Over the past several months, we have been discussing imbalance, dizziness, vertigo, disequilibrium, etc., how to find out if you are at risk, etc. We know that as part of the natural aging process individuals will become more prone to imbalance associated with changes in the spinal joints from degenerative joint disease, and the disturbances in the ocular reflexes which are pre-programmed to the spinal movements. These disturbances can also lead to anxiety, changes in respiratory dynamics and changes in the digestive system as these systems are all hard wired and linked together, thus changes in one system affect the others systems as well. Changes in breathing dynamics alone are probably responsible for half of the dizziness in society. These changes not only create anxiety and panic disorder, but will eventually lead to a permanent change in your systemic pH, which can lead to all sorts of problems.
The good news is that these disturbances are not only reversible, but are actually quite easy to fix. Inappropriate ocular reflexes are corrected through appropriate eye exercises, which are orchestrated to strengthen the specific ocular weaknesses, which need to be addressed. This alone typically improves imbalance and disequilibrium immediately. Breathing dynamics can easily be corrected by increasing rib excursion and thus increasing lung vital capacity. This will immediately reverse aberrant changes in systemic pH, any panic disorder induced from such, gastric problems, which may be associated, etc.
Inasmuch as these problems are quite reversible and easily fixed, it is certainly with an understanding that treatment is provided under the guidance of a health care provider adequately trained in treating problems associated with imbalance and postural and gait abnormalities.
It is unfortunate that the vast majority of balance problems go unnoticed and untreated when they are easiest to correct, as most individuals don’t appreciate that they even have a problem because they do not take the time to get screened. Society has been trained over time to obtain routine blood work, and other “routine” and “preventative” screening procedures, because we know that if we do not have them, we may miss something that would have been easy to fix had it been diagnosed early on but was ignored because no screening was ever done. Balance screening is no exception to this. Simply put, the longer you wait, the longer it will take to fix, and the more likely you will incur a fall and thus have a serious injury to overcome. I have mentioned several times in my column that you cannot tell if your balance is impaired without screening. If you can tell, it is only because it has already gotten so severe that it becomes apparent just standing or while walking about. If this is the case, not doing anything about it is like being diabetic and not taking your medication and not changing your diet. It will just be a matter of time.
Dr. Scopelliti is a Fellow of the American College of Functional Neurology and also a Fellow of the American Board of Vestibular Rehabilitation. Practicing at the 279 Professional Arts Bldg at Monmouth Medical Center, in Long Branch, NJ, his office focuses on the drug free management of patients with vertigo, dizziness, balance loss, presyncope, dystonia, headaches, ADD ADHD and other neurological disorders. Dr. Scopelliti has a wealth of information updated weekly on the web at http://www.dcneuro.net. Also, visit our guest book at http://www.dcneuro.net/guests.htm. Visit our Guest Book to see what real patients have had to say.
On occasion, I hear from patients who complain of feeling dizzy as if they are going to fall when they turn their head suddenly, or lose their balance if they turn around in a circle. They may also admit to motion sickness, i.e., feeling a little dizzy and unstable riding a bike or traveling by airplane or boat.
Balance problems such as these could be a sign of certain medical conditions. There are many types of balance difficulties and their causes can be simple, such as a drop in blood sugar or dehydration from not drinking enough water.
Other equilibrium problems may be more complex and need neurological testing to determine their cause. Let me explain the various types of conditions that effect balance and their possible causes so you can determine if you need to call your doctor, or re-hydrate with a good mineral replacement drink, or have a glass of orange juice and a snack!
Types of Balance Problems
As I said earlier, balance problems can have simple or complex causes. Basically, they fall into four categories:
Vertigo – a spinning, dizzy sensation with motion of the head or body. This category can be caused by several medical conditions that need a doctor’s care. These include:
?Benign positional vertigo – caused by particles that accumulate in the inner canal.
?Meniere’s disease – excessive fluid in the inner ear, causing dizziness, ringing or buzzing.
?Vestibular migraine – a bad headache that makes you sensitive to motion, turning your head suddenly can result in dizziness or off balance feeling.
?Acoustic neuroma – caused by a tumor on the acoustic nerve (connects inner ear to brain) that can cause hearing loss, ringing in the ears, and dizziness.
?Motion sickness - riding on amusement park rides, boats causes dizziness.
Feeling Faint – a general weakness, usually organic cause (blood pressure or blood sugar drop)
Disequilibrium – a loss of balance or falling, usually from mechanical causes (unstable joints, failing vision, inner ear conditions, side effect of medication).
Lightheadedness – an “out of body” sensation, usually caused by high/low blood oxygen levels from hyper/hypoventilation (anxiety, severe trauma), or inner ear conditions.
Tests for Balance Problems
If you determine that your dizziness/balance problem is not a result of lack of food or water, the next thing you should do is make an appointment with your doctor. There are certain balance tests that can be performed, or you may be sent for a CAT scan or MRI of your head to see if there are any structural causes of your balance problems (like tumor or inner ear abnormality).
Your doctor will discuss your balance problems with you and may ask a series of questions about your dizzy spells including the frequency, what you are doing when they occur, and what type of medications you may be taking to rule out the possibility of a side effect. Next, you may undergo one, or several of the following tests to pinpoint the cause of your symptoms:
EKG, possibly heart echocardiogram: To see if a too slow heart rhythm, or too low blood ejection from your heart could be the cause of your symptoms.
MRI or CAT scan: To determine if there is any physical abnormality such as a tumor or blood vessel blockage that may cause your symptoms.
Tilt Table test: To determine your heart’s response to adrenaline, such as in an anxiety attack or severe trauma. Adrenaline is slowly injected into your arm and the table you are lying on is tilted in different positions.
Hearing test: To determine if you have an inner ear condition.
Electronystagmography – monitors eye movement to see how well your inner ear/balance works.
Dix-Hallpike test - involves turning your head and monitoring eye movements to see if you get a sense of spinning or motion.
VEMP - vestibular evoked myogenic potential test. Electrodes (like those on an EKG) are placed on neck, shoulder, and forehead muscles to monitor contractions in response to sound.
Rotary Chair test – monitors eye movement while you move slowly in a circle in a computerized chair.
Treatment for Your Balance Problem
Once the cause of your imbalance has been determined, there are a number of treatments aimed at solving your problem. These may include:
?Medication dosage adjustment/discontinuation/substitution – often a dosage change is all that is needed to stop symptoms. Other times, a complete discontinuation of a drug is necessary.
?Vestibular rehabilitation – this is a special exercise program for people with inner ear problems to re-stabilize balance.
?Fall prevention – determining if vision, lack of sensation in the feet, weak muscles and joints are contributing to poor balance symptoms. You may need a walker or just a hand held quad cane.
?Positioning procedures - clears crystal deposits out of the inner ear back where they belong.
?Diet changes – reducing salt, caffeine or nicotine can help some people with balance problems completely get rid of their symptoms.
?Surgery – if you have a tumor or malfunction in your inner ear, you may need surgery to correct it. Types of surgery include gamma knife surgery, or stereotactic surgery that delivers radiation directly to the tumor site.
Some Natural Remedies That May Help You
If you experience temporary, occasional motion sickness while traveling by boat or airplane, you may be able to treat this condition yourself with:
OTC’s: Over the counter aids such as a Dramamine, or meclizine that can help you to regain your sense of stability.
Herbal: The Chinese have used Ginger for centuries as a stomach tonic and to restore balance. 250 to 500 mg every 6 hours is the usual dosage. A word of caution, if you take blood thinner-type medications for a heart problem, ginger can add to those effects and make you bleed more easily.
Acupressure: Stimulating certain acupressure points on your inner wrist can alleviate motion sickness. Bands, or bracelets, made for this purpose can be bought in drugstores or airport shops. They have a button or stud on them that presses against the acupuncture meridian on your wrist that regulates dizziness/ balance.
We all can have a bout of lightheadedness or feel off kilter now and then from simple causes like being tired, dehydrated, partying too much the night before, too much caffeine, not eating enough or riding a roller coaster! However, balance problems that occur regularly is your body telling you that something is off somewhere and you should consult your doctor to find out what.
Mark Rosenberg, M.D.
Institute For Healthy Aging
Vestibular balance disorders affect in excess of two million people every year, and feature in the top ten complaints that lead patients to visit their doctor.
Doctors need to be cautious when patients are describing their symptoms, as often-used terms such as “dizziness”, “vertigo“, and “motion sickness” can be caused by conditions other than balance problems. Instead, doctors try to encourage patients to describe their sensations in more specific terms. Below are common symptoms described by patients, and what a primary care physician would consider the sensations to be of those symptoms.
In order to satisfy the symptom of “dizziness”, physicians would be interested in sensations that are similar to feeling drunk, including being unsteady, woozy, or giddy. There may not be sensations of spinning, but a feeling of imbalance. Dizziness is typically not caused by inner ear disorders, so may point to a different condition which needs to be investigated.
The sensations associated with vertigo are those such as spinning, turning, falling, whirling, even simply moving straight ahead. The spinning sensations may refer to either the subject spinning or the actual environment. All such sensations of movement are hallucinations and usually suggest an inner ear or vestibular system disorder.
A physician would consider “lightheadness” to involve one or more symptoms such as tunnel vision, feelings of fainting, sweating, shortness of breath, numbness, or feeling cold. Lightheadness can be caused by the side effects of medication, or heart or blood vessel problems.
Common motion sickness symptoms include headache, sweating, nausea, and spinning. Rather than being a symptom of a condition or disease, motion sickness is quite a normal response to experiencing motion for which you have not yet adapted. Some people’s threshold for suffering motion sickness is much lower than others, and can be caused by relatively stable journeys by road, air, or sea.
If you are feeling any of the sensations described above, visit your doctor. There is also a new website – see below – designed for sufferers of these conditions to share symptoms and coping strategies, and there is a recommended resource which has helped many people overcome dizziness and similar unpleasant disorders.
About the Author: Beth McGrath runs an information and support website for people looking for a vertigo cure or remedy. There is also a new forum for vertigo sufferers [http://www.vertigoremedy.com/vertigoforum]. See http://www.vertigoremedy.com
With complaints of dizziness, vertigo or disequilibrium, symptoms can be the result of vestibular, neurologic, vascular, psychologic and even orthopedic pathology. As such, it is not always clear which specialty is appropriate for referral. In this age of cost awareness and effectiveness, the primary care physician must make important decisions as to the appropriateness and cost-effectiveness of diagnostic procedures and referrals to specialists.
Patient’s complaining of dizziness or disequilibrium without obvious objective signs, for lack of a more specific diagnostic direction, are often referred for MRI/CAT scan imaging studies to rule out the possibility of brain lesions. The cost effectiveness of this decision deserves scrutiny, as the yield of these studies is very low whereas the diagnostic yield of appropriate physical examination in the doctor’s office is very high. “Balance disorders are common, while brain tumors are rare”. Prior to the commencement of tests such as MRI, points that need consideration are the likelihood that MRI will provide any relevant diagnostic information and whether the sensitivity of less expensive more diagnostically useful tests can be performed first. In our office, the goal of the initial office examination is to determine the probable cause of the patient’s symptoms.
A directed history and extensive neurologic physical examination allows for more exacting diagnosis and thus successful treatment. Unfortunately, in this day of managed care, many providers must succumb to time constraints prohibiting extensive examinations, necessitating referrals to specialists. Currently, 50% of patients seen in the primary care setting receive no diagnosis for their complaints of dizziness, yet 70% receive a prescription for meclizine, (Antivert). Meclizine has not been demonstrated to be effective or appropriate in the treatment of chronic disequilibrium, dizziness or imbalance. It is occasionally effective in reducing nausea associated with vertigo/spinning in some forms of chronic vertiginous disease, however, it is not curative in any way, and in fact interferes with the natural recovery process often worsening matters further. It is appropriate to state at this time, that you do not need a specialist referral to consult with me in my office.
Dr. Scopelliti has over 1000 hours in postdoctoral neurology, and is a board certified chiropractic neurologist, practicing at the 279 Professional Arts Bldg at the rear of Monmouth Medical Center, in Long Branch, NJ. He is also currently the president of the NJ Chiropractic Council on Neurology, (website: http://www.dcneuro.info) With over twenty years of practice, ten of those years specializing in neurology, his office focuses on the drug free management of patients with vertigo, dizziness, balance loss, presyncope, dystonia, various stages of coma, and many other neurologic as well as behavioral and cognitive disorders. Dr. Scopelliti is a lecturer of postdoctoral neurology, and has also written several software applications for vestibular rehabilitation; http://www.dcneuro.biz Because of the nature of our practice and the high level of difficulty involved with the types of patients seen, our office customarily sees patients from several states for consultation and/or co-management. Dr. Scopelliti offers a free no obligation consultation including a balance test/risk of fall analysis prior to the commencement of any examinations or treatment. The office can be reached at (732) 229-5250 to arrange a free consultation, ($75 value), and balance screen. Dr. Scopelliti has a wealth of information updated weekly on the web (listed above). Go to the Guest Book link at the top of the home page to see what real patients have had to say.