Persistent Dizziness and Nausea: A Guide for Caregivers

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 iodine and advised her to drink more sports drinks), she has been experiencing dizziness and nausea.
She has a history of hypertension and has been taking 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 segments of her intestines that are adhered, and the doctor mentioned that this cannot be resolved.
Her white blood cell count has been persistently elevated (around 13,000 to 15,000), and the doctor could not determine the cause, only suggesting that there might be inflammation somewhere without specifying where.
She also has pericardial effusion and edema, for which she has been taking diuretics.
Currently, she is on medication for menopause, which includes 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, causing her distress.
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 she feels there are no other options).
Recently, the doctor prescribed her an anxiety medication, Deanxit, but she felt very uncomfortable after taking it, so she stopped on her own.
She had a 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.
Since that surgery, her health has not been great.
She has a history 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 several years 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 a doctor, they could not identify the cause and prescribed medications including Mogadon, Plendil, Flutrion, Pillian, Acetaminophen, and Stacainc, among others.
She has previously taken various medications such as Aminophylline, Serenal, Cisapride, Deanxit, Herbesser, Tamedin, Medicon, Meptin, and Phyllocontin, and has also taken 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.

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

Dr. Zeng Fenyu reply Internal Medicine

There are many causes of dizziness, including brain diseases, vestibular nerve disorders, cardiopulmonary diseases leading to insufficient cerebral blood flow, psychogenic factors, and postmenopausal syndrome in women.
Regarding the condition you mentioned, if the patient already has high blood pressure, even if it is lowered to a slightly elevated level, the patient may still experience dizziness due to inadequate circulation.
For a woman around 50 years old experiencing forehead heat and dizziness, postmenopausal syndrome is a symptom to consider.
Therefore, my recommendations are as follows: first, consult an otolaryngologist and a neurologist to determine if there are any abnormalities in the ear or head.
If no abnormalities are found, continue follow-up treatment with a cardiologist or pulmonologist.
Additionally, a visit to a gynecologist is advisable to confirm whether there is postmenopausal syndrome; if there is a deficiency in female hormones, medication supplementation will be necessary.
Neurologist Dr.
Tseng Kung-Yan.

Reply Date: 2001/03/13

More Info

Persistent dizziness and nausea can be distressing symptoms, especially in elderly patients with complex medical histories. In your mother's case, there are several factors that could contribute to her ongoing symptoms, including her history of hypertension, previous surgeries, and current medications.
Firstly, it is important to understand that dizziness can arise from various causes, including cardiovascular issues, neurological conditions, medication side effects, and metabolic imbalances. 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 mmHg, while not classified as hypertensive crisis, is still elevated and may contribute to her symptoms. It is essential to ensure that her antihypertensive medications are appropriately managed and adjusted as needed.

The presence of persistent nausea can also be linked to gastrointestinal issues, especially considering her history of abdominal surgeries and bowel adhesions. Adhesions can lead to bowel obstruction or other gastrointestinal complications, which may manifest as nausea and abdominal pain. It would be advisable to consult a gastroenterologist to evaluate her gastrointestinal health further, possibly through imaging studies or endoscopy, to rule out any obstructions or other underlying conditions.

Additionally, the elevated white blood cell count suggests an inflammatory process somewhere in the body. This could be due to an infection or another inflammatory condition. It may be beneficial to conduct further investigations to identify the source of this inflammation, as it could be contributing to her overall malaise and symptoms.

Regarding her medication regimen, it is essential to review all the medications she is taking, as polypharmacy can lead to adverse effects, including dizziness and nausea. Some medications, particularly those for anxiety and depression, can have side effects that exacerbate these symptoms. It may be worth discussing with her healthcare provider the possibility of simplifying her medication regimen or switching to alternatives that have fewer side effects.

The symptoms of feeling cold and having a sensation of fever without an actual fever could indicate autonomic dysfunction, which is not uncommon in patients with a history of cardiovascular issues. This could also be related to her anxiety and stress levels, which can manifest physically. It may be beneficial to explore non-pharmacological interventions for anxiety, such as cognitive-behavioral therapy or mindfulness practices, which could help alleviate some of her symptoms.

In summary, I recommend the following steps:
1. Cardiovascular Evaluation: Ensure her blood pressure is well-managed and consider a cardiology consultation to evaluate her heart function and any potential fluid overload.

2. Gastrointestinal Assessment: Consult a gastroenterologist to investigate the cause of her nausea and any potential complications from her previous surgeries.

3. Medication Review: Have her medications reviewed by her healthcare provider to identify any that may be contributing to her symptoms and consider alternatives if necessary.

4. Investigate Inflammation: Further investigate the cause of her elevated white blood cell count to address any underlying infections or inflammatory conditions.

5. Non-Pharmacological Approaches: Explore anxiety management techniques that do not rely solely on medication.

It is understandable that as her children, you feel overwhelmed by her complex health issues. Open communication with her healthcare team and advocating for comprehensive evaluations can help ensure she receives the best possible care.

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