What causes persistent dizziness in an over weight smoker?
I would recommend as follows:
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I carefully passed through your medical history and would explain that your symptoms are related to different disorders:
- positive Head Up tilt test is indicative of orthostatic intolerance. This disorder can cause your blood pressure to lower when standing up from seating position, leading to dizziness and vertigo during this changes in body position. You should take a lot of fluids and avoid abrupt standing up or body movement to minimize these changes in blood pressure.
- the bulging cervical discs also contribute in dizziness and neck pain. A cervical collar may be helpful time after time if you have neck pain.
- sleep apnea can cause low blood oxygenation and increased sleepiness, leading to low oxygen to the brain and thus dizziness and vertigo. If sleep apnea is confirmed, it should be treated properly to avoid increased cardio-vascular risk and dizziness. A PAP device during sleep would be really helpful in this situation.
Besides, I would also recommend consulting with the ENT specialist and perform labyrinthine tests to exclude a possible inner ear disorder.
Thyroid tests would also help exclude possible thyroid imbalance, which can be the cause of persistent vertigo.
Meanwhile, I would recommend starting Dimenhidrynate 25-50mg three times daily, which is an antihistamine, which can help you also against allergies. From the other hand it can exacerbate orthostatic hypotension, thus it should be started in low doses and increased slowly based on your tolerance. It can help you prevent and manage the episodes of dizziness.
Another treatment option would be betahistine 24mg twice daily.
You should discuss with your doctor on the above treatment options.
Hope you will find this answer helpful!
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