Help for pro­longed ver­tigo

Cape Breton Post - - ADVICE / GAMES / IN MEMORIAM - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslett

DEAR DR. ROACH: My hus­band had open heart surgery and has a pace­maker. He fell while get­ting out of the car, and his car­di­ol­o­gist rec­om­mended that he see an ENT doc­tor, who said he has the worst case of ver­tigo there is. He had a CT scan, but noth­ing showed up. Ever since then, he needs to sit down for sev­eral hours ev­ery day due to se­vere dizzi­ness. Both doc­tors told him he has to live with this.

I can­not be­lieve a per­son must live with this ter­ri­ble con­di­tion. How can we cure this ter­ri­ble dizzi­ness? — A.J.

AN­SWER: Dizzi­ness is a ter­ri­ble feel­ing, and I am sorry your hus­band has had such a bad time with this.

Ver­tigo, the sen­sa­tion of move­ment when a per­son is still, can have many causes. The ENT doc­tor was look­ing for a tu­mor on the eighth cra­nial nerve, which car­ries the sense of bal­ance. An MRI is more sen­si­tive, and it might be worth another look, although hear­ing loss and pro­gres­sive wors­en­ing of the con­di­tion are com­mon.

I have three sug­ges­tions. The first is con­sid­er­ing a sec­ond opin­ion. Eigh­teen months of un­con­trolled ver­tigo is ab­nor­mal, and I am sur­prised that, from your de­scrip­tion, his doc­tors have es­sen­tially given up on help­ing to treat his symp­toms. An ex­pert in dizzi­ness and bal­ance dis­or­ders has many tools (es­pe­cially a care­ful history and exam) to de­ter­mine the likely cause of the ver­tigo.

My sec­ond sug­ges­tion is that the ex­act cause of ver­tigo does not have to be known in or­der to get some re­lief. Vestibu­lar re­ha­bil­i­ta­tion is a ther­apy where the sense of bal­ance is re­taught through ex­er­cises su­per­vised by a spe­cially trained phys­i­cal or oc­cu­pa­tional ther­a­pist. My ex­pe­ri­ence has been that this is, by far, the most ef­fec­tive treat­ment for peo­ple with dif- fi­cult-to-con­trol ver­tigo. I rec­om­mend that you dis­cuss a re­fer­ral.

The last point I want to make is that some med­i­ca­tions mask the symp­toms of ver­tigo tem­po­rar­ily, but also pre­vent the body from ever re­cov­er­ing. The most com­monly used medicine, meclizine (An­tivert and oth­ers), is es­pe­cially bad for this, and I can­not tell you how many peo­ple I have seen who had an episode of ver­tigo that, if un­treated, grad­u­ally would have gone away, but who con­tinue to have symp­toms months and even years later be­cause they con­tinue to take the med­i­ca­tion. It’s fine to use for a few days if symp­toms are very se­vere, but I don’t ever pre­scribe it for more than a week.

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