Washington - March 27, 2009. I was fine the night before. The cold I’d had was gone, and I’d had the first good night’s sleep all week. But when I woke up at 6.15am and got out of bed, the world was whirling counterclockwise.
I knocked against the bookcase, stumbled through the bathroom doorway and landed on my knees. It was as though I’d been tripped by a ghost lurking beside the bed.
Even when I was on all fours, the spinning didn’t stop. Lightheaded, reaching for solid support, I made it back to bed and told my wife, Beverly: “Something’s wrong.”
The only way I could put on my shirt was to kneel on the floor first. I teetered when I rose. Trying to keep my head still, moving only my eyes, I could feel my back and shoulders tightening. Everything was in motion, out of proportion, unstable. I barely made it to the kitchen for breakfast, concentrating on each step, and when I finally made it there, I felt too aswirl to eat anyway.
Vertigo – the feeling that you or your surroundings are spinning – is a symptom, not a disease. You don’t get a diagnosis of vertigo; instead, you present with vertigo, a hallmark of balance dysfunction. Or with dizziness, a more generalised term referring to a range of off-kilter sensations including wooziness, faintness, unsteadiness, spatial disorientation, a feeling akin to swooning.
It happens to almost everyone: too much to drink or standing too close to the edge of a roof or working out too hard or getting up too fast.
But experts estimate that more than four in 10 of us will experience dizziness some time during our lives that’s significant enough to send us to a doctor.
I remember feeling helpless and untethered, needing to reach out for something stable to steady me, but finding there was too much give in everything I sought.
Vertigo is a carnival world and I was the Human Bumper Car. I was never comfortable or relaxed, never at ease, at home in my world.
But I was not alone. In part, that was because I had the support of my wife and daughter. I was also not alone because, as a study published in the Archives of Internal Medicine in 2009 noted, 35.4 percent of the population aged 40 and older during the four-year study period had some form of vestibular dysfunction – a term that includes vertigo.
When I was struck by vertigo, I had no idea it was such a common occurrence.
Balance
I was also not unfamiliar with balance problems. In 1988, I contracted a virus that targeted my brain and left me neurologically disabled. Besides damage to my memory, abstract reasoning, word-finding and other cognitive powers, my brain’s ability to process information – including information necessary to maintain balance reliably – had been compromised. I’d had to walk with a cane for 15 years.
Human balance is a multi-system operation. “It begins with a series of signals within the tiny balance organs of the inner ear,” according to hearing and balance expert Daniel Sklare. “These organs work with your brain’s visual system to give you a sense of your body’s position.”
Other parts of the body – skin, joints, muscles – also relay balance information to the brain.
All it takes to trigger a balance disorder is a malfunction in one of these delicate components. Researchers have identified more than a dozen different balance disorders.
On that March morning in 2009, my doctor thought my problem was the most common of those disorders, benign paroxysmal positional vertigo, or BPPV.
He explained that “ear rocks” – small deposits of calcium carbonate, probably dislodged by the viral infection I’d caught the week before at the coast – had collected in the inner-ear canals of my right ear.
Such debris, or otoconia, jitters at the least movement and sends all sorts of confusing signals through the balance system. Until it dissolved, I could expect the symptoms to persist. It could last two days or two weeks or two months, he said.
It lasted five months. By the time I’d seen the neurotologist – who spun me in an Omniax system chair, a diagnostic device that looks like a futuristic carnival ride or an apparatus for training astronauts to endure zero gravity – and the neurologist specialising in balance disorders – who sent me for an MRI of the brain and then left for a month’s holiday – and the acupuncturist, who was also a doctor of Chinese medicine, my vertigo had been going on for 138 days.
And it wasn’t BPPV, reasonable though that initial diagnosis seemed.
Beverly and I had gone home and researched it. We watched several YouTube demonstrations of the Particle Repositioning Procedure, or Epley manoeuvre, intended to relocate the otoconia.
I’d lie on our bed with my head turned to the right and dangling dizzily off the edge into Beverly’s hands. After 30 seconds, she shifted my head to the left, waited another 30 seconds and helped me rotate onto my left side, face down, where I looked at her kneecap. When 30 more seconds passed, I slowly sat up and gathered myself for a minute, trying not to puke. Three times a day.
For 69 days. Not that I was counting, but that was 1 656 hours of my life during which I had to walk with a cane; couldn’t drive; could barely endure being a passenger in a moving vehicle; fell in the supermarket while reaching for a package of paper towels; sagged to my knees while trying to walk along the street beside Beverly; couldn’t write or sustain focus on reading; grew lightheaded when tree limbs moved in a breeze or birds changed direction in flight. Through all that time I felt so disembodied, while also feeling trapped inside my body, that I believed I was losing myself hour by hour.
My vertigo had never been benign in any sense of the word; had never been paroxysmal, since it didn’t come and go; had never been a function of position; had involved more than vertigo; and had not been resolved by 207 repetitions of the Epley manoeuvre. As a result, we thought I might not have benign paroxysmal positional vertigo. My doctor agreed.
After weeks of testing – during which I had electrodes stuck deep in my ears, I was barraged by piercing sounds and by air puffed into my ear canals, and I was subjected to jerking/ tilting floor platforms and those crazy loop-the-loops on the Omniax chair – I was given the diagnosis of endolymphatic hydrops.
This condition, a fluctuation of the volume and concentration of fluid in the inner ear, can occur as a result of infection, allergy, tumour, degeneration of the inner ear, head trauma or unknown causes. In my case, the neurotologist thought the cause was a viral endolabyrinthitis – a virus attacking my inner ear. He felt it might be a reactivation of some earlier virus in my system, most likely the herpes zoster I’d contracted in 2002, when I had chickenpox for the first time at age 55.
Since the neurotologist prescribed a potent antiviral drug, I wanted to consult my doctor again before taking the medication. He was sceptical of the diagnosis. After all, besides vertigo I had none of the classic symptoms of endolymphatic hydrops.
Technology and medical science confirmed that I was dizzy. They still didn’t know quite why.
On day 95, I consulted with the neurologist, who talked about strokes in the brain stem and tumours and said, “Let’s have a look, so we can rule things out.” On day 97, I had an MRI of the brain. On day 101, my 62nd birthday and the day before the neurologist was heading off on holiday, he called to say there was no sign of anything worrisome, though there might be a slight area of contact between a blood vessel and nerves of the inner ear.
He thought I was in no danger unless I fell. We’d meet when he returned. He prescribed Valium twice a day to dampen nerve response in case there was contact with a blood vessel.
At 8.09pm of August 12, day 138, Beverly and I were sitting on the couch in our living room. I’d had my ninth acupuncture treatment the day before. I was reading, slowly, when there was a great burst of outward pressure inside my head.
It plugged my ears. I dropped the book, opened my mouth wide, put both hands to my ears. In two seconds, the pressure reversed, vanished.
“Did something happen?” Beverly asked.
Delighted that I could still talk, move both arms and shift position on the couch, I said: “I don’t think it was a stroke.”
She looked at me for several seconds and smiled. “Stand up. I wonder if your vertigo is gone.”
I did. It was.
Twelve days later, when I told the neurologist what had happened and that, except for some residual lightheadedness, the symptoms hadn’t returned, he said: “I’d like to take credit for this, but I don’t think I can.”
The vanishing, he felt, confirmed a theory he’d been considering: intracranial hypertension, a build-up of pressure inside my skull, brought on by a virus. A build-up of viral material in the spinal fluid plugged the holes through which the fluid normally drains. That led to a build-up of fluid and pressure, which caused the symptoms.
“So, it came unplugged on its own?”
“It’s a pretty elegant theory.” He smiled.
The symptoms haven’t returned. It’s been four years, eight months and 10 days. – The Washington Post
* Skloot’s most recent book is Revertigo: An Off-Kilter Memoir.
VERTIGO: THE FACTS
Dizziness is an imprecise term, according to US neurologist Timothy C Hain, of Northwestern University. Vertigo, for example, is a kind of dizziness, as is lightheadedness. Here he explains the conditions as well as the tools used to diagnose and treat them.
What is the difference between dizziness and vertigo?
Vertigo is defined as an illusion of motion. Most of the time, vertigo means a spinning sensation.
Other illusions of motion – falling, rising, accelerating in one direction – are also vertigo, but they are not frequently encountered. Dizziness is a looser term that includes vertigo. Dizziness is a collection of symptoms – vertigo, lightheadedness, imbalance, a sensation that one might pass out.
What are the typical causes of vertigo?
About five percent of the population develops vertigo every year.
Of these, almost half are due to benign paroxysmal positional vertigo (BPPV). BPPV happens when otoconia, tiny crystals of calcium carbonate in the inner ear, detach and collect in one of the inner ear’s semicircular canals.
When a person with BPPV moves his or her head, the otoconia shift, stimulating the cupula (the motion-sensitive region of the inner ear) to send false signals to the brain, producing vertigo.
A smaller number of cases are due to vestibular migraine.
Other causes include vestibular neuritis (a viral infection of the nerve between the ear and brain), and Meniere’s disease (a disorder of the ear with hearing loss, tinnitus, a plugged or full feeling in the affected ear, and episodic vertigo, which keeps recurring over decades).
What are some of the diagnostic tools you use for dizziness-related problems?
For vertigo, we commonly use the audiogram (a hearing test), the video electronystagmography test (a test of eye movement) and the rotatory chair test (in which eye movements are recorded while a patient sits in a chair that spins slowly).
What are some of the most effective treatments?
For BPPV, the “canalith repositioning manoeuvre” – a series of head position changes that resettle the otoconia – is very effective. A single treatment (often done the same day the diagnosis is made) cures BPPV about 75 percent of the time.
However, it does tend to come back – with about a 30 percent chance of another bout within a year from the time it first occurred.
Treatment of vertigo caused by migraine takes longer. Usually we start with lifestyle changes, including diet, and if this does not succeed, we move on to preventive medications such as nortriptyline, verapamil or topiramate.
These take about a month to work. Sometimes one must try several types before finding one that works.
With vestibular neuritis (a disorder that affects the nerve of the inner ear), usually the person is back to their usual activities by two weeks.
Treatment usually is just waiting for it to improve, combined with exercises.
For Meniere’s disease, treatment involves diet, a few medications and emergency medications for acute attacks.
If this is not successful, then there is a very successful treatment involving injection of gentamicin into the middle ear, which stops vertigo spells 85 percent of the time.
This treatment, unfortunately, does some damage to the ear.
At what point should a person see a specialist for dizzy spells?
Specialists for dizziness are best seen after it is clear that the dizziness is persistent and significant. Often people attempt to wait it out for a week, and often this is a successful strategy.
They will often discuss the problem with their regular doctor, who can often manage their symptoms successfully with a combination of vestibular suppressant medication (such as meclizine), and sometimes also medications for nausea (such as ondansetron) or anxiety. – The Washington Post