Daily Dizziness: When to Seek Further Medical Help

Q: Daily Dizziness: When to Seek Further Medical Help

Hello Mr. <br>Lin： If you have seen a neurologist and the initial evaluation and tests are normal, there is no need for an MRI or CT scan. <br>Your symptoms appear to be related to anxiety and hyperventilation. <br>It is recommended that you practice diaphragmatic breathing, wher

Feeling dizzy every day?

Hello, doctor! About ten years ago, one night as I was preparing to sleep, I suddenly lay down and my head started spinning, with numbness in my hands and feet.
My family quickly took me to the emergency room, where the doctor administered an IV and gave me a plastic bag to breathe into to increase my carbon dioxide intake.
He said it was caused by hyperventilation.
For the next six to seven years, I didn't experience this again until two or three years ago when it happened exactly like it did ten years ago.
The doctor performed an ECG and found nothing wrong, gave me an IV, and I went home.
After that, I visited an ENT specialist to check for issues with displaced ear crystals, but the doctor found nothing.
Years passed until recently when it started happening again, but with increasing frequency.
This month, I have been feeling dizzy almost every day, and sometimes the back of my head feels completely numb.
I went to a cardiologist for an echocardiogram and a stress ECG, and everything came back normal.
I also visited a neurologist for brainstem auditory evoked potentials, motor nerve conduction studies for both upper and lower limbs, sympathetic nerve stimulation response, and carotid ultrasound, all of which were normal.
Currently, I am on medication prescribed by the cardiologist (the company health check revealed abnormal levels of high-density lipoprotein, low-density lipoprotein, and risk factors for vascular sclerosis): 1.
Bokey 100mg x1 after breakfast 2.
Lipitor 4mg x1 after breakfast.
From the neurologist: 1.
Anxiolytic 20mg x1 after dinner.
From the psychiatrist: 1.
Alprazolam 0.5mg to take when I start feeling very dizzy, which seems to help.
This month, I have been controlling my diet and exercising.
Last week, my cholesterol level dropped from 168 to 63.
However, I still feel: 1.
Dizziness and a feeling of pressure in my head 2.
Difficulty breathing; if I breathe too deliberately, my hands and feet feel numb 3.
A heavy sensation in my eyes 4.
Numbness around my mouth and at the back of my head 5.
Sometimes while working on reports, my heart rate inexplicably increases to around 90-110 beats per minute, which has severely affected my daily life and work.
1.
Doctor, which specialist should I see next and what tests should I undergo? 2.
Do I need to get an MRI or CT scan?

Mr. Lin, 40~49 year old female. Ask Date: 2024/01/14

Dr. Lin Mianzhang reply Psychiatry

Hello Mr.
Lin: If you have seen a neurologist and the initial evaluation and tests are normal, there is no need for an MRI or CT scan.
Your symptoms appear to be related to anxiety and hyperventilation.
It is recommended that you practice diaphragmatic breathing, where your abdomen rises during inhalation and falls during exhalation.
Remember the principle: breathe in a way that is gentle, slow, even, and prolonged.
This means taking small breaths at a slow and steady pace, with longer exhalations being preferable.
The benefit of this type of breathing is that it can stabilize the autonomic nervous system and activate the parasympathetic nervous system.
When a person is anxious, they tend to breathe rapidly and deeply, often using chest breathing, which can stimulate the sympathetic nervous system and lead to a rapid decrease in carbon dioxide levels, causing hyperventilation symptoms.
In addition to practicing diaphragmatic breathing, managing stress is also important.
Symptoms in this area are often related to psychological stress, which can be addressed through counseling, and medication may also be used if necessary.
Therefore, I recommend that if you are unable to improve these symptoms through self-practice, you should seek professional help from a psychiatrist.
Wishing you peace and good health.

Reply Date: 2024/01/14

More Info

It sounds like you have been experiencing a complex set of symptoms that have significantly impacted your daily life. Given your history of dizziness and the various tests you've undergone, it is important to take a comprehensive approach to your ongoing symptoms.

1. Understanding Your Symptoms: The symptoms you describe—dizziness, tingling in your extremities, a heavy feeling in your eyes, and episodes of increased heart rate—can be indicative of several underlying issues. These could range from vestibular disorders (related to balance), anxiety or panic disorders, cardiovascular issues, or even neurological conditions. The fact that you have experienced these symptoms intermittently over the years suggests that there may be a chronic component to your condition.

2. Further Evaluation: Since you have already seen specialists in cardiology, neurology, and ENT without definitive answers, it may be beneficial to explore a few additional avenues:
- Psychiatric Evaluation: Given that anxiety can manifest physically and cause symptoms such as dizziness and tingling, a thorough evaluation by a psychiatrist or psychologist may be warranted. They can help determine if anxiety or panic attacks are contributing to your symptoms.

- Vestibular Rehabilitation: If your dizziness is related to balance issues, a physical therapist specializing in vestibular rehabilitation could help. They can provide exercises to improve balance and reduce dizziness.

- Endocrinology: If there are concerns about metabolic issues, such as thyroid function or adrenal gland function, consulting an endocrinologist might be useful.

- Further Imaging: While you have undergone various tests, if your symptoms persist and significantly affect your quality of life, discussing the possibility of an MRI or a CT scan with your healthcare provider could be beneficial. These imaging studies can help rule out structural issues in the brain or other areas that might not have been previously assessed.

3. Lifestyle Modifications: You mentioned that you have been controlling your diet and exercising, which is excellent. Maintaining a healthy lifestyle can have a positive impact on overall well-being and may help alleviate some symptoms. Additionally, managing stress through mindfulness, yoga, or other relaxation techniques can also be beneficial.

4. Monitoring Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition.

5. Follow-Up: Regular follow-ups with your primary care physician are essential. They can coordinate your care among specialists and ensure that all aspects of your health are being addressed.

In conclusion, while it can be frustrating to deal with ongoing symptoms without a clear diagnosis, a multidisciplinary approach involving various specialists may provide the answers you need. Don't hesitate to advocate for yourself and seek further evaluations as necessary. Your health and quality of life are paramount, and finding the right support and treatment is crucial.

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