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Recurring Dizziness/Vertigo, Elevated Liver Tests
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Recurring Dizziness/Vertigo, Elevated Liver Tests

I have a problem that has been intermittent over the last 3 years.  It started right after I gave birth to my son in 1999.  About 1 month after giving birth I experienced my first episode of debilitating dizziness/vertigo.  It took almost 24 hours to pass, and until it did I could not walk around without bumping into walls and feeling very nauseous.  My OB/GYN thought it was anemia and increased my dosage of iron.

This same month I applied for life insurance and was turned down because the tests indicated that I "overindulge" in alcohol and was a poor insurance risk.  This is simply not the case -- I am a very light drinker - no more than 2 glasses of wine in any given week, and usually less than this.

Over the course of the next 2 years the dizziness came about once every-other-month, each time resulting in me staying in bed for at least 1-2 days.  I have worked with my GP to try to diagnose this problem.  My liver tests have consistently come back slightly elevated (I believe the ALT measurement in particular).  The dizziness eventually hit me about once every week.  My GP asked me to stop all alcohol consumption, which I did for over 6 months.  He also had me cease all dietary supplements, including my iron.  I had been taking a great deal of iron during my pregnancy to overcome anemia (3 times the recommended daily dosage-I was instructed by my doctor to continue this dosage for the next 2 years).  

This seemed to solve the problem somewhat, but now I am concerned that I am unable to take any supplements.  I would like to know whether I could at least take supplements like Vitamins C, E, B12, and calcium.

And the dizziness is back again.  I have noticed a strange pattern -- I can have a small glass of wine (4 oz or less) and not experience any problems.  But if I have 4 ounces of beer, it is guaranteed that I will become dizzy and it will last at least a day.

I have had an ultrasound of my liver, which came back as "slightly inflamed".

Here are any other pertinent facts I can think of:

- my blood pressure is typically low - usually 85/55.
- my Hepatitis test was negative
- I had my gallbladder removed due to gallstones (1994).
- I still do not have more than 2 glasses of wine in any month.
- I have PCOS, but this seemed to resolve after giving birth.  I have been very regular and normal since the pregnancy.
- the GP ordered heart tests and all came back negative
- the GP ordered a MRI on my head and it came back clear
- the GP ruled out an ear infection

What should I do from here?  I realize that dizziness is considered non-specific and that it "generally resolves within 24-48 hours", but I am growing more concerned the longer this goes on.  It is an extremely disconcerting feeling.

Should I try a supplement like Milk Thistle?  My research shows this to be generally regarding as safe and appropriate for liver issues.

Your thoughts would be greatly appreciated.
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Dizziness and vertigo can be frustrating problems.  You have had a pretty good workup including an MRI.  At this time, you may want to consider more specialized testing including referrals to an ENT physician or neurologist.

Make sure an MRA was performed with the MRI, since posterior cerebral circulation problems can also manifest as dizziness.

Audiometry, brainstem evoked audiometry, and electronystagmography are all tests that can be discussed with your ENT physician or neurologist.  Not every place does them - you may need to be referred to a larger academic medical center.  

I would agree with the recommendation that alcohol be stopped - especially with the persistant symptoms.  Depending on how high the ALT is elevated, you may want to consider further evaluation including possible biopsy.  

Silybum marianum (Milk thistle), given alone or in combination with traditional therapy has limited scientifically proven value, although it is commonly used and probably safe with chronic hepatitis patients.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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Hi,
I have low bp, and alcohol is a vasodilater, it can acutally make me pass out after one drink.  You should inquire about vaso depressor problems. Ask about a tilt table test.

good luck
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