Tremors

Name: Andrew Smith

Age: 40 Years Old

Date of Birth: 27th August 1984

Location: General Practice

Occupation: Taxi driver

“Lately, I’ve been getting these odd tremors in both my hands. It’s not Parkinson’s Disease is it?”

• Onset: This started three weeks ago, spontaneously

• Progression: It was intermittent at first, but lately it has been getting more persistent

• Exacerbating Factors: Noticed it becoming worse when tired

• Relieving Factors: Surprised to find that alcohol calmed the tremors down a little. Wife does not note any tremors at night when asleep. Tremors happen when using hands.

• Associated symptoms: Nothing comes to mind

• Timing: There are no fixed durations for the tremors, though they have become slightly longer over time.

• Episodes of being symptom-free: Completely well and normal when tremors do not come on.

• Severity: Has been getting worse over time. 

• Impact on Daily life: Tremors are not too bothersome at the moment, but I worry they might interfere with my driving if it gets worse. Able to perform fine movements like buttoning up my shirts well without issues. Able to perform all other daily manual tasks involving hands normally at the moment.

• Precipitating Factors : Cannot think of anything that may have triggered these symptoms in the first place.

• Recent illness: None.

• Recent trauma: None.

• Recent travel: None.

• Previous episodes: Never experienced this before.

• Ideas: “I really have no idea.”

• Expectations: “Maybe some medications that can stop these tremors?”

• Concerns: “Just worried that if it gets worse, it might impact my work.”

• Bowel habits: Normal

• Urinary habits: Normal

• Appetite: Same as usual.

• Sleep: Normal.

• Weight: No change

• Pain in the chest/abdomen: None

• Anxiety: Nothing out of the ordinary

• Sensitive to heat/cold: No

• Dizziness: None

• Loss of balance: None

• Fever: None

• ENT: Normal

• Cardiology: Normal

• Respiratory: Normal

• Ophthalmology: No visual changes

Previous hospital admissions: None

Previous surgeries: None.

Medical conditions:

• Type 2 Diabetes Mellitus

• Hypercholesterolaemia

Medications:

• Metformin for T2DM

• Atorvastatin for hypercholesterolaemia

Over the counters:

• Vitamin C supplements

Allergies:

• None

Grandfather used to have some tremors as well, however, was never formally diagnosed. Everyone else is well and healthy.

• Smoking: 5 cigarettes a day. Have been smoking for the past 15 years. 

• Alcohol: “A glass of red wine with dinner every night.”

• Recreational drugs: Never

• Diet: My wife cooks so I eat homecooked meals.

• Caffeine intake: I drink lots of coffee, about 4 cups a day.

• Exercise: Nothing regular.

• Ill contacts: No one around me were ill recently

• Home: Lives with wife and two daughters.

• Active Daily Living: Good mobility and able to perform daily functions normally.