Evening Discomfort: Symptoms and Seeking Help

I start to feel unwell every evening?

Hello Doctor: When I was 19 years old, I underwent a unilateral thyroidectomy due to a thyroid nodule.
Around the same time, I developed depression (which was later diagnosed as bipolar disorder) and was subsequently diagnosed with psoriasis by a dermatologist.
I have been using the biologic medication Cosentyx for about two years.
Currently, I am taking the following oral medications: 1.
Lendormin 0.25mg, two tablets daily 2.
Lamictal 50mg, three tablets daily 3.
Geodon 60mg, one tablet daily 4.
Ligilin 300mg, two tablets daily 5.
Epram 10mg, one tablet daily.

Earlier this year, I started experiencing tinnitus and dizziness.
I visited a large hospital for evaluation, where they conducted hearing tests and auditory evoked potentials.
The doctor noted that the brain waves on the left side were weaker, so they arranged for an MRI.
While waiting for the MRI, I developed a sensation of nasal obstruction, which starts around five or six in the evening and causes discomfort from the left nasal cavity up to the forehead and down to the chest.
It is not painful, but difficult to describe.

Today, after reviewing the MRI results, the doctor said there were no blood clots or tumors in the brain and, after examining my nose, diagnosed me with allergic rhinitis.
However, I still feel very uncomfortable every evening, which persists until bedtime.
Sometimes, even taking two sleeping pills does not help me fall asleep.
Could this be a side effect of the medications I am taking? If I need further evaluation, which specialty should I consult?

phoebe, 20~29 year old female. Ask Date: 2021/06/01

Dr. Cai Zongzhang reply Neurology

Hello Phoebe! Psoriasis is an autoimmune disease, which shares common characteristics with all autoimmune disorders.
If you start experiencing discomfort in the evening, it is advisable to monitor your temperature in the morning and evening, engage in regular exercise, as this can help alleviate symptoms.
Additionally, it is recommended to consult a rheumatologist for further evaluation.

Reply Date: 2021/06/01

More Info

It sounds like you're going through a challenging time with multiple health concerns, including your history of thyroid surgery, bipolar disorder, psoriasis, and now new symptoms like tinnitus, dizziness, and discomfort in your nasal area. It's understandable to feel overwhelmed, especially when dealing with various medications and their potential side effects.

From what you've described, it seems that your discomfort intensifies in the evening, which can be particularly distressing. The symptoms you are experiencing, such as the sensation of discomfort in your left nasal cavity and the associated feelings of unease, could indeed be influenced by several factors, including your existing medical conditions and the medications you are taking.

Understanding Your Symptoms
1. Medication Side Effects: Many psychiatric medications, including mood stabilizers and antipsychotics, can have side effects that may contribute to feelings of discomfort, dizziness, or even nasal symptoms. For instance, medications like Geodon (ziprasidone) and LamiCTAL (lamotrigine) can cause dizziness or sedation, especially when starting or adjusting dosages. It's essential to discuss these potential side effects with your prescribing physician, as they may need to adjust your medication regimen.

2. Allergic Rhinitis: Your doctor mentioned allergic rhinitis as a possible cause of your nasal discomfort. Allergies can indeed worsen in the evening due to various environmental factors, such as dust mites or pollen. If you suspect this might be the case, consider discussing with an allergist for further evaluation and management options, which may include antihistamines or nasal corticosteroids.

3. Psychological Factors: Given your history of bipolar disorder, it's also worth considering how your mental health might influence your physical symptoms. Anxiety and mood fluctuations can manifest as physical discomfort, particularly in the evening when the day's distractions fade away. Cognitive-behavioral therapy (CBT) or other therapeutic approaches may help you manage these feelings.

Next Steps
1. Consultation with Specialists: Since you have a complex medical history, it may be beneficial to consult with a few specialists:
- Psychiatrist: To review your current medications and assess if any adjustments are needed based on your new symptoms.

- Allergist/ENT Specialist: To evaluate your nasal symptoms further and determine if allergies or other nasal conditions are contributing to your discomfort.

- Neurologist: If your tinnitus and dizziness persist, a neurologist may provide additional insights, especially since you have had an MRI that ruled out significant issues.

2. Symptom Diary: Keeping a diary of your symptoms, including when they occur, their intensity, and any potential triggers (like food, stress, or environmental changes), can be helpful for your healthcare providers to understand your condition better.

3. Lifestyle Modifications: Consider implementing lifestyle changes that may help alleviate some of your symptoms. This can include:
- Regular sleep hygiene practices to improve sleep quality.

- Stress management techniques, such as mindfulness or relaxation exercises, which can help reduce anxiety and improve overall well-being.

- Staying hydrated and maintaining a balanced diet, which can positively impact both physical and mental health.

Conclusion
It's crucial to communicate openly with your healthcare providers about all your symptoms and concerns. They can work with you to adjust your treatment plan and explore further evaluations as needed. Remember, managing complex health issues often requires a multidisciplinary approach, and seeking help is a vital step toward improving your quality of life. Don't hesitate to reach out for support, whether from medical professionals, friends, or support groups. You are not alone in this journey, and there are resources available to help you navigate these challenges.

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