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September 19

Medications causing dizziness and loss of balance

I am a retired psychiatrist and a friend of mine who is an audiologist asked me to write a chapter for his upcoming book about some stuff audiologists do. It turns out they do balance in addition to fitting hearing aids, so their clients are mostly elderly. He is most interested in medications that might affect man's balance, cause dizziness, etc. Also the medications he is interested in are those which he might see to have been prescribed to his clients because he needs to differentiate between organicity and medications side effects. I have written already most of the psych stuff: antipsychotics, antidepressants, antiepileptics, opioids, etc and wonder if someone can give me pointers to other areas which I possibly missed. Thank you AboutFace 22 (talk) 15:15, 19 September 2020 (UTC)[reply]

There is a list here: "Medications causing Loss of balance". www.rightdiagnosis.com.

Which links to: "Conditions listing symptom: Loss of balance - View All". www.rightdiagnosis.com.

Further, related to audiology: "Acoustic neuroma Symptoms, Diagnosis, Treatments and Causes". www.rightdiagnosis.com.

107.15.157.44 (talk) 15:58, 19 September 2020 (UTC)[reply]

Medication that makes one dizzy makes it unsafe to drive or operate heavy machinery. I think the converse also holds rather generally: medication that makes it unsafe to drive or operate heavy machinery can cause dizziness. You might want to check medication that is thus labelled (like those on this list) and that is not already on the other list(s). --Lambiam 18:41, 19 September 2020 (UTC)[reply]

Browsing this site, which generally includes references, may provides some ideas: medications associated with dizziness, ototoxic medications, drug treatment of vertigo (list of vestibular suppressants), neurotransmitters in the vestibular system. Affect man's balance, cause dizziness, etc. seems like a pretty broad scope. fiveby(zero) 18:55, 19 September 2020 (UTC)[reply]

Thank you very much! It is a GOLD MINE! AboutFace 22 (talk) 19:47, 19 September 2020 (UTC)[reply]

Shouldn't an audiologist already be cognizant of these things? ←Baseball Bugs ^{What's up, Doc?} carrots→ 21:48, 19 September 2020 (UTC)[reply]

Our writer is a psychiatrist though! Better check out the audiologist page for knowledge and skills required. (our article does not mention drugs, and is only two subsctions). Graeme Bartlett (talk) 22:25, 19 September 2020 (UTC)[reply]

Yes. But shouldn't a trained audiologist already know this stuff? If he does, why does he want someone else to write about it? If he doesn't, how did he ever get to be an audiologist? ←Baseball Bugs ^{What's up, Doc?} carrots→ 22:55, 19 September 2020 (UTC)[reply]

Don't be mean, B B. Audiologists don't get trained in drugs. To get versed in drugs you have to go through a lot of chemistry, biochemistry, physiology, etc. It is the stuff of either a medical or veterinary school. AboutFace 22 (talk) 00:24, 20 September 2020 (UTC)[reply]

Probably beyond any but specialists to keep up to date. Here's a survey of pharmacology for just the vestibular system. Amazed that homeostasis can keep such an ill-designed system as the human upright and functioning. fiveby(zero) 12:07, 20 September 2020 (UTC)[reply]

Bugs, audiologists don't deal with medications very much. You may be thinking of otologists (ear doctors). AboutFace 22, it might be of some interest that psychiatric meds (particularly escitalopram) are sometimes used to treat balance disorders. I don't know the reason for this but there is apparently an explanation that makes some sense. 2602:24A:DE47:BB20:50DE:F402:42A6:A17D (talk) 04:52, 20 September 2020 (UTC)[reply]

Examining a person's balance does not require much training. In some contexts it may be relevant to know if that balance may have been affected by the (possibly temporary) use of medication. A thorough handbook dealing (among several topics) with the topic of balance examination could do well by listing which medications are known to affect equilibrioception and therefore have a possible effect on a person's balance. --Lambiam 09:33, 20 September 2020 (UTC)[reply]

The link between audiologists and people who don't have balance disorders is this:

Someone with hearing loss may be asked to listen to sounds of varying pitch and intensity to establish where the deficiency is. Then water is irrigated into the ear canals. If there is impediment to its movement that may indicate a diagnosis of canal paresis (the degree of it is expressed as a percentage). If the water fills the canals the patient will experience balance disorder (vertigo) until it drains. 82.15.199.219 (talk) 13:33, 20 September 2020 (UTC)[reply]

Safe displays of highly radioactive isotopes

Suppose you had a museum of the elements, with a kg sample of each stable element (in an inert atmosphere if needed). What could you do for Tc, Pm and the actinides?

For example, you might want a kg of plutonium-238 oxide, or enough to glow orange hot (as in our picture at Pu-238), to illustrate its use as a power source in space probes. It decays by alpha radiation, so the glass of the display case would be all you'd need for shielding. But the decay products decay by beta radiation, which means the shielding could produce bremsstrahlung gamma radiation. That might not be significant for Pu-244 (assuming it were possible to synthesize a kg of Pu-244), but would be for Pu-238.

(I can't find how much spontaneous fission there would be, and if it would be dangerous in such a display. Some sources give alpha radiation as the only decay mode of Pu-238, some give alpha and fission.)

Also, why isn't the beta/bremsstrahlung radiation and SF damaging to radioisotope thermoelectric generators? — kwami (talk) 21:47, 19 September 2020 (UTC)[reply]

A kg sounds like a lot. I once saw a piece of radium displayed in a museum in Leiden, but that was only a few grammes. It was brought there by Marie Curie herself (in a suitcase on a regular passenger train) to have it investigated in Heike Kamerlingh Onnes' cold temperature lab (conclusion: radioactivity is not affected by liquid helium temperatures). The sample was on a 2-month temporary exhibition in a metal box, lined with lead, with a small window of lead glass. There was a fence to keep visitors 2 metres away, warning signs and a radiation counter. If it were on permanent display, there would be a risk that the guides could exceed their legal maximum radiation dose (yes, I checked the numbers). I've also seen radioactive samples on display where the visitor couldn't view the sample directly, but only in a mirror.

Radiation is damaging to RTGs. The half life time of an RTG is shorter than the half life time of the radioisotope inside. PiusImpavidus (talk) 09:30, 20 September 2020 (UTC)[reply]

Good to know, re. RTGs. And a mirror is a nice idea (would the aluminum finish degrade over time?), though it would be fun if you could put your hard against the glass and feel the heat radiating of a plug of PO2, not just see it glow. — kwami (talk) 07:21, 21 September 2020 (UTC)[reply]

You may wish to use Plutonium-244 with a much longer half life. But for many other actinides there is no way you could get a kilogram, let alone display it. Graeme Bartlett (talk) 10:08, 20 September 2020 (UTC)[reply]

I'm not sure we could get a kg of Pu-244 either -- it's supposed to be quite difficult to synthesize. But this is more an fantasy of, if we had a nuclear transmogrifier that could produce any amount we wanted of any isotope we wanted, which ones would be practical for safe display? — kwami (talk) 07:21, 21 September 2020 (UTC)[reply]

xkcd what-if has a humorous take on what would happen if you tried to collect all the elements. At this moment the what-if web server is down, but if you search the web for xkcd "Periodic Wall of Elements" you should find copies. The piece has sage advice such as "The periodic table of the elements has seven rows. [...] Do not build the seventh row." 85.76.39.125 (talk) 05:59, 21 September 2020 (UTC)[reply]

Well, yes, but OP is definitely aware (see below) that you can't display every element. And since the problems xkcd points out for the last two rows are thanks to things like astatine and tennessine, it seems to be a fair question to ask how many radioactive elements you can display before you have a big problem. Certainly the answer is nonzero because of bismuth which is only radioactive on a technicality; the more interesting question is how much greater than zero it is. Double sharp (talk) 12:06, 21 September 2020 (UTC)[reply]

I'm aware that for many elements, even the most stable isotope would be too actinic for safe display, perhaps even if it lasted long enough to put on permanent display. I figured that several would be practical, but how can I know which? It's not just halflife, but decay pathways and the halflives and decay pathways of the products that would need to be considered, and perhaps even the energy of the beta rays, which for all I know differ between isotopes. I'm wondering where I could find out what the radiation hazard would be for various isotopes, and how that would change over years to decades. — kwami (talk) 07:21, 21 September 2020 (UTC)[reply]

For actinides, daughter decay products would build up, some also giving off gamma rays. Graeme Bartlett (talk) 07:43, 21 September 2020 (UTC)[reply]

Some of the main decay chains are just alpha and beta decay, though. So it's a matter of what is needed to block the beta radiation and secondary gamma radiation. I just don't know where to find the specifics. — kwami (talk) 09:40, 21 September 2020 (UTC)[reply]

What, no one has mentioned Theo Gray and his IgNobel-winning Periodic Table Table? I half-remember seeing on his personal website some discussion of displaying the difficult elements. —Tamfang (talk) 01:55, 22 September 2020 (UTC)[reply]

Well, yes, but kwami's talking about a hypothetical here. In the real world, the problem with displaying even stuff like ²³⁷Np, ²⁴⁴Pu, and ²⁴⁷Cm with half-lives over a million years is not just radiation shielding but also the problem with getting them in the first place.

Now, Theo Gray's website does have some useful information indeed: apparently Tc is theoretically collectable, but Pa is not. (I wonder why Pa is lumped in with At, Fr, and Ac for him though: ²³¹Pa has a quite respectable 32760-year half-life.) But we don't know what quantities he's thinking of. Double sharp (talk) 08:50, 22 September 2020 (UTC)[reply]