Dizziness and Vertigo--Help Navigating Medicaid

June 13, 2012 4:41 PM

Boyfriend has been experiencing dizziness, vertigo, and nausea for 4 days. Need help navigating NY Medicaid healthcare system to get this diagnosed.

YANMD. Sorry if it is sort of long.
Sunday night, my boyfriend got up out of bed and felt dizzy and unsteady. He had to immediately sit back down so as not to fall. We went to bed thinking it would pass by the morning, but it didn't, and he has been unable to go to work or school for three days. On top of the dizziness, he has been feeling nauseous, has vertigo, and has had trouble reading because it makes him feel "carsick." He also feels pressure on the front of his head. The dizziness has mostly been happening when he tries to stand or walk, but has also happened while sitting/lying down.

Monday morning we went to the local clinic and saw his PCP, who simply checked his blood pressure and ordered blood tests, as well as referring him elsewhere to get a CAT scan, which we went to the next day.

Today, (Wednesday) I had a similar bout of dizziness and nausea, which has since passed, but it has lead us to suspect that it may be something environmental. His room is small and has very little to no ventilation. His one tiny window looks out into a dirty, tiny air shaft, and we've been running the fan/ac all day. Maybe something toxic in the air shaft has been kicked up by the fan/AC? This is an old building in Bed-Stuy. (We've now gone to my apartment elsewhere in the hopes that his condition will improve here.)

He went back to the doctor today--blood work came back normal. She did a basic check of his ears, nose, and eyes, which also came back normal. We are still waiting on the CAT scan results. She referred him to a neurologist, but the first available appointment is August 2nd! He can't afford to miss work and school for a month and a half if this continues.

Any ideas of what our next steps should be? She suggested we go to the ER if he feels worse, but it's just been a consistent sort of bad, for lack of a better term. I'm pretty sure that through Medicaid/Fidelis, you have to get your PCP to refer you to specialists. Should we find a neurologist who has a sooner appointment available and accepts Medicaid/Fidelis, and ask the PCP to refer him to them instead? Are there other specialists we should see? Any other tests we should ask her to run? She seems fairly hands off and has essentially said that she has no idea what is wrong with him.

posted by dysh to health & fitness (11 answers total)

Did she suggest anything like labyrinthitis? I had it once, described exactly as you do, and it came on fast and SUCKED SO HARD. There's nothing to be done for it directly, but you could ask the doctor about prescription anti-nausea medication. I took that for a few days to get over the very worst of it.
posted by marylynn at 4:50 PM on June 13, 2012 [1 favorite]

I am totally not any kind of doctor, but dizziness and nausea can be caused by sinus and ear canal congestion, which can be a reaction to allergens in the air. Since it's a low-cost, low-risk trial, you might try a round of sinus medication (I like Advil Cold & Sinus) plus an nasal spray (I like Flonase). I have had migraine-y experiences due to such reactions that sound like his symptoms. I apologize in advance if you've already tried this or if it is otherwise inapplicable.
posted by ClaudiaCenter at 4:53 PM on June 13, 2012

Check out some youtube videos of people demonstrating the Epley maneuver and the Semont maneuver. He'll need your assistance for both of them. Either one may help, and if they do, it is probably BPPV. (You'd see an ENT for that.) Unfortunately, if they make it worse, it could also be an inner ear issue. Ears are jerks.

Have him track his symptoms along with how much sleep he's getting, time of day of attacks, physical position at onset of attack, any drinking/smoking/etc he may have been doing.

If it lasts longer than a week I would prolly try to find an earlier neuro appointment, or get an ENT referral.

I am very definitely not a doctor.
posted by elizardbits at 5:08 PM on June 13, 2012 [2 favorites]

Can you get him somewhere else for a day or two? Friend's house? Would help isolate the environmental guess.

(My dad had similar symptoms and it turned out to be a subdural hematoma, but I have to assume that if something on the CAT scan looked that fishy they'd get back to him right away)
posted by curious nu at 5:23 PM on June 13, 2012

this happened to me, it was some sort of inner ear thing. doc said my ears looked fine but that i had strep throat. treated that and in a couple weeks i felt fine.
posted by nadawi at 5:32 PM on June 13, 2012

He could try meclizine, which is available over the counter as Antivert, for symptomatic relief. It's a vertigo-specific medication and it works great.

I wish I could like the comment about the Epley maneuver more than once. What you describe sounds awfully like benign positional vertigo (especially if it mainly happens when he changes positions), and I am surprised the PCP did not try this. It's a lot cheaper and faster than a CT scan and a neuro referral.

Just remember whoever you talk to (PCP, doctor at the ER, neurologist) that you specifically mention the word "vertigo". Vertigo means a very specific sensation that the room is spinning, and it is typically caused by very specific things (as mentioned above, labyrinthitis, BPPV, or another possibility that sometimes causes it is Meniere's disease). Less commonly it is caused by a central neurologic issue such as an acoustic neuroma, but centrally-originated vertigo typically does not start suddenly with a head movement/position change like what you describe.

"Dizziness" can mean a lot of things to a lot of people, but often gets used to mean "lightheadedness" or feeling faint, which would have prompted the primary care to check electrolytes and blood pressures.
posted by treehorn+bunny at 6:32 PM on June 13, 2012 [1 favorite]

Thirding the Epley maneuver. This exact same thing happened to my husband, and doing the modified Epley fixed it.
posted by snickerdoodle at 7:16 PM on June 13, 2012

Oh my goodness, yes re: Epley if it's benign positional vertigo. I've experienced this twice, and both times, I just woke up with it. I stood up and it was like being on a ship that listed quickly to port. I took a whole CD tower down with me! After a panicked call, a pediatrician friend sent me the link to a YouTube video on how to do it. I did it a few times, then rested, and it was like magic. I experienced it again, almost a year to the date, pulled up the video again and it worked. That said, it's supposedly much better for you if a trained medical practitioner assists the process (it takes mere minutes and is entirely non-invasive), but I had no way of leaving the house to get help, and once I figured out the procedure, it was dandy.
posted by The Wrong Kind of Cheese at 8:57 PM on June 13, 2012

Definitely try the Epley manuever. You may need to run through it a few times for it to work, but if he has benign positional vertigo it should do the trick. Labyrinthitis is generally self limiting and there's not much to do but wait it out and do normal activity as much as possible. As far as referrals go- you may be able to get him in to see a physical therapist who specializes in vestibular rehab sooner than a neuro. They can do the Epley or other manuevers if they are indicated or give him some further ideas.
posted by bookrach at 4:01 AM on June 14, 2012

I had it for a few days and took some OTC sinus medication but the Epley maneuver was the most effective. Best of all it is something you can do on your own without cost. Obviously that may not fix a more serious issue but may save you an expensive trip to the doctor if the cause is simple.
posted by JJ86 at 5:49 AM on June 14, 2012

Thanks everyone for all your help! Turns out he has a sinus infection. We went to a different doctor that my family recommended who had him in and out of the office in fifteen minutes with a prescription for antibiotics, meclizine, and flonaze. Apparently his PCP that we went to at first didn't bother to properly check his nose and ears. He's already starting to feel better. He was even dancing around some today! Thanks again!
posted by dysh at 2:23 PM on June 16, 2012 [1 favorite]