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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18757
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My husband developed shaking hands virtually over night.

Customer Question

My husband developed shaking hands virtually over night. He has lost nearly 2 stone in two months, and very easily loses his balance. He has had bloods taken for kidney, liver, diabetes, thyroid, and a general blood test which apparently covers anything that might be around in his body. They have all come back normal and he has had a brain scan which has shown no abnormalities. He is 77, and prior to this was very fit and very active despite the fact that in January 2012 he had a aortic valve replacement. He was brilliant through this and quickly got back to his trade of gardening and general small building jobs and even now is doing quite a bit but the shaking hands etc. and balance problems are making him very stressed. It has taken 3 months to get from seeing the doctor to having the brainscan and where does that leave us now to investigate? The Consultant has confirmed that he has not got Parkinsons. He has not regained his weight but it has steadied now. Help?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Hello from JustAnswer.
It will help if you could provide some further information.
What type of brain scan was done? CT scan or MRI?
Is he taking any chronic medicines?
Do you have the ability to check his blood pressure and pulse when he is losing balance?
Customer: replied 3 years ago.

It was an MRI Brain Scan. Medicines are only one bisoprolol 2.5 mg tablet and 2 x150 mg dabigatran etexilate capsules daily following his aortic valve replacement. He does not suddenly lose balance - he is off balance all the time and needs to lean on something for support if he wants to stay still. he cannot write his signature any more as he cannot keep his fingers/hands under control. His blood pressure has been checked very recently and is normal. He does have a slight mis-beat now and then which apparently is also normal following this sort of operation and his blood pressure is monitored regularly.

Expert:  Dr. D. Love replied 3 years ago.
I'm sorry for the delay, but I was away from the computer when you replied.

There are several issues to consider in this situation.

Most of these symptoms are suggestive of a neurologic disorder, but the Consultant Neurologist should have considered all of the possible neurologic diseases, not just Parkinson's disease.

I will note that a general blood test can only look for certain types of conditions. For example, a sed rate (or ESR) is a non-specific test that look for inflammation that can occur anywhere in the body. There is no blood test that can literally detect everything that can be a problem anywhere in the body.

Since the neurologic evaluation and brain MRI were normal, then it would be appropriate to look for systemic conditions that could cause the weight loss, as well as nutritional deficiencies that could be associated with the weight loss.

The primary concerns for weight loss would be whether there is occult cancer in some location, particularly in the gut. The other area of concern for weight loss would be a condition that affects digestion and absorption of nutrients. For this reason, it would be appropriate to consider a consultation with a Gastroenterologist. If he is a smoker (or former smoker), then it would be appropriate to consider a high resolution CT scan of the chest. The other common cancer in elderly males would be prostate cancer, so a prostate check would be appropriate.

It also would be appropriate to check blood tests for nutritional deficiencies, particularly certain common vitamins, such as vitamin B12, folic acid, and vitamin D The chemistry profile would have checked protein levels and the common electrolytes, but may not have checked magnesium levels.

If I can provide any clarification, please let me know.













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Customer: replied 3 years ago.

Sorry, realised that I had not mentioned that my husband is not in any pain which I hope would remove the possibility of cancer? Regards digestion he does take quite a long time to eat these days but he does eat sufficiently well. His weight has now stabilised.

Expert:  Dr. D. Love replied 3 years ago.
No, the absence of pain does not exclude cancer as a possible cause of weight loss. There are certain types of cancer that typically cause pain early in the course of the disease process, but there are also many types of cancer that do not cause pain early in the course of the disease process. So, the absence of pain does not preclude the possiblity that cancer may be present.

It is a good sign that the weight has stabilized, but that also is not an absolute sign that cancer is not present.