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 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 adhesions in her intestines, which the doctor said cannot be resolved, and her white blood cell count has been consistently 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, so 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 and decided to stop.

Twenty-five years ago, she underwent surgery for an ectopic pregnancy, but at that time, medical technology was not as advanced, and it was only after a full examination that the ectopic pregnancy was discovered.
Since that surgery, her health has not been very good.
She has a history of heart failure, and at one point, a doctor predicted she would not survive for more than a few 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 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 used steroids both orally and as a spray.

Despite all this, we still do not understand why she continues to experience dizziness and nausea.
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. Hong Hongchang reply Internal Medicine

The patient has hypertension, endocrine disorders, electrolyte imbalances, and postoperative enteritis, which may clinically present with elevated white blood cell counts associated with bacterial infection.
Additionally, the patient's use of corticosteroids may lead to decreased immunity and gastrointestinal discomfort.
Clinical issues are interconnected; therefore, it is recommended to admit the patient or refer them to obstetrics and gynecology and internal medicine outpatient clinics for a thorough examination to achieve the best diagnosis and treatment.
Thank you.

Reply Date: 2001/03/13

More Info

Persistent dizziness and nausea can be particularly challenging symptoms to manage, especially in elderly patients with complex medical histories. In your mother's case, several factors may be contributing to her ongoing symptoms, including her history of hypertension, previous surgeries, and current medications.
First, it is essential 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 could contribute to her symptoms. It may be beneficial to consult with her healthcare provider about adjusting her antihypertensive medications or exploring other treatment options.

Additionally, the presence of abdominal adhesions (as mentioned regarding her intestinal issues) can lead to chronic pain and discomfort, which may exacerbate feelings of nausea and dizziness. Adhesions can cause bowel obstruction or other gastrointestinal complications, so it is essential to keep her healthcare team informed about any changes in her symptoms.

The elevated white blood cell count suggests an inflammatory process, which could be due to an infection or another underlying condition. It may be worthwhile to pursue further diagnostic testing to identify the source of inflammation, especially if her symptoms persist. This could include imaging studies or referrals to specialists, such as a gastroenterologist or an infectious disease expert.

Regarding her medications, it is crucial to review all the drugs she is currently taking, as polypharmacy (the use of multiple medications) can lead to adverse effects, including dizziness and nausea. Some medications, particularly those for anxiety or depression, can cause sedation or dizziness as side effects. If she experienced discomfort with the recently prescribed medications, it may be necessary to revisit her medication regimen with her physician to find alternatives that are better tolerated.

In terms of managing her symptoms, consider the following recommendations:
1. Hydration and Nutrition: Ensure she stays well-hydrated and maintains a balanced diet. Dehydration can exacerbate dizziness and nausea. If she struggles with eating, consider smaller, more frequent meals that are easy to digest.

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

3. Monitor Symptoms: Keep a detailed log of her symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for her healthcare team in diagnosing and treating her condition.

4. Follow-Up Care: Regular follow-ups with her healthcare providers are essential. Given her complex medical history, a multidisciplinary approach involving her primary care physician, cardiologist, and possibly a neurologist may provide a more comprehensive evaluation of her symptoms.

5. Medication Review: Schedule a medication review with her doctor or a pharmacist to assess the appropriateness of her current medications and explore alternatives that may have fewer side effects.

6. Mental Health Support: Given her history of anxiety and the impact of chronic illness on mental health, consider involving a mental health professional who can provide support and coping strategies.

In conclusion, persistent dizziness and nausea in elderly patients can stem from multiple sources, and a thorough evaluation is necessary to identify and address the underlying causes. Collaboration with her healthcare team, careful monitoring of her symptoms, and adjustments to her treatment plan will be critical in managing her condition effectively.

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