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What Causes Imbalance Issues And Disorientation While Walking?
Question: From time to time, I, all of a sudden, feel as though I will fall. I do not get dizzy. I use the walker to get around and pretty much slide my feet when walking. But, this is scary to me because I call for help because I feel like I am falling. What do you think may be causing this?
Brief Answer:
Inner ear impairment most common cause.
Detailed Answer:
I read your question carefully and I understand your concern.
These sensations are often found in the elderly and can be be very disconcerting especially considering your osteoporosis and high risk for fractures in case of a fall.
The causes can be many, most cases are related to middle and inner ear disorders which is essential in maintaining balance. In that case most used medication are anti-vertiginous drugs like meclizine.
Another cause may be neurological conditions like a stroke or Parkinson's disease, which can be detected through neurological exam and imaging tests like MRI.
Other possible alternatives might be vitamin B12 deficiency or if symptoms are noticed to be present only when standing orthostatic hypotension (inability to maintain steady blood pressure when changing position from supine to standing).
Perhaps you have already have done them, but in case not, some routine blood tests should be done like blood count, blood sugar, liver and kidney function tests, electrolytes, thyroid function, vitamin B12 levels.
I remain at your disposal for further questions.
Inner ear impairment most common cause.
Detailed Answer:
I read your question carefully and I understand your concern.
These sensations are often found in the elderly and can be be very disconcerting especially considering your osteoporosis and high risk for fractures in case of a fall.
The causes can be many, most cases are related to middle and inner ear disorders which is essential in maintaining balance. In that case most used medication are anti-vertiginous drugs like meclizine.
Another cause may be neurological conditions like a stroke or Parkinson's disease, which can be detected through neurological exam and imaging tests like MRI.
Other possible alternatives might be vitamin B12 deficiency or if symptoms are noticed to be present only when standing orthostatic hypotension (inability to maintain steady blood pressure when changing position from supine to standing).
Perhaps you have already have done them, but in case not, some routine blood tests should be done like blood count, blood sugar, liver and kidney function tests, electrolytes, thyroid function, vitamin B12 levels.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Taka:
Thank you very much for replying.
I have not had this feeling that I will fall when going from supine to standing position. I am already walking (very slowly, as I always do), when this feeling that I am falling occurs. I have No feelings of dizziness.
Can a neurologist detect if there is a problem within the inner or middle ear?
Parkinson's disease can be detected through MRI? What about stroke? There were several times wherein my blood pressured spiked quite high, like 200 over 110 but normally it is 150 over 65 or thereabouts.
One year ago, I had fallen from standing and went backwards, and hitting the bottom of my very hard wooden table. Thank God, I did not get hurt worse than I did. I bled a little and needed about 6 or 8 stitches. Through MRI testing, NO problems were detected same day that this happened. Can a problem show up later? Do you think this may be the cause?
Twenty five years ago, I had a radical mastectomy of L breast and lymph nodes were removed. I don't know if this is the reason that I now see my body slanted, with my right side higher than the left. Possibly from this or possibly from the osteoporosis because my spine is not normal as well.
Regarding the medications that I take daily, I am aware that one or more cause depletion of magnesium and potassium. Is this a possible reason that I get this feeling that I am falling, even though I am holding onto the handles of the walker? I cannot walk without the assistance of the walker. This feeling has happened about once a week for the past few months.
I recently purchased liquid B-12, which is 1,000 mcg per dropper full. How much should I take, and how often do you suggest? I believe it states on the bottle that I can take 1 or 2 dropper fulls per day. Do you suggest any special supplemental program? I consume wheatgrass tabs, blue green algae, Co-Q10, digestive enzymes and probiotics.
Thank you.
Thank you very much for replying.
I have not had this feeling that I will fall when going from supine to standing position. I am already walking (very slowly, as I always do), when this feeling that I am falling occurs. I have No feelings of dizziness.
Can a neurologist detect if there is a problem within the inner or middle ear?
Parkinson's disease can be detected through MRI? What about stroke? There were several times wherein my blood pressured spiked quite high, like 200 over 110 but normally it is 150 over 65 or thereabouts.
One year ago, I had fallen from standing and went backwards, and hitting the bottom of my very hard wooden table. Thank God, I did not get hurt worse than I did. I bled a little and needed about 6 or 8 stitches. Through MRI testing, NO problems were detected same day that this happened. Can a problem show up later? Do you think this may be the cause?
Twenty five years ago, I had a radical mastectomy of L breast and lymph nodes were removed. I don't know if this is the reason that I now see my body slanted, with my right side higher than the left. Possibly from this or possibly from the osteoporosis because my spine is not normal as well.
Regarding the medications that I take daily, I am aware that one or more cause depletion of magnesium and potassium. Is this a possible reason that I get this feeling that I am falling, even though I am holding onto the handles of the walker? I cannot walk without the assistance of the walker. This feeling has happened about once a week for the past few months.
I recently purchased liquid B-12, which is 1,000 mcg per dropper full. How much should I take, and how often do you suggest? I believe it states on the bottle that I can take 1 or 2 dropper fulls per day. Do you suggest any special supplemental program? I consume wheatgrass tabs, blue green algae, Co-Q10, digestive enzymes and probiotics.
Thank you.
Brief Answer:
Read below.
Detailed Answer:
Thank you for providing some more info regarding your symptoms. I will try to answer your questions as follows:
-Yes a neurologist can evaluate you for the ear as well. It's a common presentation which often needs to be differentiated from neurological disease so we deal with it very often in our practice.
-Parkinson's disease itself is not detected through MRI, though it is often done to exclude some other rarer conditions which could cause Parkinson like symptoms and MRI changes. But the diagnosis of Parkinson's itself is by history and physical neurological exam.
-As for stroke, brain imaging is necessary. An MRI one year ago, if you had the symptoms back then would exclude an established brain infarction (stroke)
However there is also the possibility of transitory stroke symptoms due to narrowing of cervical blood vessels taking blood to the brain. If there is such narrowing (usually due to either atherosclerosis or cervical spinal changes leading to compression of these vessels which pass through the vertebrae). In this case simple MRI might not show brain lesion it would be needed a neck MRI with MRA (MRI of the blood vessels) of the neck to evaluate these vessels. Other imaging alternatives might be a CT of the neck blood vessels or Doppler ultrasound.
-I don't think that the reason you see your body slanted is due to the mastectomy, as you said yourself osteoporosis is the main suspect.
-Electrolite alterations (which include calcium and magnesium) can cause similar symptoms that's why I recommended those blood tests, I consider it not that likely since it should be a more continuous symptom, not in once a week episodes. But since they fairly routine inexpensive blood tests I still think they should be done.
-Vitamin B12 dosage depends on purpose, if only as a supplement one drop as suggested by the bottle is enough, so continue that way, if on tests it happens to be found a serious deficiency other ways including injections initially.
Those supplements you are taking. Another supplement which you might give a try is Ginkgo biloba, which is thought to have a modest beneficial effect on brain function and circulation.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for providing some more info regarding your symptoms. I will try to answer your questions as follows:
-Yes a neurologist can evaluate you for the ear as well. It's a common presentation which often needs to be differentiated from neurological disease so we deal with it very often in our practice.
-Parkinson's disease itself is not detected through MRI, though it is often done to exclude some other rarer conditions which could cause Parkinson like symptoms and MRI changes. But the diagnosis of Parkinson's itself is by history and physical neurological exam.
-As for stroke, brain imaging is necessary. An MRI one year ago, if you had the symptoms back then would exclude an established brain infarction (stroke)
However there is also the possibility of transitory stroke symptoms due to narrowing of cervical blood vessels taking blood to the brain. If there is such narrowing (usually due to either atherosclerosis or cervical spinal changes leading to compression of these vessels which pass through the vertebrae). In this case simple MRI might not show brain lesion it would be needed a neck MRI with MRA (MRI of the blood vessels) of the neck to evaluate these vessels. Other imaging alternatives might be a CT of the neck blood vessels or Doppler ultrasound.
-I don't think that the reason you see your body slanted is due to the mastectomy, as you said yourself osteoporosis is the main suspect.
-Electrolite alterations (which include calcium and magnesium) can cause similar symptoms that's why I recommended those blood tests, I consider it not that likely since it should be a more continuous symptom, not in once a week episodes. But since they fairly routine inexpensive blood tests I still think they should be done.
-Vitamin B12 dosage depends on purpose, if only as a supplement one drop as suggested by the bottle is enough, so continue that way, if on tests it happens to be found a serious deficiency other ways including injections initially.
Those supplements you are taking. Another supplement which you might give a try is Ginkgo biloba, which is thought to have a modest beneficial effect on brain function and circulation.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Taka,
Thank you so much for more information.
I would like to ask you which blood tests, specifically, should be done when I see my doctor. I will then ask my doctor to order these tests.
I do eat a banana daily to add the potassium to my diet; however, it is probably not much to make up for the loss from the medicines I take. I am not sure if I want to take a potassium pill but is there anything else you might recommend? Maybe more foods that contain this or any other suggestions?
And which test, please, would you suggest? Did you recommend MRI or Cat Scan? Can these be done without contrast and still have a clear picture? If you recommend the MRI, it would be MRI of what, specifically?
I have another question, but if you feel I need to ask someone else, I will. I find you to be very helpful and informative, and I thank you truly!
For the past 8 months, I have been experiencing this bad pain in my left arm, in the shoulder area and about 6 or so inches below the shoulder. I also hear a cracking sound which gets me upset. Whenever I move my arm, I hear "Crack, crack." : ( Do you have any idea about what may be causing this cracking sound near the shoulder and also in the upper back area on the left side as well?
I apply the ointment "white flower," which is an ancient Chinese remedy for pain. I prefer to use natural treatments, if at all possible.
I am worried about this constant pain in the upper arm/shoulder area. I had the mastectomy on the left breast 21 years ago. My left side goes down and my right side goes up, so I am walking at a slant, unfortunately.
Also, when I stand, my knees bend. I have not been able to straighten my knees for about 3 years. It makes me and my loved ones sad to see that this has happened because I have always been active and love to cook and clean the home and now I get around with the walker but cannot walk for long, even with it.
Thank you so much, and blessings to you!
I look forward to your next reply.
Sincerely,
XXXXXXX
Thank you so much for more information.
I would like to ask you which blood tests, specifically, should be done when I see my doctor. I will then ask my doctor to order these tests.
I do eat a banana daily to add the potassium to my diet; however, it is probably not much to make up for the loss from the medicines I take. I am not sure if I want to take a potassium pill but is there anything else you might recommend? Maybe more foods that contain this or any other suggestions?
And which test, please, would you suggest? Did you recommend MRI or Cat Scan? Can these be done without contrast and still have a clear picture? If you recommend the MRI, it would be MRI of what, specifically?
I have another question, but if you feel I need to ask someone else, I will. I find you to be very helpful and informative, and I thank you truly!
For the past 8 months, I have been experiencing this bad pain in my left arm, in the shoulder area and about 6 or so inches below the shoulder. I also hear a cracking sound which gets me upset. Whenever I move my arm, I hear "Crack, crack." : ( Do you have any idea about what may be causing this cracking sound near the shoulder and also in the upper back area on the left side as well?
I apply the ointment "white flower," which is an ancient Chinese remedy for pain. I prefer to use natural treatments, if at all possible.
I am worried about this constant pain in the upper arm/shoulder area. I had the mastectomy on the left breast 21 years ago. My left side goes down and my right side goes up, so I am walking at a slant, unfortunately.
Also, when I stand, my knees bend. I have not been able to straighten my knees for about 3 years. It makes me and my loved ones sad to see that this has happened because I have always been active and love to cook and clean the home and now I get around with the walker but cannot walk for long, even with it.
Thank you so much, and blessings to you!
I look forward to your next reply.
Sincerely,
XXXXXXX
Brief Answer:
Read below.
Detailed Answer:
I already mentioned the tests, as I said routine ones perhaps you might've done some of them recently: blood count, blood sugar, liver and kidney function tests, electrolytes, thyroid function, vitamin B12 levels.
Banana is a good choice as a source of potassium, other alternatives are spinach, white beans, apricot, XXXXXXX kiwi, prune juice.
The test I recommended for neck blood vessels is either one between Doppler ultrasound, Angio MRI or Angio CT. The first one is the most convenient one, easy and cheap and doesn't need contrast, the other two give more information but both use contrast and are more expensive.
As for the brain, if your symptoms were already there when you had the MRI one year ago there is no need to repeat it.
Regarding the shoulder problem, it seems there is a problem with the joint or the ligaments supporting it, the rotator cuff as it's called. Apart from physical exam, shoulder X-ray is recommended to evaluate the joint.
As for the problem with your knees, while again a physical exam and x-ray is needed and it's not my everyday cup of tea, it looks probably an issue of chronic arthritis. Glucosamine and chondroitin products are commonly used to slow progression but can't reverse it. Parkinson's if present due to the rigidity it causes can play a role as well.
Wishing you good health!
Read below.
Detailed Answer:
I already mentioned the tests, as I said routine ones perhaps you might've done some of them recently: blood count, blood sugar, liver and kidney function tests, electrolytes, thyroid function, vitamin B12 levels.
Banana is a good choice as a source of potassium, other alternatives are spinach, white beans, apricot, XXXXXXX kiwi, prune juice.
The test I recommended for neck blood vessels is either one between Doppler ultrasound, Angio MRI or Angio CT. The first one is the most convenient one, easy and cheap and doesn't need contrast, the other two give more information but both use contrast and are more expensive.
As for the brain, if your symptoms were already there when you had the MRI one year ago there is no need to repeat it.
Regarding the shoulder problem, it seems there is a problem with the joint or the ligaments supporting it, the rotator cuff as it's called. Apart from physical exam, shoulder X-ray is recommended to evaluate the joint.
As for the problem with your knees, while again a physical exam and x-ray is needed and it's not my everyday cup of tea, it looks probably an issue of chronic arthritis. Glucosamine and chondroitin products are commonly used to slow progression but can't reverse it. Parkinson's if present due to the rigidity it causes can play a role as well.
Wishing you good health!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again, Dr. Taka~
I have one more thing that I forgot to mention and would like your recommendations, if possible.
For the past 1+ year, I have been experiencing these streaks of light before my eyes. This can occur weekly, sometimes every other day, and sometimes it happens every 10 days or so. It has not been longer than 12 days without this happening for the past 1 plus year.
They are not floaters but look like large, silver lines that go up and down. This lasts for about 15 minutes, on average, each time it happens.
I had gone to the optometrist's office and had an eye exam and also the retina was checked with digital imaging. The dr. told me that she saw a spot of blood and this may be a need for concern if there were many of these blood spots.
Do you think this can be caused by the Diovan HCT or maybe one of the other two meds that I take daily? I believe I had read that the Diovan can cause blindness in some people.
What may be the possible cause/causes and there is anything that I can do to prevent it from recurring?
Thank you.
I have one more thing that I forgot to mention and would like your recommendations, if possible.
For the past 1+ year, I have been experiencing these streaks of light before my eyes. This can occur weekly, sometimes every other day, and sometimes it happens every 10 days or so. It has not been longer than 12 days without this happening for the past 1 plus year.
They are not floaters but look like large, silver lines that go up and down. This lasts for about 15 minutes, on average, each time it happens.
I had gone to the optometrist's office and had an eye exam and also the retina was checked with digital imaging. The dr. told me that she saw a spot of blood and this may be a need for concern if there were many of these blood spots.
Do you think this can be caused by the Diovan HCT or maybe one of the other two meds that I take daily? I believe I had read that the Diovan can cause blindness in some people.
What may be the possible cause/causes and there is anything that I can do to prevent it from recurring?
Thank you.
Brief Answer:
Hign blood pressure, not Diovan. Drug interaction possible.
Detailed Answer:
I don't think it was caused by any of those drugs. Neither Diovan nor the others do not cause eye structures hemorrhage to my knowledge. The cause is usually high blood pressure, diabetes or trauma. In your case since you don't mention diabetes or trauma, perhaps due to high blood pressure so the best way to prevent recurrences is by continuing blood pressure treatment.
On a side note, one thing I note in your treatment is that you are taking both Valsartan (Diovan) and Aliskiren (Tekturna). That combination is contraindicated. Those two drugs act on the same pathways and the combined use of the two increases the chances of drug toxicity. It's not related to what you asked directly, but since I noticed it now, I am telling you that you should talk with your doctor about their combination.
Hign blood pressure, not Diovan. Drug interaction possible.
Detailed Answer:
I don't think it was caused by any of those drugs. Neither Diovan nor the others do not cause eye structures hemorrhage to my knowledge. The cause is usually high blood pressure, diabetes or trauma. In your case since you don't mention diabetes or trauma, perhaps due to high blood pressure so the best way to prevent recurrences is by continuing blood pressure treatment.
On a side note, one thing I note in your treatment is that you are taking both Valsartan (Diovan) and Aliskiren (Tekturna). That combination is contraindicated. Those two drugs act on the same pathways and the combined use of the two increases the chances of drug toxicity. It's not related to what you asked directly, but since I noticed it now, I am telling you that you should talk with your doctor about their combination.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr.,
I thank YOU so much for writing back. I was thinking that it might be caused by high blood pressure, too. Or, maybe now that I have been taking the Tekturna for 2 years along with the Diovan.
PLEASE let me know which other one might be okay to combine with Diovan and Toprol, so I can suggest this to my doctor. I will tell him that I did research on my own and found out that it is contraindicated and will not mention that I spoke with you, since he may find this insulting, perhaps.
But, I truly thank you VERY much for letting me know that the 2 do not work together well and that toxicity can occur.
Thank you, once again! You are wonderful!!
I thank YOU so much for writing back. I was thinking that it might be caused by high blood pressure, too. Or, maybe now that I have been taking the Tekturna for 2 years along with the Diovan.
PLEASE let me know which other one might be okay to combine with Diovan and Toprol, so I can suggest this to my doctor. I will tell him that I did research on my own and found out that it is contraindicated and will not mention that I spoke with you, since he may find this insulting, perhaps.
But, I truly thank you VERY much for letting me know that the 2 do not work together well and that toxicity can occur.
Thank you, once again! You are wonderful!!
Brief Answer:
Read below
Detailed Answer:
Yes perhaps it is wise to tell your doctor you discovered it yourself. You can tell him you found it online say on Medscape drug interaction checker http://reference.medscape.com/drug-interactionchecker
I would like to precise that their use is not ineffective, they do reduce blood pressure, but side effects on kidneys are increased in particular in diabetes patients. If you have had no lab check-up for the kidneys recently you really should (I already mentioned in the tests above), because in the elderly kidney function can easily be disrupted especially in the case of long standing hypertension. So considering your tiredness and lack of energy it should be excluded by tests, as kidney impairment is a common cause of those symptoms.
As for what could it be substituted for since you already take 3 different classes of antihypertensive medication (diuretic - HCT, ARB - valsartan, beta blocker - metoprolol) another commonly used class which can be used if blood pressure can't be controlled with these three is a calcium channel blocker like Amlodipine.
If I were to choose between Diovan and Tekturna I would choose Diovan because of the long positive experience with this drug (tekturna is relatively new). The dosage of 150mg is low and it could be interrupted without weaning, but I would look at your blood pressure values as well, if it's high and difficult to control I would wait till you saw your physician to prescribe an alternative.
Read below
Detailed Answer:
Yes perhaps it is wise to tell your doctor you discovered it yourself. You can tell him you found it online say on Medscape drug interaction checker http://reference.medscape.com/drug-interactionchecker
I would like to precise that their use is not ineffective, they do reduce blood pressure, but side effects on kidneys are increased in particular in diabetes patients. If you have had no lab check-up for the kidneys recently you really should (I already mentioned in the tests above), because in the elderly kidney function can easily be disrupted especially in the case of long standing hypertension. So considering your tiredness and lack of energy it should be excluded by tests, as kidney impairment is a common cause of those symptoms.
As for what could it be substituted for since you already take 3 different classes of antihypertensive medication (diuretic - HCT, ARB - valsartan, beta blocker - metoprolol) another commonly used class which can be used if blood pressure can't be controlled with these three is a calcium channel blocker like Amlodipine.
If I were to choose between Diovan and Tekturna I would choose Diovan because of the long positive experience with this drug (tekturna is relatively new). The dosage of 150mg is low and it could be interrupted without weaning, but I would look at your blood pressure values as well, if it's high and difficult to control I would wait till you saw your physician to prescribe an alternative.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Taka,
Are there terrible side effects from the calcium channel blockers (Amlodipine)? Please let me know.
I will take your recommendations and continue with metotoprolol (I did not spell that correctly) and the Divovan HCT.
Your reply is appreciated. : )
Are there terrible side effects from the calcium channel blockers (Amlodipine)? Please let me know.
I will take your recommendations and continue with metotoprolol (I did not spell that correctly) and the Divovan HCT.
Your reply is appreciated. : )
Brief Answer:
Read below.
Detailed Answer:
Well, terrible is a big word, millions of people (my mother included) take them so the answer is no. As you were aware yourself every drug can have potential side effects, some common and some very rare.
One common side effect patients should know about Amlodipine is some swelling of the extremities, happens in around 10% of patients, there are other calcium channel blockers like Lercanidipine with which that percentage is lower.
Of course you should measure your blood pressure from time to time, if it's well controlled with Diovan HCT and Metoprolol (Toprol) another drug may not be required at all.
Also if you take only 25mg of Toprol a day, that dose could be increased, usual dosage is 50-100mg a day. Of course only if recommended by your physician after checking your heart rhythm, because it could slow heart rate excessively, just mentioning it as an alternative to adding a new drug.
Read below.
Detailed Answer:
Well, terrible is a big word, millions of people (my mother included) take them so the answer is no. As you were aware yourself every drug can have potential side effects, some common and some very rare.
One common side effect patients should know about Amlodipine is some swelling of the extremities, happens in around 10% of patients, there are other calcium channel blockers like Lercanidipine with which that percentage is lower.
Of course you should measure your blood pressure from time to time, if it's well controlled with Diovan HCT and Metoprolol (Toprol) another drug may not be required at all.
Also if you take only 25mg of Toprol a day, that dose could be increased, usual dosage is 50-100mg a day. Of course only if recommended by your physician after checking your heart rhythm, because it could slow heart rate excessively, just mentioning it as an alternative to adding a new drug.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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