My wife is dizzy (not ditzy)

[NewGuy]

For a couple of days earlier this week my wife was dizzy/had vertigo when getting out of bed, walking across the room, even just sitting on the couch. She doesn't have cold symptoms.

 

I took her to a neurologist at BPH where she had an MRI. As requested, the doc phoned me the next day and said the scan showed she did not have a tumour, did not have a stroke and did not have internal bleeding.  She does have sinusitis on both sides. I didn't get a response on 'what to do'?  I asked about her taking my Nasonex (for my COPD); the doc said it might help her, but hasn't so far.

 

She alternates dizzy and not and now lacks confidence to go to the market or Friendship, alone or with me.

 

What to do?

 

Cheers

[Sheryl]

How old is she?

 

SI she on any medications (if so, what)?

 

Did they do any blood work (electrolytes etc)? Has she been sweating ?

[b17]

My wife has also had bouts of dizziness from time to time. When we went to the doctor, he determined that she had extremely low blood pressure, and needs to ease out of bed very slowly, or dizziness will ensue. On another occasion of dizziness, we learned that she had an underactive thyroid, and underwent a course of medication that seemed effective vs the problem. 

I hope you can figure out the cause of your wife's vertigo, and get it sorted very soon. 

 

[Carib]

I assume her blood pressure has been checked (with intervals) .

How is her eyesight? Ever felt the need to see an eye doctor? 

[Morch]

I had a spell of such dizziness bouts a few years ago. Went for consultation, which amounted to asking a few questions, looking at stats, and announcing it "could be a tumor". The advice, which didn't seem to rely on much, was to check in and get a series of tests.

 

Thought it better to get a second opinion, headed to my usual hospital. Was referred a doctor, which turned out to be a visiting American. Asked the same questions, etc. then prescribed ear drops.... Said if no improvement within a few days or worsening, may want to thing about serious checkups. A week later the whole thing was history. 

[NewGuy]

Hi Carib,

 

She's had a few bp & hb tests recently - BP okay, hb was 104 yesterday, 75 just now.

 

She wears glasses and doesn't think they need to be changed. Her opthamolic test two months ago gave her usual result.

[NewGuy]

Hi Morch,

 

The ear drop idea sounds like a possibility.  What kind of drops, brand name, etc. My local Fascino druggist knows nothing.

 

 

[Sheryl]

How old is she? (Very relevant - benign postural vertigo is common as people get older, unlikely if she is young).

 

 

[Morch]

7 minutes ago, NewGuy said:

Hi Morch,

 

The ear drop idea sounds like a possibility.  What kind of drops, brand name, etc. My local Fascino druggist knows nothing.

 

 

 

Wouldn't know, as said, this was some years ago. Possibly antibiotic, though really can't recall. Got them just the one time at the hospital's pharmacy so no idea if it was a prescription only thing. The diagnosis offered was that it might have been an ear infection or something, thus the loss of balance. Said it was quite common as such things go. I'd consult a doctor before self-medicating.

[NewGuy]

Hi b17 and Sheryl,

 

I'll take her to the local clinic tomorrow for B12, Thyroid and Electrolytes tests.

 

Sheryl again: 56 years old, not hot or sweating. She takes some heavy duty stuff: fluoxetine 20 mg, Neuris 2 mg, Bestatin 20 mg, Clozapine 100 mg, 1/2 pill daily, Edronax 4 mg, plus a bunch of vitamins.

 

Cheers

[sirineou]

12 minutes ago, NewGuy said:

Hi b17 and Sheryl,

 

I'll take her to the local clinic tomorrow for B12, Thyroid and Electrolytes tests.

 

Sheryl again: 56 years old, not hot or sweating. She takes some heavy duty stuff: fluoxetine 20 mg, Neuris 2 mg, Bestatin 20 mg, Clozapine 100 mg, 1/2 pill daily, Edronax 4 mg, plus a bunch of vitamins.

 

Cheers

is it possible that some of the medications might react with each other?

My Mom was under a lot of medications and was a basket case, we were running back and forth to the hospital every other week with dizzy spells. when she changed doctor he reviewed her medication , adjusted some and took her of from others, Miraculously she  started feeling fine, and lived am other twenty healthy years, in to her late eighties.

[Sheryl]

Heavy duty indeed! Could definitely be the meds, and she may need to talk to her psychiatrist  for medication adjustment. I have never before come across someone simultaneously taking risperidone and clozapine as well as both  an SSRI AND an NRI.  In fact the combination of risperadone + clozapine has been known to produce neurological symptoms in some people.  And nowadays there re antidepressents which are both serotonin and norepinephrine reuptake inhibitors so ti would not be usual to presecribe the two separately. The more different drugs given, them more room there is for undesirable drug interactions.

 

However do go ahead and exclude other causes, which in addition to electrolyte disturbance (unlikely if she has had no unusual fluid losses) include cardiac arrythmia, anemia and low blood sugar. So while at the clinic get also a fasting blood sugar and complete blood count and may as well check liver and kidney function while at it (creatine and AST/ALT), given the meds she is on. And, very important, get an EKG with a 1 minute rhythm strip to check for arrythmias (the medications may cause them or could be a primary heart problem).

 

Another possibility is simply menopause, it affects some women like this and sometimes very suddenly. Could be a combination of her meds plus menopause. But do get the EKG and blood work.

 

I would also suggest perhaps a second opinion on her psych meds. Not a standard combination that she is on, to put it mildly. In fact from the looks of it I almost question whether somneone started her on new meds not realizing what meds she was already on.

[NewGuy]

Thanks Sheryl - a lot there.

 

She'll also get fasting blood sugar, CBC, and liver function rests (already done every couple of months - pretty normal results I figure - as requested by her shrink). She has had only one shrink over the years: all prescriptions come from him.

 

We'll go for a BPH ekg.

 

How do I go about questioning/triggering a review of her meds (which are for past paranoid schizophrenic episodes - no fun for either of us)? I guess docs at the same institution won't criticize or change treatments of others.

 

cheers.

[Sheryl]

They might or might not, depends on the doctor.

 

She is being treated nto only for schizophrenia but also for severe depression, based on her meds.

 

I suggest, once the blood work and EKG etc are done, doing one of the following:

 

1. Go back to her usual pyschiatrist explaining that she has developed extreme dizziness and that other causes have been ruled out (or, if applicable, that EKG showed X abnormality, as mentioned these meds can cause this) and ask if her meds can be reviewed. While there, specifically ask him (1) why she needs to be on both clonzapine and respiradone (would usually be one or the other, not both) and (2) whether instead of taking 2 antidepressents, one an SSRI and one an SNRI, she could take a single dual action one.

 

2. Change to a different psychiatrist and same as above. This US trained doc in Bkk is excellent and very, very nice:

 

https://www.bumrungrad.com/doctors/Suttiporn-Janenawasin

 

Get all her records to bring with you.

 

Which of these approaches you take depends on how you think her current pysch will respond to such questions and also how attached your wife is to him/her. It can be very difficult to get people to follow meds prescribed so if she has particular confidence in this doctor might be reason enough to stay with him/her.

 

It is common for psychotic symptoms to worsen during the pre- and peri-menopausal years and then markedly improve once menopause is reached and the hormone levels stabilize. With that often comes a decreased need for medication and for that reason alone a review is well in order...she may be able to get by on fewer drugs and/or lower dosages than was true just a few years before. But obviously you want to proceed with caution and under close medical supervision for any changes.

 

 

[NewGuy]

Geez, thanks Sheryl,

 

After all the tests and a consult with our usual, non-shrink md, we'll go down the hall to the shrink and I'll bring up the meds question, discuss easing her off florotoxine (sp?) and re-evaluating the current meds approach. She likes and trusts him and I know he wants to the best for her. He might have been over-influenced by my earlier stating I would be challenged if faced with another P S episode.

 

Thanks again,

[Sheryl]

It is also within possibility that he meant to replace one antipsychotic med with another but failed to cancel the first in the orders and does not realize she has been
Receiving and taking both clonzapine and respiradone all this time.

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[NewGuy]

Here's my (positive) update.

 

After seeing our regular BPH doc ('sounds like vertigo'), and her shrink, she was sent to an ENT specialist. The shrink said her psych meds regime was appropriate after I pushed a bit with the comments above.

 

Just a couple of questions from the ENT and a one minute of manipulation therapy and my wife got the diagnosis - BPPV (google it: interesting though hard to explain, not uncommon it seems, and very easy to treat).  The bill for three mds, meds, manipulation was just over 3,000 Baht - much cheaper than the MRI.

 

One med was STUGERON 25 mg, 10 tabs, 1 tab every 8 hours when dizzy, the other was SERC 16mg, 14 tabs, 1 tab after breakfast and dinner.  She needed only a single Stugeron and was rapidly dizzy-free; she completed the week's Serc pills.

 

No problems in the six weeks since then. If there is a reoccurrence we will hit BPH again, but a lot of people have only one episode.

 

Thanks all.