06 May

Dr. Sylvester Ikhisemojie

Dizziness is a feeling of being light-headed and it may be caused by disturbances of the gastrointestinal system or of the vision or even of the vestibular system of the inner ear where balance is regulated. Many people often refer to this feeling as one of being woozy. Some others classify it as a state of unsteadiness and also as vertigo, a sensation of having the immediate surroundings spin around a person much like the earth spins around the sun. The most common causes of dizziness are medications, migraine and alcohol.

There are many features of dizziness or factors which are found in association with it. People may feel dizzy when they are diagnosed with anaemia and in such a situation, the person will have a pale skin and feel intense fatigue and weakness. They will also have palpitations. It can also be found in people who have diabetes and are being controlled with insulin. Dizziness may thus be accompanied by feelings of anxiety and sweating. When it just happens for no obvious reason, it can be very debilitating. Many of us enjoyed childhood games in which we often playfully spun around and collapsed in a heap afterwards with the world spinning around us. That feeling is very unsettling and many playful children will know that when you stay still, it will often pass away. It is very different, however, when a similar sensation occurs when there is no palpable reason for it.

Anxiety is a feature in us which could provoke a sensation of dizziness; it is severe when it is related to stress and part of the measures to be taken to deal with it is to reduce the consumption of alcohol, caffeine and cigarette smoking. Regular exercise is also beneficial and many people who swim will attest to the fact that swimming is a thorough enough sport to get them to focus on the task at hand. Yoga exercises involving slower, deeper breathing efforts will also help.

When a person has a low blood pressure, dizziness can be provoked if such a person gets up suddenly from a lying or sitting position. To have a low blood pressure is a good thing certainly but you can only bask in that kind of comfort when you have seen your doctor and he has assured you after important tests that there is nothing else underlying it. Similar feelings may occur in pregnancy when blood pulls in the legs as a result of an increase in the bulge of the abdomen and the increasing weight of the developing baby. Both of these factors reduce the amount of blood returning to the heart per unit time and could therefore provoke dizzy spells with possible fainting attacks.

Low blood count known also as anaemia may cause tiredness, fatigue and dizziness. The reason for this happening is that there are not enough red blood cells to carry adequate amounts of oxygen to the brain. When that happens, it will lead to dizzy spells much like is experienced amongst pregnant women. Therefore, when a pregnant woman is also anaemic, there is double jeopardy as the two reasons combining in one person will lead to a definite situation of genuine crisis. When that results, hospitalisation with blood transfusion and absolute bed rest are important aspects of the required treatment necessary to restore health.

Certain medications especially those ones meant to control systemic non-communicable diseases like hypertension and diabetes are known for causing dizziness to their users. Anti-hypertensive medicines like Aldomet and Nifedipine are notorious for this, especially the former. In the same way, as previously stated, diabetics who are on insulin injections are particularly prone to developing dizzy spells after taking their medications. This is worse in the face of inadequate food intake or on occasions when the injections are followed by vigorous outdoor exercises. The sudden increase in blood flow to the muscles and the spike in the blood levels of insulin could drive down the level of blood sugar so low that dizziness supervenes. Sometimes, it is even worse with confusion and coma resulting. As for aldomet, the medication is known for exaggerating the drop in blood pressure with the erect posture which is why it may even be dangerous to use it in certain circumstances because of its potential for a precipitous drop in blood pressure.

Then there is the entity known as Meniere’s disease which is frequently accompanied by a sensation of fullness within the ear and temporary deafness. This is characterised by the presence of increased fluid pressure within the ear, noises inside the ear known as tinnitus as well as problems with maintaining the balance and progressive hearing loss over many months and even years.  The efforts to treat this condition are centered on the use of medications and exercises. A low salt diet is often recommended because they have been shown to help by reducing the build-up of pressure within the ear. Specific drugs aimed to help with balance and nervous system support have been found useful in the management of this condition. Besides that, the use of medications that treat motion sickness and others that help control vomiting are the others that have found useful accomplishment in the management of this sometimes frustrating condition.

As seen in the above paragraph, so it is with the invasion of the ear by bacteria and viruses which cause inflammation within the ear and can then lead to vertigo, which is actually a very severe form of dizziness. Nausea and temporary hearing loss can also occur due to an inflammation of the lining of the inner ear known as labyrinthitis. Antibiotics can be of help if the infection is deemed to be of bacterial origin. When the cause is deemed to be a virus, it is only those medications that are known to control the nausea and the dizziness that are of benefit. These are often the strong anti-histamins, similar to those medications used in controlling vomiting and allergies.

Finally, old age is one more factor that is very likely to be responsible for vertigo and dizziness. That is often because unsteadiness and dizziness are more likely when the eyes, the vestibular system of the inner ear and muscles no longer work in tandem. When age-related cardiovascular problems that have to do with the heart, blood vessels and blood pressure regulation are added, blood flow to every part of the body is then affected with associated dizziness when the brain and ears are involved.

Ask the doctor

Dear doctor, I am a 17-year-old SSS 2 male student. I’m quite tall and a bit huge with big buttocks. I feel ashamed of myself when I check the mirror. I feel like committing suicide at times, especially when my friends tease me with it. It does pain me a lot. Please what do I do to really lose weight and have normal buttocks like every normal boy. Thanks in advance sir. xxx@xxx    

Young man, there is absolutely nothing to feel guilty about your current physique. You have stated here very clearly that you are a bit huge so, it is something of an aberration to be huge and not have buttocks of a commensurate size. Any thought of suicide should be expunged from your thinking because deep down, some of the folks who now make fun of you would wish to have your size and your dimensions. For most people, the advancement of the years obtained as we age is such that will eventually catch up with the final adult size we attain. Nothing is wrong with you with the way you are presently built.

Dear doctor, I am one of your readers in SUNDAY PUNCH. I am on anti-hypertensive drug nifedipine 20mg morning and night and ramipril once daily, but I noticed recently that my blood pressure increases overnight to around 159/88 in the morning. What do I do? Should I increase the nifedipine or ramipril or ignore and continue with my normal dosage?  Thanks. xxx@xxx

I believe that a doctor is currently responsible for your care and that you get to see them regularly so that your medical condition is closely monitored. If that is the case, then you must complain to that doctor so that they can review your medications as the need arises. What is evident in the story you have narrated here is that you did not disclose the dose of ramipril you are taking, whether it is 5mg or 10mg as may be the case in most patients. All that may be required for you therefore, at this time is an adjustment in dosage to take care of whatever extra stress you may be undergoing at the moment. That should put paid to your current level of anxiety.

Dear doctor, keep on with the good works via your articles. I am 18 years plus and I had surgery to remove a lump in my right breast in December 2016. In 2017, I still experienced pains there but then it stopped for a while. Since this year began, I have been seriously itching in that breast with redness developing because of my complexion. Later, it looked as though my skin was peeling making it look like scales were falling off, (I think you will be able to understand this), so I need your recommendation to stop the itching, clear the scar and to stop the scale-like surface. Thanks.       xxx@xxx

You do need to see a dermatologist at any of the large hospitals around the country,depending on where you live,  so that they can determine why the scar is now scaly and itchy too. That is the guaranteed way to have the most beneficial treatment for this condition. Since it appears to be a local skin inflammation, all you might require is a useful dermal cream you will have to use for a definite period of time. Good luck.

My dear doctor, I have an ear problem I do not understand.  The ear always feels full and the hearing is impaired feeling always like something wants to pop out of it. When I chew bubble gum, I feel better and hear more clearly similar to when I lick sweets. I have been to the teaching hospital in Port Harcourt and was placed on Augmentin tablets with Flagyl for 10 days. I finished all that and went for a follow-up visit only to be placed on the same kind of drugs for a further two weeks. I can tell you that I am not better, my hearing remains spotty and very embarrassing because I do not hear people clearly and when I speak it is as if people around me do not get to hear me. My new tendency is to shout and my family members now complain that I shout too much. What then do I do? I am very confused and now also very worried. Thank you.                                                                                0705xxxxxxx

It is one of those baffling symptoms we often suffer from usually as we get older. Perhaps, your hearing loss is due to drugs if you are on any medications or perhaps due to some allergic condition. It is important to know that the two most common causes of hearing impairment are infections and allergies. Others include drugs, systemic diseases like diabetes, age, thyroid disease and nervous diseases. See your local ear, nose and throat surgeon for a proper assessment and be sure then that you can get the relevant treatment that will blow away your current condition.

Dear doctor, thank you so much for your past help. I have been experiencing some degree of internal heat off and on for the past five months. I first complained at the National Hospital in Abuja where my doctors asked me to run some blood tests and they basically assured me that there was nothing to worry about. However, about three months ago, I observed that I was losing weight rapidly and was sweating quite profusely even when an air-conditioner is on. I complained again and was asked to run another series of tests which the current strike has interrupted. However, I do have a niece who suffered from similar problems and I know you were instrumental in getting her treated. I have no swelling as such on my neck and I do hope to avoid doing an operation just like she did. What do you suggest I do now and how do I go about it? I am very disturbed about this. Thank you very much. 0817xxxxxxx                                                                                                                                   

First of all, I must thank you for your faith in what we are doing here. The most important thing as I see it now is to make a diagnosis regarding your condition. You can have a toxic goiter even in the absence of a neck swelling and there is a distinct terminology for that and it is then known as an occult kind of disease. You will need to have thyroid function tests done as well as X-rays of the chest and neck and possibly an ultrasound scan. After all of that, a diagnosis is hopefully made clear and treatment can then be considered. I am sure that when you have obtained the relevant results, your doctors will be able to advise you as required or you can also reach out to us here for further directions. But the very first thing to do now is a confirmation of the clinical diagnosis that has been reached.

Dear doctor, I have been suffering from recurrent boils around my anus for as long as I can remember. I have been to many different hospitals with each doctor calling it a different name and the treatment has always been the same: antibiotics, sitz baths and pain relievers but it has always come back after a few weeks or months. Two weeks ago, I encountered a specialist when I accompanied my friend’s wife to a hospital for her recommended check-up and complained to the doctor. He examined me and called it “fistula in anus” (actually it is fistula in ano). He advised me to have an operation to remove it permanently and I am very concerned about that. Won’t the operation be a problem to me? Is it life-threatening? Must I do it before the problem can be solved? Please tell me what to do. Thank you. 0809xxxxxxx

Thank you very much for your questions. The sheer number does indicate that you are very fretful about having this operation but I must warn you that no operation is a tea-party; all carry some element of risk. That said, every surgeon will do everything necessary to diminish that risk. As for the problem you have described here, I can say from the history that a fistula in-ano is most likely to be the case. Consequently, I agree completely with your surgeon that an operation is the only sure way to get this irritating problem behind you. As you have seen yourself, many different types of medications have been used in different hospitals with the same result in effect. Therefore, as this is the treatment modality that is different from all of them, the outcome is also bound to be different. Get it done and over with. It will not cause you harm.

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