Persistent Dizziness and Nausea: A Guide for Caregivers

Headache

Hello, I would like to inquire about my mother.
Ever since she fainted last November (the doctor mentioned a deficiency in thyroid hormones 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 is not considered high blood pressure, which I find questionable.
Additionally, she has several adhesions in her intestines, 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 and only suggested there might be inflammation somewhere, but could not specify where.
She also has pericardial effusion and edema, so she is currently taking diuretics.
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 has not received clear guidance from the doctor, which is quite distressing.
When the weather changes, she often experiences pain in the area where she had surgery, so she has been taking anti-inflammatory medication on her own (I know this is not advisable, but there seems to be no other option).
Recently, the doctor prescribed her an anxiety medication called Deanxit, but she felt very uncomfortable after taking it, so she stopped.
She had surgery for an ectopic pregnancy 25 years ago, and at that time, due to the limitations of medical technology, it was only discovered after a full examination that it was an ectopic pregnancy.
Since that surgery, her health has not been very good.
She previously had a record of heart failure, and doctors had 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 feels 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 including Mogadon, Plendil, Flutrion, Pillian, Acetaminophen, and Stacainc, among others.
She has also taken various other medications in the past, such as Aminophylline, Serenal, Cisapride, Deanxit, Herbesser, Tamedin, Medicon, Meptin, and Phyllocontin, and has been on steroids for a period, both oral and inhaled.
However, we still do not understand why her dizziness and nausea persist.

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

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

Dr. Li Huixiong reply Internal Medicine

Seeing you write extensively indeed leaves you, as children, unsure of what to do.
In fact, simplifying matters and focusing on the key points is essential.
The most common situation in outpatient clinics is that after prolonged illness, patients often lose sight of the main issues.
Your mother's problem lies in whether there is a correct diagnosis accompanied by a thorough evaluation.
Many patients have a tendency to "shop around" for medical care, leading to a cacophony of opinions, making it difficult to pinpoint the core issues.
As a result of bouncing from one doctor to another, not only does the condition fail to improve, but the side effects of medications can also trouble the patient.
Therefore, I recommend that you find a trustworthy physician (internist or family medicine specialist) for consistent outpatient treatment and follow-up.
By addressing the real issues, you can achieve better results with less effort.
Wishing you all the best.

Reply Date: 2001/03/13

More Info

Persistent dizziness and nausea can be distressing symptoms, especially in older adults with complex medical histories. In your mother's case, several factors could be contributing to her ongoing symptoms, including her history of hypertension, previous surgeries, and current medications. Here’s a comprehensive overview of potential causes and management strategies.

Understanding the Symptoms
1. Dizziness: This can stem from various sources, including inner ear issues, blood pressure fluctuations, or neurological conditions. Given your mother's history of hypertension, it's essential to monitor her blood pressure regularly. While a reading of 143/103 mmHg may not be classified as hypertension by some standards, it is still elevated and could contribute to her symptoms, especially if she experiences orthostatic hypotension (a drop in blood pressure when standing up).

2. Nausea: This can be caused by gastrointestinal issues, medication side effects, or even anxiety. The fact that your mother has a history of abdominal surgeries and adhesions may complicate her gastrointestinal function, leading to nausea.

3. Other Symptoms: The sensation of feeling cold and having a feverish forehead without an actual fever could indicate autonomic dysfunction or anxiety. It’s also worth considering that her medications, particularly those for anxiety and hypertension, may have side effects that contribute to her overall discomfort.

Potential Causes
- Medication Side Effects: The numerous medications your mother is taking could interact in ways that exacerbate dizziness and nausea. For instance, diuretics can lead to dehydration, which may cause dizziness. Additionally, some medications for anxiety and hypertension can have sedative effects, leading to increased dizziness.

- Electrolyte Imbalance: Given her use of diuretics and potential gastrointestinal issues, electrolyte imbalances (such as low potassium or sodium) could be contributing to her symptoms. Regular blood tests to monitor electrolytes may be beneficial.

- Infection or Inflammation: The elevated white blood cell count suggests an inflammatory process, which could be due to an infection or another underlying condition. Identifying the source of this inflammation is crucial, as it could be contributing to her symptoms.

- Cardiac Issues: Given her history of heart problems, it’s essential to rule out any cardiac causes for her dizziness. Conditions such as heart failure or arrhythmias can lead to inadequate blood flow to the brain, resulting in dizziness and nausea.

Recommendations
1. Comprehensive Evaluation: It may be beneficial for your mother to undergo a thorough evaluation by a geriatrician or a specialist in internal medicine. This could include a review of her medications, a detailed physical examination, and possibly imaging studies or referrals to specialists (e.g., cardiology, gastroenterology).

2. Medication Review: A pharmacist or physician should review all her medications to assess for potential interactions and side effects. Adjusting dosages or switching medications may alleviate some of her symptoms.

3. Hydration and Nutrition: Ensure she stays well-hydrated and maintains a balanced diet. If she has difficulty eating due to nausea, small, frequent meals may help.

4. Monitoring Blood Pressure: Regularly monitor her blood pressure at different times of the day, especially when she changes positions (sitting to standing). This can help identify any patterns related to her dizziness.

5. Physical Therapy: If her dizziness is related to balance issues, a physical therapist specializing in vestibular rehabilitation may provide exercises to improve her stability.

6. Mental Health Support: Given her history of anxiety and the stress of managing chronic health issues, consider involving a mental health professional to help her cope with her symptoms.

Conclusion
Persistent dizziness and nausea in older adults can be multifactorial, requiring a comprehensive approach to diagnosis and management. By addressing her medications, monitoring her health closely, and seeking specialized care, you can help improve her quality of life and potentially alleviate her troubling symptoms. It’s essential to maintain open communication with her healthcare providers and advocate for her needs as you navigate this complex situation together.

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