Bit of a break

Needed to sort important matters of life and focus on dealing with the Dizziness. I definitely feel more in control now. I am now able to recognise the dizziness and treat it successfully, at least I can limit the triggers successfully. I am now 1000% convinced that my dizziness and that of others is the same and has little or nothing to do with a virus or physical problem in the inner ear. The break has allowed me to study the matter in more detail and for me to try a new treatment which I highly recommend but for now will keep monitoring it until I feel like sharing with the world at large.

I promised so major content and information about dizziness and will be onto this ASAP.

DD

Is your GP fit enough?

The duties of a doctor registered with the General Medical Council

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must:

• Make the care of your patient your first concern
• Protect and promote the health of patients and the public
• Provide a good standard of practice and care
  • Keep your professional knowledge and skills up to date
  • Recognise and work within the limits of your competence
  • Work with colleagues in the ways that best serve patients' interests
• Treat patients as individuals and respect their dignity
  • Treat patients politely and considerately
  • Respect patients' right to confidentiality
• Work in partnership with patients
  • Listen to patients and respond to their concerns and preferences
  • Give patients the information they want or need in a way they can understand
  • Respect patients' right to reach decisions with you about their treatment and care
  • Support patients in caring for themselves to improve and maintain their health 
• Be honest and open and act with integrity
  • Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
  • Never discriminate unfairly against patients or colleagues
  • Never abuse your patients' trust in you or the public's trust in the profession.

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

Vestibular Migraine Today

I know what caused it and was able to treat it, it was a monster though. Similar episodes in the past had me in A&E, doomed with the lack of knowledge and care from the Doctors. What can they do?

Once the Migraine starts to play with the Vestibular System it is very difficult to keep control. Your sense of balance starts to go, you feel eveything including your mind spinning out of control. Vestibular Migraines are not the same as a Migraine. A Migraine cannot be stopped, a Vestibular Associated Migraine is not the same and can. I spent many 18 months in alot of discomfort before I worked this out.

It took me another 18 months before I worked out why the medications I used and various other holistic therapries worked and how to use them most effectively. I am not talking about the stuff Neurologists give out which make you lose the will to live. I am talking about drugs that treat the source of the problem whilst allowing you a LIFE.

I cannot publish this sort of advice since it would be putting people at risk. I will however be making as much medical information available as I can and pushing the right people so others can benefit. Maybe I am not the only one here with some personal success stories, please get in touch if you have had positive results from thinking outside the box.

Demosthena's Mord Sith Diary of Pain

• Nerve Blocking Injections: During the first ten injections I sat on the operating table edge as a needle with a nerve blocking agent was injected into different parts of my back. The pain consultant asked me if I was going to pass out, I said, not yet. 10 Deep tissue injections into the shoulder and back. After these I had to lie down so they inject into muscle around the spine Cortisone using an x-ray so they don't puncture the Spinal Cord. I have had this 3 times, you don't get used to it.
• Workstation Migraines: These develop if you continue to work at a PC without the right treatment. If you persist with VRT then you will soon get there. Your neck starts to develop muscle spasms which interfere start to trigger referred pain at the front of the head. In the last 3 years I have had a migraine during every work day (~600).
• Tachycardia: Several times a year until I started getting the right treatment I would end up in A/E with heart rates above 200 bpm. When you heart is moving at this speed you experience anxiety of which there is no equal.
• C1 Vertebrae manipulation: Another Medically approved but dangerous way to treat potential causes of dizziness. Was hospitalised after a treatment to the Atlas due to extreme dizziness, the manipulation caused me to lose consciousness to the point of blacking out.

Vestibular Rehabilitation Therapy and beyond

If you have classic problems of a imbalance (true Vertigo) then VRT is a very obvious way to train your Vestibular System. Most exercises are about 70 years old and based on Cawthorne-Cooksey exercises. (I know a VRT Physio in Harley Street charging a fortune for this).

For most other Dizziness affected people there is a problem, they do not work. Over the last 3 years I have worked outr treatments that work really well through trial and error. Before I bang on about why these work which could take weeks I thought I might as well summarise them for your benefit:

1. Bikram Yoga is simply amazing (just discovered it cannot say enough about it). It is tough and not for everyone.
2. Acupuncture is essential but short lasting. Need to do weekly but it has an amazing impact. Much better than any pain medication medication.
3. Cross training is the backbone of my pain control management. You can get a cross-trainer second hand quite cheaply.  
4. Shiatsu Massage provides similar relief to acunpuncture.
5. Meditation is very difficult, but very rewarding if you persist with it.
6. Trigger Point Physio Massage (this needs a section in itself, this is for those who are advanced in their assessment of their disorder).

If you are Dizzy, THESE WILL HELP. I know what it is like to train hard with the room spinning, nausea, sore eyes and tension headaches, but once you are finished you always feel better and it does get easier.

P.S I have LOTs to add so will continue to edit this blogpost so do keep coming back to it. I will be explaining why these are so successful in treating non Vestibular Dizziness.


References:

1. http://www.dizziness-and-balance.com/treatment/rehab.html
2. http://en.wikipedia.org/wiki/Bikram_Yoga

Temporo Mandibular Joint Disorder and Dizziness

I am going to jump in and start talking about the relationship between Temporo Mandibular Joint Disorder (TMJ) and Dizziness. Many people who have Dizziness and start to research the internet always come up with overlaps between dizziness and another physical complaint. Temporo Mandibular Joint Disorder (TMJ) is one, Bruxism is another. The sort of stuff you read about sounds like this;

Ear pain: About 50% of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.

Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.

Dizziness: Of patients with a TMJ disorder, 40% report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.

Fullness of the ear: About 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube.

Ringing in the ear (tinnitus): For unknown reasons, 33% of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.

For someone with Vestibular Presenation this is too close to what might be a solution not to considered, especially after months maybe years of misery. I have seen about 3 Maxillofacial Surgeons (maybe even 4). I have a CT Scan and a medical report which says, yes I have TMJ.

So is there a link? Yes, but TMJ whilst common in people with Dizziness is not the trigger of the symptoms. I can assure you of this based after I personally harrassed some of the top Maxillofacial Consultants in London.  I will develop the reasoning behind this statement later since I want to keep the developing of the ideas behind dizziness inline with how I developed my understanding of the disorder. The key point made share by each consultant is that TMJ is generally caused my pyschological triggers and that treating the underlying pyschological component would stop the development of the TMJ presentation (in me). Everyone ruled out surgery, instead opting for splints and diet changes (soft food) combined with stress management.

This is important for 2 reasons:

1. It establishes a link between a disorder closely associated with dizziness being triggered by  pyschological factors. TMJ is not the source of dizziness, TMJ and Dizziness are simply triggered by similar pyschological factors and are therefore common in people who have in those with pyschological presentations.
2. Plenty of Maxillofacial establishments which will profess to help those with Vestibular Symptoms because of the known but yet unexplained associated symptoms between the TMJ and Dizziness. (You will start to see the important interference between Money and Medicine Opinion as I keep blogging and how it is so destructive in helping those get treatment for dizziness).

References:

1. http://www.medicinenet.com/temporomandibular_joint__disorder/page2.htm
2. Medical Report

Right TMJ- Closed

The condylar head is stightly irregular with a veqy early osteophyte formation in the most antaior surface.The disc is situated in the normal position betwcen the condylar hear and the glenoid fossa. The glenoid fossa and articular eminence appear normal. No evidence of joint effusion noted.


Right TMI - Open

There is a good range of movement with the disc remaining in the normal position.


Left TMJ- Closed
Similar appearamce of the condylar head is noted where there is a very early ostcophyte formation. The disc is tcthered antcriorly but also rnedially displaced.


Left TMJ- Open

There is a good range of movement and the disc returns to a normal position. This is anterior and medial displacement of the disc with reduction.


Summary:

Anterior but also medial disc displacement of the left temporomandibular joint with reduction with noevidence of joint effiusion bilateralty.

Link between Migraine Associated Vertigo and Psychological triggers

Taken from my own medical report by a Consultant Neuro-tologist

She told me she felt as if there is a trigger in her brain with a simultaneous onset of her abdominal symptoms. She told me that she had undergone several endoscopies and several biopsies without a final diagnostic formulation. She continues to experience episodic symptoms of headache, nausea and dizziness followed by a sensation of feeling “numb”. I asked her what she meant by this. She described an emotional blunting and off balance sensation. With these symptoms she often has discomfort deep in both ears. She has a background sensation of imbalance which compromises her ability to exercise. She has find that many exercises trigger her nausea and headache. She has a documented peripheral vestibular lesion and he has been prescribed the vestibular rehabilitation exercised by VRT Physio, but she probably does not practise these as often as she should. She spends much of her time working with a computer running her business. She has found that using computers for long periods aggravates her symptoms.

This complex medical history raises in the differential diagnosis a migrainous and autoimmune association. The visuo-vestibular projections to the hippocampus, Papez circuit and neighbouring areas would account for the overlap between the vestibular and psychological aspects of the presentation and the response to xxxxx

This NT will be referred from now on as Dr Wonderful

This for me was a very important step towards understanding the condition and validating some of the ways I was treating my MAV without realising it. I will refer back over and over again to this since it is pivotal in later understanding the triggers and how the link back to Vestibular Problems.

The VRT part is also important since I at the time after spending months with no improvement with VRT had started to develop better treatments through trial and error by focussing on the psychological triggers prior to this report.

Unfortunately after seeing a member of http://www.dizzytimes.com/ desperate to understand the link between anxiety and dizziness  and obviously needing some support and witnessing the tired drivel from the admins of the site I posted the medical evidence above. The admin deleted the post but still left her own "opinion" unchallenged. Their "expert" then posted asking what evidence do I have to demonstrate a link between psychological conditions and dizziness. I am not sure how far the term expert extends, I can understand this I am sure anybody else could even without "medical training".

Unlike http://www.dizzytimes.com/ I am not going to offer medicine advice (since it is rarely the answer), but I will be posting many of the complimentary therapies which really help and how they work. If you are desperate and want to talk to someone then please just contact me through this blog. I can give you the names of real medical experts who I respect and admire for what they do to help people with this disorder. There is alot of mis-information on the web, there is also lots of useful information, my advice is to challenge everything but discount nothing. It was my persistence that paid of in the end because of the poor primary medical support I received.

This is not the full explanation, but merely an important relationship established. There are many more important interactions which I have understood as my experience of the disorder developed. The body is a system with many functions. You cannot have a problem with one part of the system and not impact it elsewhere. I will try and communicate my observations about these interactions later so you can maybe challenge whether you think it's nonsense or not. Please do since I like some lively debate. I will publish a comment no matter what the content as long as it's relevant and does not hurt anyone.

Final Rant about Dizzytimes (on this post): Why when a forum which has maybe thousands of posts querying the link between anxiety and dizziness do the moderators immediately discount a link between the Psychological triggers? Why do they then delete without consultation the first evidence of such a link? Why do they instead promote disorders instead which are unverifiable (medically documented as being so)?

Even More Evidence

http://www.ncbi.nlm.nih.gov/pubmed/1443950

CONCLUSIONS: Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.

http://en.wikipedia.org/wiki/Migraine

Unifying theoryBoth vascular and neural influences cause migraines.

1.stress triggers changes in the brain2.these changes cause serotonin to be released
3.blood vessels constrict and dilate
4.chemicals including substance P ir

Comment: This unifying theory is similar to my own but mine varies due to the fact I believe a Vestibular Migraine is different from a Classic Migraine. More later...

http://www.vestibular.org/vestibular-disorders/specific-disorders/vestibular-migraine.php

Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking, and other factors can trigger migraine. Vertigo and imbalance secondary to migraine usually respond to the same treatment used for migraine headaches. Treatment of migraine includes eliminating from the diet substances known to trigger migraine attacks, such as chocolate, nuts, cheese, red wine, and other foods. Medications may also be prescribed.

I challenge the Dizzytimes Community Advisor to comment here and ask again what evidence do I have that Anxiety/Stress is a contributor to Dizziness.  Stress is the trigger, it took me a long time to understand what stress is at a neurological level, but given that my GP could not be bothered to read up about it I had no choice.

NB. I would strongly advise those with BPPV and Labyrinthitis diagnosis to consider whether Compensation Pain might just be Migraine Associated Vertigo (especially if you have had it for sometime).