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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Woman Tying Her Shoes"Woman Tying Her Shoe", Painting by Pierre-August Renoir, 1918

Do the shoes you are wearing matter when you have a balance problem or a history of falling? The answer to this question is ABSOLUTELY!

I still remember the lady who came to see me for balance therapy in Sarasota, Florida with complaints of falling. She was wearing 5-inch stilettos that didn’t even have an ankle strap! Now I ask you, do you have to be a balance specialist to know that maybe this is not such a good idea?

So what is a good idea?

1. A FLAT shoe is the best, avoid shoes with a high heel if you can tolerate a flatter shoe.

2. A shoe with a flat WIDE HEEL is better than a small pointy heel. The wide heel provides a more stable foundation when shifting your weight.

3. NO FLIP FLOPS or SLIDE style shoes. These loose shoes can cause a trip and fall.

4. A shoe with a SNUG FIT around the HEEL is important.

5. STRAPS or LACES that tighten- Don’t just slide your feet in and out of your shoes. If they have Velcro straps or laces, use them to make your shoe secure. Ankle straps should fit snuggly.

6. For people with peripheral neuropathy, avoid shoes that are too cushioning as they decrease your already limited ability to feel the ground.

7. Make sure that your toes are comfortable in the shoe, as you use your toes to stabilize your balance.

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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.

Published in Blog
Wednesday, 03 June 2015 14:41

How to Fix Vertigo at Home

Carpenter Oil PaintingCarpenter, Oil Painting by Kazimir Malevich, 1927 
 
If you search the Internet, you will see many articles and videos about how to treat yourself at home. Some are good, some aren’t. There is really only one type of vertigo that you can fix at home, and it is called BPPV (Benign Paroxysmal Positional Vertigo).  With this type of vertigo, the spinning sensation lasts for only seconds, and is caused by changes in position such as bending over, getting in or out of bed, or tipping one’s head back.  If a person is experiencing vertigo lasting for minutes to hours, then it is not BPPV but another type of vertigo.  If that’s the case, the person needs to go and see their doctor because doing the maneuvers will not help a bit. 
 
When it comes to the repositioning maneuvers, there are a few.  The most commonly used is the Epley Maneuver, because this treats the posterior canal, which is where the crystals are usually dislodged to in about 75-80% of cases. There is also the anterior canal or the horizontal canal, where BPPV occurs about 10-15% of the time.  Each canal has a different treatment.  For a person looking on the Internet to treat this problem, it is a bit of a crapshoot because first they have to first figure out which ear has the problem, and then which canal has the problem.  
 
Sometimes people have a sense of which ear is affected. If a person gets 
dizzy when tipping their head back and to the side, sometimes they can figure out which ear it is.  For instance, if my dizziness only happens when I look up and to the right, then it is probably the right ear. It is also possible, but less common, to have BPPV in both ears.
 
This week I had a patient who had BPPV over the holiday weekend. She didn’t want to go to the ER, and she didn’t know what to do. She started surfing the Internet, saw some maneuvers on the Internet, and decided that she could do it with the help of her husband. She did not improve, and came to me.  After examining her, I could see that she was doing the wrong maneuver. She had BPPV in the posterior canal, and she was doing treatments for the anterior canal. Needless to say, it didn’t work. Here are some questions my dizzy patients in Sarasota, Florida ask me about doing vertigo treatments at home. I hope the questions help you decide if trying to fix your vertigo at home is right for you.
 
1. Should I try to fix my vertigo at home?  
It’s up to you. Perhaps you will get lucky, and figure out which ear it is and which canal it is. 
 
2.  Can it make it worse?
Yes, there is the chance that what you are doing at home may make it worse.  For instance, if the crystals then move into more than one canal instead of going back where they belong, the person may be even more sensitive to movement than before.    
 
3. Will it hurt me to try the maneuvers on my own at home?  
Doing the maneuvers incorrectly will not cure your problem, but it is not dangerous per se.  BPPV is not the kind of health problem that will kill you, that’s why it is called “Benign”.  If you have a neck problem, you may want to have a professional do the treatment so that you don’t injure you neck accidently.
 
Published in Blog
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

Published in Blog
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!

Published in Blog

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!

Published in Blog
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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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?

dizziness

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

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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