This story first appeared in Healthy You - July 2024, The Gazette’s quarterly health publication.
As far back as a teenager, Dorothy de Souza Guedes remembers dealing with vertigo.
“Most kids enjoyed carnival rides that spun, but not me. I only liked roller coasters but didn't know why,” she recalled.
“The first severe vertigo that I recall happened when I was 17, and (I) came back from beach vacation with a bad ear infection. Throughout my adult years I've had severe bouts of vertigo and always felt like my balance was off,” she added.
The now 62-year-old is a freelance writer in Cedar Rapids. The vertigo she’s been dealing with is called benign paroxysmal positional vertigo, or BPPV.
“BPPV is a condition where people will feel a sensation-of-motion type of dizziness, usually a spinning sensation. This sensation typically occurs with some sort of head movement. The classic scenario is with rolling out of bed, but it can be any head movement,” explained Dr. Ryan Dempewolf, a physician and surgeon with Physicians Clinic of Iowa.
Dempewolf says it’s a common disorder of the inner ear and the most common cause of vertigo, especially in people over the age of 65.
“An understandable description is that little crystals in the inner ear that are responsible for sensing head movement become loose or dislodged. Their free movement in the inner ear causes the sensation of spinning,” he added.
For de Souza Guedes, dealing with it has been a challenge.
“Most days vertigorestricted my ability to maintain my balance fully, making me clumsy.Having to look up made me anxious because I didn't know if the movement would trigger my vertigoor imbalance,” she said. “For example, I couldn't look up while climbing a ladder or I'd lose my balance. I worried that I appeardrunkbecause I couldn't maintain my balance or walk in a straight line.”
Her worst days meant waking up with a spinning sensation that was nauseating.
“Imagine suddenly feeling like you're on a spinning carnival ride but you're trying to walk, read or work.Before I'd open my eyes each morning, I'd hesitate, not knowing whether the room would be spinning or I'd be okay,” she lamented.
Then a suggestion from Dempewolf changed her life.
“When I mentioned my vertigo during a routine allergy appointment with my ear, nose and throat doctor, Dempewolf, he suggested I make an appointment with a physical therapist at Rock Valley Physical Therapy at the PCI Vestibular Therapy Clinic across the lobby from his offices at PCI.”
She was skeptical and had a "been there, done that" attitude because she’d tried physical therapy with no success.
“Only this time was different because the physical therapist, Nicolle Cabalka, used special goggles with cameras that allowed her to see changes in my eye movements that indicated when I got dizzy as she moved my head into various positions,” de Souza Guedes said. “The same goggles allowed her to see which movements were working to move the loose crystals back where they were supposed to be in my vestibular system. I got relief after that first visit.”
Cabalka, who is a physical therapist and the clinic manager at Rock Valley Physical Therapy in North Liberty, calls this technique canalith repositioning.
“During your first treatment session, an exam will be completed to determine which of
the three semi-circular canals the otoconia or ‘crystals’ are located in and on what side of the
head — right or left. The exam will consist of a series of movements that include laying
down with your head in different positions to reproduce your symptoms,” she said.
Both the North Liberty and PCI-ENT Rock Valley clinics offer vestibular goggles that help the physical therapists better see your eye movement and determine proper treatment. Once they determine where the crystal is located, they take you through a series of movements to dump the crystal back to where it belongs.
“It felt like a miracle. For the first time the dizzy feeling was gone no matter how I turned my head. I feel more stable on my feet and don't lose my balance easily.And the relief has lasted since last summer,” de Souza Guedes said.
The first step, according to Dempewolf, is to talk to your doctor.
“ Talk to your primary care physician about it. Your PCP can send you to vestibular therapy. The vestibular therapist will confirm the diagnosis with tests and can perform the treatment. You do not need to be seen by an ENT doctor to get to the vestibular therapist. ENT doctors usually don't do anything specific for this condition other than send you to the vestibular therapist,” he explained.
As for what causes vertigo?
“There is not usually a known cause of BPPV unless you have had a recent head
injury. BPPV does, however, have a higher incidence in those with inner ear infections,
vitamin D deficiency, estrogen deficiency, Meniere’s disease, migraines and allergies,” Cabalka said. “It is also more common in females compared to males.”
“I'd been diagnosed with significantly low vitamin D a few years ago,” de Souza Guedes said. “Anxiety can also cause vertigo, and I've been treated for anxiety for years. Nicolle also taught me some balance issues that have helped. I'm 62 and falls are a real danger for us as we age.”
Unfortunately, once you have vertigo you can be more susceptible to it.
“There is a 30 percent reoccurrence in the first year and 50 percent chance in the next five years,” Cabalka explained. “Meclizine is often prescribed to help with the symptoms in the short term but will not help with repositioning of the otoconia or crystals.”
De Souza Guedes believes the key to treating BPPV and is finding a vestibular physical therapy clinic that uses the goggles. And don’t be afraid to speak up.
“Even though I wasn't seeing my doctor for anything other than my allergy treatment, he asked me if there was anything else I was concerned about. If he hadn't asked the question, I wouldn't have thought of my inner ear crystals and the connection to vertigo. Mention health concerns to your doctor even when you're not sure the issue is something they treat,” de Souza Guedes said.
