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What Causes Balancing Issues In A Heart Patient?
Question: My husband had an aortic valve surgery two years ago. He is on several meds, including 225 mg vanlafaxine,
2 mg aripiprazole, 6.25 carvedilol 2xs daily, 1 mg alprazolam ER nightly, as well as 300 mg allopurinol, 10 mg enalapril, and a baby aspirin daily. He is 77 years old. He is VERY unstable in the morning! Our daughter who is an OT put a bar on his side of the bed to steady him, but he can barely get up to use the urinal next to his bed. He says as soon as he gets moving he is alright. Drives the car well, and the riding mower (up and down several times while mowing our many acres). Do you think his meds are causing his unsteadiness? He is scheduled to see a neurologist on Monday, and a repeat CAT scan on Thursday because he fell and hit his head causing a hematoma between the brain and the skull. They want to see if it is shrinking, and that is causing his problem.
2 mg aripiprazole, 6.25 carvedilol 2xs daily, 1 mg alprazolam ER nightly, as well as 300 mg allopurinol, 10 mg enalapril, and a baby aspirin daily. He is 77 years old. He is VERY unstable in the morning! Our daughter who is an OT put a bar on his side of the bed to steady him, but he can barely get up to use the urinal next to his bed. He says as soon as he gets moving he is alright. Drives the car well, and the riding mower (up and down several times while mowing our many acres). Do you think his meds are causing his unsteadiness? He is scheduled to see a neurologist on Monday, and a repeat CAT scan on Thursday because he fell and hit his head causing a hematoma between the brain and the skull. They want to see if it is shrinking, and that is causing his problem.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully read your question and would explain that his symptoms may be related to the intracranial hematoma (chronic subdural hematoma).
Have you measured his blood pressure in the morning? What are the values? Low blood pressure or orthostatic hypotension could also trigger this symptomatology.
From the other hand I would recommend stopping alprazolam ER intake, because it is a benzodiazepine and as such it acts also as a muscular relaxant, which means that it can exacerbate imbalance and difficulty standing up from lying position.
I would encourage you to consult him with a neurologist and perform a brain CT scan to examine the evolution of he intracranial hematoma, which is a serious condition and should be monitored closely to exclude possible rebleeding.
A close monitoring of his blood pressure would also be advisable to avoid possible low blood pressure and make the proper changes to his actual anti-hypertensive therapy.
Hope to have been helpful!
Best wishes,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully read your question and would explain that his symptoms may be related to the intracranial hematoma (chronic subdural hematoma).
Have you measured his blood pressure in the morning? What are the values? Low blood pressure or orthostatic hypotension could also trigger this symptomatology.
From the other hand I would recommend stopping alprazolam ER intake, because it is a benzodiazepine and as such it acts also as a muscular relaxant, which means that it can exacerbate imbalance and difficulty standing up from lying position.
I would encourage you to consult him with a neurologist and perform a brain CT scan to examine the evolution of he intracranial hematoma, which is a serious condition and should be monitored closely to exclude possible rebleeding.
A close monitoring of his blood pressure would also be advisable to avoid possible low blood pressure and make the proper changes to his actual anti-hypertensive therapy.
Hope to have been helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. lliri,
I will check his blood pressure in the morning to see if it has lowered to any degree. He was given directions which indicate that he has to lower the alprazolam very slowly. Do you know if that would cause serious side effects? I will ask the neurologist on Monday, and he does have a second CAT scan ordered for the 25th of this month.
Thank you so much for your input,
XXXX
I will check his blood pressure in the morning to see if it has lowered to any degree. He was given directions which indicate that he has to lower the alprazolam very slowly. Do you know if that would cause serious side effects? I will ask the neurologist on Monday, and he does have a second CAT scan ordered for the 25th of this month.
Thank you so much for your input,
XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Dear XXXX!
I agree with his doctor recommendations to taper alprazolam very slowly until stopping it, in order to avoid withdrawal symptoms (anxiety, lack of sleep, etc.).
I would be happy to review his performed tests as soon as you can upload them for another second professional opinion.
You can ask me directly at any time at the following link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear XXXX!
I agree with his doctor recommendations to taper alprazolam very slowly until stopping it, in order to avoid withdrawal symptoms (anxiety, lack of sleep, etc.).
I would be happy to review his performed tests as soon as you can upload them for another second professional opinion.
You can ask me directly at any time at the following link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. lliri,
Thank you for your reply. Would it help to change to a regular Alprazolam rather than the extended release? I neglected to tell you that on April 14th XXXXXXX was diagnosed with a UTI infection and kidney stones. He was prescribed cefdinir 300 MG 2 xs daily for a week for the infection, and hydrocone-acetaminophen 5-325 MG - 1 -2 every 4 - 6 hours for pain which he did not take at all. He has always been a beer drinker ( Wisconsin habit ) - but has cut down, drinking Non-Alcoholic beer most of the time, and 1-2 light beers per day for the last month. His doctor here told him he should not drink at all, but he has been drinking beer for 60 years, and I felt it would do him more harm than good to quit completely. If I can figure out how to get his medical records off his "My Aspirus" - i will forward to you. Again - thanks for your input - Mary D
Thank you for your reply. Would it help to change to a regular Alprazolam rather than the extended release? I neglected to tell you that on April 14th XXXXXXX was diagnosed with a UTI infection and kidney stones. He was prescribed cefdinir 300 MG 2 xs daily for a week for the infection, and hydrocone-acetaminophen 5-325 MG - 1 -2 every 4 - 6 hours for pain which he did not take at all. He has always been a beer drinker ( Wisconsin habit ) - but has cut down, drinking Non-Alcoholic beer most of the time, and 1-2 light beers per day for the last month. His doctor here told him he should not drink at all, but he has been drinking beer for 60 years, and I felt it would do him more harm than good to quit completely. If I can figure out how to get his medical records off his "My Aspirus" - i will forward to you. Again - thanks for your input - Mary D
Brief Answer:
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
Thank you for the additional information.
Yes, you can switch to regular alprazolam and then try to gradually reduce the dose very slowly until stopping it (you can reduce the dose with 0.25mg every 1 week, until stopping it).
Regarding the UTI infection, it does not seem to be related to his actual symptoms. It is not a problem that he didn't take acetaminophen-hydrocodone, because it was just for pain relief. It would not change anything.
Anyway, I would recommend performing kidney function tests in order to examine his kidney function and exclude possible dysfunction, which can contribute to his actual symptomatology.
I would be happy to review all his performed tests when you will be able to upload them.
Regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
Thank you for the additional information.
Yes, you can switch to regular alprazolam and then try to gradually reduce the dose very slowly until stopping it (you can reduce the dose with 0.25mg every 1 week, until stopping it).
Regarding the UTI infection, it does not seem to be related to his actual symptoms. It is not a problem that he didn't take acetaminophen-hydrocodone, because it was just for pain relief. It would not change anything.
Anyway, I would recommend performing kidney function tests in order to examine his kidney function and exclude possible dysfunction, which can contribute to his actual symptomatology.
I would be happy to review all his performed tests when you will be able to upload them.
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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