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Suggest Treatment For Vertigo When Diagnosed With Cogenital Hip Issue
Question: I'm a Physical Therapist. My home care client is 61 year old female on minimal meds. She has a cogenital hip issue and the R le is 2" short and very weak. She refused a shoe in the past and walks on toe. I believe I can strengthen her hip and get her a specil shoe. The problem is vertigo. Absent in sitting, Begins immediatly on standing. She is clear it is vertigo not lightheadedness. Not orthostatic hypotension as her Bp goes from seated 130/70 to standing 140/80?? Is there orthstatic hypertension? Also know that no cervical motions in sitting that trigger vertigo moving slow or fast: lateral bend , rotate or fles extend. What do you think? She is Medicaid and the clinic has had a cast of thousands and no consistant care.
Brief Answer:
Some more information about her client please.
Detailed Answer:
Hi XXXX,
Thanks for the query under HCM forum.
I appreciate your attempt to go to the root cause of your client's problem. It indicates a sincere attitude towards the sevice you provide. I admire it.
The vertigo your client has needs to be studied in detail.. I would need some more information about her symptoms.
- Is it a recent problem or a long running one ?
- Is the vertigo every time she stands up or some times only?
- Is it associated with nausea?
- Does she have any opthalmic ( eye ) problem ?
-Is her general condition normal ( specially her Hb % ?
- Is she addicted to alcohol/ smoking.?
Please provide me the details to allow me think in all possible directions & find most likely possibility.
Thanks.
Some more information about her client please.
Detailed Answer:
Hi XXXX,
Thanks for the query under HCM forum.
I appreciate your attempt to go to the root cause of your client's problem. It indicates a sincere attitude towards the sevice you provide. I admire it.
The vertigo your client has needs to be studied in detail.. I would need some more information about her symptoms.
- Is it a recent problem or a long running one ?
- Is the vertigo every time she stands up or some times only?
- Is it associated with nausea?
- Does she have any opthalmic ( eye ) problem ?
-Is her general condition normal ( specially her Hb % ?
- Is she addicted to alcohol/ smoking.?
Please provide me the details to allow me think in all possible directions & find most likely possibility.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Long running problem
Good health other then yes she smokes.
I do not have access to blood tests
Full med list : 81 mg Asprin , Atenolol 25 mg AM, Celexa 20 mg , lisinopril 10 mg and pravastin 40 mg PM.
Hs of cardiac stents and ischmic heart
Clinic says Vit D deficiency but no supplement ordered?
Good health other then yes she smokes.
I do not have access to blood tests
Full med list : 81 mg Asprin , Atenolol 25 mg AM, Celexa 20 mg , lisinopril 10 mg and pravastin 40 mg PM.
Hs of cardiac stents and ischmic heart
Clinic says Vit D deficiency but no supplement ordered?
Brief Answer:
Care assessment for cause & expert advise would help.
Detailed Answer:
Hi XXXX,
Thanks for the information. I do appreciate the detailed history you take & also your keen interest to give a total relief to your patients. I understand your concern.
In my view-
1. Your patient's problem of vertigo with change of position ( sitting to standing ) typically suggests an Orthostatic hypotension.Orthostatic hypotension is defined to be drop of systolic blood pressure by minimum 20 mm of HG.& diastolic blood pressure by minimum 10 mm of Hg.-in Standing position.& she shows difference of 10 mm in her diastolic blood pressure.
-Conditions like anemia/ dilatation of blood vessels by the medications used to prevent heart problem /Inner ear problem/Age generated & smoking supported thickening of blood vessels ( atherosclerosis ) may contribute for low volume of blood reaching brain & lead to postural hypotension & vertigo.
2.Medications she is taking for controlling her blood pressure( Lisinopril, Celexa,) And also Pravastin 40 for for reducing bad cholesterol from blood- have known side effects of dizziness .. which can create her problem.
- Vitamin B12 deficiency can lead to vertigo .. which is easily reversible after supplementation.
- Vitamin D 3.Begnin Paroxysmal postural vertigo (BPPV) - is another condition a
which can some times produce the symptoms . Here involvement of internal ear is the cause.
4. Cervical spinal problem causing vertigo is out of question.. as per your reporting of no symptoms with neck movements... still it deserves exclusion.
* In this context.. I would suggest your patient to-
- Consult her family physician .. he will assess her health in detail , get her investigated for her blood counts/ Vitamin B12 level in blood,/gross ear check up . followed by medications Or refer her to ENT specialist/ cardiologist / orthopedic doctor for further management.
- Consult her cardiologist & ask for need of change in medication/ dosage of present medications to relieve her of the vertigo ( secondary to postural hypotension ) she has.
- Consult ENT specialist for necessary investigations/ treatment of internal ear problem causing the problem.
* After systematic assessment / exclusion of problem creating causes, followed by expert advise for management would definitely relieve your patient off vertigo & will get a full benefit of the physical therapy you are intending to offer her.
I hope you find the answer informative & would help your patient too. Any follow up query is welcome.
Thanks.
Care assessment for cause & expert advise would help.
Detailed Answer:
Hi XXXX,
Thanks for the information. I do appreciate the detailed history you take & also your keen interest to give a total relief to your patients. I understand your concern.
In my view-
1. Your patient's problem of vertigo with change of position ( sitting to standing ) typically suggests an Orthostatic hypotension.Orthostatic hypotension is defined to be drop of systolic blood pressure by minimum 20 mm of HG.& diastolic blood pressure by minimum 10 mm of Hg.-in Standing position.& she shows difference of 10 mm in her diastolic blood pressure.
-Conditions like anemia/ dilatation of blood vessels by the medications used to prevent heart problem /Inner ear problem/Age generated & smoking supported thickening of blood vessels ( atherosclerosis ) may contribute for low volume of blood reaching brain & lead to postural hypotension & vertigo.
2.Medications she is taking for controlling her blood pressure( Lisinopril, Celexa,) And also Pravastin 40 for for reducing bad cholesterol from blood- have known side effects of dizziness .. which can create her problem.
- Vitamin B12 deficiency can lead to vertigo .. which is easily reversible after supplementation.
- Vitamin D
which can some times produce the symptoms . Here involvement of internal ear is the cause.
4. Cervical spinal problem causing vertigo is out of question.. as per your reporting of no symptoms with neck movements... still it deserves exclusion.
* In this context.. I would suggest your patient to-
- Consult her family physician .. he will assess her health in detail , get her investigated for her blood counts/ Vitamin B12 level in blood,/gross ear check up . followed by medications Or refer her to ENT specialist/ cardiologist / orthopedic doctor for further management.
- Consult her cardiologist & ask for need of change in medication/ dosage of present medications to relieve her of the vertigo ( secondary to postural hypotension ) she has.
- Consult ENT specialist for necessary investigations/ treatment of internal ear problem causing the problem.
* After systematic assessment / exclusion of problem creating causes, followed by expert advise for management would definitely relieve your patient off vertigo & will get a full benefit of the physical therapy you are intending to offer her.
I hope you find the answer informative & would help your patient too. Any follow up query is welcome.
Thanks.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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