Solve the Medical Riddle: She Suspected That Her Husband Was a Closet Drinker, First Week
By Marie Savard MD
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, a specialist 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 specialist will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!
The Patient’s Wife and the Patient Report His Symptoms
Elaine, age 55,noticed that her 60-year-old husband often had alcohol on his breath at all times of the day. She was afraid he had become a closet alcoholic but he insisted he had never had a drop to drink before the evening. Although Elaine wanted to believe him, she knew by his erratic behavior and slurred speech that something was wrong. She convinced him to see their family physician for a check up.
As always in ThirdAge Medical Riddles, the doctor uses 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 learn what Elaine and her husband, Sam, told the doctor:
Elaine: Lately I’ve been smelling alcohol on Sam’s breath at odd hours of the day, sometimes even in the morning after breakfast. Not only that, but he often slurs his words and when we’re watching TV, he starts slumping in his chair. I suspect he is secretly drinking. However, I’ve never found any beer or wine or liquor hidden in the house and I haven’t seen extra empty bottles in the recycling bin. I’ve read that older people sometimes can’t hold their liquor as well as they once could so maybe that’s what’s going. He has always had one or two small bottles of beers before dinner with no problem. Could he be getting drunk on that much alcohol now? Still, that wouldn’t explain why he is often drunk in the morning!
Sam: I swear I’m not a closet drinker! I don’t deny that I feel dizzy and drunk even in the morning sometimes but I have never touched a drop that early in the day. As my wife said, I do have a couple of beers in the evening. I’ve been doing that for years. Actually, I tried going a week without the beer as a test but I still felt drunk! Believe me, I am not lying. I hope you can help me because I’m afraid I might get pulled over for drunk driving and then fail the breathalyzer test even if I haven’t been drinking. Or worse, I could get into an accident and hurt someone else. And I might even lose my job if my boss smells booze on me. I’m telling you, Doc, I’m scared. I know there’s something wrong with me! I sure hope you can find out what it is.
The doctor noted that Sam is otherwise healthy, has a great appetite, is mildly overweight with a BMI of 28 and is taking occasional vitamins and supplements he purchases from a health food store. The latter could include a peculiar supplement toxicity effect that might be the cause of his symptoms.
He is on no other medications including sedatives or drugs for anxiety and depression. His wife does use sleeping pills on occasion but Sam insists he has never taken them surreptitiously.
He has never taken a prolonged course of antibiotics.
Both of his parents had late onset coronary disease (heart attacks). His younger sister is healthy at age 55.
There is no history of diabetes. Acute diabetic ketoacidosis could cause fruity alcohol type breath but he would obviously be sick with weight loss and other symptoms if he had the disease.
He and his wife live in a suburb of Chicago and he drives to and from his job in the city at insurance company so this could be a potential risk if he is at the wheel while drunk.
Complete blood work was drawn including a test for alcohol level. The patient had been instructed to fast for the previous 18 hours. Results came back normal.
A complete physical exam and thorough neurological exam were all normal with no signs of intoxication, no alcohol on his breath, and a normal gait.
A drug screen for sedatives and opiates was also negative at this visit.
The doctor referred Sam to a gastroenterologist for further testing. The GI specialist requested that Sam refrain from fasting prior to the appointment.
To be continued . . .
Come back to ThirdAge.com next Thursday to learn how the GI specialist continued the quest for a correct diagnosis of Sam’s condition . . .
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.