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Equinox is a physical therapy practice in Sarasota, Florida. We specialize in treating people with dizziness, vertigo, balance problems and facial paralysis.

Wednesday, 26 November 2014 15:20

What is Labyrinthitis?

What is LabyrinthitisLabyrinthitis is a condition that affects the inner ear hearing and balance system. It is caused by an infection to the inner ear that can result in temporary or permanent damage to the inner ear. Symptoms associated with labyrinthitis include complaints of severe and sudden vertigo, dizziness, nausea, imbalance, veering during ambulation, difficulty walking, and sensitivity to head motions. Patients who have had labyrinthitis may be sent to a physical therapist that specializes in treating inner ear problems. This therapy is sometimes referred to as Vestibular Rehabilitation. The therapist is sometimes referred to as a “vestibular therapist”. This therapy is very specialized. Vestibular therapists must go for specialized continuing education after completing their degree and obtaining their license, in order to become competent. My physical therapy practice in Sarasota, Florida specializes in treating people with vestibular inner ear problems.

When it comes to labyrinthitis, the good news is that it is not very common for a labyrinthitis to affect both ears. What does this mean for the brain? It means that the good ear is sending the full amount of information that it always did, but the bad ear is not. Testing by an audiologist can confirm how much information each ear is sending. Patients with labyrinthitis can lose up to 100% of their inner ear balance function, or just a portion. Testing for this is done with video nystagmography (VNG). For there to be considered a clinically significant difference in the two ears, one ear must show a reduced responsiveness to testing of at least 21% to 100%. Even if the bad ear is 100% damaged, with therapy the brain will adjust and learn to depend on the good ear, and whatever amount of information the affected ear is capable of sending. Once the brain recalibrates itself to this difference in information that it is receiving from each ear, the symptoms will stop. The patient will regain their balance, and no longer be dizzy, nauseated, or sensitive to movement. They will be able to turn their head quickly, turn quickly, bend over, walk and look to the side, and basically return to life as normal. For many people, this recovery happens on its own. As the person gets back to life as normal and resumes their normal activities, the brain gradually adjusts. That is why it is really important once you are over the worst of things that you start moving your head again, and become active! The patients that come to see me for physical therapy in Sarasota somehow were unable to make this transition on their own, and need a therapist to guide them in exercises and activities to help them recalibrate their balance system and get back to life as normal. In general, a person suffering from labyrinthitis should get completely better within 8-12 weeks of the proper therapy. If you are having these types of problems, please know that there are treatments that can help!

Clissa Turned Left with her Hand to her Ear, pastel portrait by Mary Cassatt, 1895.

Monday, 10 November 2014 19:36

How does the balance system work?


Basically, our brain relies on sensory input that tells it where our body is in space.  Then the brain deciphers this information, and tells the joints and muscles what to do to maintain balance.

Where does the brain get its sensory information from?  The 3 main sets of information the brain relies on come from our eyes, our ears, and the joints and muscles. 

1.  The eyes provide visual feedback as to where we are in relationship to our environment.  For instance, if I walk outside and have to cross a crooked sidewalk, I see what is coming and subconsciously my brain tells my legs what to do to adjust my steps and maintain my balance. 

2.  A second set of sensory information comes from the nerve endings in our muscles and joints that tells that brain how we are shifting our weight on our legs, and if we are standing or walking on something firm, or soft, or slanted.  We call this proprioception.

3.  A third set of information comes from our inner ear system, (we actually have two of these, one in each ear).  The ears act like little gyroscopes to tell the brain if we are moving.  They tell the brain how far, how fast, and in what plane of motion we are experiencing movement.

The brain takes this sensory information, and then tells the joints and muscles what to do to maintain balance. 

If you understand this concept, then watching Nik Wallenda walk a couple weeks ago between the skyscrapers in Chicago, will be even more meaningful to you.  As some of you may have figured out, Nik Wallenda and I both live in Sarasota, Florida.  A friend said to me,  “Hey, Nik Wallenda is practicing for his Chicago walk tonight at 6 pm, do you want to go watch and show our support?”.  How could I say no to that?!!!  After watching him practice, I knew he could do it, and I was able to watch the Discovery Channel to see his triumph.

Here are some pictures I took of him when he was practicing in Sarasota.

Nik Wallenda

As you can see here, he is walking on the wire up an incline. He is using his vision, his proprioception (feeling the alignment of his body on the wire), and his inner ear system. You could even argue that he is using his hearing too, but that is a topic for another blog. His brain is getting this SENSORY information, and then tells his joints and muscles what to do to maintain balance and walk the wire. At every second, this system is analyzing and reanalyzing, and deciding what to do next. When walking with his eyes open, his vision and inner ear system are sending very reliable information on what is happening, and his proprioceptive system is also sending information, but it is more variable because the wire can move and be unpredictable.

Nik Wallenda

In this picture, Nik is walking blindfolded.  WHATTTT!!!  He essentially deprived his brain of very reliable information, and now he only has the sensation from a wire that can move, and from his inner ear system.  His inner ear system is sending the most reliable information in this condition.

Nik Wallenda

Nik- blindfolded on his way to the tower. Doing what he does, walking the wire blindfolded, with only 2 sets of information for his brain to utilize is astounding. When watching the Discovery program that night, I remember his wife and mother saying that they were most worried about the blindfolded portion. When they said that, I thought to myself, me too!!! Now I hope you can understand from a physiological standpoint why this was so unbelievable. Hopefully one day, Nik will be a guest blogger on my blog, because his mission is to inspire people. I bought one on his signed posters that day to put in my office to help inspire my patients with balance problems. It says at the bottom, NEVER GIVE UP-DARE TO BE GREAT! Thanks, Nik Wallenda for all you give to others.

Nik Wallenda

Time to check my messages…

Thursday, 23 October 2014 17:37

Inner Ear Disorders are “Invisible”

vangoghIn this self-portrait of Vincent van Gogh, we can look at it and see that he has his right ear bandaged, and without even knowing him, we can surmise that something is wrong with his ear. He has a bandage on his outer ear, and looking at the painting, one can has some empathy for him. But when a person has an inner ear disorder, there is no bandage one can wear that alerts others that we are having a problem. I think it is fair to say that Inner Ear Disorders are “invisible” to others. What do I mean by that? Well, if you had a broken arm, every one would see the cast on your arm, and they could relate to that. I you had a cold, or the flu, even without a bandage, others can understand that because they know what it feels like themselves to have this type of illness. But with inner ear disorders, for those friends and family members who have never had an inner ear balance problem, it can be hard to understand what if feels like to have vertigo, dizziness, or imbalance. Some patients tell me that they feel as though their family doesn’t understand their problem, because they don’t “look” sick.

For the person with the inner ear problem, this can add to their stress and sometimes cause added depression. Hang in there!!! If it is possible (and you want them to), having a spouse, grown child, or your best friend come with you to your doctor or physical therapy sessions can help that person better understand your condition, and in so doing, be better able to offer you the empathy, support, and understanding you could use. I have also had physical therapy patients in Sarasota, Florida who did not have this support network. They may live alone, or have no children or friends near by. This is not uncommon here, where many people come only for the winter months to escape the cold northern winters. Some of these individuals decided to take the bull by the horns, and go and see a psychologist who helped them learn better coping skills that they could apply on their own. I really admired these patients and their commitment to do whatever it takes to help themselves learn ways to better deal with their “invisible disease”. Whatever the case, don’t be afraid to ask those around you for help. We all need a helping hand at some point in our lives...

Painting by Vincent van Gogh, Self Portrait with Bandaged Ear, 1889

Sculpture by Alice Aycock entitled Hoop-La (2014), Park Avenue Paper Chase, Painted aluminum & steel
Art and the Inner Ear System

You would have to be a person who loves the inner ear, and knows what it looks like anatomically speaking, to see what I see. I was in NYC July 2014 for the Open Forum ENT Meeting. When exiting my hotel to walk to the conference, I had to cross Park Avenue. For those of you familiar with NYC, they usually have sculptures in the median where they feature a new artist every year.

This year, the artist was Alice Aycock. She created a series of huge sculptures made out of metal. This sculpture reminded me of the inner ear with the circular patterns on the bottom right being the cochlea for hearing, and the swirls on the top and left being the vestibular system and its semi-circular canals.

Here is an anatomical drawing of the inner ear system:

Inner EarInner Ear














This drawing was taken from the NASA website for teachers and educators. Click here to check it out.

I don’t know what Alice Ayock’s inspiration was for this sculpture, but if you ask me, it’s an inner ear...The artist entitled this work Hoop-La, and if you are talking about the inner ear system, I understand what all the Hoop La is about... Do you?




The Infant (The sick child) by Jean-Francois Millet 1858If you are reading this blog right now, chances are you are an adult. But adults aren’t the only ones with inner ear balance problems! Children are also affected. For example, dizziness may be a sign of an inner ear problem, and it is estimated that up to 15% of children have dizziness at some point in their childhood. If the child has a hearing loss, that number can be as high as 50%! As adults, it may be hard for us to know if a child is having a balance or dizziness problem, especially if they are young and unable to express their feelings.

Lucky for us, there are doctors like Dr. Sharon L. Cushing from Sick Kids The Hospital for Sick Children in Toronto, Canada, who specializes in treating children with inner ear problems. Dr. Cushing and I recently connected at the American Academy of Otolaryngology Meeting last September 2014 in Orlando, Florida. Together, we decided to create this blog to help parents recognize the top 5 signs that their child may be having an inner ear balance problem. This way, parents are better able to help their children get the help they need...

TOP 5 SIGNS of INNER EAR BALANCE PROBLEMS in CHILDREN

1. Delayed Head Control (these children often get labeled as “Having a head that is too big for their body”) Delayed sitting (>9months) and delayed walking (> 18 months).
2. Unable to stand on one foot (a 2 1⁄2 year old should be able to do for 1 second, a 5 year old for 10 seconds).
3. Unable to ride a bike without training wheels.
4. Brief attacks where children stop what they are doing and cling to a parent or object (they may be experiencing vertigo but may not have the vocabulary to articulate it).
5. Jumpy eye movements – the eyes twitch back and forth (this is an entity called nystagmus).

If these symptoms sound like something your child is experiencing, I encourage you to go see an otologist (an Ear, Nose, and Throat doctor who specializes in the treating the inner ear). If you live in the Toronto area, you’re lucky, because help is just around the corner...

Painting: The Infant (The sick child) by Jean-Francois Millet 1858

Tuesday, 16 September 2014 17:02

Treating Dizziness: Balance Awareness Week

This week, we are celebrating Balance Awareness Week at my physical therapy practice in Sarasota, Florida.  In honor of this recognition, I am happy to share with you a new infographic from the Vestibular Disorders Association.  Infographics are pictures boards that help to communicate a concept or idea.  I hope this infographic helps you better understand what causes dizziness, and what to do about it!

Feeling Dizzy Chart

Screen Shot 2014-09-11 at 5.58.19 PMBell Palsy is a condition that causes facial paralysis, and was named after Sir Charles Bell (1774-1842) who described the Facial Nerve and cases of facial paralysis in his writings. 

Who:  20-30 people per 100,000 people develop Bell Palsy per year.  It can occur at any age, but the median age is around 40 years old.

What: by definition, it is defined as idiopathic, acute unilateral peripheral facial palsy.  

Where:  It usually occurs on one side of the face.  Bell Palsy causes weakness or paralysis in all branches of the nerve.  In other words, people show signs of weakness or paralysis in the forehead, midface, and lower face with Bell Palsy.  

When: It comes on suddenly, usually within 48 hours and reaches its peak within a week.   People with Bell Palsy should show some signs of recovery within 6 months of onset.  If a person has complete facial paralysis with no signs of recovery at 6 months, they need further work up, because chances are it is not Bell Palsy, and they may have something serious causing their facial paralysis.  

Why When Bell Palsy was defined, it was defined as idiopathic, meaning “we don’t know what causes it”.  However, new research is pointing to the herpes simplex virus type 1 as a major cause of Bell Palsy.  

What to do:  If you have sudden facial paralysis, you need to find out right away what is causing it so that you get the proper treatment.  A physician needs to examine you and determine if it is Bells Palsy, or something more serious such as a stroke or brain tumor.   

How is it treated:  Initially, patients with Bells Palsy may be prescribed an anti viral medication, and/or a steroid medication to help protect the facial nerve and promote healing.  If the facial weakness does not completely recover on its own, the patient may be sent to a speach, ocupational or physical therapist who specializes in treating facial paralysis to retrain the facial muscles how to work again. 

Reference:  The Facial Nerve by Slattery and Azizzadeh, Chapter 9 on Bells Palsy & Ramsey Hunt Syndrome by Shingo Murakami.

 

 

Painting: Green Eye Mask by Amadeo de Souza-Cardoso, 1915

Wednesday, 10 September 2014 16:53

Falls, Canes and Walkers, and Balance Problems

Old woman seen from behind, sketch and study in pencil by Van Gogh, 1882Van Gogh 1882

Most people with balance problems want to avoid walking with a cane or rolling walker unless absolutely necessary. Even when necessary, many people refuse to use a cane because they are too proud or embarrassed for others to see them walking with one. The thing is, if a person is at risk for falling, a fall can cause serious injuries, and even death.

The Center for Disease Control estimates that one out of three adults age 65 and older falls each year, but less than half talk to their healthcare providers about it. And among older adults (those 65 or older), falls are the leading cause of injury death! This is a serious issue...

So I tell my clients, “You need, what you need, when you need it”. The purpose of the balance exercises is for the person to improve to the point where they don’t need the cane or walker. But until that time comes, the last thing a person needs is to add to their problems by falling and getting hurt... When my balance patients in Sarasota understand that the cane or walker isn’t meant to be a “forever thing”, they are usually willing to use it temporarily until their condition improves.

If you or someone you love falls into this category, I encourage you to use a cane or walker, and to seek out a physical therapist who specializes in balance disorders, so that you can address your balance problem and regain your safe and independent lifestyle again.

Wednesday, 27 August 2014 18:45

Balance Awareness Week, Sept 15th-21st, 2014

Balance Awareness Week is September 15th-21st, 2014!Balance Awareness Week

Are you having a balance problem? The goal of balance awareness week is to help people recognize if they are having a problem, and to urge them to seek help. Falling is not a normal part of aging. We know that falls can lead to serious injuries and even death. If you have had one fall with serious injury in the last 12 months, or 2 falls without injury, I encourage you to seek out a professional vestibular balance specialist. Something can be done to help your problem!


Friday, 15 August 2014 18:06

Facial Paralysis and Inner Ear Conditions

Facial paralysis occurs when the facial nerve is damaged and unable to send messages to the muscles of the face that create facial expressions. This problem can occur for several different reasons. Some causes include: tumor, trauma, stroke, or genetic disorders.
Facial Paralysis and Inner Ear Conditions
The most common cause of facial paralysis is due to Bell Palsy. While most of the time, Bell Palsy patients recover fully, research tell us that about 20-30% have lasting weakness or paralysis.

I first started treating people with facial paralysis because I was a vestibular specialist. The vestibular system or inner ear balance system is innervated by cranial nerve 8 (the Vestibular Nerve). The muscles of the face used for facial expression are innervated by cranial nerve 7 (the Facial Nerve). These 2 nerves run side by side on their way to the brain in a tunnel in the bone called the Internal Auditory Canal (IAC). This is a very narrow space, with only enough room for the nerves to travel. If a tumor is growing in this small place, or an infection travels to this area, both nerves can be damaged. We see this with large acoustic neuroma tumors, or with infections such as Ramsey Hunt Syndrome.

When facial paralysis does occur, it can take a lot of time for the nerve to heal. The first signs of movements of the face can be only just a flicker, but as the nerve heals, the movements can become stronger. Working with a physical therapist who has special training in treating facial paralysis can help improve the outcome for patients with this problem. They can teach a person what to expect while they are recovering, how to do stretches to ease pain and tightness in the face, how to retrain the muscles to move in a symmetrical way with the unaffected side of the face, and how to manage a condition called synkinesis (when facial muscles which should not be working when making a certain expression try to “help” anyway).

*Sculpture by Jun Kaneko 2007, Untitled Head in Glazed Ceramic and Steel

This is the title of a radio interview I did on July 1st, 2014 with Heidi Godman on her radio program Health Check on WSRQ Sarasota Talk Radio. She interviewed me, and also my husband Dr. Jack Wazen who is an MD, to discuss answers and treatment advice on balance and dizziness problems. During the podcast, I shared with Heidi how physical therapy can treat these problems, and Dr. Jack Wazen talked about the medical side of diagnosing and treating specific balance or dizziness problems. Conditions we discussed included Meniere’s Disease, BPPV, labyrinthitis, and tumors.

Cilck here to go to the Sarasota Talk Radio WSRQ website, where you can find Heidi Godman’s Health Check program, which was recorded on July 1, 2014. I hope you enjoy listening to the program as much as I enjoyed making it.

U-STEP: A WALKER DESIGNED FOR PARKINSON’S PATIENTS by Laura Wazen and Charlie

 

Hi.  My name is Laura Wazen and this is my friend Charlie.  Today we want to show you a very cool walker you may not have seen before, that is especially good for people who are having Parkinson’s Disease.  So, one of the things about Parkinson’s Disease, is that sometimes, it can be a little bit hard to control your momentum if you’re walking with a traditional walker- that is in a sense, rolling away from you.  So the neat thing about this U-Step walker is that it will only move if you squeeze the handles.  So if Charlie wants to take a step, he squeezes the handles, and takes a couple of steps forward.  Now the neat thing about this is, if he’s feeling unsteady or needed to stop, all he would have to do is release the handles.  And then he could regain his balance, and he can then take a step forward which is a really, really cool thing!  Another neat thing about this walker is that if a person is having a problem taking a step forward, (they’re freezing for example), it has a little button, which is right here, that if you push the button, it puts a red laser on the floor that serves as a visual cue, so that you can just look down and see the red line, and then the person initiates a step by stepping over the line.  Charlie, could you push the button on the laser?  (Charlie demonstrates pushing the button).  The laser would project on the ground, and then he could use that red line as a visual cue to take a step, and start walking again.  There you go. 
Very good, Charlie.

Thursday, 03 July 2014 14:36

NEW OFFICE LOCATION!!!

20140702 161000

We have moved our office to 950 South Tamiami Trail, Suite 101, Sarasota, FL 32439. It is a great space with lots of windows, ample parking in the shade (which is huge if you live in Florida), and on the 1st floor of the building.

The new office is right on US 41 South, across the street from the old Sarasota High School Building. I am really pleased to be opposite such a great Sarasota landmark, because the old school is now the new home for the Sarasota Museum of Art (SMOA)!

What does this mean for me? Well, I won’t have to go far to see inspiring art. In fact, if you are sitting in my treatment room, you can see a fascinating art installation right on the front lawn of the museum. I thought you might enjoy it as much as I have, so below you can see some of the photos I took with my phone the other day. As you can see by the pictures, this makes giving directions to my clinic very easy…

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I have driven by this exhibit hundreds of times, but actually being able to walk in and around the art, and touch the walls of the structure gave me a whole new personal experience to the art work.  If you live in Sarasota, I highly recommend you take 5 minutes, and stop and do the same.  While you’re at it, stop by my office to say hello!

 

 

 

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Saturday, 24 May 2014 23:44

What is Balance Therapy?

536aa267b3db6.preview-300Generally speaking, balance therapy is a type of physical therapy that is performed to help a person with a balance problem. Different therapists may approach treating a balance problem based on their own background and expertise. For example, a therapist who comes from an orthopedic background and loves treating mainly people with joint and muscle problems, will tend to do what makes their other orthopedic patients better. That is, put the patient on a bike, and give them leg exercises. If the patient’s balance problem is caused by muscle weakness, they will improve.

However, if the problem is not weakness, they will not improve. It is not unusual for me to get a patient for balance therapy in my Sarasota office, and for the patient to say straight out that they don’t think I will be able to help them, because they have had a lot of physical therapy and did not get any better. The next question I ask is, “Well, tell me what you were doing?”, and 9 times out of 10 they will say sitting on a stationary bike and using machines to strengthen their legs. I usually tell that person, well, good, I am glad to hear that the exercises I have in mind you haven’t done before, so there is still a chance that you will get better.

What are these exercises? They include inner ear balance exercises. Our inner ear system is the major organ in our body that powers our balance. It tells our brain when our head or body is moving, so that the brain can tell the joints and muscles how to move to maintain balance. A classic inner ear exercise is to improve the vestibular-ocular reflex, or VOR. This is a reflex between the ears, the eyes, and the brain. Just to explain it a bit… If a person looks at a target and moves their head side to side, they are stimulating their VOR. The inner ear sends messages to the brain to tell the brain how far or how fast the person is turning their head, and the brain uses this information to coordinate the person’s eyes on the target while the head is turning. If the VOR was not working properly, then when the person turns their head, instead of keeping their eyes on the target, they would find that they are looking in the direction of the head turn. If the person’s VOR is not working properly, the patient could have complaints of dizziness, and be unsteady when walking, especially if turning their head to look at something to the side. Another exercises involves keeping the head still, but watching a moving target. If you would like to see this exercise demonstrated, click here to check out the segment on falls and balance that I recently did for ABC News 7.

According to the CDC, one out of three adults age 65 or older suffer falls each year.

These are only a couple of examples of exercises that improve one’s balance. I know it may sound complicated, but it makes perfect sense. If you have a good balance physical therapist, they should know these exercises and include it in your program to make your ability to use inner ear information stronger. This is just one example of how working with a qualified balance and vestibular therapist, and not just someone who went to PT school, can make all the difference. 

Related Article: Trips and falls cause millions of injuries a year

Sitting old man waiting in hall by Abraham van Strij

Sitting old man waiting in hall, by Abraham van Strij

 Medicine and technology are amazing. People who are deaf can get cochlear implants to restore their hearing, while others get corneal implants for their eyes. There are hip and knee replacements for arthritic joints, and the list goes on… If you have in inner ear balance problem, you may be wondering, “When will someone make an implant to restore my balance?"

Well, Dr. Jay Rubinstein from the University of Washington is definitely one of the researchers in the know. A few years ago, I met Dr. Rubinstein at a University of Colorado ENT meeting. At that time, he was reporting on his early results from implanting human subjects with his vestibular device. When I saw him again in February 2014, he was kind enough to give me an update.

His first studies were done on rhesus monkeys that had healthy inner ear systems with intact hearing and balance function. In order to start testing the device on human subjects, the device needed approval from the Food and Drug Administration (FDA), and the study had to pass strict scrutiny by an institutional review board (IRB) to prove that the research was ethical and would not harm the subjects involved. Dr. Rubinstein had to find a population of people who from a hearing and balance point of view had nothing to lose and everything to gain by participating in the study.

The first group of 4 people to be implanted had a condition called Meniere’s Disease. These patients had already lost their hearing and vestibular function (inner ear balance control) due to Meniere’s Disease before they were implanted. He has now been following these initial patients for one to three years. Because the device can be turned on and off, Dr. Rubinstein compared how the device benefits the person’s balance control, and also how the device improves the ability of the person to stabilize their vision and decrease the visual bouncing phenomenon called Oscillopsia. Oscillopsia is kind of like the effect one would get if watching an amateur video that someone took as they were walking down the street. It looks as if the world is bouncing. One goal of the implant is that by restoring inner ear function, the oscillopsia would stop.

So you must be wondering, what did he find? Dr. Rubinstein found that over time, the electrical response from the device declined. Based on these findings, he adapted the vestibular implant to make the responses generated more robust.

Sounds great, right? But not so fast. Because research on human subjects is very, very regulated, Dr. Rubinstein has to go back to the FDA to get the new device approved, and then has to submit a whole new IRB research protocol for approval! Once that hurdle is jumped, the next hurdle is funding. As you can imagine, this type of research is very expensive and takes a lot of money…

So you see, research takes perseverance. Dr. Rubinstein certainly has that! I am very grateful that he took the time to talk with me, and has allowed me to share these things with you! I told him that my patients are always asking me when there will be a cure for their problem, and I tell them – “they’re working on it...” Truly, hope is on the horizon.

Wednesday, 07 May 2014 17:24

Equinox Physical Therapy on ABC 7 News

Breaking long

Breaking News! Hi, Everyone. I was just interviewed for a segment on Balance by Alix Redmonde from ABC News 7. For those of you who live in the Sarasota/Tampa area, you can check out the segment tonight during the prime time evening news. Alix says the segment should run at 5:40 pm, although sometimes the health segments can be shown at 5:30 pm. If you are around, check it out!

Cliff near Dieppe 1985 Paul Gauguin

Cliff near Dieppe 1985, Paul Gauguin

Vertigo, Dizziness, and Dysequilibrium. These words mean different things to different people. However, if you are using these words in the medical sense of things, understanding the definition will help you communicate more precisely when talking with your doctor or physical therapist.

VERTIGO is a spinning sensation, either that you are still and the world is spinning, or that the world is still but you are spinning. If things aren’t spinning, then saying you have vertigo is not quite right.

DIZZINESS has to do with a funny feeling in the head, but nothing is spinning.

DYSEQUILIBRIUM has nothing to do with dizziness, or vertigo. People with dyequilibrium have no dizziness or vertigo, but they are unsteady walking.

Hopefully these definitions will help you in explaining your symptoms!

Tuesday, 22 April 2014 20:29

Crystals in the ears?

crystal

Crystal, 1921 Watercolor by Paul Klee

My physical therapy clinic in Sarasota, Florida sees many patients who are surprised to learn that they have crystals in their ears, and yes, they are supposed to be there! The crystals are made of calcium carbonate, and are called otoconia. Under an electron microscope they look like little grains of rice.

The crystals sit on top of the nerve cells in the ear. The purpose of these crystals is to help stimulate the nerve when the inner ear fluid whooshes over the nerve in response to movement. However, if these crystals come loose and start floating in the ear canals where they don’t belong, this can trigger vertigo.

Vertigo is a sensation that the world is spinning around you, or that the world is still but you are spinning. The name of the condition is Benign Paroxysmal Positional Vertigo (BPPV). The vertigo sensation is triggered by motion, and it usually lasts just a few seconds. Treatment for this problem consists of maneuvers to guide the crystals back into the part of the ear where they belong.

Once there, we want the crystals to sink back into a jelly-like matrix on top of the nerve cells, so that they stick in place and stay where they belong. Once back in place, life returns to normal, and the vertigo episodes cease.

Thursday, 03 April 2014 15:20

Will my vertigo come back?

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My Eyes in the Time of Apparition, 1913. By August Natterer

This is one on the most frequent questions that my patients in Sarasota, Florida ask me, “Will my vertigo come back?” It is the question they usually ask right after I tell them that their BPPV (Benign Paroxysmal Positional Vertigo) was successfully treated, and is now gone. Research tells us that in about 40% of cases, the condition will come back. Sometimes it can come back within a year, other times the person can go for many years before the condition returns.

The next question is usually, “Is there anything I should avoid doing so that the vertigo doesn’t return?” There is nothing that the person does that makes it come back, it just does. So in that case, I tell my Sarasota BPPV patients that they should go back to life as normal. That means sleeping flat like they normally did before all this started, and to resume all their normal every day activities. This includes bending over, for example to pick something up off the ground, or tipping their head back as they would to reach over head.

If the condition does return, the person will just need to call and come back to therapy to have treatments to put the crystals back in place again. Knowing that they have a plan of what to do if the BPPV returns, usually takes the fear away, and allows the person to go on with their lives- which is the goal after all…

This is a frequent question that many of my patients ask me. Antivert, Meclizine, Bonine, and Dramamine are all drugs that can be bought over the counter to treat dizziness. But the question is, when should a person take these drugs?

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To answer this question, one must first understand how these medications work. These drugs decrease or prevent dizziness, by blocking signals FROM the inner ear TO the brain. If a person is having a full blown vertigo attack, these drugs may be necessary, and may be prescribed by your doctor. However, once the attack is over, continuing to take these medications can interfere with one’s recovery.

For instance, when a person comes to physical therapy to treat an inner ear disorder, the purpose of the therapy is to teach the brain how to respond better to inner ear signals in order to improve one’s balance and decrease one’s dizziness. In other words, we want the inner ear to be able to send signals to the brain, so that the brain can learn how to adjust and use inner ear information again.

If a person is taking one of these drugs, then the medication is actually blocking the very signals that the brain needs in order for the person to get better. Therefore, in most cases, it is not advised to take these medications. In fact when used chronically, these medications can actually prevent or delay recovery.

*Disclaimer: The above recommendations reflect basic treatment philosophy when working with patients with inner ear disorders. Since physical therapists do not dispense medications, further specific questions about your medication regimen should be directed to your personal physician.

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Dr. Laura Wazen

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Listen. Listening is the most important step in understanding a patient’s concern. It is the most basic beginning, and in health care today, so often undervalued. It directs understanding, direction of testing, and formulation of a plan. It is the most important step in paving the road to treatment and recovery.

Learn. My role is not only to learn from my patients, but to guide them in how to learn from me, what they should do to take back their lives and create positive change.

Live. Life is a gift. The purpose of all treatment at Equinox Physical Therapy is to restore function, independence, and freedom to clients recovering from or living with an illness.

Vertigo

Dizziness

BPPV

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