Brief Answer: Clinical Examination Detailed Answer: Dear XXXXXXX Thanks for contacting Ayurveda with your health concern and following guidelines are worth mentioning. When a person comes to my Clinic with complaint of Dizziness, I usually ask them and/or follow the following set of questionnaire and clinical examination: 1. Is giddiness associated with light headedness, nausea? 2. Is giddiness associated with any neurological sign [ make sure you consult a Neurologist to rule out any brain pathology] 3. If giddiness is not promptly controlled, I usually ask for Hemoglobin [for pallor], X-ray: Cervical spine [AP & Lateral] and cardiovascular examination [for any murmur] 4. Since to rule out BPPV [benign paroxysmal positional vertigo] have an ENT checkup [since vestibular symptoms are there] and also Ophthalmic check up for any vision problem. 5. because you had social and general anxiety [work pressure??], this reflects ‘emotional withdrawal symptoms” i.e. you have a constant fear of being judged or evaluated by and has resulted in anxious thoughts and anxious behavior. [correct me if I am wrong] 6. Avoid: excess physical –mental exertion, sun exposure, corrylium, smoking, errhine therapy, betel leaves, gruel, soup, day time sleeping, garlic, ginger, onion, spicy-heavy- junk food, mustard oil, pickles, dehydration,Caffeine,alcohol, tobacco,Artificial sweeteners and highly sweet or salty foods. .Avoid dizziness-inducing activities,like heavy exercise in hot weather, rapidly-moving rides or roller coasters,or heavy drinking. 7. Take: mint, coriander, tomato, cumin, plenty of water, vitamins and mineral supplements, XXXXXXX banana,grapes,dates 8. Lemon juice mixed with sugar in a glass of water helps release stress removing hormones from the body and bring mind at peace/rest. 9. i. Take 1 spoon black pepper powder and 5 spoons jaggery in 4 cup water and boil till 2 cups remain, filter it and drink for 1 month. ii.Take 3 teaspoons of bitter gourd with a glass of water every morning for a month. iii.Mix 4-5 dates in half glass of water and drink 2 times daily for a month. iv. XXXXXXX almond, banana, broccoli, cantaloupe, melon, carrot, cashew nut, corn, cauliflower, grapes, guava, lemon, mango, orange, pineapple, soybean, spinach have anti oxidant so take them in plenty. Do revert back with your concerns and with any health check up reports for Ayurveda line of Management. Dr. Munish Sood Consultant & Physician Naimittika Clinic

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Brief Answer: GAD Detailed Answer: Dear XXXXXXX thanks for reverting back with your concern(s) 1. Because panic attacks are repeatable, which means you feel endangered and unable to escape [correct me if Wrong!!] which means there is ‘fear of fear’ i.e. vicious anxiety- panic- anxiety cycle, thus before taking panic attacks to be due to anxiety or depression make sure you have ruled out following medical conditions like use of excess caffeine, cocaine, amphetamines or heart problem. [since overactive thyroid, low blood glucose came within normal limits thus can be excluded] PS. i. practice relaxation techniques like yoga, [stretching Yoga poses like Dhanurasana, Matsyasana, Janu Shirsasana, Paschimottanasana, Hastapadasana], hot shower, meditation and Pranayam [anulom vilom] which will strengthen the relaxation response of body as opposite to stress response during panic attacks, [i.e. hyperventilation], don’t try to flee away from the situation which will reinforce the perception that your panic attacks are unbearable [remember they are uncomfortable but not life threatening], allow the symptoms to pass and you will gain ability to cope with them. ii. Prescription drugs and procedures available for your problems are: sarpagandha, khus, jatamansi, bramhi, kevada, vacha, tagar, amla, XXXXXXX XXXXXXX ras, mahakalyanak ghrita, manasmitra vatkam, XXXXXXX vati, mann XXXXXXX vati,Ashwagandharishta, sarasvatarishta, stresscom, nasya karma. iii. regarding position, get an ENT check up first, if the BPPV test comes normal [Lift your head slowly, if you feel any dizziness go back to put your head between your legs] Dr. Munish Sood Naimittika

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Brief Answer: Neuro- Ophthalmologist and Otolarynglogist Opinion Detailed Answer: Dear XXXXXXX Thanks for reverting back with your concern 1. As symptoms are aggravating I will approach the disease as whole i.e. “BALANCE DISORDER”, which requires: i. Neuro- Opthalmology opinion [for eye muscle imbalance] ii. ENT/otolaryngologist Consultation [ for BPPV, Labyrinthitis, Meniere’s disease, Vestibular neuronitis, Perilymph fistula, and in rare cases Mal de debarquement syndrome (MdDS)] to rule out the cause of the unsteadiness with relevant clinical examination like [Epley maneuver: since BPPV is the most common balance disorder] and/or with investigations like electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of head and brain [to rule out Acoustic Neuroma first] 2. A vestibular rehabilitation therapist can help you in reducing/decreasing dizziness, nausea along with Dietary Regime and life style management as described earlier. Do check for/with necessary/relevant Clinical Examination and Investigations for further line of Management and do let me know the same so that Ayurveda Medicine can be incorporated. Dr. Munish Sood Naimittika

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