[72M] Experiencing internal tremors, back ache, and other symptoms

Patient Description

A 72-year-old male reports non-stop internal tremors that worsen at night and affect balance, causing shaking when standing. The tremors have been present for about a year, with no relief found. The patient also experiences back pain, described as a middle back ache with lower back pressure and stiffness, which has been occurring on and off for a couple of years. Constipation began around the same time as the tremors, about 6 months ago, and is severe enough to require the use of laxatives like MiraLAX. The patient's bowel movements are infrequent, with the last one being hard. Erectile dysfunction has been an issue for over a year, with no erections even with medication, and a decrease in sexual desire. There have been four recent falls, usually tripping over the right foot, indicating balance issues that have been present for about 6 months. Additionally, the patient has been experiencing a parched dry mouth and difficulty swallowing, particularly with dry foods like bread, for the same duration. Emotional distress is evident, as the patient feels an urge to cry frequently. No recent weight changes have been reported, and there is supportive companionship from the spouse despite the lack of sexual activity.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, the following conditions could be possible:

  • Parkinson's Disease: This is a progressive nervous system disorder that affects movement. Symptoms often start gradually and could include tremors, balance problems, rigid muscles, changes in speech and writing, and difficulty with automatic movements like swallowing. It can also cause non-motor symptoms such as constipation, depression, and sexual problems like erectile dysfunction.

    • Treatment typically involves medications to manage symptoms, and in some cases, surgery may be an option.
  • Multiple System Atrophy (MSA): This is a rare, degenerative neurological disorder affecting your body's involuntary (autonomic) functions, including blood pressure, heart rate, bladder function, and digestion. It shares many Parkinson's disease-like symptoms, such as slow movement, rigid muscles, and poor balance. Autonomic problems, including erectile dysfunction and loss of bowel or bladder control, are also common.

    • There's no cure for MSA, so treatment involves managing symptoms.
  • Depression: This is a mood disorder that causes a persistent feeling of sadness and loss of interest. It can lead to a variety of emotional and physical problems and can decrease a person's ability to function at work and at home. Symptoms can include feelings of sadness, tearfulness, emptiness or hopelessness, and loss of interest or pleasure in most or all normal activities.

    • Treatment typically involves psychotherapy (talk therapy), medications, or a combination of the two.

Please note that these are just possibilities. You should consult with a healthcare provider for a formal diagnosis.

What you can do

  1. Schedule an appointment with your primary care provider as soon as possible to discuss your symptoms. They may refer you to a neurologist for further evaluation.
  2. Keep a symptom diary. Note when your symptoms occur, what you're doing at the time, and how severe they are. This can help your healthcare provider diagnose your condition.
  3. Stay active. Regular physical activity can help manage symptoms of both Parkinson's disease and depression.
  4. Seek support. Consider joining a support group or speaking with a counselor or therapist about your feelings.

What you should look out for

Seek immediate medical attention if:

  • Your symptoms worsen or you develop new symptoms
  • You feel suicidal or have thoughts of harming yourself
  • You experience severe difficulty swallowing, which could lead to choking or aspiration (inhaling food or drink into your lungs)

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1 yr ago

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People Also Ask


What are internal tremors and how do they differ from external tremors?

Internal tremors are sensations of shaking inside the body that are not visible externally. They can be associated with neurological conditions like Parkinson's Disease, where they may occur due to disruptions in the nervous system. External tremors, on the other hand, are visible and involve involuntary shaking of body parts.


How can constipation be related to neurological conditions like Parkinson's Disease?

Constipation can be related to neurological conditions like Parkinson's Disease due to the impact on the autonomic nervous system, which controls involuntary bodily functions, including digestion. The disease can slow down the movement of the digestive tract, leading to constipation.


What are some common causes of erectile dysfunction in older adults?

Erectile dysfunction in older adults can be caused by a variety of factors, including reduced blood flow, hormonal changes, medication side effects, and underlying health conditions such as diabetes, cardiovascular disease, or neurological disorders like Parkinson's Disease.


How can emotional distress manifest in physical symptoms?

Emotional distress can manifest in physical symptoms through the mind-body connection. Stress, anxiety, and depression can lead to symptoms such as fatigue, muscle tension, headaches, and digestive issues. In some cases, emotional distress can exacerbate existing physical conditions or lead to new symptoms.


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