Vertigo after stroke - a case
Posted: Wed Sep 29, 2004 1:05 am
I had this case in today. I feel it is Nat Mur, but am not
convinced. Also rans are Lyco. Not enough anxiety for Ars although
it repped out well. I looked at nat Ars but wasn't impressed. It is
tempting to get involved with the cancer aspect of this case but he
has come to me purely to get the vertigo he feels sorted out. I
used the rubric reeling to describe the vertigo. Cocculus repped
well for all his Sx but I don't think the chronic picture is good
enough.I would appreciate any one else's take on this before I
prescribe.
All the best
Rochelle
28th September 2004
Background – He presented as a very tall, fit looking, slim man of
ruddy complexion who still had black hair which is white only at the
sides. The right side of his cheek looked redder than the left. When
recalling something he didn't look at me but to the left. Some of
the time he talked with his hands having them parallel palms facing,
moving them along to emphasise something. Some of the time his arms
were folded. He also kept swirling a water glass on the table
around with his finger. He talked quite freely when I asked
questions. Present medication – Atoravastin 10mgs, Warfarin 3mg,
paracetamol when needed. He takes cold liver oil, multi-vitamins and
Glucosamine when he remembers. In 1980 – he broke his leg, 2003-
prostate cancer, 2004-stroke
Presenting complaints – Unsteadiness following a stroke, catarrh
which the doctor but not him calls asthma, left hip pain on walking.
Stroke – a minor one in February 2004. He was in a shop and he felt
dizzy and slid to the floor. An ambulance was called and he was in
hospital for 11 days to have physiotherapy so he could start walking
again, initially with a Zimmer and stick. 24 hours earlier he had
some blurred vision. The specialist said it was caused by an
irregular heart beat. 18 months previously suddenly he lost the
sight in his left eye for a few moments. He thought it may have been
to do with the treatment he was having for prostate cancer but now
has been told it may have been a minor stroke.
Prostate cancer – discovered 2003 accidentally during an anal
examination because he thought he had piles. The PSA was 20. He had
no symptoms. A biopsy revealed the cancer. He had 2 hormone
injections to reduce the size and then 7 weeks of daily radiation
treatment with no side effects. The PSA is now <1.
Catarrh – always suffered with it with coughing in the morning. He
got bronchitis badly after the radiation treatment which took a long
time to go and the doctor now says he has asthma but rejects this as
he says he is not breathless.
Hip – he thinks this is age related as he has always been very
active as a golfer. It huts only when he walks and it annoys him
that he can't walk fast and keep up with the grandchildren. It aches
on the left side in one place – doesn't extend anywhere. It could be
a drawing pain or gnawing pain. "I have always had trouble with my
knees. The right one goes as it is at the moment.
After his prostate treatment he had to take his wife daily for
radiation treatment for her complaints.
"I feel unsteady on my feet when I walk. Also when I get up from
sitting. No one else can see it." I asked him to stand up and shut
his eyes and he seemed to be falling slightly round in an anti
clockwise circle. At one point he did start to fall backwards but
steadied himself. This is what he wants cured.
When he was signed off at the hospital his BP was fine.
"I am a close family person and honesty and integrity is important
to me. I have the capacity to talk easily to people – and I am
helpful. I don't forgive easily. (This came out naturally –I did not
ask!!) Other people think that I am an extrovert but I think I am an
introvert. I have difficulty making very close friends – there is
something inside. I get bored with people very quickly and I can't
be bothered.
Environment – "I would prefer to live in a town because of the
facilities. I play golf and there's the church. I do go regularly
but now I go as a penance.
I like sunny days summer or winter when I can get out. If it is very
hot I will move into the shade these days. I am not bothered by the
cold when I am wrapped up."
"I was very involved in the church but not now. I have been a
volunteer in the ambulance service. When I retired I didn't really
want to do accountancy any more but realised that people wanted
accountants. I always end up as treasurer. I was treasurer of one
church and left because the vicar was a rogue. I tried to introduce
things and the vicar wouldn't play. At another church we disagreed
when they made an outside appointment so I left. Yes I did opt out
because things didn't go my way."
"When I worked I had a major chance of being a director but I was
not prepared and competent to make some of the decisions. I became
chairman of the golf club and I saw that through and got rid of a
paid officer. That was 7 or 8 years ago."
"I am happier working under someone, but making my own decisions but
with someone to say `yeah'. I was confident at work. I always felt I
was a good Lieutenant rather than a General. My management style was
non confrontational. I felt I had a good relationship with those
under me. I would make a decision and then get people to agree. Yes
I could be swayed. I'm not inflexible. I looked on myself as not
making many mistakes but I hasten to say that I did. I would try to
defend my mistakes which was wrong. I didn't suffer fools gladly. I
have been described as abrasive although I would never accept that.
By abrasive I mean hard, predetermined, not easily persuaded; a
strong personality."
"Now I won't argue. I don't enter into it now. If I don't have to do
something then let them get on with it."
Anger – "if I don't leave myself enough time to meet an appointment,
rushing, playing bad shots at golf. I don't express my anger." (See
temper, later!!)
Unhappy – "Concerns about my family and other sick people. I cry
very rarely. I'm undemonstrative."
Happy- "When I can relax having got all my jobs done. I like sitting
in the garden and reading a book. I read fiction- thrillers. If I
watch TV it is thrillers. I will also watch cricket and horseracing.
I like doing crosswords. "
Company – "I like being at home. I am not looking forward to going
out to dinner but I know when I get there I will enjoy it. I am
quite happy on my own but I like to know that my wife will be back.
I like being on my own with someone else in the house (Lyco)"
Temperature – "I think I am warm blooded."
Temper – "If I can't do something or do it wrong – like manual
stuff. I shout.
"I think I am quite closed.
Food – Desires – sausages and cheese. Desires spicy. Dislikes sweet
corn- too bland. Drinks a couple of glasses of wine a day. Drinks
water - quite thirsty.
Sleep – fine.
Occasional pins and needles when he lies on a limb.
Memory – bad with names – always has been but thinks it is worse
since the stroke.
"I have more concern about mortality than ever before." More for
others than himself.
Security – doesn't always bother to put the alarm on at night.
Dwells on unpleasant things that happened and never forgets them. He
did not go into anymore detail. Possibly feels revenge on me asking.
Very organised.
Music – doesn't do much for him.
He doesn't think there is any past grief that has bothered him. "To
be terribly moved is not me. I have never been stricken with grief.
Childhood – "I felt distant from my parents. I find it hard to show
affection but do with my family."
Family Medical History
Father – d 75 from a weak heart during an operation
Mother – d 80's natural causes.
convinced. Also rans are Lyco. Not enough anxiety for Ars although
it repped out well. I looked at nat Ars but wasn't impressed. It is
tempting to get involved with the cancer aspect of this case but he
has come to me purely to get the vertigo he feels sorted out. I
used the rubric reeling to describe the vertigo. Cocculus repped
well for all his Sx but I don't think the chronic picture is good
enough.I would appreciate any one else's take on this before I
prescribe.
All the best
Rochelle
28th September 2004
Background – He presented as a very tall, fit looking, slim man of
ruddy complexion who still had black hair which is white only at the
sides. The right side of his cheek looked redder than the left. When
recalling something he didn't look at me but to the left. Some of
the time he talked with his hands having them parallel palms facing,
moving them along to emphasise something. Some of the time his arms
were folded. He also kept swirling a water glass on the table
around with his finger. He talked quite freely when I asked
questions. Present medication – Atoravastin 10mgs, Warfarin 3mg,
paracetamol when needed. He takes cold liver oil, multi-vitamins and
Glucosamine when he remembers. In 1980 – he broke his leg, 2003-
prostate cancer, 2004-stroke
Presenting complaints – Unsteadiness following a stroke, catarrh
which the doctor but not him calls asthma, left hip pain on walking.
Stroke – a minor one in February 2004. He was in a shop and he felt
dizzy and slid to the floor. An ambulance was called and he was in
hospital for 11 days to have physiotherapy so he could start walking
again, initially with a Zimmer and stick. 24 hours earlier he had
some blurred vision. The specialist said it was caused by an
irregular heart beat. 18 months previously suddenly he lost the
sight in his left eye for a few moments. He thought it may have been
to do with the treatment he was having for prostate cancer but now
has been told it may have been a minor stroke.
Prostate cancer – discovered 2003 accidentally during an anal
examination because he thought he had piles. The PSA was 20. He had
no symptoms. A biopsy revealed the cancer. He had 2 hormone
injections to reduce the size and then 7 weeks of daily radiation
treatment with no side effects. The PSA is now <1.
Catarrh – always suffered with it with coughing in the morning. He
got bronchitis badly after the radiation treatment which took a long
time to go and the doctor now says he has asthma but rejects this as
he says he is not breathless.
Hip – he thinks this is age related as he has always been very
active as a golfer. It huts only when he walks and it annoys him
that he can't walk fast and keep up with the grandchildren. It aches
on the left side in one place – doesn't extend anywhere. It could be
a drawing pain or gnawing pain. "I have always had trouble with my
knees. The right one goes as it is at the moment.
After his prostate treatment he had to take his wife daily for
radiation treatment for her complaints.
"I feel unsteady on my feet when I walk. Also when I get up from
sitting. No one else can see it." I asked him to stand up and shut
his eyes and he seemed to be falling slightly round in an anti
clockwise circle. At one point he did start to fall backwards but
steadied himself. This is what he wants cured.
When he was signed off at the hospital his BP was fine.
"I am a close family person and honesty and integrity is important
to me. I have the capacity to talk easily to people – and I am
helpful. I don't forgive easily. (This came out naturally –I did not
ask!!) Other people think that I am an extrovert but I think I am an
introvert. I have difficulty making very close friends – there is
something inside. I get bored with people very quickly and I can't
be bothered.
Environment – "I would prefer to live in a town because of the
facilities. I play golf and there's the church. I do go regularly
but now I go as a penance.
I like sunny days summer or winter when I can get out. If it is very
hot I will move into the shade these days. I am not bothered by the
cold when I am wrapped up."
"I was very involved in the church but not now. I have been a
volunteer in the ambulance service. When I retired I didn't really
want to do accountancy any more but realised that people wanted
accountants. I always end up as treasurer. I was treasurer of one
church and left because the vicar was a rogue. I tried to introduce
things and the vicar wouldn't play. At another church we disagreed
when they made an outside appointment so I left. Yes I did opt out
because things didn't go my way."
"When I worked I had a major chance of being a director but I was
not prepared and competent to make some of the decisions. I became
chairman of the golf club and I saw that through and got rid of a
paid officer. That was 7 or 8 years ago."
"I am happier working under someone, but making my own decisions but
with someone to say `yeah'. I was confident at work. I always felt I
was a good Lieutenant rather than a General. My management style was
non confrontational. I felt I had a good relationship with those
under me. I would make a decision and then get people to agree. Yes
I could be swayed. I'm not inflexible. I looked on myself as not
making many mistakes but I hasten to say that I did. I would try to
defend my mistakes which was wrong. I didn't suffer fools gladly. I
have been described as abrasive although I would never accept that.
By abrasive I mean hard, predetermined, not easily persuaded; a
strong personality."
"Now I won't argue. I don't enter into it now. If I don't have to do
something then let them get on with it."
Anger – "if I don't leave myself enough time to meet an appointment,
rushing, playing bad shots at golf. I don't express my anger." (See
temper, later!!)
Unhappy – "Concerns about my family and other sick people. I cry
very rarely. I'm undemonstrative."
Happy- "When I can relax having got all my jobs done. I like sitting
in the garden and reading a book. I read fiction- thrillers. If I
watch TV it is thrillers. I will also watch cricket and horseracing.
I like doing crosswords. "
Company – "I like being at home. I am not looking forward to going
out to dinner but I know when I get there I will enjoy it. I am
quite happy on my own but I like to know that my wife will be back.
I like being on my own with someone else in the house (Lyco)"
Temperature – "I think I am warm blooded."
Temper – "If I can't do something or do it wrong – like manual
stuff. I shout.
"I think I am quite closed.
Food – Desires – sausages and cheese. Desires spicy. Dislikes sweet
corn- too bland. Drinks a couple of glasses of wine a day. Drinks
water - quite thirsty.
Sleep – fine.
Occasional pins and needles when he lies on a limb.
Memory – bad with names – always has been but thinks it is worse
since the stroke.
"I have more concern about mortality than ever before." More for
others than himself.
Security – doesn't always bother to put the alarm on at night.
Dwells on unpleasant things that happened and never forgets them. He
did not go into anymore detail. Possibly feels revenge on me asking.
Very organised.
Music – doesn't do much for him.
He doesn't think there is any past grief that has bothered him. "To
be terribly moved is not me. I have never been stricken with grief.
Childhood – "I felt distant from my parents. I find it hard to show
affection but do with my family."
Family Medical History
Father – d 75 from a weak heart during an operation
Mother – d 80's natural causes.
