Around and around it goes

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She woke up with a start, sure that she had missed her alarm for the third consecutive time and her job was truly in jeopardy. She was about to fling the covers aside like yesterday’s crush when suddenly the most unusual thing happened. It seemed like a scene from a horror movie was unfolding right before her very eyes.

The ceiling was moving like it had taken on a life of its own. The beams danced about in a dizzying circle as though they were being accompanied by an inaudible waltz. A wave of nausea washed over her and she held onto the wall hoping for dear life that it was steady.

Relief flooded through her veins as her palms met the cool bedroom wall and she quickly closed her eyes and lay down, willing the terrifying tumult to come to an end. After what seemed like forever, she cracked one eye open and glancing upwards she discovered the ceiling had returned to its original spot.

Much more slowly this time, she got up, gingerly placing her feet on the floor tiles and walked to the phone in the next room. She got ready as quickly as she dared and arranged to have a friend to take her to see the doctor. This was it… this was the end… she was dying.

As she sat in the doctor’s office, she diagnosed the brain tumour that had grown overnight and eaten half of her brain and started planning her funeral because there was not much time left. After sitting with the doctor and explaining her frightening experience, he did various examinations and then pronounced with a smile that she was not dying.  She had experienced an episode of vertigo.

Certainly, it was good news to learn that one was not a stone’s throw away from the cemetery. However, didn’t vertigo mean that there was an underlying problem? The doctor reached into a nearby drawer and pulled out a model of the ear and began to explain.

The ability to maintain one’s balance is a complex affair involving input from the eyes, the muscles and nerves in the spinal cord, the ears and the brain. If an individual is in a particular position, the body functions in such a way to keep the individual in that position unless he or she desires to move and puts measures in place to do so.

Perhaps it is a good thing that there are several organs and cells involved in maintaining balance so that in the event that one entity is lost, such as in the case of blindness, individuals can still maintain balance.  Within the ear, there is a specialised group of cells responsible for assisting with balance. This specialised unit is made of canals, nerve cells, fluid and microscopic crystals which work together to keep people steady. Should one desire to turn to the right, this movement ‘turns on a switch’ which relays a message to the brain that the individual has indeed turned to the right.

However, when any part of this unit malfunctions, there is a mismatch between what is occurring and what message the brain receives. As a result, although there is no actual movement, the brain perceives that there has been movement and that leads to the phenomenon of vertigo.

Most cases of vertigo are as a result of Benign Postural Positional Vertigo (BPPV) which comes about due to a change in position. This condition can be self-limiting and although it may seem like forever for the awful sensations to stop, the dizziness usually does not last longer than a minute. For some people, however, the symptoms can be recurring and severe enough to interfere with everyday activity. Other causes of vertigo include head injury, labyrinthitis (inflammation of the labyrinth, a structure deep in the ear), Meniere’s disease (underlying cause not completely understood).

Dizziness and vertigo are amongst those conditions that cause people to seek medical attention as a matter of urgency. At the doctor’s visit, a patient can expect to be asked a series of questions such as:

·       When did the dizziness start?

·       Was the room spinning?

·       What were you doing at the time?

·       Did you have any additional symptoms such as ringing in the ears, blurred vision, excess sweating, chest pain or shortness of breath?

·       How long did the dizziness last?

·       What movements or activities make the symptoms worse?

·       Have you ever had this problem before?

·       How are these symptoms impacting on your daily activity?

Further questions may be asked depending on the answers to the previous questions and then the doctor would proceed to physical examination. This would involve a general exam with special focus on the ENT (ear, nose and throat) system and the CNS (central nervous system) examinations.

Patients may then be treated with medications to try to alleviate the symptoms or referred for further investigations. Sometimes, in the case of BPPV, doctors and other specialists are able to do certain head positioning manoeuvres which can lead to the resolution of the vertigo.

Here are a few tips to try to prevent attacks of vertigo or to be safe should an episode of vertigo occur.

·       Lie in a dark room with your eyes closed.

·       Take deep calming breaths as being anxious worsens the vertigo, and the associated nausea.

·       Avoid sudden changes in position such as tilting one’s head too quickly or getting out of bed quickly.

·       Take medications prescribed by a doctor, or some over-the-counter preparations for nausea and motion sickness.

·       Avoid excess alcohol which can make balance symptoms worse.

·       Make sure that rugs and cords are safely placed in the home to avoid falls when bouts of vertigo occur.

·       If the attacks of vertigo are unpredictable, then climbing ladders and other jobs with a high fall risk should be avoided as much as possible.

Experiencing vertigo can be frightening and alarming to anyone.  Should you have what seems to be vertigo make sure to see your doctor as soon as possible.

(Rénee Boyce is a medical doctor, a wife, a mother and a Christian, who is committed to Barbados’ development. Email:[email protected])

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