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Suggest Treatment For Dizzyness, Imbalance And Lightheadedness

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Posted on Tue, 9 Sep 2014
Question: Hi,

I have had the following symptoms for the last 2 weeks. Dizzyness, Imbalance, Lightheadedness, At times blurry vision, imbalance, coughing, back pain, warm sensation in my back, chest feels heavy when I breathe in, headaches, tingly fingers and legs. I have been to GP and he diagnosed as Vitamin b12 deficient (level was 178), Vitamin D (level 32). Also had an endoscopy 1 week ago and the report suggests I have oesophagitis, duodenitis & gastritis. I am due a follow up with the gastro specialist in a week.
My history is that I have had a MI 3 years ago. Visit to Cardiologist on July 15. Echo and Stress ECG were normal as per Cardiologist. Also had an ECG on July 01st and that came back as normal.
Xray of the back as suggested by GP also came back as normal.

Any suggestions as to what this could be? Any help is welcome.
doctor
Answered by Dr. Shoaib Khan (2 hours later)
Brief Answer:
Discussing all points

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help.

From the provided symptoms and information, vitamin B12 deficiency is likely but still does not cover all the symptoms sir. I would also be interested in learning more about your intestines. Vitamin B12 is absorbed in the intestines and some abnormalities (Eg. irritable bowel syndrome, diverticulosis, etc.) prevents the absorption of this vitamin and other nutrients resulting in their deficiency. So I would recommend a colonoscopy as well, as only your upper gastrointestinal tract (GIT) was studied and not your lower GIT.

Symptoms of dizziness, imbalance, light headedness, and blurry vision warrant a neuro check, especially an MRI of the brain. So please do request for an MRI also to make sure causes from this field are ruled out.

If at all, an MRI brain returns clean then we should suspect vascular conditions that may have resulted from vitamin B12 deficiency; atherosclerosis is one such condition and a lipid profile would be required for the same.

As you have a positive history of cardiac condition, I would like to know if you are on any cardiac medications (Eg. ecosporin, aspirin, coumadin, atorvastatins, etc.). If you are not, then please discuss the initiation of preventive medication not only to prevent future heart events but also to promote good blood circulation and delivery.

I would also like to add, an upper GIT endoscopy was conducted and this procedure examines the oesophagus, stomach and duodenum. All of these parts were found inflamed, and so why did these results not warrant an investigation into the rest of the GIT parts.

I hope I have explained things well enough, and in a manner best understood by you sir. Please feel free to discuss anything you want, as I am always here to discuss and help you.

Best wishes.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Shoaib Khan (19 minutes later)
Thank you for the reply. The Lower GIT was not analyzed as far as I know. As far as I know I do not have any IBS etc, although it is possible as I do pass a lot of gas. I also have been burping quite a lot which is unusual for me.

I am going to follow up with the Gastro Specialist this week about the results and follow up procedure.

My heart medication is as follows.
Aspirin 75mg
Bisoprolol 1.25mg
Ramipiril 1.25mg
Artovastatin 40mg
Lansoprozole 30mg

Thanks, I will request a Neuro check from my GP. This is one of the things I suggested and he was not too keen.

doctor
Answered by Dr. Shoaib Khan (8 minutes later)
Brief Answer:
Thank you for the information sir

Detailed Answer:
Hello once again sir.

Thank you for your kind reply.

I am sure you are well aware about the symptoms of IBS, and other similar conditions which is why you are quite confident of not having them, but as you have a few gastric symptoms (which could also be due to the gastritis), it still warrants a complete gastrointestinal evaluation sir.

Thank you for the list of medications, you are indeed well protected from future cardiac events and god willing you will never have to face them. The only reason I had to inquire about this is to make sure you were on anti-coagulant medication to realise that your blood is reaching all parts of your body well enough and possible thickening of your blood is not the cause for your neurological symptoms sir.

I can understand how some doctors can seen uninterested as symptoms of some patients may not seem valid enough for investigations, but this is considered negligence. Request for an MRI brain and consult either a neurologist or an ENT specialist as some of your symptoms can be related to vertigo which can also have an ENT source.

Please keep me updated sir, I am here to guide you and am always available to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Shoaib Khan (16 hours later)
Thanks for your reply. It is very useful. I am going to request a referral to a neurologist first and then perhaps an ENT to find out what is going on.
doctor
Answered by Dr. Shoaib Khan (3 minutes later)
Brief Answer:
My pleasure entirely

Detailed Answer:
Hello once again sir.

I am glad I could be of assistance. Please do not hesitate to keep in touch or write to me for any further clarifications, I am always here to help.

Best wishes.
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
Answered by
Dr.
Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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Suggest Treatment For Dizzyness, Imbalance And Lightheadedness

Brief Answer: Discussing all points Detailed Answer: Hello sir and welcome. Thank you for writing to us. I have gone through your query with diligence and would like you to know that I am here to help. From the provided symptoms and information, vitamin B12 deficiency is likely but still does not cover all the symptoms sir. I would also be interested in learning more about your intestines. Vitamin B12 is absorbed in the intestines and some abnormalities (Eg. irritable bowel syndrome, diverticulosis, etc.) prevents the absorption of this vitamin and other nutrients resulting in their deficiency. So I would recommend a colonoscopy as well, as only your upper gastrointestinal tract (GIT) was studied and not your lower GIT. Symptoms of dizziness, imbalance, light headedness, and blurry vision warrant a neuro check, especially an MRI of the brain. So please do request for an MRI also to make sure causes from this field are ruled out. If at all, an MRI brain returns clean then we should suspect vascular conditions that may have resulted from vitamin B12 deficiency; atherosclerosis is one such condition and a lipid profile would be required for the same. As you have a positive history of cardiac condition, I would like to know if you are on any cardiac medications (Eg. ecosporin, aspirin, coumadin, atorvastatins, etc.). If you are not, then please discuss the initiation of preventive medication not only to prevent future heart events but also to promote good blood circulation and delivery. I would also like to add, an upper GIT endoscopy was conducted and this procedure examines the oesophagus, stomach and duodenum. All of these parts were found inflamed, and so why did these results not warrant an investigation into the rest of the GIT parts. I hope I have explained things well enough, and in a manner best understood by you sir. Please feel free to discuss anything you want, as I am always here to discuss and help you. Best wishes.