’s what they didn’t shen I slippled on the ice and hit my head. I was fine, but I’ve heard that’s a common test. Perhaps the doctor already had her diagnosis in mind and didn’t think that test was relevant! Or maybe she did the test during the cerebellar part of the exam and didn’t mention it because it was normal.

— Olivia P.

To be continued . . .

Come back to thirdAGE.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

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.