Tuesday, September 18, 2018

Benign Paroxysmal Positional Vertigo (BPPV)

It is day 4 of Balance Awareness Week and we are going to talk about the most common cause of vertigo, Benign Paroxymal Positional Vertigo or BPPV for short.

Me posing with the flamingos which are the mascot for this week.

BPPV is caused when crystals in your ear canal move from there normal spot.

People who have BPPV get brief mild or severe attacks of vertigo. These episodes are hard to predict. Unlike some of the other causes of vertigo there is a test for BPPV called Dix-Hallpike maneuver. Your doctor will also look for abnormal eye movements and ask if you are experiencing a spinning sensation. 

The most common symptom:

  1. Dizziness 
  2. Spinning 
  3. Blurred Vision
  4. Lightheaded
  5. Unsteadiness 
  6. Headache
  7. Loss of Balance
  8. Nausea
  9. Vomiting 
  10. Malaise 

Your doctor may run other tests to rule out other causes of vertigo.

  • Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air.
  • Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

The good news is benign paroxysmal positional vertigo may go away on its own within a few weeks or months. But, to help relieve BPPV sooner, your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.

You can also do something called the Eppley Maneuver at home.

  1. Sit down on a bed or a comfortable sofa
  2. Turn your head 45 degrees to the side of the ear affected with vertigo.
  3. Put a pillow behind you and lie back for 30 seconds so that the pillow is under your shoulders.
  4. Turn your head 90 degrees to the opposite side, but make sure you don’t raise it. Remain in this position for 10 seconds.
  5. Turn your body 90 degrees to the same side you turned your head, but make sure not to change the position of your head while doing so. Remain in this position for 30 seconds.
  6. Start to slowly sit up and bring your head back to its normal position.

There is another treatment that you can also do at home called Semont-Toupet Maneuver.

  1. Sit upright on a flat surface.
  2. Place a pillow behind you and stretch your legs.
  3. Slowly lie down and turn your body to the right side while your head is facing the left side and looking upward.
  4. Change your position so that your body is turned to the left side while your head is facing the right side looking downward.
  5. Return to your normal position with your body sitting straight up while your head is looking forwards.

Also, you can do simple exercises like head rotations. Avoid stress. Head massages can help.Get adequate sleep. Drink water and limit alcohol. Also, ginger and almonds might help in addition to watching your diet and limit your salt intake.

In rare cases surgery may be required.

I hope you are all spin free.

Love, Peace and Light! Rita


Monday, September 17, 2018

Vestibular Migraine 

Simply put a vestibular migraine is vertigo associated migraine.

 It may also be called migraine-associated vertigo (MAV), migrainous vertigo, or migraine-related vestibulopathy.

Migraine is a nervous system disease. Stress and environmental factors may trigger a migraine. 

Symptoms:

  1. Dizziness that lasts more than a few minutes
  2. Nausea and vomiting
  3. Balance problems
  4. Extreme motion sensitivity -- feeling sick or dizzy when you move your head, eyes, or body
  5. Feeling disoriented or confused
  6. Feeling unsteady, like you’re in a rocking boat
  7. Sensitivity to sound

Sometimes there is no pain in a Vestibular Migraine.

Other symptoms may include:

  1. neck pain
  2. discomfort turning, bending down, or looking up
  3. feeling of pressure in the head or the ear
  4. ringing in the ears known as tinnitus
  5. partial or complete loss of vision
  6. visual disturbances, such as flashing lights, spots, or blurring

Once again with so many vestibular and other chronic illnesses the doctors do not know the cause. 

Your doctor, usually a neurologist, will use your history to diagnose VM. 

  1. You have migraines or had them in the past.
  2. You have at least 5 episodes of vertigo that make you feel like you are spinning or moving. This isn’t the same as motion sickness or feeling faint.
  3. These feelings last between 5 minutes to 72 hours.
  4. Your symptoms are moderate to severe. That means they stop you from doing everyday tasks or they’re so bad you can't do anything at all.
  5. At least half of the episodes happen with one of the following migraine symptoms:
  6. A headache that has two of these characteristics: is one-sided, pulsing, moderate to severe, or gets worse with activity
  7. Sensitivity to light or sound
  8. Seeing shimmering or flashing lights in your vision (a migraine aura)

There is no cure but your doctor may prescribe medication to help ease the symptoms. 

  • Triptans
  • Vestibular suppressants 
  • Traditional migraine medications

For more severe cases:

  • Anti-seizure medications
  • Blood pressure medications
  • Tricyclic antidepressants 
  • SSRIs or SNRIs

There are some devices that may give relief.

  • Cefaly
  • SpringTMS or eNeura sTMS
  • gammaCore 

Again figuring out your triggers for the episodes might help some. Common triggers are chocolate, cheese and alcohol.

Tracking your diet may also help determine if your vertigo is related to migraine or another disease such as Ménière’s Disease. For instance a high salt diet can make things worse for MD, but not VM.

While I have migraines and vertigo, dizziness and balance issues I have not been diagnosed with VM. It is possible to have both Vestibular Migraine and Ménière’s Disease. 

Keeping track of your episodes will help your doctor determine your diagnosis.

I hope you are all spin free.

Love, Peace and Light! Rita

 #BAW2018 #BalanceAwareness #MenieresSociety #DefeatDizziness


Sunday, September 16, 2018

Ménière’s Disease 

What is Ménière’s Disease?

  1. Bouts of Vertigo (room spinning)
  2. Hearing loss
  3. Tinnitus 

It’s the unpredictability of the attacks that makes the disease so hard. Usually there aren’t any symptoms (at least that others can see) between attacks. The tinnitus and hearing loss are major symptoms that people may not be noticeable to others.

Many with the disease fear going out, because of the unpredictability of an attack. Holding a conversation can be difficult in crowds or where there’s a lot of background noise. Because of this many people with MD don’t go out where they feel inadequate.

When I first learned I had the disease my prognosis was I would eventually go deaf and have no balance. Now after having spoken with over 900 others with the disease, I know that may not happen for many years or it could happen tomorrow.

Periods of remission are possible. The duration seems to differ for each individual. Mine lasted six years with only tinnitus and minor balance issues.

How is MD diagnosed? Mostly it’s a rule out other things such as a brain tumor or inner ear damage and your history. 

Typically, your doctor will perform a series of basic lab tests, a hearing test, and may consider an imaging study such as an MRI (brain scan) to rule out other causes for the symptoms.

  1. Hearing test
  2. Balance testing: VNG, Rotary tests and a few others.
  3. Test to rule out other causes like MRI.

There is no cure for Ménière’s Disease. There are some things you can do that may help. Medication such as anti-nausea and motion sickness may help. Also diuretics are often prescribed to help with fluid build up in the ear.

Vestibular Therapy can help. And hearing aids are helping some patients. There is also invasive treatments such as steroid and gentamicin injections that help some find relief. Also surgery can be an option.

Still all this will not cure the disease. It will just help make it possible to enjoy life. I got one will continue to enrich my life through music, travel and having fun between episodes.

Love, Peace and Light! Rita

 #BAW2018 #BalanceAwareness #MenieresSociety #DefeatDizziness

Wednesday, September 12, 2018

Mind Over Body

When my symptoms first began, my late husband told me I just had to think positively and I could get better. I felt inadequate when I would still wake up dizzy or sore. (Ménière’s and Fibromyalgia were my biggest foes.)

It’s not a matter of mind over body.

The stress of not being able to think my way to good health made me worse. It wasn’t until I accepted that I had chronic health issues and began to learn what my triggers were that I managed to feel better. Even then my health issues popped up when I least expected. 

Stress is a major trigger for me in all my health issues. With meditation and exercise I learned to get it under control. However, as with everything you must keep up the practice. I haven’t been able to exercise because the vertigo was present daily. Though I can still meditate I often forget. 

Diet is an important part of managing my illnesses, especially since I have food allergies. And the food allergies were triggering the constant vertigo I had for months. Changing my diet eliminated the constant internal vertigo. 

Exercise is something that I need to get back to doing. Especially since I am losing weight the exercise will help continue that process. And a healthy body helps control all manners of illnesses. My doctor was not wrong when he told me to exercise. 

Identifying triggers is another way I can help to control the Ménière’s. Salt is a trigger for me, but only in that my tinnitus will increase in volume if I have too much. It doesn’t seem to trigger episodes of room spinning vertigo. Lights and sounds can trigger vertigo and migraines for me. Other than stress I haven’t figured out any other triggers.

My thoughtful husband bought me blue light filtering glasses which I wear everywhere. Shopping, movies, sporting events or anywhere that lights may trigger vertigo or migraine. I still have to close my eyes and turn my head for strobing or flashing lights. I carry earplugs with me in case noise causes my ears pain. They are handy in crowded places so I can block out background noise. And my cane folds up to fit in my back pack in case I need it. 

Pacing myself is helpful. When I push myself to do too much, I know I will pay for it for a couple of days after, especially with the Fibromyalgia.

Medication can help control the symptoms.

So though maintaining my health isn’t a simple matter of mind over body, using my mind to figure out what helps can. Unfortunately, in my two major complaints symptoms and triggers are different for everyone.


Monday, September 10, 2018

Vestibular Disorders

This is balance awareness week and I’m going to take some time discussing them. Since I have Ménière’s Disease this is the one that I speak about the most, but there are other types of inner ear dysfunctions. Too many for us to discuss in detail during the week. I have found some great information at vestibular.org

The most common vestibular disorders include benign paroxysmal positional vertigo (BPPV), labyrinthitis or vestibular neuritis, Ménière’s disease, and secondary endolymphatic hydrops. There are other things that account for dizziness including acoustic neuroma, migraine-associated vertigo, and mal de débarquement. Also complications from aging, autoimmune disorders, and allergies can cause vestibular issues.

Many of these present similar symptoms making it difficult to diagnose. Or more often than not there may be overlap between the types of vestibular issues and there causes. For instance I have migraines, an autoimmune disease and allergies which can exacerbate or contribute to my Ménière’s symptoms. 

During this week I will try to cover some of the basic symptoms of each disorder. You will find there is a lot of overlap.

Uncertainty 

How Long Will This Keep Going On?

Though I changed the words, Van Morrison’s song is playing in my mind. Every time a mini-spin hits, I ask that question. I almost wish for a full blown episode that will last for a few hours, leave me as wobbly as a newborn foal for a couple of days. 

The face of MD between episodes of mini-spins. 

I woke up this morning to a mini-spin. And though I fought it becoming a full blown vertigo episode, I can’t help but wonder if it would be quicker to have one. This is day two of mini-spins. Day 2 of a full blown vertigo attack would just leave me exhausted. Instead I am paralyzed with fear that if I do anything that doesn’t involve my bed or recliner, I’ll fall. 

It’s not as if falling is that frightening, I mean I do it all the time. Sometimes through my own clumsiness, but sometimes totally out of the blue. I can be walking and down I go. Nothing tripping me, not my carelessness, nothing causing it. I used to think it was my ankle not doing it’s job. Now I think it’s a drop attack. Maybe not Ménière’s related, since I’ve had them since junior high. 

I haven’t fallen during these mini-spins, but I am becoming intimate with my walls and door jambs. While mini-spins are easier to navigate, they are more unsettling than the full on vertigo attack. At least with the latter you know you can’t do anything. 

Between mini-spins you think maybe I can just do this or that, but then the next wave hits when you least expect it. Oh and it drains you as if you were in the big one. I slept quite a bit during my attack yesterday. My muscles are aching. I still feel exhausted. 

I know this will pass, but after a bit of time with only being unbalanced, I was hoping it would continue. I was in remission for 6 years... I guess I expect the good days to continue. I will try to smile my way through this. Maybe it will convince my brain there is nothing wrong, but how do you convince your inner ear when it has constant tinnitus and it’s been screaming since yesterday. 

I can be thankful that while I have nausea, I rarely vomit. Unfortunately, I rarely lose my appetite either. Others have it much worse than me. 

I don’t know what stage I’m in... if the stages are truly what happens. As far as I can tell from our large group of MD warriors, nothing is certain with this disease. (Ménière’s Worldwide) We battle this disease filled with uncertainty everyday. Trying to live our lives, choosing what battles to fight and when we should go to war with our disease. Sometimes we loose, but we pick ourselves back up and try again. 

There is so much positivity that flows from the people in Ménière’s Worldwide that it encourages me to keep on going. Those around us may not get it, but the nearly 900 in the group gets it and it’s so heartening to know they do. Though I wish none of them had this disease or similar diseases. 

I am rambling so I’ll leave you now. Be spin free!

Love, Peace and Light! Rita

PS. With Balance Awareness week coming up, I may be posting more about it. September 16-20.

Thursday, September 6, 2018

The Results Are In

The good news is no cancer. I had my follow up for my endoscopy yesterday. My esophagus and stomach are inflamed, which I knew. My ulcer is back or another formed in my esophagus, which doesn’t surprise me as I was throwing up so much. All that stomach acid is harsh. So, bland diet it is and through the holidays. Bleh.

Wheat and Cow’s milk are my worst allergies, so definitely no cheating. The others are less severe, but the doctor said to continue to avoid them. I was hoping that I could get some leeway. She said I was only tested for the most common allergies so if something I eat doesn’t agree with me, stop eating it too. 

It’s a shame since I know I have trouble digesting beef. I love beef... Maybe I’m allergic to the whole cow.

Chicken and fish will be my main stays until my next endoscopy in December. I feel better since I began my allergen free diet about a month ago. So, I may be on a healing path already.

There is a bright side to my new diet... I didn’t gain weight on the cruise. 

I usually gain about 3-5 ponds.)


Stay healthy my friends. I hope you are spin free.

Love, Peace and Light! Rita