Brief Answer:
Happy to help

Detailed Answer:
Thank you for your clarification on the specialist you were looking for as I was looking at this question 2 hrs. when it was first posted but since you said ONCOLOGIST- well, I just left it alone.

I've read your concerns as well as the response from Dr. Spaho and I do agree with my colleague that other issues should also be looked at, if both ENT and neurology could find no explanation for your symptoms. Having said that I would just throw in the aside that meningiomas can and are known for causing symptoms of dizziness and imbalance (as Dr. Spaho points out) if they are anywhere in the vicinity of the vestibular nerve which regulates balance. However, there are other reasons that meningiomas can cause problems and especially if they are NOT in the territory of the vestibular nerve. They could cause compression and pressure on centers of the brain which regulate blood pressure. And in fact, your symptoms to some extent in the shower do sound as if blood pressure changes are to blame for your symptoms. Therefore, could the meningioma be causing this type of problem?

I believe that gabapentin could potentially worsen your symptoms since it can cause fatigue, lethargy, and even a drop in blood pressure. I do not know why they are thinking in terms of using gabapentin without having a solid diagnosis unless someone is thinking about headaches which you have not really related as being significant nor present. I believe the recommendation for the MRI of the cervical spine is to look for some type of RADICULOPATHY that someone interprets as causing your symptoms. The trouble with that theory is that you are not referring the more typical and usual symptoms of pains and paresthesias that cause a lot of problems in patients in the upper extremities not to mention the tremendous sharp/burning neck pain. Imbalance is not a major feature of cervical radiculopathy.

In other words, if you were my patient I wouldn't send you for an MRI of the c-spine or use gabapentin with your symptoms before I took Dr. Spaho's suggestions to look for other problems. Medications are definitely one of them. Side effects of imbalance and dizziness are common in all medications used for blood pressure, sugar, pain, and sleep control. Other things such as dehydration, HYPER, or HYPO-glycemia (sugar dyscontrol) is another reason for your symptoms but to me the biggest clue that you are giving as to what's possibly going on here is the fact, that you identify taking a shower as being related EVERY MORNING.

I believe that your shower (coupled with your morning medications.....OR EVEN BY THEMSELVES....shower may be red herring) could be triggering what we call a VASOVAGAL RESPONSE which ultimately results in a drop in heartrate, a drop in blood pressure, a flushing feeling in the head/neck/face, and causes people to become extremely dizzy, imbalanced, and even pass out. You need to be careful in the shower until more is known about your condition. May I recommend you take a chair or something to sit on while doing your shower so you don't risk suddenly going on and giving yourself a traumatic brain injury without meaning to do any such thing?

And so to test all these issues you will need to have your primary care provider refer you to the cardiologist who SHOULD:

1. check out your ticker very well....hopefully, even maybe an echocardiogram to show an EJECTION FRACTION which is hopefully around 55-60% or better.

2. Holter monitor for a minimum of 3-5 days (typically, I get it on patients with similar problems such as yours for up to 30 days consecutively....but I could live with 3-5 days in this case if your symptoms are occurring fairly regularly and predictably.

3. Orthostatic blood pressures either by tilt table testing or by doing simple bedside maneuvers such as Aminoff's protocol where the patient is supine, stands up, and then, remains standing for a few minutes while pulse and blood pressure are taken.

4. Finally, let's make sure that all of the bases have been covered metabolically so I would check the following: Vitamin D, D2, and D3 in serum; TSH and FT4 (thyroid hormones); serum cortisol, glucose, and Hemoglobin A1C. I might even go for an ESR and CRP (markers of inflammation in the body).

5. I might also RE-LOOK at the brain with MRI scans but this time with GADOLINIUM CONTRAST.....but only if nothing else showed up in the above recommended testing. And in real life....most peoples' problems of your type are resolved long before we need to get to another MRI. But if you did get there then, I would add just one more wrinkle to the study. I would get what is referred to as a SEIZURE PROTOCOL and I would even consider getting an EEG (electroencephalogram). All of these last tests should be ordered and authorized by the neurologist on your case.

Last but not least.....is your nutrition and especially hydration adequate? So many people just end up being plain dehydrated. We tend not to take care of ourselves in that department as we age. We think our bodies are in the same shape and condition with respect to fluids as they were 20 or 30 years ago and they're not. We need more water, more volume, and absolutely should not be skipping meals, skimping on protein and carbohydrates just because we are worried about weight....unless of course, we NEED TO lose weight due to medical concerns.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 32 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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