dizziness

אני בת 38 מזה כחודשיים אני סובל מהרגשת סחרור/מסוחררת, אשר אינו מרפה בעיקר בעת פעילות פיזית יומיומית פשוטה. לפני שהתלחתי להרגיש רע היו לי כאבים באוזן שמאל אך לא של דלקת. אין שום סימן לבעיה באוזן. אני מחלימה כרגע מסרטן שד: בשנה האחרונה עברתי כריתה חלקית+ כימו+ הקרנות ואני מקבלת תרופות: טמוקסיפן וזולדקס. הרופאה האונקולוגית לא מוצאת קשר למחלה או לתופעות הלוואי שלה רופא א.א.ג שלח אותי לבדיקת שמיעה, צילום צוואר וENG - הכל תקין. אני מחר עושה CT. האם יכול להיות קשר פסיכולוגי לתחושות הללו? האם לפנות לפסיכיאטר כפי שהם ממליצים? אני מצרפת חומר שמצאתי באתר של אונ' פנסילבניה בארה"ב + תשובתם לפנייתי. http://www.uphs.upenn.edu/balance/patient%20education%20brochures/anxiety%20and%20dizziness.htm Dizziness, Imbalance, & Psychologic Stress Physicians have known for many years that psychologic disorders, such as anxiety, can cause symptoms of dizziness AND imbalance. This entity was given the nonspecific name of psychogenic dizziness, reflecting the fact that little was known about the entity. Recent advances now allow us to make specific AND accurate diagnoses AND institute effective treatments for this disorder. What disorders are associated with psychogenic dizziness? Several studies point to a specific set of disorders that can cause symptoms of dizzuiess AND imbalance. All these disorders are in the anxiety disorder family AND include panic attacks, certain phobias, AND chronic anxiety disorders. What symptoms are associated with this disorder? Patients with psychogenic dizziness will present with a variety of complaints including lightheadedness, feeling heavy headed, feeling a pressure sensation in the head, feeling far away OR detached from the environment, feeling like they are going to fall. "But doctor - I have a balance problem, not a psychologic problem!" Symptoms of balance disorders can be caused by a variety of underlying processes. The successful treatment of a balance disorder is dependent on the precise identification of the cause of the disorder. In some cases, underlying psychologic processes are responsible for symptoms of balance disorders AND dizziness. Why would psychological symptoms lead to dizziness AND balance disorders? This is a very difficult question to answer, AND we are involved in active investigations dedicated to answering thus question. At this point, it seems that psychologic processes can cause symptoms of dizziness in 3 situations: 1. A patient had a straightforward inner ear problem that has completely resolved. However, the symptoms persist, despite the resolution of the inner ear disorder. In this situation it appears that the inner ear disorder triggered an anxiety, panic, and/or phobic state. In this situation, the psychologic disorder perpetuates the dizziness, despite the fact that the underlying inner ear disorder has resolved. Why inner ear disorders trigger a psychologic problem in certain patients is not known, but is under active investigation. 2. The patient never has had an inner ear disorder but does have a psychologic disorder. In this case, one of the manifestations of the psychologic disorder is dizziness, usually of a fairly nonspecific variety. 3. The patient has an active inner ear disorder, but also has a psychological disorder. In this situation, the psychological disorder is making die inner ear disorder much more difficult to deal with. Can there be anything else wrong with me? There are several physical disorders that can present with symptoms similar to those experienced with psychogenic dizziness. If the brain fails to compensate to a loss of inner ear function, the patient can experience unbalance when placed m situations that challenge the balance system. This is called a noncompensated vestibular loss AND is diagnosed based on the patient's symptoms, physical examination, AND balance function testing. People with intermittent drops in their blood pressure can also have similar symptoms. This condition is diagnosed based on a patient's development of symptoms only when upright. A tilt table test will confirm this diagnosis. It is important for the patient to realize that psychological disorders may coexist with these physical conditions AND may, in fact, be responsible for the majority of the patient's symptoms. How is this disorder diagnosed? The patient seen in our center undergoes a comprehensive evaluation by the physician. The patient's history is usually highly suggestive of this disorder. Testing will typically include balance function tests, a psychologic screening questionnaire, a questionnaire pertaining to the degree of handicap the dizziness is causing, and, on occasion, other tests including tilt table AND MRI scan. This allows us to complete a comprehensive evaluation AND make an accurate diagnosis. Can this disorder be treated? Absolutely! We are fortunate that there are excellent treatments available for panic, phobic, AND anxiety disorders. If our evaluation indicates that you are suffering form one of these disorders, we will make arrangements for you to see our consulting psychiatrist, who has a specific expertise in the way the balance system interacts with psychologic disorders. He will confirm the diagnosis AND institute appropriate treatments. Thus far, we have been very gratified with the results! תשובתם בקשר לפנייתי: Dear Ms. Schwartz, Dr. Ruckenstein referred your inquiry to Dr. Staab of Penn Behavioral Health. Dr. Staab sent the following response: I do not know of any psychiatrists in Israel who specialize in the care of patients with dizziness. However, this patient could be helped by a psychiatrist with experience in medical-psychiatry OR psychosomatic medicine (both terms refer to psychiatrists who work with patients who have medical illnesses). I recommend that she contact one of the medical schools in Israel AND ask for an appointment with a psychiatrist who works with medically ill patients. She may want to provide our Balance Center web information to that person. Regards, JPS Please let us know if we may assist you further. Sincerely, Web Inquiry Specialist UPHS Health Care Web Team Comments: I am writing to you after speaking with Shirley , D. Ruckenstein's secratary. I am looking for a physicain in Israel that is familiar with the Dizziness, Imbalance, & Psychologic Stress that is mentioned in the balance center info. I am 38 yrs. woman, I have had a lempectomy almost a year ago AND had Chemo+ radation treatment. I am taking Tamoxifen AND have recently stopped taking Paxil (for hot flashes). Since early Jan. i have been suffering from dizziness symptoms that are mentioned in your web site. I have had hearing tests, neck X-rays AND ENG tests - all are negative. I would like to have some more info on your diagnosis AND treatment AND if there are doctors here in Israel that can help me.

לשרון האמת היא שלא קראתי את כל התשובה המפורטת באנגלית בגלל קוצר הזמן אבל העיקר אם הבנתי נכון הוא שבהחלט עלולה להיות סחרחורת על בסיס פסיכולוגי-נפשי והתופעה בהחלט מוכרת. וכמובן שהבסיס הוא חרדות ואפשר לטפל בחרדות באופן יעיל. כמובן שהטיפול האפשרי הוא בשיחות וגם בתרופות, לאור גילוי הסרטן והטיפולים הייתי מציע קודם כל לחשוב על פסיכותרפיה. יחד עם זאת צריך לבדוק האם התרופות שאת נוטלת או הטיפולים שקיבלת עלולים לגרום לסחרחורות ולתחושות שהרגשת. לפי זכרוני, אבל איני בטוח בכך גם הטיפולים עלולים לגרום לסחרחורות, גם אחרי זמן. הרבה בריאות דר' גיורא הידש