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INTELLIGENCER JOURNAL (Lancaster, Pa.)
Cover, Business Monday

Finding relief for vertigo
When rocking and rolling can heal
Upon awakening one morning, Robin Sprecher, 48, Lancaster, felt as though someone had lifted her by the ankles and was whipping her in a circle around the room.

Jolene Kapczynski, 37, Akron, woke up and suddenly felt as though she was doing back flips, even though she was lying still.

Very ill with a migraine headache, Susan Patchett, 43, Ephrata, was in the bathroom vomiting forcefully when suddenly the room started spinning. Nauseous, in pain, and now dizzy, she sank to the floor, unable to move.

While everyone's first experience is unique, the above descriptions of benign paroxysmal positional vertigo, commonly called BPPV, provide a glimpse of what vertigo is like.

According to the National Institutes of Health, BPPV is but one of a number of vestibular or balance disorders that strikes people in all walks of life. Vestibular dysfunction adversely affects the ability to perform the most routine activities including driving an automobile and may prevent patients from holding certain jobs.

An estimated 90 million Americans, 42 percent of the population, will experience a problem with balance sooner or later. U.S. physicians report a total of 5 million dizziness or vertigo visits a year, for an estimated cost exceeding $1 billion.

The good news is that the hallucinations of movement and resulting misery brought on by BPPV is related to physical matter that is able to be repositioned using gravity. Once diagnosed, this disorder is correctable in a couple of sessions with a trained therapist.

Unfortunately, the most effective therapy for BPPV is not widely known, even by most physical therapists. Typically, the problem is treated with medication, which is ineffective. Many individuals suffer needlessly for years before they find a health care professional trained in vestibular disorders, who recognizes the problem, and knows how to fix it.

F. Owen Black, M.D., a neurologist and human vestibular physiologist who heads the Neurotology Research Department at the Legacy Clinical Research and Technology Center in Portland, Ore., says that the average patient has seen at least six to eight physicians before they see him.

Black, who works with the National Aeronautics and Space Administration (NASA) in studying the re-adaptive transitioning of returning shuttle astronauts, and is one of the nation's principal investigators in a range of vestibular disorders, says that BPPV can disrupt all aspects of a person's life, including his or her economic well being.

"I cannot recall seeing a single patient who, if working at the time of BPPV onset, did not lose some work time," he said.

"Some had to change jobs. Some lost their jobs. I am aware of several professionals who even had to change their professions or retire."

What is BPPV?
BPPV is caused by microscopic crystals of calcium carbonate, called otoconia. These weight-bearing otoconia, often called canaliths or ear rocks, are ordinarily embedded among the sensory hair cells in the vestibule of the inner ear. Here they play an important role in helping us keep our balance.

If they get dislodged somehow, through head trauma, infection, or even the consequences of aging, they can roll into one of our three semicircular canals, essentially confusing the brain.

When this happens, an individual's world spins in a sickening condition called vertigo.

Incredibly, however, these microscopic crystals can be rocked out of the sensitive back part of the semicircular canal, and rolled back into the utricle by means of very specific therapies.

The most commonly used therapy, the Epley Maneuver, is named for John Epley, M.D., a trailblazer in the field of vestibular disorders. Epley designed this therapy about 20 years ago.

"While the Epley maneuver has definitely reduced the socio-economic devastation from BPPV for both patients and their employers, it has not completely removed significant socio-economic consequences of this disorder, especially when associated with other vestibular disorders," Black said.

Living with vertigo
Sprecher's story
Sprecher's first experience with vertigo 6 years ago was severe. She literally could not get out of bed. When she did, she had to crawl from place to place.

"I felt like the vertigo never ended and I had terrible nausea, because of being out of balance. I couldn't even watch TV.

"I had to lay on my back with my eyes closed. If I lifted my head off the pillow, it would throw the vertigo into high gear."

Sprecher was diagnosed immediately and referred to a specialist.

"My doctor said that there was this new procedure, called the Epley Maneuver, that could correct the problem, but very few people were trained in it.

"I had three or four treatments, every other day. The vertigo improved with each treatment and then disappeared entirely for many years."

Sprecher suffered a second bout of BPPV in 2004, which was corrected quickly.

Kapczynski's story
Kapczynski, an x-ray technologist who heads the Imaging Operations team at Ephrata Hospital, had a bad first day during which she, too, had to crawl to get around. Dizzy and nauseated, she couldn't even stand and was running into walls when she did.

"I couldn't see straight and I couldn't focus on where the doorway was."

She stayed in bed the first day, sleeping much of the time, but felt steadier upon awakening the next morning, so she was able to get to work.

Because BPPV is triggered by change in positions, such as rolling over in bed or looking up, for example, Kapczynski learned quickly to adapt.

At home, she slept in an upright position. At work, she couldn't lookup at x-rays, as usual, so she kept her head straight, moving her eyes instead.

Kapczynski was initially treated with medication, first for dizziness, then for an infection, because she had suffered a severe sinus infection two months earlier. When medication did not help, her doctor suspected BPPV and referred her to a specialist.

"One therapy session and it was gone!" Kapczynski said, astonished at the quick fix once she got the right treatment.

Patchett's story
Patchett's symptoms were so severe the first day that she was taken to the hospital, where she had a CAT scan.

"They told me they didn't know what to do, so they sent me home. It was frightening."

Patchett was treated with various medications in the weeks ahead, but nothing helped. She says it was horrible and she could not work. She could not drive. She couldn't even use the computer or do simple things around the house.

If she shut her eyes while taking a shower, her body would sway forward, popping the shower door open. If she tilted her head backwards while shampooing her hair, she would get dizzy.

When she leaned over to get something from the dishwasher, she fell in, slicing her fingers on a knife.

When she opened the oven door to check on brownies her daughter was baking, she lost her balance. Her hand went into the oven, getting burned.

"I couldn't even bend over to hook our dog outside."

Finally, she needed to see her gynecologist. It was he who suspected an inner ear problem and referred her to a specialist. She was out of work almost eight weeks before getting correctly diagnosed and treated.

Patchett, who had worked for the same company for 13 years, credits her employer with understanding and handling things well.

Had she been a new employee, and they didn't know her, however, she doesn't think she would have kept her job, because no one understands what vertigo is like. In fact, people are miserable, but they look just fine.

When rocking and rolling can heal
Physical therapist Martin McKeon, who is trained in vestibular rehabilitation, treated Sprecher, Kapczynski, and Patchett with the Epley Maneuver.

McKeon, who serves as facility director of The Rehab Center in Lititz, one of Ephrata Hospital's out-patient physical therapy centers, talks about the loose microscopic particles floating around in the semicircular canals with BPPV.

"The Epley Maneuver allows the therapist to use positioning techniques to move these objects out of the canals.

"The theory behind it makes sense," McKeon said. "Once you apply the technique and see the results, it's very exciting for the patient and therapist!"

Among experienced and knowledgeable otologists, therapists, or other clinicians trained in inner ear balance, diagnosis of BPPV is relatively straightforward. Usually, nystagmus is present. Nystagmus is an abnormal jerking of the eyes that occurs during vertigo, which is visible to the attending specialist.

"It is important to know that treatments often reproduce the dizziness, but that is part of the retraining process," McKeon said.

"In order to get past the dizziness, you have to train your body to do the things that bother you. Over time, your body learns to perform certain movements without that dizziness."

Many individuals with BPPV can be helped with just the Epley Maneuver, but there are additional exercises to help those who have a lingering problem," McKeon said. McKeon treats about four to seven people with this disorder every month.

"BPPV is not rare," he said.

"There probably are a lot of people who are undiagnosed."

Black agrees. "BPPV is the most common vestibular disorder," he said. "This is one of the few agreements amongst otologists the world over."


Resources:
The Vestibular Disorders Association: http://www.vestibular.org/
--Trained therapists by geographic region: http://www.vestibular.org/resource.html