BPPV can Develop Due to Increased Hormonal Fluctuations
otoconia 90 caused by hormone replacement therapy, and impaired calcium absorption following estrogen deprivation corrected by estrogen replacement therapy and
Known as the most common cause of recurrent vertigo
Benign Paroxysmal Positional Vertigo (BPPV):
A Review (by Seong-Hae Jeong) of common occurrences of benign paroxysmal positional vertigo (BPPV) in women and clinical experience has shown that BPPV can develop due to increased hormonal fluctuations, especially during menopause. Therefore, knowledge about neurochemicals and their involvement with BPPV is imperative for the management of neurological issues in women.
For BPPV Vertigo Treatment contact:
Wendy Webb Schoenewald, PT, OCS
WWS Physical Therapy and Vestibular Rehabilitation
1456 Ferry Road, Suite 601
Doylestown, PA 18901
P-215-489-3234
F-215-489-0131
www.WWSPT.com
VITAMIN D is an important Supplement for Women!
As we move into the winter months, we are exposed to less sunshine and therefore Vitamin D levels can drop. #VITAMIND is an important supplement for women especially as we age, since it prevents #Osteopourosis, #Depression, and helps with #MenopauseSymptoms.
Low levels of vitamin D have been found in patients with vestibular disorders such as benign paroxysmal positional #vertigo, #BPPV, #MenieresDisease, and #VestibularNeuritis. A few studies (reports) have shown Vitamin D supplementation to be beneficial for preventing BPPV attacks and Meniere’s symptoms. The dosage should be discussed with your doctor and should be adjusted based on your current blood levels of Vitamin D.
A recent topical review by Seong -Hae Jeong, MD, Ph.D., and Ji-Soo Kim, MD, Ph.D. explored the evidence related to the association between deficient calcium metabolism and BPPV. It also describes the development of therapeutic options to prevent recurrences of BPPV and introduce results from a recent randomized controlled trial on the effect of vitamin D and calcium supplementation in preventing BPPV recurrences.
Summary of Key Points:
The literature describes 3 lines of evidence on the association of impaired calcium metabolism and development of BPPV:
(1) decreased bone mineral density was more frequently observed in persons with BPPV than in healthy controls.
(2) estrogen plays a vital role in the maintenance of otoconia, and estrogen deficiency appears to precipitate degeneration of otoconia and development of BPPV; and
(3) lower serum vitamin D level is associated with the development of BPPV, and supplementation of vitamin D and calcium carbonate may reduce further attacks of BPPV in persons with BPPV and subnormal serum vitamin D levels.
Reference:
Impaired Calcium Metabolism in Benign Paroxysmal Positional Vertigo: A Topical Review
Seong -Hae Jeong, MD, Ph.D., and Ji-Soo Kim, MD, PhD
Travis Manion Foundation – “If Not Me, Then Who…”
Fall 2020, and #COVID19 has forced the cancellation or a re-schedule of most of our plans. The annual community-wide Travis Manion 5K event, in Doylestown, PA., is one of the important events we have missed most, this year. I have been a participant of The Travis Manion Foundation walk/run since year two. This event honors Travis Manion, other fallen heroes, and friends and family in service with a celebration and with a 5k walk/run. We have many patients and friends who have served our country and we walk/run for them. “We are not just keeping their legacy alive, we are passing their values along to the next generation of leaders.”
WWS Physical Therapy & Vestibular Rehabilitation, #WWSPT, Doylestown, PA. has been a proud sponsor of this run every year, and that has not changed even with the pandemic. This year the event was virtual, where people signed up to run and be a part of a smaller event. We hosted our own little Travis Manion 5K run Sunday, November 1st, at Warwick Park to run or walk the park. We participated in a 3-mile walk/run. Some of us carbo-loaded before the event and had gigantic sandwiches afterward. We wore our masks, complied with the PA guidelines, and came together to commemorate our heroes.
We have many to thank for their support of our Travis Manion Walk/Run event.
First, thank you to Joy Feigles, who serves on the committee for the Travis Manion 9/11 Heroes Run of Doylestown, PA, to honor the heroes of September 11th and the wars since. She organizes expo booths, golf events, and auctions to raise funds in support of TMF’s mission and never misses an opportunity to share the “If Not Me, Then Who…” mantra of the foundation with everyone she meets.
Thank you to Travis Manion volunteers Jen and Kenny Bauer.
Thank you to Warwick Parks & Recreation, Jamison, PA, for the use of the pavilion. It was the perfect refuge from the rain that began halfway through our run/walk.
Thanks To our loyal friends Joe Thiroway, wife Laura, and daughter Elizabeth of BP Solutions, who came out to support us. We are grateful to BP Solutions for making sure we had the necessary cleaning supplies throughout the #COVID19 pandemic to keep the clinic sterilized and clean for our patients and staff.
Thank you to Silvio’s Deli, Hatboro, PA, for the delicious hoagies that we scarfed down after our walk/run!
Last but not least, Thank you to my amazing WWS Physical Therapy & Vestibular Rehabilitation staff and physical therapists. — Amanda, Jenna, Cassie, Greg, Danielle, and Nellie Thank you also to our families and friends …including family pets, for their participation.
https://www.travismanion.org/
How Do You Know If You Have Vertigo?
People are often referred to my office for treatment with a medical diagnostic code of “dizziness and giddiness.” This is an old term used when we didn’t understand the vestibular system, but it has remained in the medical coding system. I find this diagnosis interesting because giddiness makes me think of someone laughing and happy, but most of my patients with vertigo are not either of those things! They are struggling with dizziness throughout their day and are often frustrated and fearful.
People with vertigo describe many symptoms including dizziness, spinning, nausea, vomiting, migraines, loss of balance, difficulty walking, and mental fogginess. The balance center located in our inner ear, called the vestibular system, is essential to our body’s ability to function every day. Although it is small—the size of a peanut M&M’s®—when it doesn’t work properly, it becomes a big problem. It can keep you from walking safely and thinking properly and can cause you to feel disoriented and sick.
The vestibular system’s job is to coordinate our brain and vision with our postural system. This sounds simple, but anyone who’s had a vestibular event knows that, when this system is disrupted, it makes it very difficult to see clearly or move your head quickly. It can cause disorientation so intense that it can knock you over when trying to get out of bed. Fortunately, the specialty of physical therapy known as vestibular rehabilitation can be effective in restoring balance to this tiny but powerful system. Most people referred to my office say they’ve never heard of vestibular rehabilitation, but two out of three people have had some kind of vestibular dysfunction and are aware that therapies can be helpful. According to the National Institutes of Health, about 15% of American adults, or 33 million people, had balance or dizziness problems in the past year. Often patients aren’t clearly diagnosed, so it is part of my role to look for the signs and symptoms of a vestibular problem. Due to the widespread effect that the vestibular system has on proper functioning and coordination, determining a proper diagnosis can be challenging.
The most common vestibular disorder—which accounts for a third of vertigo presentations to dizzy clinics and emergency rooms—is BPPV or Benign Paroxysmal Positional Vertigo. It is more common in adults but also presents in the younger population due to its relationship to migraine and concussion. BPPV affects the inner ear, causing spinning spells that typically last one minute or less and are provoked by a change in body or head positions like looking up to a top shelf or getting out of bed. In the inner ear, there are three structures called Semicircular Canals that sense rotational head movements. Calcium carbonate crystals sometimes get loose, and, when they find their way into these canals, they trigger a spinning sensation associated with nausea, vomiting, imbalance, and discomfort. This condition can be treated with maneuvers designed to put the crystals back into their proper location, such as the Epley maneuver. For more detailed information on BPPV, visit Http:// bit.ly/WWSPTFeb2016.
Vestibular migraine is the second most common cause of dizziness. Patients with migraine can have associated vertigo occurring with a migraine headache, afterward, or even without a headache at all. About 12% of the population suffers from migraines, with a higher prevalence in women than men. About 10% of children experience migraines, but it is most common between the ages of 25 and 55. Vestibular migraine is often preceded by visual symptoms of aura, or warning, including neurological symptoms like sensitivity to light and sound, as well as nausea and imbalance. Management of vestibular migraine includes being aware of what may trigger your migraine, drinking lots of fluids, and exercising regularly. BPPV can trigger a vestibular migraine but is also a common sequela of a migraine attack. Learn more about vestibular migraine at http://bit.ly/WWSPTOct2018.
Ménière’s disease is a well-known disorder that can cause spells of disabling vertigo and is commonly associated with hearing loss. It is thought to be a fluid imbalance problem in the inner ear, causing vertigo symptoms lasting a full day that become more disabling with each attack. The mechanism of Ménière’s is not clear, but the attack can occur frequently without a specific trigger, making it more difficult to manage.
Vestibular neuronitis, also called labyrinthitis, is an acute disorder of the inner ear caused by a virus attacking the inner ear and reducing input to your brain, which causes severe and sudden onset of dizziness and imbalance. Some patients also have associated hearing loss. Often these patients cannot get out of bed for 1 to 2 days and have symptoms of nausea, vomiting, and imbalance. In this disorder, there is damage to the vestibular nerve, so recovery can take between 3 and 12 weeks depending on the severity. The research shows that starting vestibular rehabilitation as early as possible facilitates a faster recovery.
The impact of vestibular disorders on a person’s lifestyle is considerable. They cause a significant interruption of daily activities and an increased need for medical leave from work. Most vestibular patients see 3 to 4 physicians before being properly diagnosed, affecting patients fiscally as well. Vestibular disorders are shown to impact mood, causing increased depression and anxiety. They affect cognitive status because patients are working harder to function which leads to difficulties in spatial memory and attention or “brain fog.”
The team of professionals at WWSPT is committed to the proper evaluation and diagnosis of patients with vestibular dysfunction. This helps us utilize the appropriate strategies and treatment to return you to a more active, healthy lifestyle. If you’re dizzy, please give us a call today so we can help you on the road to recovery.
Wendy Webb Schoenewald, PT, OCS
WWS Physical Therapy & Vestibular Rehabilitation
1456 Ferry Road, Suite 601
Doylestown, Pennsylvania
215.489.3234
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