the importance of a diagnosis to a patient

During my gerontology placement i had a patient who came to see us in the outpatient department through the falls clinic. However, this patient had never actually fallen, she'd just become so scared of falling over the last few months that she went from no walking aid, to 4 wheeled walker to being house bound and dependent on friends and family for most of her ADLs. When she presented to the clinic she had no muscle weakness or balance problems but was extremely anxious when asked to carry out any task. However the patient reported feeling very dizzy and unbalanced when walking around. her family had previously sent her to numerous doctors for many tests, all which came back negative including vestibular. Her family came to us in the outpatient clinic hoping that we'd be able to give her some confidence and maybe be able to refer her on for a psych evaluation as they now all thought it was a mental problem not a physical one. After the initial ax and first few treatments for general strengthening and balance exercises with lots of encouragement and education on the importance of being active were having no effect on the patient, we started looking at possible causes for this patient's decline in activity. the patient reported being very anxious most of the day, and "flapped" her hands around when she got nervous, feeling dizzy, nauseas, breathless, sleep disturbances, numbness and excessive sighing. it was this excessive sighing that drew my supervisor to take more notice about the patient's mode of breathing. the patient would be talking and suddenly sigh out and take a deep breath in. on looking at her breathing pattern, her respiratory rate was found to be averaging about 22 per minute. my supervisor diagnosed the patient with chronic hyperventilation which explained all her symptoms. I started incorporating specific exercise for chronic hyperventilation along with her general exercise such as calming strategies when she got anxious, reading out aloud as books have structured grammar on when to take a breath and pause in a sentence and also other breathing strategies. The patient's lifestyle immediately began to change, she had more confidence, started venturing out of the house on her own and not having so many anxiety attacks. It took her a few weeks to master the strategies we taught her but by the end of my placement she was back to being independent and more active. the patient said that hearing that there was an actual physical problem with her and not a mental one as her family had thought gave her so much relief. it helped her understand the condition and work with us to help control this problem.