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.

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
Wednesday, 22 April 2015 13:45

Fall Alert Buttons

IcarusWho can forget the commercial when fall alert buttons first came out,where the individual is lying on the floor and yells out “HELP! HELP! I’ve fallen and I can’t get up!” I do not want to make light of the situation, because being in such a vulnerable situation is awful. I know, because I once dislocated my kneecap when playing with my dog in the front yard. I didn’t have my cell phone, and I was on the only one home at the time, and I had to lie there for a half hour before some stranger walked by who could get me the help I needed.

Many times when an older person lives alone and has started to have some falls, the kids who lives out of state starts trying to get their mom or dad to get a fall alert button. It is hopefully a back up plan that they will never need to use.

When the emergency call buttons first came out, they worked through your phone. Back in the day, this was what we now call your “land line”. It meant that you had to be within 200-300 feet of the phone in order for it to work. You can still get this kind today, but I don’t recommend them. When one patient of mine from Sarasota, Florida, fell in her yard when gardening, she was too far away from the phone for it to work.

These days, there are fall alert devices that work via GPS. That means you could be anywhere, push the button, and they would find you! One of my “snow bird” patients who went back up to Maine for the summer pushed the button just to see if they would answer, and they did!

Another one of my patients fell when stepping off the curb on the way home from the theatre one night. He is a huge 6-foot tall 250 lb man, with an itsy, bitsy wife, and she was not able to help him up. All she had to do was push the button, and the paramedics knew where to find him. She didn’t have to figure out what address she was at, fiddle in her purse to find her cell phone, or risk hurting herself trying to help him up. She just had to push the button that was hanging around his neck.

So the gist of the message is that even fall alert devices are using GPS technology, and you might as well take advantage of good technology that could really save your life. The best way to compare the different plans is to do a Google search for “GPS Fall Alert Buttons”, and check out what comes up.

Painting: The Fall of Icarus- Marc Chagall, 1975.

 

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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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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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