Vertigo/Dizziness

I recently had my first personal experience with vertigo, and oh my, it is a frightening experience! I have a new appreciation for the emotional severity of this condition, to say the least.

Those who suffer from vertigo know what I’m talking about. I used to place vertigo lower on the list of really bad conditions, I mean, there is no pain involved (unless you get injured from falling, or end up vomiting repeatedly), so how bad could it really be? Let me tell you, it is very bad.

I’m specifically talking about the type of vertigo I recently experienced: Benign positional vertigo (BPV). I woke up and felt fine. Then I got out of bed and immediately felt the room tumbling backwards and I sat/fell back onto my bed. I was moderately nauseous. The dizziness and nauseousness passed within 30 seconds, but as I sat there on my bed, I had an overwhelming feeling that it was going to happen again at any moment. So after several minutes, I slowly stood up and slowly walked into the bathroom, being careful not to move my neck or head anymore than absolutely necessary. As I carefully sat on the toilet, I felt a mild wave of nausea and dizziness. I thought that maybe if I just slowly kept getting ready for work, it would go away. No such luck. The more I moved around, the more easily I became dizzy and nauseous.

My saving grace was that in 2015 I had learned from my trips to Michigan what causes BPV and how to fix it. So, I knew exactly what was going on with me and that it was curable. Had I not known any of this, I would have been in a panic. But I was dreading the treatment, because it involves causing the vertigo to happen repeatedly for 30-60 minutes!

Dreading the treatment, and still hoping it would just go away without it, I decided to head to work. I had Roshannah drive me there, to prevent a wreck should the vertigo suddenly take me over while driving! The car ride was very difficult, even the slightest acceleration or brake made me mildly nauseous and on the edge of dizziness. As I’m writing this I’m realizing that I keep saying that it was “mild” or on the “edge” of a problem. I’m realizing that the reason it was actually so “very bad” was because of the fear. The one episode where the floor quickly moved as I fell backward into bed was so frightening that any hint that it could happen again was terrible.

Finally at the office, I realized that this wasn’t going to go away, it had to be treated. And by this point I realized that it was specifically forward head nodding that would set it off. There was no way I could treat patients all day without looking down at the table. So I had Roshannah call and cancel my morning appointments to give me time to attempt to treat my condition. If unsuccessful, I would have to cancel the rest of the day as well.

Before I go on with the story, let me say that dizziness and nausea can be signs of very serious, even deadly conditions. The reason I knew I was not having a medical emergency was because I had none of the following symptoms:

A new, different or severe headache

A fever

Double vision or loss of vision

Hearing loss

Trouble speaking

Leg or arm weakness

Loss of consciousness

Falling or difficulty walking (I had this once, but it immediately subsided once I stopped forward head motion)

Numbness or tingling

Any of the above symptoms mixed with sudden vertigo can be a sign of a stroke or other life threatening condition that may need immediate medical attention, so go to the emergency room right away if you have the above symptoms mixed with vertigo.

I did have falling or difficulty walking, but only right after nodding my head forward, which I was being careful not to do.

So when none of the above symptoms are present and the vertigo only happens when the head is in a specific position, this is BPV and is only an emergency if you cannot walk at all or if you can’t stop vomiting.

Now back to my story.

As Roshannah called the morning patients to reschedule them, I knew I had about 90 minutes to properly diagnose and treat my condition if I was going to expect to treat patients in the late morning, afternoon and evening. So I needed to act quickly. Despite this time crunch, I spent a long time studying pictures of inner ear drawings. My inner voice’s excuse for dragging my feet was that I wanted to be sure I knew exactly which of the three canals was involved and which treatment to perform. But really, I was stalling, because I did not want to experience the dizziness and near vomiting nausea again.

Time was getting thin, so I bit the bullet and began the treatment.

Because only forward head nodding caused the symptoms, I knew it was the superior vestibular semicircular canal. But I didn’t know if the stone that had formed was stuck in the front, back, or top of this canal. I took a guess that it was at the top, and decided I wanted to move the stone forward first, then down, slightly back, and then hopefully out the drain. So I decided to lie face down on the treatment table with neck in neutral so that gravity would pull the stone where I wanted it to go. This was the equivalent of nodding my head forward 90 degrees, a scary prospect since 10 degrees had caused dizziness and near vomiting.

To avoid falling over, I jumped onto the table into the face down position as fast as possible (it’s hard to fall if you are already lying down, right?) Successfully face down, the dizziness began, but it only lasted about 10 seconds (which seemed like 10 minutes), then it was completely gone! But it was like the calm before the storm because I knew that this meant the stone had left the motion sensing hairs of the canal and was now free falling in the canal fluid. It would hit the hairs again once it fell far enough and hit the “bottom.”

Sure enough, the dizziness started up again about 60 seconds later, lasting about another 10 seconds.

So did the stone hit the hairs and stop, or did it bounce? I waited in fearful anticipation to find out. Three minutes later, nothing more had happened, so I assumed the stone was settled into it’s new position. So I reached my arm up to the face cradle of the adjusting table I was lying on, careful not to move my head suddenly, and slowly tilted the face cradle up about an inch. Instantly it felt like the room was spinning. But only for about 10 seconds, then it stopped. Again, about 60 seconds later, the dizziness started as the stone settled into it’s new position along the path of the canal.

I repeated this about 4 more times until the face cradle was at the maximum vertical angle. My head was pretty close to vertical so I decided to quickly lift my head the rest of the way to vertical. Luckily this time the dizziness was milder. Once things calmed again in this vertical head position, I was able to stand up and look at the computer screen images of the inner ear canals again while cautiously not moving the position of my head. It looked like the stone should be on the ledge of the exit hole and all I needed to do was slowly tilt my head backwards until about at a 45 degree angle. So I carefully sat on the table with the face cradle still lifted up, I leaned back keeping the top of my head upright. With my body face up on the table with my chin tucked to my chest, I now leaned my head back a bit onto the face cradle. Luckily only a mild dizziness for 10 seconds, then 60 seconds break, then 10 seconds dizzy. So it was still not out.

I then began to lower the face cradle backward an inch at a time. After about two times, the dizziness stopped no matter how far down I moved my head! So I laid there for about 5 minutes getting up my courage to stand up again. Gambling on my expertise, I held my breath and jumped up off the table… nothing! So I quickly looked down… nothing! It was gone! What a relief!

I did feel slightly off, almost like a shadow of dizziness lingered for about three days after. But no more vertigo and it has been about two months now, so I’ll keep you posted.

The procedure took about 60 minutes (yes I know, the times don’t add up, but most of the time was waiting to make sure the stone had reached “bottom” and not just bounced, as well as getting up the courage to cause the vertigo again), but it seems to have been curative. If anyone has recurring vertigo, they should not wait until it comes back. I believe you should come in and let me turn your head in all positions until we “set it off” so that we can locate the stone and figure out which canal it is in and which head direction treatment is needed to get the stone to permanently go away.

This treatment is called the Epley maneuver, but if it doesn’t make it stay away permanently, then it isn’t being performed correctly. Either the wrong canal is being treated or it is being done too quickly or the stone was assumed to be in the wrong part of the canal. Because I had no one to help me get into some of the positions that would have been needed if the stone were located elsewhere, I got lucky. I made the assumption that it was at the apex of the canal, hoping I was right. Because had it been on the back side of the canal, I may not have been able to treat it myself.

Let me know!