Should I Undergo Further Health Checks for My Ongoing Symptoms?

Q: Should I Undergo Further Health Checks for My Ongoing Symptoms?

Hello： The possible side effects of Propafenone (心利正) listed in the package insert include dizziness, drowsiness, dry mouth, headache, gastrointestinal discomfort, diarrhea, constipation, vomiting, and decreased appetite. <br>However, these may not necessarily be caused by the me

Should I undergo further comprehensive health screening?

Hello, doctor.
I have been experiencing fatigue and dizziness for the past two months, so I would like to ask a question.
On August 12, 2017, I drank quite a bit of alcohol for my birthday, and after returning home, I started to vomit severely, throwing up seven to eight times until only water remained.
The next day, I woke up with stomach discomfort and a feeling of pressure and pain located between my navel and the xiphoid process.
I continued to visit general clinics, where my medications were adjusted repeatedly, but there was no improvement, and I began to experience fatigue and dizziness after exertion.
On September 22, 2017, I could no longer tolerate the daily stomach pain and fatigue, so I underwent an upper gastrointestinal endoscopy, which revealed a more generalized gastritis.
The clinic doctor changed my medications again, but even after taking the medication, the stomach pain persisted.
I then brought the endoscopy report to a family medicine department at a major hospital for further examination.
To my surprise, they only performed blood tests for biochemical indices, which showed only mild anemia, triglycerides elevated to 422, slightly high low-density lipoprotein cholesterol, slightly low high-density lipoprotein cholesterol, and liver function tests (GOT and GPT) around 20.
They did not test for pancreatic inflammation.
The family medicine department prescribed B vitamins and iron supplements, but I only took them once because the iron supplement made my stomach very uncomfortable.
On September 25, 2017, I also had an abdominal ultrasound at the clinic, which indicated moderate fatty liver, kidney stones in both kidneys, and a cyst in the right kidney, while there were no abnormalities in the spleen, pancreas, bladder, or prostate.
Later, I went to a health check-up center at a major hospital for evaluation.
Since the director was originally a cardiologist, after hearing my situation and reviewing my medical history, he suggested that I return to the hepatobiliary and gastroenterology department for continued follow-up and examination.
On February 5, 2017, I had an emergency visit where atrial fibrillation was discovered as the cause of my arrhythmia, and I began to follow up with the cardiology department.
I was originally required to take "Sotalol" daily to prevent arrhythmias.
During the evaluation, I asked if I could temporarily stop taking "Sotalol," and the director said it was fine, but if symptoms occurred, I should take two tablets urgently to suppress the symptoms.
Unexpectedly, after I stopped taking "Sotalol," my feelings of fatigue and dizziness gradually improved.
Additionally, I have been taking psychiatric medications for anxiety and panic disorder caused by autonomic nervous system dysregulation for over three years, including: Duloxetine, Zolpidem, and Buspirone (all taken before bedtime).
In summary, I have two questions: 1.
Could the anti-arrhythmic medication "Sotalol" be causing my fatigue and dizziness? Can I continue to stop using the anti-arrhythmic medication? 2.
Should I undergo further examinations, such as a full-body CT scan or a colonoscopy, to check if there are any abnormalities in my body?

Keik, 40~49 year old female. Ask Date: 2017/10/13

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: The possible side effects of Propafenone (心利正) listed in the package insert include dizziness, drowsiness, dry mouth, headache, gastrointestinal discomfort, diarrhea, constipation, vomiting, and decreased appetite.
However, these may not necessarily be caused by the medication.
It is recommended to consult with a gastroenterologist and a cardiologist for a professional assessment to determine if further examination is necessary.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2017/10/13

More Info

Given your ongoing symptoms of fatigue, dizziness, and gastrointestinal discomfort, it is crucial to approach your health concerns systematically. Your history of alcohol consumption leading to severe vomiting, subsequent gastric issues, and the discovery of moderate fatty liver and kidney stones indicates that your body is under significant stress. Additionally, your previous diagnosis of atrial fibrillation and the use of antiarrhythmic medication (likely Sotalol, known as "心利正" in Mandarin) adds complexity to your situation.

1. Medication Side Effects: It is possible that the antiarrhythmic medication you were taking could contribute to feelings of fatigue and dizziness. Many medications, especially those affecting the heart rhythm, can have side effects that include tiredness and lightheadedness. If you have noticed an improvement in your fatigue and dizziness after stopping the medication, it may suggest that the drug was indeed contributing to these symptoms. However, it is essential to consult your cardiologist before making any permanent changes to your medication regimen. Stopping medication without medical advice can lead to serious complications, especially with a history of atrial fibrillation.

2. Further Investigations: Given your symptoms and medical history, further investigations may be warranted. While you have undergone several tests, including blood tests, abdominal ultrasound, and endoscopy, there are still areas that could benefit from additional scrutiny. A full-body CT scan can provide a comprehensive view of your internal organs and help identify any abnormalities that may not have been detected in previous tests. Additionally, a colonoscopy could be beneficial, especially considering your gastrointestinal symptoms and the need to rule out any potential issues in the colon.

3. Lifestyle and Dietary Considerations: Alongside medical evaluations, consider your lifestyle and dietary habits. The presence of fatty liver and high triglycerides suggests that dietary modifications could be beneficial. A diet low in saturated fats, sugars, and refined carbohydrates, combined with regular physical activity, can help manage your weight and improve liver health. Consulting with a nutritionist may provide tailored advice to help you make these changes effectively.

4. Mental Health: Your history of anxiety and panic disorders, along with the medications you are taking for these conditions, should not be overlooked. Chronic stress and anxiety can exacerbate physical symptoms, including fatigue and gastrointestinal discomfort. It may be helpful to engage in stress-reduction techniques such as mindfulness, yoga, or therapy, which can improve both your mental and physical health.

5. Regular Follow-Up: Given the complexity of your symptoms and medical history, regular follow-up with your healthcare providers is essential. This includes your cardiologist, gastroenterologist, and possibly a mental health professional. Keeping an open line of communication about your symptoms and any changes you experience will help your doctors provide the best care possible.

In summary, while it may be tempting to attribute your symptoms solely to medication or lifestyle factors, a comprehensive approach that includes further testing, medication review, lifestyle changes, and mental health support is necessary. Always consult with your healthcare providers before making any changes to your treatment plan or lifestyle. Your health is multifaceted, and addressing it holistically will yield the best outcomes.

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