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Why the Room Feels Like It's Spinning & Solutions to Vertigo · Doctor Turned Health Coach

• 0:21
  In today's podcast episode, I want to focus on dizziness.
• 0:25
  Now, some of you may have come across this term, some of you are dealing with this condition.
• 0:30
  Even if you're not currently dealing with it, it's important to point out that
• 0:35
  the majority of individuals, the majority of adults,
• 0:39
  at some point in their life, are going to deal with this condition called vertigo, or dizziness,
• 0:47
  or the sense of just not having proper balance.
• 0:51
  And if you've never experienced it, it is really uncomfortable.
• 0:55
  But in today's podcast episode, we're going to focus on why the mainstream medical
• 1:00
  system may not be doing all that it can to help patients.
• 1:06
  Specifically, vertigo or dizziness is a sensation that,
• 1:11
  often is coming and going, so you'll have moments where you feel quite good,
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  and then you'll have moments when the symptoms are really severe,
• 1:19
  especially if you're dealing with this chronically.
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  The majority of Americans, or the majority of adults I should say,
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  fortunately only deal with this episodically.
• 1:29
  Maybe once or twice in their lifetime, they'll have a sensation of feeling off-balance,
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  the room is spinning, they wake up in the morning, open their eyes,
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  and they feel like they're rolling off the bed, even though everything is perfectly fine.
• 1:44
  This would be similar to being on a boat and feeling seasickness.
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  So you usually will get some nausea, you'll get a headache, you'll get an empty
• 1:56
  feeling in your stomach, something in the back of your throat.
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  You might vomit, you might have chills, you might get ringing in your ears.
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  Oftentimes it disappears, but there is going to be that moment when it's the
• 2:10
  most severe until it eventually calms down.
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  Now, over the years, I've taken care of many patients with different types of
• 2:17
  vertigo, with different types of busyness.
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  And what we always want to distinguish is the type of dizziness where you feel
• 2:25
  like you're about to faint. That's very different.
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  That we usually call lightheadedness or syncopal episode or presyncopal episode.
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  And that's very different because this dizziness that we're talking about,
• 2:37
  this vertigo is really all about balance problems.
• 2:40
  The other one is usually a blood pressure problem or an abnormal heart rhythm,
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  and that's very different.
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  So when we talk about vertigo, the patients that I usually see are dealing with
• 2:51
  things like benign proxysmal positional vertigo, BPPV, very odd name.
• 2:58
  We have other conditions like Meniere's disease. We have vestibular migraine.
• 3:04
  That's a common one in both men and women.
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  And we'll talk about why it's not really a migraine. And then there is the postural,
• 3:11
  perceptual, positional, or postural.
• 3:17
  Anyway, I forget the name of that one, PPPD. That one is not as common,
• 3:22
  and it's actually one of the tougher ones to treat because it is so persistent.
• 3:27
  The goal with migraine, sorry, the goal with vertigo therapy is never to treat
• 3:32
  the diagnosis, and that's often where Western medicine or any kind of mainstream
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  medical system falls short.
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  We're trying to improve the symptoms of the patient.
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  That should always be the goal. The goal for me is to make it more tolerable
• 3:47
  for my patient to deal with these symptoms.
• 3:50
  Even more important, I never want to just rely on my patient's symptoms.
• 3:54
  If I constantly ask about vertigo, dizziness, I guarantee you that you might
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  even, for a moment in your day, if I ask you enough times, get the sensation
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  that, yeah, actually, you know, my balance doesn't seem that good.
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  Of course, if you just did a trail hike or did some trail running or did mountain
• 4:14
  biking and you were on a bunch of uneven surfaces, or if you just finished scrolling on your phone,
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  or if you were looking out in a really busy traffic area, tons of cars, tons of moving things,
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  or you looked at a super white background with a very busy arrangement of decor,
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  that can actually cause you to feel dizzy.
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  So if I ask enough times, I'm going to catch a lot of people in dizziness.
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  So we don't want to just rely on somebody's report of dizziness or symptoms.
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  We also want to train their perception and make sure that we've done everything
• 4:48
  possible so that this person has a genuine retraining of how they perceive dizziness.
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  A classic example, I think for me, is vestibular migraine.
• 4:59
  A vestibular migraine is not a migraine in the sense that most people don't
• 5:03
  have the traditional headache with it.
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  But they actually just develop a sensory change where they feel off balance.
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  They feel unstable. They feel like things are moving around them.
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  They can't really focus their gaze or their eyesight on something.
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  And that's a very classic type of non-headache migraine.
• 5:24
  I call it a vestibular migraine, or it's called a vestibular migraine.
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  There's other things like ophthalmic migraines, where you just get visual hallucinations,
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  where maybe there's lights in the corner of your eye, or your vision tunnels a bit.
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  And while this type of migraine, or this type of vestibular migraine,
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  is often treated with medications,
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  the downside to this approach is that
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  the majority of people are going to need a much more
• 5:48
  extensive thorough approach to
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  eventually overcoming this situation and
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  this problem and the good news is that everyone everyone
• 5:58
  99 is going
• 6:02
  to have an incredible recovery and over the long run they will find many great
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  ways of coping with their dizziness with their vertigo and be able to do quite
• 6:12
  well with it however getting there can seem like a really daunting task and
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  it can seem like it's going to take forever to get there.
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  One of the best ways that I can help someone with vertigo cope with this condition
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  and really thrive in life is to number one, help them get an idea of what the diagnosis is.
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  Sometimes patients get too caught up with finding the exact diagnosis.
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  And the reason this doesn't matter and the reason that sometimes this is a disservice
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  to patients is because even with the exact diagnosis, the treatment pattern
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  might be very similar there's a lot of overlapping ways that we treat this condition.
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  My approach to treating or helping somebody manage such a chronic condition,
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  and remember, most things in our lives are eventually chronic.
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  We get a little bit of acid reflux.
• 7:02
  We get a little bit of jaw pain from TMJ. We get a little bit of shoulder aches
• 7:07
  and pains when we work out a lot.
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  So there are things in life that are best managed, but not best treated.
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  So number one is lifestyle. One of the most important things that I focus on
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  is what is the lifestyle that somebody has,
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  because the amount of inflammation of this vestibular or balance system in the
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  brain is what's going to dictate whether someone's going to have a lot of these
• 7:30
  episodes or hopefully very few.
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  Number two, I really want somebody to know what their triggers are.
• 7:36
  We have to identify what the triggers are. For a vestibular migraine,
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  for example, it's often going to be scrolling and seeing those busy background
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  images and sometimes even just not having very stable gait.
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  When you walk, if you're not walking very steady, it can cause some problems
• 7:54
  with the vestibular system.
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  The third one is really perception. Perception. How do you perceive dizziness?
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  I actually have to train everyone when they have a chronic condition,
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  whether it's chronic pain, chronic dizziness, chronic joint instability.
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  I have to retrain the way they perceive this problem.
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  When we have a medical problem, it's very normal to feel ultra-sensitive to
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  all symptoms and conditions to the point that our mind will sometimes blow it out of proportion.
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  So even with a little bit of dizziness that many of my other patients have,
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  who generally would report no dizziness at all.
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  The person with this chronic dizziness condition is going to be out.
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  They're going to be like, I can't work today. I can't do anything today.
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  I can't go do my exercises. I can't do my daily routine. And that's really sad.
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  So the way my patient perceives dizziness is something that we also often have
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  to retrain, which takes us to the fourth level, which is the actual management of this condition.
• 8:57
  The management of this condition often requires a lot of exposure therapy.
• 9:03
  So we call this vestibular rehabilitation.
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  We call this neurophysical therapy, whatever you want to call it.
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  Probably the biggest hurdle with this, with this vestibular exposure therapy,
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  vestibular rehabilitation, is that it is a commitment.
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  You have to sit there, do these exercises day in and day out,
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  even if you don't want to.
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  And sometimes after you get completely better and your symptoms are almost fully
• 9:31
  gone, if you don't do these vestibular rehabilitation exercises,
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  sometimes the thing just comes back.
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  And so one of our goals is to make this a regular habit, something that you
• 9:43
  do on a not daily basis, but a few times a week, at least a few times a month
• 9:47
  for some sort of a maintenance medication's goal.
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  So I know I didn't go into a lot of specifics, and I certainly didn't,
• 9:54
  mention medications, but I hope I gave you guys an idea of what we do when we
• 10:00
  really want to approach somebody's chronic dizziness in a sustainable way.
• 10:06
  And while medications can be effective, a point that I want to mention about medications,
• 10:11
  things like SSRIs, SNRIs, anticholinergic medications like meclizine or many
• 10:18
  other patches and oral dissolving tablets. There's a lot of different medications out there.
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  The problem with these medications is that long term, their efficacy wanes,
• 10:31
  meaning they just don't become, they don't stay effective for a long time.
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  And if anything, you become desensitized.
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  Even worse, some of these medications can actually make your dizziness worse
• 10:42
  when it is something that is used long term.
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  Therefore, I always recommend using medications. Absolutely.
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  There's nothing wrong with it during very severe episodes or when,
• 10:54
  for whatever reason, your vertigo has flared up.
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  We may get it under control for a few weeks, a few months with medications.
• 11:00
  But the long-term goal with any chronic condition is to usually try to manage
• 11:06
  it through the other modalities that I mentioned.
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  So I hope this is of value to you guys. If you have any kind of dizziness condition,
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  I would love to hear from you what chronic dizzy conditions,
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  dizziness conditions. Have you managed?
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  Have you worked with your specialists, whether ENT or physical therapy or neuro?
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  And maybe what are some frustrations that you experienced? You can email me
• 11:28
  and the information is in the show description as always.