Brief Answer:
Consider POLYPHARMACY and/or ORTHOSTATIC HYPOTENSION

Detailed Answer:
Good evening.

If your husband has been suffering from continuous vertigo and he is 74 years old then, following major surgery I would consider the possibility that he may be suffering from either excessive medications or interactions between medications which in a 74 year old man are less well tolerated than in young people. Certainly, a HUGE LIST of medications for blood pressure and atrial fibrillation has the distinct risk of LOWER BP which in itself is going to affect your husband's sense of balance and equilibrium.

The presence of many medications and their untoward effects on a person is known as the effect of POLYPHARMACY. When blood pressure is so affected, however, that it changes dramatically upon postural changes which causes imbalance, dizziness, and lightheadedness (sometimes to the point of falling or even fainting) then, we refer to this as ORTHOSTATIC HYPOTENSION. This is measured by taking blood pressures while the patient is lying quietly for several minutes followed by immediately STANDING and then, standing for 2 minutes each time checking blood pressure and pulse.

If the numbers drop by a certain amount or the patient becomes symptomatic we understand them to be suffering from clinically significant ORTHOSTATIC HYPOTENSION that can be corrected best by stopping or reducing medications. There are other methods as well but if the problem is being caused by excessive medications then, obviously the solution would be to stop offending medications. In my opinion, the best doctor you should look for in trying to help your husband is the one who will look at what's in front as one of the most likely solutions to the problem and take action on proving one way or the other if it is in fact the problem. If it does not pan out....then, your husband is no worse off than he is now and you will know that taking "a huge list" of meds has nothing to do with what's going on....but tell me....do you REALLY BELIEVE that a 74 year old man who has had major surgery and who has hypertension and atrial fibrillation would not be affected by that many different chemicals not to be suffering even a little? Again, find a doctor with an eye toward seeing the obvious and acting on it rather than looking for yet another "specialist"....

This is the exact way I would handle your husband if he came to see me with these complaints. I would look to streamline and wean him off from anything that was not absolutely essential to his well being.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and would be grateful for a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with the responses.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like.

This consult request has taken a total of 107 minutes of time to read, research, and respond.

---

Brief Answer:
Fair enough but hold the phone

Detailed Answer:
Before, you and your husband put this off as "not life threatening" (and perhaps that's absolutely true) but let me bring you up to speed on a little known neurological piece of trivia which can kill the unsuspecting patient....much to the dismay of both patients and doctors who think that this type of presentation is "not life threatening."

The theory of orthostatic hypotension based upon the issue of polypharmacy and your husband's age is the most obvious differential in this type of case. However, let's take it on faith that the doctors actually did properly and diligently ruled this out....what else can cause continuous and ISOLATED VERTIGO with no other neurological symptoms? The answer: Brainstem ischemia due to lack of blood flow...but not so little flow that the patient would faint, pass out, almost pass out, or show hard cranial nerve signs....but just enough to cause one of the most oxygen hungry parts of the brainstem to YELL OUT which in this case manifests as VERTIGO, nausea, or dizziness.

This condition most commonly goes by the name Vertebrobasilar insufficiency or VBI. It is caused by blockages to the vertebral arterial system which feeds the brainstem which can cause major stroke that can be as fatal and unexpected as a massive heart attack. Yet it can masquerade for years as annoying dizziness and/or vertigo which people somehow learn to live with until the amount of blood flow to that part of the brain falls below critical levels at which point the stroke occurs.

Diagnostic screening for VBI can be done by MRA or 2 vessel conventional angiogram of the posterior fossa. An MRI is not sufficient unless a perfusion weighted image is obtained as well.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and would be grateful for a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with the responses.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like.

This consult request has taken a total of 150 minutes of time to read, research, and respond.

---