Suggest Treatment For Extreme Weakness In Body

Posted on Tue, 17 Jun 2014

Question: Doctor, My father is 65 years old. Since the last six months, we have noticed he has grown very week. He seems to be more and more fragile, for example, he may not be able to hold our hand very strongly to give a shake hands. Now he seems to think twice before climbing steps. He feels he may loose balance. He has given up driving since he says he is not very confident now. He is unable to write properly. He has high BP for which he takes tables. BP is always in control when he takes the tables (we monitor the same daily). No sugar. No other complications. Please can you suggest how we need to go about this?

Answered by Dr. Hardik Thakker (3 hours later)

Brief Answer:
Please read detailed response

Detailed Answer:
Dear XXXXXXX

Greetings from health care magic!!! I am Dr Thakker and shall be answering your question.

I can understand your concerns for your dad's health.

I have been through the clinical scenario and his past medical history. I would formulate the following differential diagnosis for his condition

Dementia due to senility/ Alzheimer's / multi infarct status

Stroke

Parkinsons disease

Normal pressure hydrocephalus

Hypothyroidism

Pernicious anemia

I would advice the following for reaching the right diagnosis:

Blood test: T3,T4,TSH. lipid profile

MRI brain

VDRL, Vitamin b12, Folate, D3 levels

For diagnosis of parkinsonism, a clinical examination is necessary to look for clinical signs of parkinsonism.

We cannot label this as depression and start him on anti-depressants right away. we first need to rule out an organic cause. if no organic cause is found then we label it to a psychiatric disorder.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Hardik Thakker (19 hours later)

Thank you so much Doctor for your response. I wanted to update you about two other symptoms that i have observed. If that could help in further diagnosis, please let me know:

1. Recently, in a couple of instances, he has lost his balance and fallen (once while getting down the stairs and once when he was getting down from his bed)
2. He has absolutely no memory loss issues (except for the fact that he may take a few seconds before responding or recollecting anything). He continues to make all decisions but in a slower way.
3. He loves to watch kids play and is generally happy otherwise.

He had been a chain smoker but had given up smoking the in the last 5 to 6 years. Do you think these could have any link to his condition now?

Also, I am based in XXXXXXX Do you have any suggestions for a good doctor to whom we can refer to for his condition?

Thanks & Regards
XXXX

Answered by Dr. Hardik Thakker (7 hours later)

Brief Answer:
Please read the response

Detailed Answer:
Dear XXXXXXX

Thank you for updating me with more of his symptoms. I would like to add few more differentials to his condition in view of these symptoms:

Orthostatic hypotension

Benign paroxysmal positional vertigo

Cerebellar stroke.

I would recommend a MRI brain and the blood tests as per my primary response.

I am currently based in XXXXXXX and unable to make a recommendation for a specific doctor in XXXXXXX NIMHANS is a good neurology institute in XXXXXXX If you don't mind the crowd it has one of the finest neurologists in XXXXXXX

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj