Skill Checkup: An Active Woman With Vertigo, Fatigue, Leg Cramps, and Often Chews on Ice

James L. Harper, MD


November 01, 2021

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 63-year-old woman presents with vertigo. She has been experiencing fatigue and reports that she has been sleeping on the first floor of her house because walking up the stairs can cause what she describes as a "charley horse" sensation. As an avid bicyclist, she tries to stay hydrated and notes that she often chews on ice. It has also been hard to swallow. She specifies that these symptoms started within the past 3 or 4 months. She notes that she adopted a plant-based diet to improve her health and reduce cardiovascular risks about a year and a half ago. She has mild hypertension and takes bisphosphonates for osteopenia, which have markedly improved her bone health. She has had no recent surgeries.


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