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Name
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Barbara Davies
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DOB
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08/11/1981 (36 years)
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Occupation
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Hair Salon Owner
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History
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I have this terrible shaking in my right arm and hand which I noticed when I start doing something. It’s really bad at work when I pick up or use equipment to do my client’s hair; I have even dropped things because of how bad the shaking is. I found that drinking really helps, but I don’t want to drink much. I don’t notice anything when I am sitting down in the evening and weekends. I think it has been getting worse over the last couple of years, I am definitely noticing it more often now than I used to. It’s starting to affect my work a lot and can be quite embarrassing, I also feel nervous when I go out with friends because I am scared people will stare at me in restaurants. It mainly happens in my right arm but very occasionally in my left too. I have no other symptoms or complaints.
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Past Medical History
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Nil
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Drug History
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Penicillin allery - causes all over rash
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Family History
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I’m not really sure but my father had a similar thing with shaking of his hands but was not formally diagnosed with anything.
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Social History
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I live in a house
with my husband and 9 year old daughter. I work as a hairdresser in my own
salon. I have never smoked and drink 2 small glasses of wine a day to help with
the shaking at work
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Introduction & consent
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Name, age, occupation
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Asks open question
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Site (fingers, hands etc.)
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Onset
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Exacerbating/Alleviating factors: deliberate movements, rest, when doing actions, when stressed, alcohol, caffeine intake
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Time course (intermittent or continuous, particular time of day)
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Screens for Parkinson's disease (flat expression, bradykinesia, difficulty turning, falls, rigidity)
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Screens for Hyperthyroidism (unintentional weight loss, palpitations, heat intolerance)
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Screens for Anxiety (feeling anxious, triggers, palpitations)
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Screens for alcohol & drug withdrawal (previous use and if has suddenly stopped)
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Screens for red flags: raised intracranial pressure, sensory or motor symptoms, loss of consciousness, speech disturbance (cerebellar)
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Checks impact of symptoms on occupation, daily tasks e.g. driving, eating & drinking, dressing, ADLs
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Past medical history (e.g. hyperthyroidism)
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Family history (Parkinson's disease, essential tremor)
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Drug history (e.g. salbutamol), smoking and allergies
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Ideas
"Was there anything you thought it might be?" | |
Concerns
"What about it is worrying you in particular?" | |
Expectations
"Is there anything in particular you were hoping we would to today?" | |
Communication skills (empathy and avoids jargon)
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Summarises back to patient
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Gives reasonable differential diagnosis (Essential Tremor, Anxiety)
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