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Product Details
| ISBN-13: | 9781945188282 |
|---|---|
| Publisher: | Bull Publishing Company |
| Publication date: | 01/08/2019 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 200 |
| Sales rank: | 944,738 |
| File size: | 7 MB |
About the Author
Read an Excerpt
CHAPTER 1
An Introduction to Benign Paroxysmal Positional Vertigo (BPPV)
"There was no reason for trouble to start. I was sitting in a restaurant in Maui, chased indoors by heavy rains, looking forward to lunch and a piña colada. No sooner had the food arrived, without any warning, I suddenly felt a horrible twisting inside my head. I felt like I was being pulled out of my chair to the side and flipped over all at the same time. I grabbed the chair seat with both hands and managed to keep from falling off of the chair onto the restaurant floor. I looked around the restaurant and no one else seemed to be acting unusual. Nothing was moving except inside my head. The spinning stopped about 15 minutes later, returned briefly a few days later, and then disappeared for four months. But then it started to come back often and lasted 30 minutes, an hour, several hours at a time. Gradually, it was happening almost every day. During the worse spells, I could see the room shifting about me, and I noticed odd sounds and feelings in one ear, including roaring noises, clanking, and a sensation of stuffiness.
After a year of this torture, something new happened. One morning, when I rolled over in bed toward the bad ear, it felt like the room began to spin intensely. It was more violent than any of the prior spells but stopped after about 30 seconds. Trying to get out of bed set it off again, however, so I was only able to get out of bed when I moved very slowly. That morning, I went to see an ENT I had worked with previously, and he diagnosed Benign Paroxysmal Positional Vertigo (BPPV), but he also expressed concern that I had more going on in the bad ear than just BPPV. After experiencing months of BPPV spells and the daily vertigo, I had begun to lose hearing in the bad ear and was ultimately diagnosed with Meniere's disease.
My Vertigo Journey and the Half Somersault
At that moment, when I experienced vertigo on Maui, my entire life shifted and it would never be the same again. It was especially cruel because I was a physician, trained in otolaryngology, the field that deals with vertigo, so I had treated many people with these vertigo disorders and knew from my clinical experience just how horrible these disorders could be. There weren't many treatments that seemed to help, and I had witnessed the sufferers coming in again and again seeking help in their misery. Now I was one of them.
Over the next few years, I suffered from severe vertigo (a disease called Meniere's disease) until I was rescued by my residency mentor, Dr. Jeff Harris, who finally cut the nerve to my bad ear so it could no longer make me spin. What I had learned about vertigo as a physician didn't come close to matching what I learned from personally experiencing it. It was much, much worse than I ever imagined before it happened to me, and it became my life's mission to help as many other people with vertigo as possible. To that end, I did a fellowship in neuro-otology at UCLA with Dr. Robert Baloh and Dr. Vicente Honrubia, who had written a key textbook on vertigo disorders and taught me all the latest knowledge of vestibular diseases.
I moved to the University of Colorado in 1994 and began treating dizziness and imbalance. One of the most common dizziness problems was positional vertigo (dizziness in certain head positions), and I tested every patient for this. At the time, very few people in Colorado knew that it was most often a small mechanical problem involving crystals in the ears and could usually be treated with a simple maneuver. Over the years, I first saw hundreds, and eventually thousands, of sufferers and conducted the treatment maneuver and its variations many thousands of times. The ability to relieve an awful disease using your bare hands is so very unusual in medicine, and I enjoyed doing it as much as my patients loved being helped. There was one problem with this kind of positional vertigo, though: Even though it can often be cured by a simple maneuver, it can also easily happen again. Many patients would ultimately need another treatment, some would need to be treated over and over. I tried giving patients various maneuvers as home exercises to cure recurrences, but patients still returned because the home maneuvers did not help them enough. After more than a decade of seeking, I hadn't found the perfect home treatment. That changed in 2006, when I discovered the Half Somersault maneuver.
The discovery was serendipitous. I was getting up one morning to go to work and treat people in my vertigo clinic. When I rolled over in bed, I suddenly developed positional vertigo in my "good" ear. This had never happened to me before, and I knew it meant that I had dislocated some crystals into the wrong part of my ear. I tried to do the usual office maneuvers and ended up getting the crystals into other places in my ear that caused even more severe vertigo. I crawled back into bed with a bucket in case I got sick and tried to figure out an alternative. Using my fingers as rings I constructed a little model of the inner ear and moved it around to see if there was a way to remove the crystals more easily. After a few minutes I realized that a modified somersault position should work. I got down on the floor and did the Half Somersault maneuver for the first time. I arose completely free of vertigo.
Naturally, I added this exercise to the others I was already "prescribing" as home treatments. Patients that took the other exercises home often came back with recurrences, but those using the Half Somersault did not. This led me to assemble a team to perform a study of the new exercise. Our evidence-based research paper showing the effectiveness of the Half Somersault was published in 2012, and since then millions of people have downloaded videos and handouts of the exercise for home use.
What Is Benign Paroxysmal Positional Vertigo (BPPV)?
The most common vertigo disorder is Benign Paroxysmal Positional Vertigo, which we commonly refer to as BPPV. Although there are many ailments that cause vertigo, it is only this particular disorder — BPPV — that can be relieved using simple maneuvers. BPPV does not require surgery, medications, or prolonged physical therapy to treat; in most people, the vertigo caused by BPPV can be stopped in a matter of minutes. In BPPV, heavy crystals that are normally used by the ear to detect the pull of gravity accidentally fall into one of the spinning sensors of the inner ear. By placing the head in just the right position, the crystals can be shaken back out, restoring normal function and ending the symptoms of vertigo almost instantly.
The typical symptoms of BPPV are easy to recognize: The world spins briefly when you make certain rapid head movements. The vertigo can be severe enough to cause nausea and vomiting. Most BPPV spells occur around bedtime or when you are getting out of bed in the morning and improve once you are upright. However, some people continue to feel mildly off balance during the day. Hearing is not affected by this disorder. While most forms of BPPV cause this relatively mild pattern of vertigo, there are some forms of BPPV that cause more severe and prolonged vertigo (I cover these forms later in this book).
BPPV can occur in children, but the number of people with symptoms begins to rise steadily with age starting around age 30, and by age 60 about 10% of people experience this vertigo. Overall, more than two people out of every hundred will experience BPPV during their lifetimes; of more than 7 billion people on earth, this means over 150 million already have or will one day experience this disease. Women are twice as likely to get BPPV as men.
How Do I Know if I Have BPPV?
The key symptoms of BPPV are very short spells of vertigo — less than a minute long — that are brought on by head movement. Spells are more likely to happen around bedtime than during the day, and are brought on by rolling over in bed, lying down in bed, or arising quickly from a lying down position. Tipping the head up, as you might do when reaching up to a top shelf or screwing in an overhead bulb, can set it off. I created this book to be a resource and a tool for people to figure out if they have BPPV and potentially treat themselves at home. The flow chart in Figure 1.1 will help you decide if your symptoms of dizziness are due to BPPV.
Treatment for BPPV and How to Use This Book
BPPV is a mechanical disorder of the ear, and therefore it is treated mechanically with maneuvers that involve certain head positions. Fortunately, there is no pain during treatment, but it does stir up the dizziness briefly. Medications can be used to reduce this dizziness while the maneuvers are done, but there are no medications that "cure" BPPV.
In the century since it was first identified, physicians learned early on that moving the head sometimes resolved the dizziness stemming from BPPV. However, it was only a few decades ago that the first "instant" treatments were created — the Epley and (later) the Semont maneuvers. These maneuvers (named after the physicians that popularized them) are usually performed by trained providers such as a physician, audiologist, or physical therapist. The Epley maneuver and the Semont maneuver are covered in detail in Chapter 10, "Maneuvers Performed by a Provider." As this book is a tool for people to potentially treat their BPPV at home, most readers who pick up this book will no doubt be looking for an easy home remedy for their symptoms. To that end, Chapter 7, "The Half Somersault Maneuver," and Chapter 8, "Variations on the Half Somersault Maneuver," cover the Half Somersault maneuver, which I developed in my own medical practice, and its variations. These exercises are intended for home treatment. Over the years, researchers have continued to learn about less common varieties of BPPV and have devised new maneuvers for these specific variations. These treatments, which are usually performed by trained therapists, are found in Chapter 9, "Unusual Forms of BPPV."
Understanding the process that results in vertigo spells depends on knowing the anatomy and physiology of the vestibular system — the sensors, brain pathways, and reflexes that control balance and sense motion. The next chapter introduces the key anatomy and also introduces the discoveries that gradually allowed physicians to find out what caused BPPV and to find ways to treat it.
CHAPTER 2The History of BPPV
"In the early hours of the morning, you snuggle half-asleep into the blankets and begin to roll over, as you have safely done countless times before, but this time something suddenly goes horribly wrong. You feel an intense twisting and pulling as if your head is flipping in a circle. The feeling intensifies in the next few seconds into a violent, head-over-heels spinning. You feel like you are about to fly off the bed in a spiral, and you struggle to grab a handful of sheets to ground yourself. Your heart is pounding. You open your eyes and the world appears to be spinning so fast it's just a blur. You're vaguely aware that you have just rolled over and you turn your head back to try to undo whatever it was that set off this nightmare. Almost magically, the spinning stops, as if a switch has been shut off.
You lie there perfectly still, afraid to move for fear you will set it all off again. The panic that arrived with the spinning makes you feel shaky, and it's hard to calm down because you don't know what just happened. Are you having a stroke or heart attack? Are you going to pass out? Or worse — is this what death feels like? It doesn't take long to realize, though, that nothing else is happening and that you are not going to faint. You're feeling queasy and decide to get up to visit the bathroom, but as soon as you try to get out of bed, you endure another identical spell that almost flings you back onto the bed. It quickly becomes clear that moving your head triggers the spells. You carefully prop yourself up on a pillow and call for help.
Defining Vertigo and Benign Paroxysmal Positional Vertigo (BPPV)
Although the first attack might convince you that your demise is imminent, you have likely just experienced a type of positional dizziness, a simple mechanical disorder that is one of the most common and least serious forms of vertigo. A number of forms of vertigo, the sensation of whirling and loss of balance, exist (Table 2.1). Vertigo creates an illusion of a spinning motion inside the head when there is no actual head movement going on. The spinning that some little kids like to set off by spinning on their feet and suddenly stopping is a form of vertigo. Two or three people out of a hundred experience at least one attack of positional dizziness during their lifetime, and episodes become more common with aging, eventually affecting up to 10% of the elderly. This type of positional dizziness, and the unusually fast sensation of spinning it produces, isn't fatal and doesn't cause any permanent damage to the ear or brain, but it feels particularly frightening because it is one of the most intense forms of vertigo you can experience.
The disorder that results in the most common form of positional dizziness was originally named benign paroxysmal positional vertigo, but this has fortunately been abbreviated to BPPV. Let's look carefully at the name of this disorder and break it down to learn more about BPPV. While other types of vertigo can be damaging to the balance system, BPPV is benign because this type of vertigo is not associated with hearing loss or damage to the balance system (and is not at all fatal). BPPV is paroxysmal, meaning that it comes in sudden brief spells that last just a few seconds. Most other forms of vertigo last longer, from minutes to days at a time. BPPV is positional, brought on by changes in the position of the head in space, in contrast to other forms of vertigo or dizziness that can come on without any movement of the head at all (see Figure 1.1 on page 6). Finally, BPPV is most assuredly a form of vertigo because it results in an intense feeling of rotation inside the head even when the head is being held perfectly still.
BPPV in Human History
Humans have been experiencing BPPV for millennia. BPPV occurs in other animals, too, and has been clearly shown experimentally to affect cats, but humans are more susceptible and far more likely to be diagnosed than other animals. BPPV is caused by a malfunction in one of the spinning sensors in the inner ear. The sensor involved is one of the three semicircular canals in each of our ears (Figure 2.1), a tiny curved tube filled with fluid that first arose in early chordates (including the vertebrates, which are animals with backbones) over 300 million years ago. This sensor arose as a way to sense head movement. Ideally, the sensor turns on only when the head is rotated; if it turns on when no rotation is taking place, this causes vertigo.
Even the words used to describe the experience of BPPV are ancient. The word vertigo derives from the Latin word vertere, meaning "to turn," and has been in use for at least 2,000 years. The Latin root is in turn derived from an even older Indo-European stem word wert-, wer-, or wel-meaning "to turn or rotate." Later, the "w" was changed to a "v" in some words. This stem gave rise to other English words with circular or spinning connotations, such as wreath, vortex, and whirlpool.
The term vertigo is used in Latin sources to describe the sensation of spinning brought on by excessive drinking, a feeling that is still all too well-known today. The word vertigo languished during the Dark Ages but was rediscovered with a resurgence of interest in classical writings during the Renaissance and entered the English language in the Middle Ages. In the meantime, English speakers had to make do with the word dizzy, which referred more to a feeling of being stunned or dazed. Now both words — vertigo and dizziness — are used interchangeably. Until the nineteenth and twentieth centuries, no one made an effort to distinguish among the different dizziness disorders and they were generally all lumped together and referred to as vertigo.
"Discovering" BPPV
In fact, while people were no doubt experiencing BPPV symptoms for thousands of years, no one wrote down a clear description of the disorder until 1921. The identification of BPPV is attributed to Dr. Robert Bárány (1876–1936), a Viennese physician who specialized in vestibular disorders, diseases of the ear and brain that can cause dizziness (Figure 2.2 on the next page). By the time he described BPPV, Bárány had already won the Nobel Prize for his explanation of the caloric reaction, a test that is still used to evaluate inner ear function. It was once quite common for diseases to be named after the person who first described them, called an eponym, and in the past, there was considerable competition to achieve this recognition. Most discoveries depend upon clues that have been reported in earlier papers, and an eponym tends to effectively erase the work of many researchers who supplied pieces of the puzzle leading to the final recognition of a disease. It is difficult to remember what the disease means if the name of it does not contain a clue. It can also be an annoyance for people with the same last name who don't want to appear to be named after a disease (for example, what if your last name actually was Alzheimer?). For these reasons, the trend over time has been to name diseases using descriptive terms and to avoid eponyms. BPPV was ahead of its time because it was given a descriptive name and was not named after Bárány. However, interestingly enough, most of the treatments for BPPV are now known by their eponyms. One of the reasons I named the Half Somersault maneuver so descriptively was that the name conveys key information about how the exercise is done.
(Continues…)
Excerpted from "Overcoming Positional Vertigo"
by .
Copyright © 2019 Carol A. Foster.
Excerpted by permission of Bull Publishing Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface,
Acknowledgments,
1 An Introduction to Benign Paroxysmal Positional Vertigo (BPPV),
2 The History of BPPV,
3 How Does Vertigo Happen?,
4 Non-BPPV Causes of Vertigo,
5 Central Vertigo: Non-BPPV Positional Vertigo and Nystagmus,
6 Why BPPV Happens: What Did I Do to Get This?,
7 The Half Somersault Maneuver,
8 Variations of the Half Somersault Maneuver,
9 Unusual Forms of BPPV,
10 Maneuvers Performed by a Provider,
11 Preventing Recurrences of BPPV,
12 Troubleshooting,
Bibliography,
Index,