Don’t Just Live With Dizziness - Let’s Talk About It

Scott Webb (Host): It's not uncommon for many of us to feel lightheaded or dizzy from time to time, but if these feelings are persistent and interfering with our daily lives, it's probably time to seek the advice of somebody who can help. And I'm joined today by somebody who can help. Dr. Jenise Chappell is here.

She's an Audiologist with Memorial Care, Long Beach Medical Center, and Miller Children's and Women's Hospital.

Doctor, it's nice to have you here today. We're going to talk about rehab and physical therapy, but really through the lens of folks who are lightheaded or dizzy, off-kilter, if you will, and how you can help them. So let's just start there. Because it seems like, you know, I'm a person, you're a person, we're all people, right? So a lot of us feel lightheaded or dizzy from time to time. How do we know if it's something more serious?

Jenise Chappell, Au.D.: Good question. So a really good sign is if you find yourself having to limit your daily activities because your dizziness has just gotten so bothersome and you have a now increased anxiety around doing things that would normally be easy or even fun because you don't want to trigger a new episode. For example, you may now have such concerns for your own balance, that you have a new fear of falling, and obviously those fears and anxieties can have a really bad impact on quality of life.

Host: Yeah, they can. And, I speak with a lot of experts from Memorial Care and otherwise, and you know, that seems to be a common thread, Doctor, is that, you know, if you're experiencing things, but you can still live your life right, then you're probably okay, but you should see your doctor.

But if you just can't live your life, if your quality of life is suffering, if you're worried to whatever, go out of the house or drive a car, that's probably time to reach out. And it makes me wonder, like, why do we suffer from vertigo or balance problems? Are there some common causes or culprits, if you will?

Jenise Chappell, Au.D.: Oh, absolutely. There's a lot of people who have had different injuries, even car accidents, so you may have heard the term whiplash. This can involve issues of our neck muscles, or joints in our cervical spine that can lead us to have dizziness or unsteadiness. That's a big one. What I'm seeing a lot now in our kids and our younger population are things like sports injuries or other head injuries that can result in concussion.

So this can actually lead to a common condition called BPPV or the long-term, benign paroxysmal positional vertigo, where you can have tiny crystals or particles within our vestibular structure that are essentially knocked loose from their rightful place. So they end up lodged actually in areas where they don't belong.

Another big one, we'll see kids who have had, or adults even, who have had lots of medications that are used for lifesaving treatments like chemotherapy, antibiotics in large quantities, can actually become ototoxic over time. So oto meaning the ear, essentially these medications can create a toxic impact on the structures of our inner ear that are responsible for balance and hearing. And if you're like me and you suffer from migraines, you may know that migraines can often include symptoms of vertigo and imbalance. So these are just really common issues anyone can have.

Host: For sure. I want to find out for me what vestibular therapy is and how that helps folks with dizziness or just being off balance.

Jenise Chappell, Au.D.: Absolutely. So vestibular therapies are essentially therapies designed to correct things like particle displacement, often by repositioning the body and head. If there were cause that was due to weakness in our vestibular system, we can actually help to resolve these things over time with vestibular therapies.

They're essentially a customized physical therapy that's aimed at decreasing symptoms of dizziness or imbalance over time.

Host: Okay. Yeah, it's if someone is feeling dizzy or off-kilter, let's say, what happens during that first visit? How do you sort of get folks, get folks moving?

Jenise Chappell, Au.D.: So a really good first step will be a thorough case history. This can be a big bulk of the conversation, the appointment even, and an audiological evaluation. So because of our close proximity of those inner ear structures for hearing and balance, we can sometimes see that there can be damage to both the hearing and balance system. So hearing loss can be a necessary thing to identify. Also your case history can just be so informative to figuring out triggers. The first time this happened, what were you doing before or after? How long did this last? Was it just seconds, days, or weeks even? And then also looking at more recent episodes and any change between the initial episode and the most recent.

You may even be asked about family history. Does anyone else in your family have these issues? Are you taking medications that have side effects that could create these issues? It can really be a way to help guide the balance specialist like myself to determine next steps. For example, if additional referrals need to be had, for optometry or neurology, if additional invasive testing is needed, like a VNG or if direct referral right to the vestibular therapy is necessary.

Host: Yeah. Sticking with vestibular rehab therapy, I want to learn more about this. Let's say that that's what's prescribed, if you will, right, for a particular patient. So what kinds of exercises or techniques are involved?

Jenise Chappell, Au.D.: So this can be a complicated question because it really depends on the cause of your dizziness or vertigo. Say for example, BPPV. So because we have these crystals that have become dislodged, we have to put them back where they belong. So repositioning the head and body to relocate those crystals can help to correct the issue in just one visit. You may have an issue where your vestibular system in your right and left ear, which are normally talking at all times, working perfectly together, one may become weakened, so you may have to begin implementing a vestibular system exercise to help strengthen that weak side. This can help improve communication of both systems in the brain, to over time reduce your symptoms altogether. For our whiplash patients often having to address that neck pain, that neck discomfort is really critical to improving their symptoms, so it can really vary based on the cause.

Host: Yeah. And as you mentioned earlier, you know, thorough patient history, and I know it, it really does sound like these are personalized individual plans. So let's talk about that, like what factors influence the decisions when we think about personalizing these plans for a particular patient? What are the factors?

Jenise Chappell, Au.D.: So it's really about first diagnosing the origin of the pathology. In doing so, we're able to better pinpoint what the problem is. If it involves a brain injury, if it involves a inner ear structural problem. By using a neurodiagnostic vestibular evaluation called the VNG, we can actually get more answers for our patient and better treat the issue.

So there's a popular saying that the eyes are the windows to the soul. The eyes can actually guide me to the source of the vestibular problem. You may have heard, but sometimes our eyes move in really crazy ways if we're dizzy. So during that evaluation, I'm actually observing the eye movement, the direction of that eye movement can tell me where the problem is. Using that information, it helps me determine what the best strategy is for management. So for positional influenced vertigo like that BPPV, we may have different repositioning maneuvers based on where the issue is. Things like a Epley Maneuver, which is more commonly used, and the Semont Maneuver. There are some awesome developments for those dizzy patients suffering from brain injuries and concussions. So there's a vestibular training system based in Minnesota that teaches our brain and vestibular system to improve itself by incorporating a spinning technique used by figure skaters.

So imagine being able to spin like a figure skater, but without the skates. It's really cool stuff actually. The system includes a safety harness and motorized platform with or without rails to hold onto, and the platform spins at varying speeds while the patient completes hand-eye coordination exercises, like passing a ball back and forth, or tracking moving targets.

This teaches the vestibular system to improve neural integration, improve balance, and even cognitive function. It helps the brain process spacial awareness, the awareness of what's going on around you while moving.

Host: Yeah, it's really interesting again, the not a one size fits all approach and probably in terms of results, so when we think about patients and how quickly they start to feel better, you know, what kind of progress can folks expect? Like, I'm sure for some folks, as you say, like maybe it's one time and they're good, they're on their way. Others, it may be many sessions, right? So what can folks expect?

Jenise Chappell, Au.D.: Absolutely. So again, depending on the cause, the most common form of vertigo in adults that we see is that BPPV. You can literally just have one repositioning treatment, maybe two, and the patient experiences a huge relief in their symptoms. However, if you come across a patient that has a much more chronic issue that may involve muscles in the neck, you have to actually treat the pain and the discomfort that they're experiencing to resolve the issue altogether. This can take more like six weeks of consistent biweekly therapies until you get some good relief. Then you may have those more complex medical cases that include other comorbid factors.

You may need to have treatment for 12 weeks or so for concussion cases until we're really seeing a big improvement.

Host: Right. I like to do a little myth busting from time to time, doctor, but let's talk about some of the misconceptions, right, about dizziness and balance disorders. I'm sure you hear a multitude of things in the office. Maybe you can share some of those and bust some myths for us.

Jenise Chappell, Au.D.: I'll have to admit the one that really grinds my gears, unfortunately, a lot of people just want the symptoms to stop. They just want the dizziness gone, and they'll do so whatever can be the quickest, easiest way. This can sometimes mean using just medication, anti dizziness medications like meclizine, can mask your symptoms, but it doesn't address the underlying issue.

So I may see patients who are just using it constantly, constantly, constantly for months on end, but that can actually dampen and delay our body's natural ability to resolve these issues for itself. And especially with treatments, it can actually delay your progress with treatments if we're overusing meclizine. So a big misconception that I see is that a patient just needs meclizine. That's not always the case.

Host: Right. It sounds like, for some folks it's just a bandaid, but it's really, as you say, masking the underlying cause of the balance disorder, dizziness, whatever it is.

Jenise Chappell, Au.D.: Absolutely. Absolutely.

Host: So what advice would you give someone who's been maybe silently, you know, some folks suffer in silence, others not so silent. Right. But, what would advice, would you give them, they're dealing with these symptoms and they haven't quite reached out, they've been thinking about, but haven't done it yet. What would be your recommendation?

Jenise Chappell, Au.D.: Make an appointment, start with your primary physician. They can often be the ones to begin making appropriate referrals to balance specialists like myself, audiologists, your ear, nose, and throat physicians who are involved in diagnosing and management and Neurologists too. Oftentimes imaging might be necessary.

Want to see if there's any other component that can be impacting this patient. So start with your primary physician first.

Host: Yeah. Right. As we talked about at the beginning, doctor, if, if you're suffering, if it's affecting your quality of life, reach out to your primary, get a referral. There's lots of experts out there, especially at Long Beach Medical Center. And let's finish up there. Where should someone go if they want to learn more about vestibular therapy at Long Beach Medical Center?

Jenise Chappell, Au.D.: We are in the midst of trying to develop a program, so I'm actually hoping to get things off the ground really soon here. I would recommend giving me a call personally. You can reach me at 562-728-1355.

Host: That's perfect. Well, I appreciate your time and your expertise today. I think, you know, these are the things that we think we know about and then you get an expert on and you go, you know what? I didn't really know what I was thinking or talking about, but, that's why we have you, we need to reach out for your help. Of course. So thank you so much.

Jenise Chappell, Au.D.: Of course. Thank you.

Host: And to l more, And if you enjoyed this episode, please share it on your social channels and check out the entire podcast library for additional topics. This is Weekly Dose of Wellness, brought to you by Memorial Care Health System.

Thanks for listening.