BPPV and Christmas TreesIt’s that time a year for the annual trip to the Christmas tree lot. When a person has Benign Paroxysmal Positional Vertigo (BPPV), bending the head down, or tipping the head back, can trigger a vertigo spell. It goes without saying, that if you are standing on a ladder and reaching overhead to hang something on a tree, you definitely don’t want the world to spin!

So this is a tip for those with holiday cheer and vertigo, let someone else do the ladders, and the reaching overhead and bending over! If you have positional vertigo, aim for the ornaments in the middle of the tree where you can keep your head level. This way you won’t have to worry about triggering the vertigo, and potentially falling and getting hurt during the holiday session. Or, if you live alone, you could get a smaller tree this year that is 3 feet tall, and place it on a small table so that you can decorate it without having to tip you head back or bend over too much…

For those of you with balance problems or BPPV, give yourself the present you deserve, and go and see a trained vestibular specialist and get treated for your problem. That would be the best present of all!

Happy Holidays! - Dr. Laura Wazen, Equinox Physical Therapy 941-404-4567

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Money MattersMoney Matters (Selected Part of Letters from Aunt Evelyn), conceptual art by Barton Lidice Benes, 1982.


This is an article that I thought I would never write. When I first started working as a physical therapist, I worked for a big hospital in Manhattan. I never had to think about insurance, because basically the hospital accepted every type of insurance there was! In fact, these were the days when there was no such thing as a co-payment. When co-pays did come along, for many years the hospital never attempted to collect the 5 to 10 dollars per visit. But that was 17 years ago, and a lot has changed now.

Things really started to change after Obama care. I not saying that I am either for or against Obama care, I am just saying that things are very different now. For example, in order to have insurance, many families are choosing insurance where the deductible is 5 to 6 thousand dollars per year! This means that the patient has to pay the first 5 or 6 thousand dollars in medical services, thus meeting their deductible, before their physical therapy services are covered. In addition, the person usually has a co-pay required at each physical therapy session, which can be as high as 50 to 75 dollars per visit with some plans. Take the time to consider these factors when choosing your insurance needs.

At Equinox Physical Therapy, we check a patient’s insurance benefits before they even arrive for their first visit. I am a standard Medicare Part B provider for out-patient physical therapy services. That means that I accept standard Medicare Part B because I am committed to treating people over 65 years of age who have balance problems, dizziness, vertigo, falls, inner ear problems, concussion, or facial paralysis. I don’t want my Medicare patients to fall and break a hip, when I know that I can help them to enjoy their retirement in sunny Sarasota, Florida, and live a long and healthy life! Medicare pays 80% for out patient physical therapy services, and most people have a secondary insurance that covers all or part of the remaining 20% of the bill.

As far as other types of insurance, I see patients who do not have Medicare, but some other type of insurance, and in these cases I am classified as an “out-of-network” physical therapy provider. Because I am not a major hospital, I cannot accept every insurance under the sun, because it would be too much for my small practice to manage.

Why would someone come to me, an out-of-network provider, when they could see someone in-network instead? That should be your next question. The reasons are probably many. When I see a private insurance patient, they pay me, and then I give them the papers they need to submit their physical therapy bills to their insurance company. Then, their insurance company will reimburse the patient directly for whatever their out-of-network physical therapy benefits are. The patient calls their insurance company to verify their benefits before they even step inside my door. They know exactly the percentage that their insurance company will reimburse them, and the percentage that they will have to pay of the remaining bill.

Again, why would someone come to me instead of going to his or her “in-network” provider? For one thing, many of these patients have BPPV, a condition that causes vertigo and seriously interferes with their ability to work, or function properly. With this condition, it usually goes away if treated properly in 2-6 sessions. So, it is not such a big expense to come see me. If they have a big deductible, they will have to pay either way. At least if they come to see me, they know they are being seen by someone who treats this problem 3-4 times a day, as opposed to someone who has little experience, or only treats this problem occasionally. For patients with conditions that take longer to treat, they come to me because they know that their chances of having a good outcome are enhanced if they have the best possible therapist that their money can buy, because again, they still have to pay the large deductible either way. Other patients come to me because I am a specialist in treating inner ear disorders, concussion, falls, dizziness, and facial paralysis, and their “in-network” therapists are not.

Another point to consider is the co-payment. Because I am out of network, I do not collect a co-payment. For those patients whose co-payments are 50 to 75 dollars per visit, the difference between their co-payment and what they have to pay me may be the same, or not much more.

If you are considering going out of network for your out-patient physical therapy services, here are a list a questions that you should ask your insurance company to help you decide if going out of network is right for you or your loved one. One thing to remember is that you, the patient, have the right to receive services from any physical therapist you choose.

TOP 4 QUESTIONS REGARDING OUT-OF-NETWORK PHYSICAL THERAPY BENEFITS

1. Do I have out-of-network physical therapy benefits? If not, what does that mean?
2. Am I eligible to receive direct reimbursement from the insurance company for my physical therapy visits?
3. What percentage of the money I paid at my physical therapy visit will you, the insurance company, reimburse?
4. Do I have an out-of-network deductible to meet first?

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VertigoProspective Chromatique, Abstract art by Martha Boto 1972

Several years ago I was working at a hospital in Manhattan, and I was trying to get a patient out of bed. They didn’t want to get up, or do their exercises, even though that was what they needed to do to get better. I remember the patient, because I was working on the open heart surgery floor at the time. The patient got really mad, and demanded to know how I could I possibly help them, because I had not had open heart surgery and therefore didn’t know what they were going through.

Thank goodness for all the physical therapists, doctors, and nurses in this world that we do not need to have every disorder there is under the sun before we can help patients! Yet, I understand how the patient feels at the same time. Sometimes it is comforting to know that you are not the only one who knows what it feels like to have a condition. My vertigo patients sometimes ask if I have had vertigo. Luckily, I have not, but I work with people who have vertigo every day. One of my patients offered to tell her story of how vertigo and BPPV was affecting her life. I hope her story helps those of you out there who do not know someone with vertigo, and that it gives you comfort that you are not alone, and that there is hope that things can get better.

 

 

 

Published in Blog
Monday, 13 July 2015 19:02

Vertigo- What’s it like?

Flying PeopleFlying People by Karel Appel, 1971

 

From a medical terminology stand point, vertigo is the sensation that the world is spinning around you, or that the world is still and you are spinning. But what’s it really like?

From a personal standpoint, everyone experiences vertigo differently. I have had many patients who seem to have a mild case, and find it to be mainly an annoyance. In the case of BPPV (Benign Paroxysmal Positional Vertigo), there are some patients who only experience the spinning when getting in and out of bed, and since the spinning only lasts less than a minute, the person finds it to be more of a nuisance than anything else.

I have also had patients who complain of dizziness and imbalance only (not a spinning sensation), and then when I test them for BPPV it turns out they have BPPV after all. There have even been times when the nystagmus (spinning of the eyes) is extremely strong, and the patient denies feeling dizziness or spinning at all!

On the other hand, I have some BPPV patients who have an incredibly strong case of BPPV, and the vertigo sensation feels incredibly violent and awful. Sometimes it causes nausea, and can be very frightening. One of my new BPPV patients last week had such a strong sensation of spinning that she said she would rather get her other hip replaced than have to have vertigo again. She felt like she could control her pain with a hip replacement, but she couldn’t control her vertigo.

I have also had BPPV patients who are so afraid of their vertigo, that they don’t want to do the repositioning maneuver because they might feel the spinning again. Of course, this is not a logical or viable option, because if they don’t get treated they are very likely to have continued vertigo, but if they do get treated they are very likely to make the vertigo stop. What would you choose? So far, no one has refused treatment once they really understand that this is their best alternative. 

Luckily for those with BPPV, the vertigo only lasts for seconds. And again, luckily for BPPV, most people respond to the repositioning maneuvers, and we are able to stop their vertigo.

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Le Golf PaintingPainting: Le golf by Emilio Grau Sala, 1961

BPPV hit the international stage this last week at the 2015 US Open Golf Tournament in Chambers Bay when Australian golfer Jason Day suffered an attack of vertigo and fell to the ground. It’s not every day that people all over the world are talking about and witnessing the debilitating effects of a vertigo attack...


I have been surfing the net, looking at the video footage, and listening to and reading the various commentaries that people are posting. The bottom line is that BPPV is a real drag, and it is horrible in general, but especially difficult if you are trying to play golf. Why do I say that? It is because we know that head or body motions trigger BPPV. The crystals in the inner ear become out of place, and when we bend over, tip our head down or back, or turn quickly, it can trigger the vertigo. Needless to say, it is pretty difficult to play golf without bending over or turning your head quickly, not to mention playing championship level golf and competing with people who are not having this problem.


The good news is that BPPV can be treated! Living in South Florida, I treat a lot of golfers who have this condition. All they want is for the vertigo to go away so that they can get back on the golf course. My BPPV patients in Sarasota, Florida couldn’t stop talking about Jason Day, because they knew how he felt, and hoped that this international exposure of the condition might help others understand what they are going through.


The most common treatment for BPPV is a repositioning maneuver where the head is moved in a certain way in order to put the crystals back in the part of the ear where they belong so that the person no longer has vertigo. There are several treatments that will do this, including the Epley Maneuver, Semont Maneuver, or the Foster Maneuver. These 3 treatments are for the Posterior canal. (The inner ear has 3 canals and each canal requires a different treatment). If maneuvers do not work, there is a surgery to occlude the canal where the crystals are floating, but this surgery is only done in the worst of cases and for very few people since most people respond to the repositioning maneuvers. Also, sometimes BPPV goes away on it’s own.


If you are having vertigo, you need the proper diagnosis in order to get the proper cure. Some of the people who were commenting on the Internet were talking about other causes of vertigo, such as Meniere’s Disease, and offering advice on what they do to control their vertigo. The treatments for BPPV and Meniere’s Disease are completely different, and what works to help Meniere’s Disease does not work to treat BPPV (and vice versa). I would recommend that if you are having vertigo, do not take antidotal advise from a layman with no medical training. Go and see an Otologist (an ENT physician who specializes in treating inner ear problems), or a vestibular therapist (a physical therapist who specializes in treating inner ear problems) who can test you for this problem and get down to business in helping you find the correct answer to your problem.

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Thursday, 08 October 2015 12:31

Can People Have BPPV in Both Ears?

Sergey SolomkoBPPV (Benign Paroxysmal Positional Vertigo) is the most common type of inner ear problem, comprising approximately 25% of all inner ear problems. It is caused when crystals in the ear that are supposed to sit on top of the nerve fibers in a jelly like matrix, become loose and start floating in the semi-circular canals of the ear. When this happens, the person can experience a spinning sensation (vertigo) that lasts for seconds and is triggered by changes in head or body position. For instance, it happens when getting in/out of bed, bending over, or tipping your head back.

In answer to the question, “Can people have BPPV in both ears?” the answer is YES. About 40% of people can have it in both ears at the same time. The good news is that if the condition does not go away on its own, it can be treated with maneuvers to guide the crystals back into the part of the ear where they belong.

If you think you have BPPV, I encourage you to find a qualified doctor or physical therapist, who can test to see if BPPV is your problem, and if it is in one ear or both ears. The proper testing leads to the proper treatment, and to the proper cure…

Painting entitled,  A Serious Question, by Sergey Solomko

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Wednesday, 17 December 2014 14:56

BPPV and Christmas Trees- A Holiday Tip

Holiday TipsIt’s that time a year for the annual trip to the Christmas tree lot. Last week I went with my family to find the perfect tree. We walked around and around each tree, trying to find the one that looked just right. We were tipping our head back to look at the top of the tree, and then looking down to examine the bottom of the tree, searching for the perfect shape and height… We looked at so many trees! When we got home, we had to tip our heads back when we reached overhead to pull the tree off the roof of the SUV. Then we carried the bulky, heavy, awkward tree into the house. Once the tree was set up, which was tricky on it’s own, we climbed up and down ladders putting the star on top, not to mention the lights and the ornaments! Then I had to get down on my hands and knees and crawl under the tree to pour a pitcher of water in the container for the tree to drink.

I couldn’t help but think of my balance therapy patients in Sarasota, Florida, and of my patients with positional vertigo (BPPV). I was praying that they weren’t doing the same thing I was doing, and that I wouldn’t come in to work on Monday morning to find out that someone had fallen and gotten hurt.

Can you imagine doing all these things if you had vertigo? When a person has Benign Paroxysmal Positional Vertigo (BPPV), bending the head down, or tipping the head back, can trigger a vertigo spell. It goes without saying, that if you are standing on a ladder and reaching overhead to hang something on a tree, you definitely don’t want the world to spin!

So this is a tip for those with holiday cheer and vertigo, let someone else do the ladders, and the reaching overhead and bending over! If you have positional vertigo, aim for the ornaments in the middle of the tree where you can keep your head level. This way you won’t have to worry about triggering the vertigo, and potentially falling and getting hurt during the holiday session. Or, if you live alone, you could get a smaller tree this year that is 3 feet tall, and place it on a small table so that you can decorate it without having to tip you head back or bend over too much…

And also, for those of you with balance problems and BPPV, give yourself the present you deserve, and go and see a trained vestibular specialist and get treated for your problem, so that you can enjoy all the festivities that this time of year brings, but without the vertigo or imbalance! That would be the best present of all!

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BPPVBPPV is a condition of the inner ear where the crystals in the ear that are supposed to be sitting on top of the nerve fibers become dislodged and start floating in the semi circular canals. When this happens, it can trigger symptoms of vertigo (a spinning sensation), dizziness, or imbalance. Unlike other inner ear symptoms, vertigo caused by BPPV lasts seconds, not for extended minutes, hours or days.

Top 5 Motions that can trigger BPPV listed in no particular order:
1. Vertigo or dizziness when getting in or out of bed.
2. Vertigo or dizziness when rolling over in bed.
3. Vertigo or dizziness when tipping your head back to look overhead.
4. Vertigo or dizziness when bending over.
5. Vertigo or dizziness when moving your head or body quickly.

Motion, 1962  an Abstract Painting by  Ernst Wilhelm Nay

Published in Blog
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.

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Thursday, 03 April 2014 15:20

Will my vertigo come back?

my-eyes-in-the-time-of-apparition-1913

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…

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Dr. Laura Wazen

DSC 1920

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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