Patient: "Colleen" (name changed)
Age & bio: 83-year-old female, retired, has supportive partner
Presenting Complaint 👵🏻
Colleen first presented in August with two primary concerns. The first was a sensation of congestion in her ears that dampened her ability to hear well. The second—and far more distressing for her—was a growing sense that her nervous system felt as though it was constantly "on edge."
She described waking each morning with a low-grade feeling of anxiety. At times she experienced sensations in her chest, accompanied by sudden and profound drops in energy that seemed to occur without warning. These episodes were unpredictable and could happen while she was enjoying time with friends or participating in activities she normally found relaxing.
What stood out most during our conversations was her confusion.
She repeatedly told me:
"I don't understand why I feel anxious. I have nothing to be anxious about."
From her perspective, life was stable. She was financially secure, enjoyed healthy relationships, and did not identify any significant external stressors. The emotional story simply didn't match the intensity of the physiological symptoms she was experiencing. And when the story doesn't match the symptoms - that's when things get interesting - and flags get raised 🚩.
Clinical Course 🩺
Over approximately five treatments between August and October 2025, we focused on helping regulate her nervous system and improve her day-to-day comfort.
Although treatment provided some temporary relief, the underlying symptoms continued to progress. Her anxiety remained significant, and I also began noticing additional changes, including occasional repetition of conversations we had already had together.
At this point, several aspects of the presentation began raising concern for me.
The episodes of chest sensations, sudden fatigue, escalating anxiety, and cognitive changes didn't feel entirely consistent with stress alone.
While anxiety certainly affects the nervous system, something about this presentation suggested there could be an underlying physiological contributor.
Clinical Reasoning 🧐
I encouraged Colleen to follow up with her physician. She reassured me that she had already undergone medical assessment and that everything had been investigated.
Given the persistence of her symptoms, I discussed the case informally with a physician colleague. Without attempting to diagnose, we considered whether some of her symptoms could resemble presentations seen with cardiac rhythm disturbances or other medical conditions.
Because her primary complaint remained her inability to calm her nervous system—and because she believed her medical workup was complete—I referred her to a local neurofeedback clinic that is overseen by a physician. My hope was twofold: to provide another avenue of support while also ensuring she remained connected with medical professionals who could reassess her if necessary.
The Outcome ✅
Just this past month, Colleen has returned to my practice.
During the intervening months, further blood work had been performed. The testing revealed that her dosage of levothyroxine had become excessive, placing her into a hyperthyroid state.
The undetected hyperthyroidism was driving many of the symptoms that had initially appeared to resemble anxiety:
- Persistent nervous system activation
- Feelings of panic and internal restlessness
- Chest sensations
- Sudden drops in energy
- Difficulty regulating her emotional state
Once her medication dosage was adjusted appropriately, she reported that the overwhelming sense of nervous system dysregulation improved remarkably quickly.
Because we established a relationship based on trust she was delighted to return to work with me regarding a primarily orthopedic concern she's been dealing with.
Emotional Anatomy Reflection 🪞
This case beautifully illustrates both the strengths—and the limitations—of using an Emotional Anatomy lens.
It would have been easy to conclude that her symptoms reflected unresolved emotional stress or subconscious anxiety. After all, those patterns frequently present with similar physiology.
Instead, the most important clinical clue was her insistence that the emotional explanation simply didn't fit her lived experience.
Rather than dismissing her perspective, it became essential to listen and not let my emotional anatomy understanding bias the very real clinical evidence in front of me.
Emotional Anatomy should never replace comprehensive clinical reasoning. Instead, it should deepen our curiosity.
Sometimes emotional patterns are the primary driver.
Sometimes they are a contributing factor.
And sometimes the body is responding to something entirely physiological.
Our role is not to force every patient into one framework. Our role is to remain curious enough to recognize when the pieces don't quite fit.
That's what makes you exceptional at your work and adaptable to every patient that finds their way to your clinic.
Clinical Pearl 🦪
One of the greatest gifts we can offer our patients is knowing when to refer.
As healthcare practitioners, we are not expected to have every answer.
We are expected to recognize when something falls outside our scope, trust our clinical instincts, and collaborate with other healthcare professionals when appropriate.
Supporting a patient doesn't always mean solving the problem yourself.
To be very frank, some of my longest clinical relationships with patients have stemmed from me referring them out.
The trust that develops when you have the courage to say "Actually - this isn't adding up - let's get someone else to take a look" does far more for your credibility than continuing to chase a problem you don't realistically have the tools to resolve.
Sometimes the most impactful treatment you provide is helping guide someone toward the next piece of the puzzle.
Reflection Question ✨
Have you ever told yourself someone is just not acknowledging the emotional root even after they have shared that it doesn't fit their experience?
Does referring out feel like failure to you? What part of you feels over-responsible for your patient outcomes?
I get these questions are ones you may want to quickly breeze by and say they dont apply to you but I want to let you know it's very human to sometimes feel disappointed when you've trained for so long, have so much knowledge and experience and still don't have all the answers - even if you really really really want to.
But the silver lining really lives in the fact that this work humbles us all as practitioners and as humans. You don't need to solve every problem, you just need to bring your best to the table and trust the rest will unfold accordingly.
💛Geneviève
PS. Please feel free to share your thoughts/comments below or bring it to the community. The community space is like a lab- a place where we can share these kinds of observations and get feedback on your real cases! And if you don't quite get how the community piece works just reply to this email - I'm happy to help!
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