Sunday, June 21, 2009

Bad news changed to good news then to uncertainty

The words of the day are BPPV and nystagmus. My initial reaction was, How many ailments can descend upon one person? Quite a few, apparently.

Who knew that treatment for pelvic pain would end up revealing something about my ears? Fate moves in mysterious ways. Not that I didn't try to get the ear problem diagnosed; it was just waved off as being a medication side effect or an effect of aging.

Toni the PT was concerned about the little hump that has formed on my upper back at approximately T1-T3. It didn't respond to ice, anti-inflammatory medication, dry needling, or traction. Toni said it was time for an expert: her coworker Phil. Phil has chiropractic training in addition to being a PT.

Phil is very muscular and he exhibits the effects of generous amounts of weight training. I feel like a blobby bag of blubbery, gelatinous lack of fitness in his presence. He doesn't seem to hold this against me. He checked out the humpette, felt my ribs, and pushed on the vertabrae in my upper back. His conclusion surprised me. The problem was a side-effect of shingles. For the past year, I've been shifting the work of my back muscles up toward my shoulders in an unconscious effort to avoid anything that would aggravate the post-herpetic neuralgia. No worries--Phil said he could fix the problem in about four weeks.

On my second visit with Phil (these are so much better than what goes on with the pelvic pain therapy), he asked me to lie down on a foam roller to stretch out the muscles running along my spine. I told his assistant that this always makes me terribly dizzy--the room spins and I wobble when I stand up. The assistant mentioned this to Phil and made sure to steady me when it was time to get up and move to the therapy table.

Phil asked about the dizziness. I explained that it came on around the same time as the BP and I have always been convincd that they're somehow related. Phil said that lithium will affect balance, but not this way. He had the look of someone who knows he has an idea and he's about to be right.

Phil ran me through a series of manuevers that involved falling back onto the table while abruptly turning my head in different directions and at contorted angles. Each time, the room started to spin. I wasn't allowed to close my eyes, and that made me feel sick to my stomach. Phil said it wasn't unusual for people to throw up immediately following the procedure. Terrific.

Despite the violent dizziness, Phil repeated the test three more times. At the end, he said, "This is a very clear case of BPPV and nystagmus. It's usually very easy to fix, and you'll stop falling down stairs and watching the room spin when you wake up. Google it when you get home. You have it in both canals, and that's very rare. I'm going to refer you to another PT, but you need to see an ear-nose-throat doctor, and possibly a neurologist." Ka-ching. Visions of my pay check flying off danced in my head.

Taking Phil's advice, I looked up BPPV and nystagmus. BPPV stands for Benign Paroxsymal Positional Vertigo. Nystagmus is a condition that can only be decribed as involuntary rapid eye shaking. BPPV is a vestibular dysfunction of the inner ear. The condition results the inner ear, specifically in the semi-circular canals, which control body equilibrium/balance, there are tiny hairs that help us orient ourselves within physical space. Each hair has a calcium crystal on top of it. In some people, the crystals get knocked off of the hairs. When the head is in certain positions, the "rocks" bump into the hairs, thus sending wrong information to the brain about balance. This causes nystagmus because the eyes are trying to assist in the balance process.

The really good news: BPPV is easily remedied through a meaneuver similar to what Phil did. The really bad news: 98% of BPPV cases are only in one canal. The maneuver that drops the crystals into a neutral position only works on one side. By repeating it on the other side of the head, the crystals on the first side will fall back into the chamber they were just rolled out of.

Rare. Two-chamber BPPV is very rare. Of course it is. In the case of two-chamber BPPV, surgery is indicated. It must be performed by a neurologist, and it's risky. No, thank you.

A few hours after my appointment with Phil, I had an appointment with Dr. B (psychiatrist). I asked if this could be caused by medications. He said no, but he wanted me to follow up with an ENT doc or a neurologist because the BP brain is just to susceptible to other stressors.

And here's the thing about me and BPPV: Half of all BPPV cases are caused by a head injury. I haven't had a head injury. In the other 50% of cases--the idiopathic cases--migraine is strongly indicated as a possible cause based on patient data studied to date. Well, I certainly get migraines and I have since I was about 15. Not just migraines, but debilitating migraines.

Migraines...Studies have consistently shown that 70 percent of people with bipolar disorder also suffer from migraines. Yes, 70 percent. Nobody has yet figured out why that is, but it's a definite link within BP populations. Bipolar disorder. Migraines. BPPV. Migraines. I want someone to study the comorbidity of BP and BPPV. Please.

I'm so dizzy,
My head is spinning;
Like a whirlpool,
It never ends...
'Cause I'm so dizzy.
I can't see;
I need to call a doctor for some help,
I'm so dizzy...
--T. Roe/F. Weller 1969

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