Persistent Dizziness and Nausea in Elderly Patients

Q: Persistent Dizziness and Nausea in Elderly Patients

Hello Kany： Based on your description, your mother has hypertension, dizziness, and suspected intestinal adhesions. <br>It is recommended to schedule an appointment with a neurologist to adjust her antihypertensive and dizziness medications. <br>Additionally, for the issue of int

Headache

Hello, I would like to inquire about my mother.
Since she fainted last November (the doctor said it was due to a lack of thyroid hormone and advised her to drink more electrolyte solutions), she has been experiencing dizziness and nausea.
She has a history of hypertension and is on antihypertensive medication, but when she feels dizzy, her blood pressure reads 143/103.
The doctor said this does not qualify as hypertension (which I find questionable).
Additionally, she has several areas of intestinal adhesions, which the doctor said cannot be resolved, and her white blood cell count has been persistently elevated (around 13,000 to 15,000).
The doctor could not determine the cause, only suggesting there might be inflammation somewhere (but could not specify where).
She also has pericardial effusion and edema, for which she is taking diuretics.
Currently, she is on hormone replacement therapy for menopause, taking both white and blue pills, but due to irregular menstruation, she often doesn't know how to take them, and the doctor has not provided clear guidance, which is quite distressing for her.

When the weather changes, she often experiences pain in the area where she had abdominal surgery, so she has been taking anti-inflammatory medication on her own (I know this is not advisable, but she feels there are no other options).
Recently, the doctor prescribed her an anxiety medication called Deanxit, but she felt very uncomfortable after taking it, so she stopped.
She had a surgery for an ectopic pregnancy 25 years ago, and at that time, the medical technology was not as advanced, so it was only after a full examination that they discovered the ectopic pregnancy.
Since that surgery, her health has not been very good.
She previously had a record of heart failure, and at that time, the doctor predicted she would not survive for many years due to pericardial effusion and pulmonary edema; however, she has lived well beyond that prognosis.
Recently, she has been feeling dizzy, nauseous, cold, and has a sensation of fever in her forehead every afternoon, although she does not actually have a fever.
After seeing the doctor, they could not identify the cause and prescribed medications such as Mogadon, Plendil, Flutrion, Pillian, Acetaminophen, and Stacainc, among others.
She has also taken various other medications in the past, including Aminophylline, Serenal, Cisapride, Deanxit, Herbesser, Tamedin, Medicon, Meptin, and Phyllocontin, and has used steroids for a period, both orally and via inhalation.
However, the issues of dizziness and nausea remain unresolved.

Doctor, do you have any suggestions? We, as her children, truly do not know what to do.
Please provide us with some advice.
Thank you.

kany, 20~29 year old female. Ask Date: 2001/03/13

Dr. Ke Zhengchang reply Internal Medicine

Hello Kany: Based on your description, your mother has hypertension, dizziness, and suspected intestinal adhesions.
It is recommended to schedule an appointment with a neurologist to adjust her antihypertensive and dizziness medications.
Additionally, for the issue of intestinal adhesions, please consult a gastroenterologist for further examination.

Reply Date: 2001/03/13

More Info

Persistent dizziness and nausea in elderly patients can be quite challenging to diagnose and manage, especially when there are multiple underlying health issues. In your mother's case, it appears that she has a complex medical history that includes hypertension, previous surgeries, and possibly chronic inflammation, which may contribute to her current symptoms.

Firstly, it is essential to understand that dizziness and nausea can stem from various causes, particularly in older adults. These can include cardiovascular issues, vestibular disorders, medication side effects, metabolic imbalances, and even psychological factors such as anxiety or depression. Given your mother's history of high blood pressure and heart issues, it is crucial to monitor her cardiovascular health closely. The blood pressure reading of 143/103, while not classified as hypertensive emergency, is still concerning and may require further evaluation and management.

The persistent elevation of her white blood cell count suggests an ongoing inflammatory process, which could be related to an infection or another underlying condition. It is essential for her healthcare providers to investigate this further, as chronic inflammation can lead to various complications, including fatigue, malaise, and potentially contribute to her dizziness and nausea.

Your mention of her experiencing symptoms that worsen in the afternoon could indicate a pattern that might be linked to her medication regimen or daily activities. Some medications can cause sedation or dizziness, particularly in older adults who may be more sensitive to these effects. It would be beneficial to review her current medications with her healthcare provider to assess whether any of them could be contributing to her symptoms. The combination of medications she is taking, including diuretics and anxiety medications, may also interact in ways that exacerbate her dizziness and nausea.

Additionally, the history of abdominal surgeries and the presence of adhesions could lead to gastrointestinal issues, which might manifest as nausea. It is important to ensure that her gastrointestinal health is being monitored, as any obstruction or motility issues could contribute to her symptoms.

In terms of management, it may be helpful to consider a multidisciplinary approach. This could include:
1. Cardiology Consultation: Given her history of heart issues, a thorough evaluation by a cardiologist may be warranted to assess her heart function and rule out any cardiac causes of her symptoms.

2. Gastroenterology Referral: If gastrointestinal issues are suspected, a gastroenterologist could evaluate her for potential complications related to her previous surgeries and current symptoms.

3. Medication Review: A comprehensive review of her medications by her healthcare provider or a pharmacist could help identify any potential side effects or interactions that may be contributing to her dizziness and nausea.

4. Physical Therapy: If her dizziness is related to balance issues, a physical therapist specializing in vestibular rehabilitation may help improve her stability and reduce dizziness.

5. Psychological Support: If anxiety or depression is a factor, involving a mental health professional could provide additional support and management strategies.

6. Lifestyle Modifications: Encouraging hydration, a balanced diet, and regular, gentle physical activity can also help improve overall health and potentially alleviate some symptoms.

In conclusion, it is crucial to maintain open communication with her healthcare providers and advocate for a thorough evaluation of her symptoms. Given her complex medical history, a comprehensive and coordinated approach will likely yield the best outcomes. It is understandable that you feel overwhelmed as a caregiver, but seeking support from healthcare professionals and possibly connecting with support groups for caregivers can also provide valuable resources and assistance.

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