It happened quite suddenly. One minute I was looking down at my phone, the next, I was nauseous and feeling unsteady. At first, I thought it was just the fact that I didn’t sleep well, or that I was possibly coming down with something, but the symptoms kept persisting. I felt as if the room was shifting beneath me. I went back to bed to lie down, but I wasn’t feeling any better. My wife asked if I was okay, seeing a pale look come over me. Fortunately, the symptoms died down and I was able to go about my day. The following day, while in the middle of work, the symptoms started again. This time, I was talking to a drug rep, eating a peruvian lunch that they provided. In the middle of biting into the lomo saltado, I wanted to vomit. I didn’t want to be rude, so I kept eating. For the rest of the day, I was falling into the walls and knocking into coworker’s chairs. By day’s end, I was just grateful that I got home accident free.
I was experiencing what my coworkers refer to as “old people problems.” In this case, benign paroxysmal positional vertigo, or BPPV. To understand how this happens, you have to have an understanding of the inner ear and how it works. To simplify, there are a series of gyroscopes within the ear called the semicircular canals. These canals contain fluid and are lined with hairlike projections that help sense your head’s position in space. It helps track the rotation of the head. In addition to this, there are other tiny little sense organs called the otolith in the head that track your head’s sensitivity to gravity and head tilt. Once in a while, debris from these otolith is produced and can form into crystals as you age. If these crystals get dislodged, they can possibly float into the semicircular canals like an asteroid floating in space. That’s when hell breaks loose and the world starts spinning out of control. Any slight movement of the head worsens the symptoms, as the movement causes the debris to brush up against the semicircular canals and can lead to all sorts of perception problems.
In the past, I’ve had patients tell me that they thought they were having a stroke, and truly, when you experience BPPV, it can feel like one. However, BPPV is actually quite benign in terms of any long term consequences. Should the vertigo be accompanied with any fever, limb weakness, loss of consciousness or numbness, it’s important that you seek medical attention as it may be more than just BPPV.
Certain conditions can lead to BPPV, but the majority of cases are spontaneous. In cases where there is trauma involved, as in a car accident or fall, or staying in a specific position for an extended period of time, as in sleep or lying back in a lounge chair, may also provoke the symptoms.
Treating BPPV requires repositioning of the debris in the ears. It can be tedious and sometimes, more nauseating than the actual problem, but the more consistently and frequently you do the exercises, the faster you will likely recover. In certain cases, physical therapy can be of benefit in helping you perform these repositioning exercises, but a simple YouTube tutorial is usually sufficient in teaching you how to do these maneuvers.
That night, I started performing these maneuvers and started feeling better each time I did it. I went to bed early and got a good night’s rest. The following day, the world stopped spinning. I felt much more secure on my feet. The nausea disappeared. Typically, BPPV can last for weeks if nothing is done to reposition the debris. After two days, for me, enough was definitely enough.
By: Dr. Juan Borja
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