Anesthesiology/Post-Epidural / EBP Question
QUESTION: Good afternoon!
I delivered my son 6 weeks ago and had a labor epidural. Following delivery, I unfortunately had spinal headaches which were resolved via blood patch. One week after the EBP I began feeling strange (for lack of a better way to say it) with long episodes of lightheadedness ("foggy" headed) with nausea and no appetite. This was and still is accompanied by a feeling of shakiness as if my blood sugar is very low (it isn't). I've had an MRI on my brain (with and w/o contrast) and an MRI on my lower spine as well as blood work, which have all been great.
These episodes have been happening for 5 weeks now. - What is your opinion? I'm still concerned about infection as well as possible inflamed meninges. Is it possible that I'm having a central nervous system reaction to the anesthesia or EBP?
I'm looking for as much information as I possible can, as I'm ready to go back to work from maternity leave.
THANK YOU for your time.
ANSWER: Light headedness or foggy headed and shakiness are not typical of what you might expect from an epidural or spinal headache. If there was an infection you should have other signs like elevation in your white blood cell count, fever etc, the mechanism by which you have head aches after spinal relates to low pressure in the brain from lack of CSF. If the head aches resolved that is a good indication that the low pressure has improved. The MRI is an excellent way to rule this out as a cause as well and it is also very good at picking any structural issues in the brain and spinal column. The issues you describe sound more related to metabolic problems, I.e. Hormonal or chemical imbalance of some sort and likely unrelated to the anesthesia.
I don't know how thorough the blood work was, but that is where my suspiscios would lie.
I hope you start feeling better.
---------- FOLLOW-UP ----------
QUESTION: Thank you again for your thorough response!
Could potential nerve damage in the lower spine possibly cause these symptoms?
What are so tests to indicate a potential metabolic issue that may be causing these symptoms?
Again, I greatly appreciate your input!
Nerve damage from a nap a girl or spinal would not cause the symptoms. The test to rule out metabolic issues are probably best to determined by her primary care doctor. However some examples may include thyroid test hormone levels, electrolyte levels, your blood pH, your glucose, and in addition to DC very careful and detailed history and physical exam is important to rule out other sources of not feeling good or low energy which could also be coming from your heart. In some cases, although rare, women develop heart failure after delivery. Heart failure is manifested by swelling in the legs trouble breathing easily becoming shorter breath, bulging veins in the neck, and other more subtle signs. The approach to a patient who has nonspecific symptoms such as yours low-energy dizziness etc. requires a very detailed history of all the things going on in your life as well as a careful physical exam.