Chronic Dizziness Affecting Quality of Life.

It was about 4 pm and I  had just seen what I thought the last of my patients for the day. Then my nurse said " Patrick (not his real name) is here to see you". I could not quite recall which patient she referred to when the nurse blurted  out "Dizzy Patrick".Of course ...

Patrick had insisted to see me in November last year. He had been seeing various doctors for some time. He told me one of his friends had suggested to him to see me as her frequent headache had apparently stopped when I changed her medication regime. She was very grateful and told Patrick to try me! Ahah..very flattering to say the least.

Patrick then narrated his long sad story of frequent headache, hearing problem and dizziness which he had been suffering for many years. Quite often he had to take days off work when the condition became unbearable and socially annoying. From the history and looking at his medical record, Patrick was suffering from vertigo ( medical jargon for dizziness) which was worse at certain head position. In fact Patrick was already on a specialist Ear Nose and Throat (ENT) follow-up and he was also on an appropriate drug. He still suffered from the condition that was often accompanied by troublesome nausea and impaired hearing.

He came to me last year because he thought I had a "wonder drug". I asked him to get his friend to  show me the drug. Well it turned out to be a class of an anti-hypertensive drug which was better tolerated by his friend than another type she used to take previously. I said "So Patrick your condition and your friend's are not the same." Then I advised him to  wait for the results of Magnetic Resonance Imaging (MRI) of his brain and stick to the Specialist follow-up clinic. And to take those specialist medications as prescribed.

In the intervening period, I noted Patrick had seen several doctors for his constant intractable dizziness and some of the doctors had already given up on him! The poor guy. He just wanted relief and perhaps  reassurance as well. I also  figured out that he must have tried  all sorts of traditional medicines. He was agitated and appeared helpless. So I thought he would no longer return to my clinic after that well meaning advice.

Yet, here he came again, and this time he brought along the MRI report. Agitated as usual Patrick said he just got the report and wanted me to look at it before he showed it to the specialist on his appointment date in April 2010! And he also told me his dizziness was getting worse and he was then experiencing  an abnormal  heaviness in his neck and was feeling faint. I took his blood pressure it was 100/70, rather low as the last time the  reading was 130/80. Upon further questioning he admitted to taking a herbal medicine "Misai Kucing" (Orthosiphon Stamineus) normally taken ( not on doctor's order) by people  for all sorts of conditions! I advised  him to stop taking the herb as it was adversely affecting him. And to also quit self-medication.

                                                            Misai Kucing plant (wikipedia)

                                                          

Patrick was at his wit's end.

The MRI report noted a bilateral chronic otitis media with  cholesteatoma which could have contributed to his long-term vertigo. In layman terms " chronic infection of both middle ears with abnormal benign tissue growth". Taking pity on him I picked up the phone and spoke to the ENT Specialist, who happened to be my Houseman some years ago, to please see Patrick much earlier, if possible on the following Monday and he graciously obliged despite his many patients. Patrick smiled and was verbose in his gratefulness.

In his younger days Patrick used to swim and dive a lot in the river near his house. He recalled suffering from frequent ear discharge. The problem was not properly attended to as he was living in a remote village.This swimming and diving habit could have been a risk factor to his current ear condition giving rise to chronic dizziness which made his life miserable.

Before she left the room, my nurse said, " I think he will come to see you again after he has been to  the Specialist"... Oh My!  I hope his cholesteatoma would have been surgically removed by then.