Undiagnosed symptoms

I am 65, male, 210#, 5/9. NIDDM since 1996. I had a mild stroke in 1995 and have resulting left hemisensory syndrome. Meds: HCTZ, Avapro, Advicor, Tekturna, Metformin, Byetta. No drug or alcohol use. Non-smoker. BP and BG control are generally good (although my BG has been creeping up over the past several months).

For years I have been experiencing a constellation of symptoms which are becoming more severe, more frequent, and are affecting my quality of life. None of these episodes appear to have any relation to my BG or BP readings when they occur, and I have been unable to associate them with food, environment, stress level, or any other factor I can think of. These symptoms, at a much lower level of intensity and frequency, predate my stroke and NIDDM diagnosis.

I have periods of nausea (no vomiting, but episodes range from mild to severe), vertigo, and constant tinnitus (bilateral - sometimes mild and sometimes intense). The nausea and vertigo are not necessarily simultaneous - I can have nausea without vertigo and vertigo without nausea. I would characterize the vertigo as being similar to being slightly intoxicated, but with no pleasurable component. My typical pattern is to feel tolerably well for a week or two followed by a week or so of feeling either not very well, or so bad that my work and life are affected.

I have had upper/lower GI examinations, nuclear stress tests, and a complete workup at the vertigo clinic at Johns Hopkins Dept of Otolaryngology, all with negative results. My PCP is stumped, and I am at a loss as to how to find somebody who could come up with a diagnosis and treatement. Is polypharmacy the culprit? Allergy? How can I find out?

[J.M. Keyes, MD]

I'm sorry to hear that you have been struggling with this for so long with no answers.  
I am assuming that your ENT work up at Johns Hopkins included a consideration of Meniere's disease and also some imaging (eg CT or MRI) to rule out any masses affecting the inner ear.  If you have not had imaging, I would suggest that at this point, and if so, a neurological evaluation would be something to consider because nausea and vertigo may be related to a neuro problem.

Polypharmacy may also be affecting your symptoms, so I would talk to your doctor about whether withdrawing any medications is an option, for a trial.

Best of luck,

JMK MD