Year-Long Dizziness: Seeking Answers from Western and Traditional Medicine

Dizziness for over a year?

Hello, doctor.
Over the past year, I have seen many doctors and undergone numerous tests, both Western and traditional Chinese medicine.
The Western doctors have suggested that I might be experiencing panic disorder or sleep apnea, while the traditional Chinese medicine practitioners have indicated issues such as liver qi stagnation, excessive liver fire, heart fire, and spleen deficiency with coldness.
I have been unwell for quite some time, and last year I experienced sensations similar to earthquakes.
Since mid-January of this year, I have been feeling a swaying sensation.
I noticed that heat application to my neck or taking a hot shower tends to make me feel more dizzy, and even after neck traction from a therapist, I feel more lightheaded.
I initially thought it might be cervical spondylosis, and I sometimes experience numbness in my hands and feet (especially on the left side).
The Western doctor suggested it might be psychological.
Additionally, spending too much time in air-conditioned rooms makes me uncomfortable, and my dizziness seems to worsen in bad weather.
My massage therapist mentioned that my neck and shoulder muscles are not stiff, but I do feel tightness near the Fengchi acupoint.
After each massage, gua sha, or physical therapy session, I often feel uncomfortable for a day or two.
The swaying sensation started in mid-January this year; prior to that, I did not experience it.
At that time, I also felt a cool sensation in my left foot.
My blood pressure was high last April (155/101, due to my weight of 116 kg), and the doctor advised me to lose weight and prescribed medication to help with that.
After a week of taking the medication, I noticed some sharp pain near my heart, and after an ECG, the doctor said everything was fine, but my blood pressure was still a bit high.
After taking blood pressure medication for three days, I experienced numbness in my hands and feet and was sent to the emergency room.
The emergency doctor said it was a side effect, and the next day, with the doctor's consent, I stopped all medications.
Following that, I had two days of insomnia, with a constant throbbing sensation at the back of my head that made it impossible to sleep.
Eventually, I lost 18 kg within two months, as I was worried that my dizziness might lead to death.
I started using a CPAP machine in September of last year, and my energy improved compared to before (I used to doze off while driving), but my dizziness has actually worsened this year.
Since mid-January, I have been experiencing insomnia, with fragmented sleep and vivid dreams.
I truly don’t know what to do anymore; I feel helpless.
Western medicine hasn’t provided answers, and I have tried several traditional Chinese medicine clinics without improvement.
This situation is affecting my life and my relationships with family and friends, and I am unable to work.
Could you please provide me with some advice? Thank you.

Alvin, 40~49 year old female. Ask Date: 2017/06/19

Dr. Chen Taicheng reply Family Medicine

● It sounds like you are experiencing a sensation of swaying and imbalance, which can be exacerbated by neck movement or exposure to hot water, leaning more towards a feeling of unsteadiness.
If you also experience a spinning sensation, this is referred to as "vertigo" (the article can be found here #119155), primarily associated with issues near the ear (such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, etc.).
Some individuals may describe symptoms like a heavy head, dizziness, unsteady walking, and nausea, which may be accompanied by changes in hearing, tinnitus, or nystagmus.
A medical evaluation is necessary for accurate diagnosis.
Since you have previously consulted an otolaryngologist and undergone a vestibular test, ear-related issues may be somewhat ruled out.

● Given that you feel more dizzy when exposed to heat, please first check for any differences in blood pressure between your two arms.
A significant discrepancy may indicate vascular narrowing on one side (such as subclavian steal syndrome).
Additionally, if neck movement also triggers dizziness, it may be due to hypersensitivity of the carotid sinus (which monitors and regulates blood pressure; hypersensitivity can lead to drops in blood pressure and heart rate).
This can occur when both carotid arteries are compressed or when the neck is bent, potentially causing syncope.
● Measuring blood pressure can also help diagnose orthostatic hypotension.
Please measure your blood pressure while lying down or sitting, then quickly stand up and measure your standing blood pressure.
A drop of 20 mmHg in systolic or 10 mmHg in diastolic pressure indicates a positive result.
● The most common cause of syncope is neurogenic reflex syncope, with vasovagal syncope being the most prevalent (the vagus nerve is part of the autonomic nervous system, controlling internal organs and blood vessels).
Situations such as prolonged standing, sitting, or sudden position changes, as well as stress (like during blood draws), pain, or sleep deprivation, can trigger this type of syncope, which is often situational (such as during coughing or bowel movements).
This type of syncope is common but has a good prognosis.
You may have already ruled out this diagnosis with a tilt table test.
● I have another article regarding dizziness for your reference #119677.
● Other potential causes include arrhythmias, hypoglycemia, anemia (iron deficiency, folate deficiency, vitamin B12 deficiency), hypothyroidism, or side effects from certain medications, which you may have already ruled out through previous blood tests and ECGs.
● Please confirm the blood pressure status in both arms to rule out vascular narrowing or orthostatic hypotension.
Additionally, do not attempt to test for carotid sinus hypersensitivity on your own; this should be done under the supervision of a physician (such as a cardiologist).
● If no specific cause can be identified, consider consulting a psychiatrist regarding panic disorder-related issues.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department is concerned about you~

Reply Date: 2017/06/19

More Info

Dear Patient,
I understand that you have been experiencing persistent dizziness for over a year, and it has significantly impacted your quality of life. You have consulted various medical professionals, both Western and Traditional Chinese Medicine (TCM), but have not found a satisfactory resolution to your symptoms. Let's explore your situation in detail.

Understanding Your Symptoms
Dizziness can arise from numerous causes, and it is essential to consider both physical and psychological factors. Your symptoms, including the sensation of swaying, numbness in your limbs, and the exacerbation of dizziness in certain conditions (like after hot baths or during weather changes), suggest a multifactorial issue.
1. Physical Causes:
- Vestibular Disorders: Conditions affecting the inner ear can lead to balance issues and dizziness. This includes benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease.

- Cervical Issues: Given your mention of neck discomfort and the possibility of cervical spine problems, cervical vertigo could be a contributing factor. This occurs when neck issues affect the vestibular system.

- Cardiovascular Factors: High blood pressure and potential heart issues can also lead to dizziness. Your history of elevated blood pressure and subsequent medication changes should be monitored closely.

- Sleep Apnea: Since you mentioned using a CPAP machine, untreated sleep apnea can lead to daytime fatigue and dizziness due to disrupted sleep patterns.

2. Psychological Factors:
- Anxiety and panic disorders can manifest physically, leading to symptoms like dizziness, palpitations, and numbness. Your experiences of panic and the psychological impact of your health concerns may exacerbate your physical symptoms.

Recommendations
1. Comprehensive Evaluation:
- It may be beneficial to undergo a thorough evaluation by a neurologist or an ear, nose, and throat (ENT) specialist. They can conduct tests to rule out vestibular disorders or neurological conditions.

- A thorough cardiovascular assessment, including an echocardiogram and possibly a Holter monitor, could help evaluate your heart's function and rhythm.

2. Physical Therapy:
- Vestibular rehabilitation therapy (VRT) can be effective for managing dizziness. A physical therapist specializing in vestibular disorders can provide exercises to improve balance and reduce dizziness.

3. Psychological Support:
- Given the psychological aspects of your symptoms, consider consulting a mental health professional. Cognitive-behavioral therapy (CBT) can help address anxiety and panic symptoms, which may, in turn, alleviate some of your physical symptoms.

4. Lifestyle Modifications:
- Weight management is crucial, especially with your history of obesity and high blood pressure. A balanced diet and regular exercise can improve overall health and potentially reduce dizziness.

- Ensure you are well-hydrated and avoid excessive caffeine or alcohol, which can exacerbate dizziness.

5. Monitoring and Follow-Up:
- Keep a symptom diary to track when your dizziness occurs, its severity, and any associated factors (like stress or dietary changes). This information can be invaluable for your healthcare providers.

Conclusion
Your situation is complex, and it may take time to identify the root cause of your dizziness. A multidisciplinary approach involving medical doctors, physical therapists, and mental health professionals may provide the best chance for improvement. Remember, you are not alone in this journey, and seeking help is a crucial step toward recovery. Please continue to advocate for your health and seek out specialists who can provide the care you need.

Wishing you the best in your journey toward better health.

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