Solve the Medical Riddle: Her Daughter Feels as Though the Room is Shrinking, First Week
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.
We’ll start this week by letting you know what the patient told the doctor and how the doctor proceeded with the examination. Next week, the doctor will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!
The Patient’s Reports Her Daughter’s Symptoms
Marlene, age 50, called to say that her 18-year-old daughter Chloe was complaining of an unsettling sensation that the room was shrinking as she was trying to fall asleep at night.
The doctor used the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
A=Assessment or Analysis
P=Treatment Plan or Recommendations
This week, we’ll cover S, Symptoms or Chief Complaint. Here’s what Marlene told the doctor when she called to make the appointment:
“Chloe moved into the dorm for her freshman year at college right after Labor Day. She was really excited and I was happy for her even though it was bittersweet to have our only child leave the nest. Everything was great for more than a month. We texted a lot and Skyped as well, which reassured me she was enjoying her classes and making friends.
“Then I got a text from her saying she wasn’t feeling well. I called her and she sounded scared, but she didn’t say what was bothering her. Rather than have her go to the campus physician, my husband and I drove to the college and brought Chloe home. Once she was back in her own bedroom, she confided in me that she had started having the bizarre sensation that the room was shrinking every night when she was trying to go to sleep. She said she was afraid she was going crazy. She also says she’s tired all the time. She’s talking about dropping out of school! I don’t want that to happen. I hope you can figure out what’s wrong with her.”
The doctor wanted to get a complete history of Chloe’s problem so he asked Marlene to bring Chloe in for an office visit. During the questioning, the doctor learned that Chloe had noticed that when her roommate adjusted the mini blinds at night before going to bed, an episode would begin.
Chloe gave a detailed description of what she experienced. The entire room and the objects in it would seem to be shrinking although Chloe remained her true size. She had no distortion of body size although she couldn’t be sure because the shrinking room was so unsettling.
Also the colors of her bedspread and the curtains would start to change slightly.
Chloe reported no dizziness, vertigo, nausea, or other neurologic symptoms. However, the episodes made her feel confused and disoriented. These reactions caused a rising sense of anxiety and fear.
The episodes would last from five minutes to 30 minutes and then subside. Before long they were happening during the day as well as at bedtime. Sometimes Chloe had five or more episodes a day
The doctor asked about Chloe’s periods, birth control method, whether or not she drank or did drugs, whether she had any history of psychological problems, whether she ever had motion sickness, whether there was a family history of migraines, and whether Chloe has migraines. Finally the doctor asked whether Chloe had recently been somewhere such as a camping trip that might have exposed her to tick-borne Lyme disease. Chloe denied all of these possible causes.
Finally, the doctor asked Chloe about her recent problem with fatigue. Chloe said she just never felt rested even if she got a good night’s sleep and that this was new for her. She said that during the first weeks at school, she had not had this problem even though she was working hard and sometimes studying late.
To be continued . . .
Come back to ThirdAge.com next Thursday to learn how the doctor moved on to O, Objective Findings and A=Assessment or Analysis, in her quest for a correct diagnosis of Chloe’s complaint . . .
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. Pleas visit DrSavard.com