Best Treatment for Vertigo Is Easiest One

By Dr. A. R. Scopelliti

Dec

21

A new guideline was published in the May 27 issue of Neurology, stating that the “Best Treatment for Vertigo Is Easiest One”.  The Guideline urges immediate therapy with a simple series of head, body movements to clear the inner ear of otoconial debris on the affected side.  The guideline published by the American Academy of Neurology, goes on to describe several maneuvers which can be performed efficaciously to treat the alleged benign, Paroxismal Positional Vertigo, aka BPPV, an extremely common cause of vertigo.

“The good news is that this type of vertigo is easily treated. Instead of telling patients to ‘wait it out’ or having them take drugs, we can perform a safe and quick treatment that is immediate and effective,” guideline author Dr. Terry D. Fife, of the University of Arizona College of Medicine and Barrow Neurological Institute, said in a prepared statement.  This is a statement which I happen to agree with as too many people suffering with vertigo are simply told to “learn to live with it”.  In light of the simplicity of this diagnosis and treatment, being told to learn to live with it is not only a ridiculous thing to say, but also a clue as to the competency of the individual making the assessment.

Benign paroxysmal positional vertigo is caused by loose calcium carbonate crystals, (otoconia), that become dislodged in the vestibular labyrinthine canals. The maneuvers recommended in the guideline move the crystals out of the canals and into another part of the labyrinth, where they can be destroyed by your bodies natural immune system.

My office has been successfully treating this disorder probably longer than anyone in the area, and with great success.  It remains unfortunate however that the general population goes to their PCP, (primary care provider), first, and is typically treated with inappropriate drug therapies, which often times cause profound dizziness as a side affect.  Additionally, referrals for a myriad of completely unnecessary and expensive diagnostic testing are also typical.  This is unfortunate in light of the fact that better than 97% of these tests will not yield any useful information at all, and most will cost around $1000.  It just seems to make a lot more sense to treat the disorder quickly and appropriately and be done with it, at a fraction of the cost.

Vestibular, (Inner Ear) Dysfunction = Increased Risk of Falls

By Dr. A. R. Scopelliti

Dec

2

A recent study suggests that after age 40, dizziness makes you 12 times more likely to suffer serious injury from a fall.  About 69 million Americans over age 40 have some form of inner-ear dysfunction or another, that predisposes dizziness and makes them up to 12 times more likely to suffer a serious fall.

“More than 22 million of those people are unaware of their risk, mostly because they’ve had no previous incidents of dizziness or sudden falls”, said Johns Hopkins researchers who surveyed more than 5,000 men and women over age 40.  In this study the authors find that compared to those with a healthy sense of balance, those with an inner-ear dysfunction who had experienced no symptoms as of yet, were actually three times more likely to suffer a potentially fatal fall than other people, while those who actually have experienced symptoms had a 12-fold greater risk of a fatal fall.

The survey additionally noted that 85 percent of those over age 80 already had a balance problem and people with diabetes were 70 percent more likely to suffer imbalance than those without diabetes.  The findings were so significant they were published in the Archives of Internal Medicine.

So why is all this important?  Because vestibular imbalances need to be taken extremely seriously, because they can unwittingly lead to a fatal fall, or leave you disabled from an unintentional injury, possibly associated with long hospital stays and significant loss in quality of life.

The CDC, (Centers for Disease), reports that accidental falls are a leading cause of death and injury among the elderly. Each year in the United States, falls kill about 13,000 seniors and result in more than 1.5 million visits to hospital emergency rooms.

“Our survey shows that balance testing needs to be part of basic primary care, and that all physicians need to be monitoring and screening their patients for vestibular dysfunction so that we can take preventive measures to guard against falling,” was the conclusion drawn by the researchers.  Our office is compliant in this regard, offering computerized dynamic posturography, which assesses stability and thus risk of fall in seconds.  We offer this service free as a community service, which according to this study, is invaluable no matter your age or your perceived sense of balance.

Imbalance and Falls, The Elderly, and the not so Elderly…

By Dr. A. R. Scopelliti

Nov

19

Falls are the leading cause of injury, death, and emergency room visits for people over age 65 years.  Falls also rank highly for those under 65 years, despite what most people believe, or want to believe.  Some falls are unavoidable and happen purely by accident.  Unfortunately however, many are not.  Many individuals suffer from imbalance, and because the brain is so good at compensating for things, imbalance typically goes unnoticed until a fall actually occurs.  This usually happens when back up balance systems, such as visual reliance become excessively relied upon unconsciously, and then when they are not permitted to assist in balance, i.e. while walking at night and changing surfaces from a sidewalk to grass, which is much softer than cement, balance loss and a fall occurs. In the elderly however, there is more going on here than is obvious.  As humans age, the spine undergoes arthritic changes which typically begin immediately following maturation of bone, around the third decade.  These arthritic changes become observable in the 4th-5th decade for most, and by the 6th decade, become more significant.  Due to the arthritic changes in the spine, the ocular reflexes, which are in fact programmed early in age and are hard wired to the spine, are now on a different frequency than the aging spine.  It is actually this phenomena that predisposes imbalance and thus falls particularly as we age.  If these reflexive movements are not corrected for, they do not correct themselves and will only worsen with age and increased spinal degeneration. These changes are only permanent if no effort is put into reversing them.  Ask any elder who has been a patient of mine.  Most all of my patients over 55 have high fall risk associated with imbalance at the onset of treatment, and at the time of discharge, are normal, or at least significantly improved, pending their overall level of health.  In fact, imbalance is the chief presenting complete for many of my adult, (as well as younger) patients, either standalone or associated with side affects from vertigo.  The point of all this is that as we age, it is important to retrain the ocular reflexes to match that of what the spine is doing to prevent imbalance and falls.  And this exactly what I spend much of my day doing for my patients.  It is actually not very complicated or lengthy treatment, it just involves a commitment to be evaluated for balance and stability once, and then given recommendations to follow, which, are usually quite simple, much of which individuals can be easily instructed on to perform at home.

Swine flu

By Dr. A. R. Scopelliti

Nov

2

Swine flu has certainly made its way into the media.  Each day, several of my patients ask my opinion as to whether or not the vaccine is a good idea for them and their families.  So here is my opinion.  First, let’s keep things in perspective.  According to the Centers for Disease Control, (CDC), around 15,000 people die in the USA each year from falls.  36,000 people die every year from regular flu.  The World Health Organization, (WHO), reports ~4 million cases of flu world wide each year, from which some 300,000 deaths will occur.  Since most of these deaths occur in third world countries, it doesn’t provoke a media response such as that associated with swine flu here in the USA.

I am not a proponent of flu vaccines.  There is much in the literature to suggest that with respect to flu vaccines, they do not work. Making matters worse, there are known side affects which can be severe.  By now I am sure many reading this article have seen the video going around the internet of the Washington Redskins cheerleader who is alleged to have been crippled with Dystonia following a seasonal flu shot.

Many readers may recall in 1976, the swine flu ordeal from which very few people actually got sick, yet following a vaccination hype, hundreds developed Guillan-Barre’ syndrome, a crippling neurologic degenerative disorder.  Since pharmaceutical companies have virtual immunity from legal actions from vaccine related deaths/disorders, it would appear that the absolute safety of said vaccines would not be as high on the agenda as it ought to be.

Hygiene is of utmost importance during flu season.  If you are sick, stay home, that simple.  Whenever you touch money, one if the biggest carriers of germs, do not touch yourself or food/drink without sanitizing first either with soap/water, or with a alcohol based hand sanitizer.  Immunocompromised individuals should wear a mask in public places.  Keeping ones immune system working effectively in the first place, something that has been largely neglected by the vast majority of our society, is integral, especially during flu season.  Information on healthy eating and on exercise/fitness can be found on my website, and virtually anywhere on the internet.

The American College of Functional Neurology

By Dr. A. R. Scopelliti

Aug

31

Recently I have announced fellowship by the American College of Functional Neurology.  Well, once again I am proud to report that I have recently been advised that I have been accepted as a Fellow of the American Board of Vestibular Rehabilitation as well. The American Board of Vestibular Rehabilitation, (ABVR), certifies qualified physicians at the fellowship level in the specialty are of vestibular rehabilitation.  Vestibular rehabilitation is that area of neurology and otology that concerns itself with the diagnosis and management of balance disorders, including vertigo, dizziness and dysequilibrium.  The ACFN maintains standards for competent practice in the health care specialties for which they offer fellowship. The College and board also conducts recertification designed to enhance the continued competence of accepted Fellows.  Functional neurologists use and utilize current concepts of brain function to formulate brain based neurologic rehabilitation programs to treat patients with neurologic disorders.  Treating patients with dystonia, ADD/ADHD, headaches and traumatic brain injuries, as well as pain, pain syndromes and other types of disorders, our office is no exception.  And with further sub-specialization in vestibular rehabilitation, we would typically see patients with disorders such as vertigo, dizziness and dysequilibrium/imbalance and fall risk, disorders with which we have met with a myriad of success.  More information about the FAVBR or FACFN certifications is available at www.acfnsite.org.

Ménière's Syndrome

By Dr. A. R. Scopelliti

Jun

26

Ménière’s syndrome is a disorder caused by a small defect in the vestibular labyrinth, which essentially causes an unexpected change in the barometric pressure within the chamber from the side with the defect to the good ear.  As a result of this change in barometric pressure, information being delivered to the area of the brain responsible for posture and balance is different from one side to the other.  Whenever this occurs, the brain experiences what we refer to as a sensory mismatch.  When a sensory mismatch occurs, whichever side the brain listens to will be wrong with respect to the other side.  As a result, of this mismatch, the eyes are pushed away from the side of the defect and when they can be pushed no further, they snap back to the neutral position, only to be pushed back again, over and over.  We call this cycle nystagmus, and it is nystagmus that is responsible for the feeling of rotary movement commonly associated with Ménière’s syndrome. This sensation is in essence, vertigo. Unfortunately, it doesn’t stop here.  As I said earlier, this area of the brain is responsible for posture and balance.  As a result of the constant feed of “bad” information during an episode of Ménière’s syndrome, those afflicted invariably begin to demonstrate imbalance associated with dysequilibrium.  If nothing is done to compensate for this, balance deteriorates over time and risk of fall becomes high associated with severe instability and imbalance.  Although Ménière’s syndrome is not treatable, it is manageable.  Management is done through dietary measures and dietary recommendations specific to Ménière’s syndrome patients is available on my website.  The imbalance and dysequilibrium secondary to Ménière’s attacks, is easily treated.  Individuals with Ménière’s syndrome should be on a schedule at minimum once per season for CAPS posturographic stability and fall risk assessment, which literally takes 20 seconds.  As soon as balance is noted to be at less than acceptable level, this can be quickly remedied using neurologic-vestibular rehabilitation, much of which can be done at home if properly advised.  Using this method of ongoing analysis and quick remediation, imbalance will no longer be an issue for long term Ménière’s syndrome patients.  If you or someone you know has Ménière’s syndrome, we invite you to our office for a free balance screen.  If you pass, we see you in three months time, also free.  If you fail, we can talk about a management plan appropriate to your needs.

The American College of Functional Neurology

By Dr. A. R. Scopelliti

Jun

8

I am proud to report that I have recently been advised that I have been accepted as a Fellow of the American College of Functional Neurology. The American College of Functional Neurology, (ACFN), certifies qualified physicians at the Fellowship Level in a variety of neurological specialties. The ACFN maintains standards for competent practice in the health care specialty of Functional Neurology. The College also conducts recertification designed to enhance the continued competence of the Functional Neurologist. Functional neurologists use and utilize current concepts of brain function to formulate brain based neurologic rehabilitation programs to treat neurologic disorders, such as vertigo, dizziness, dystonia, ADD/ADHD, headaches and traumatic brain injuries, as well as pain, pain syndromes and other types of disorders. Our office is no exception and we would typically see patients with the aforementioned disorders and symptoms, with which we have met with a myriad of success.  More information about the ACFN certification is available at www.acfnsite.org.

How Important Is Screening?

By Dr. A. R. Scopelliti

Apr

23

I just returned from my daily trip to the hospital, and today, a nurse’s station was setup in the foyer graciously screening blood pressures for passersby.  It dawned upon me that I check blood pressure for patients all day long, but never have my own checked.  So I decided to stop and participate, (incidentally, my pressure was on the low side of normal).  As I sat in the chair it occurred to me how many individuals have high blood pressure that never stop to have it checked, and what an enormous mistake this is.  Disorders of high blood pressure such as stroke, can be averted before they occur with simple management of their blood pressure before it becomes a problem.  The real problem however is that most people don’t perceive that anything is wrong as high blood pressure is insidious with no real signs or symptoms, until something goes catastrophically wrong, such as a stroke, or aneurism.   Well, then it occurred to me that the same thing occurs with balance loss and falls.  Most people don’t know they have a balance problem because they don’t perceive it, (which is a big mistake), and then, suddenly, one day fall and end up in the hospital with a pelvic fracture or even worse.  Not unlike high blood pressure, imbalance is insidious, you do not perceive that your balance is bad, until it gets sufficiently bad that you begin stumbling about.  It is at this point that imbalance becomes notable.  By the time that you realize that you have poor balance, or a balance problem, the cause has already long passed the point of early intervention.  Much like blood pressure, individual’s need to be screened regularly for balance and fall risk to obtain the benefits of early intervention when there is a problem.  Using specialized “computerized posturography” balance testing equipment, in twenty seconds we can determine your stability, your risk of fall, and whether or not you may have a potential neurologic problem that could easily be remedied with early intervention.  My office performs this test free of charge as a community service.  We offer each individual who chooses to take advantage of it four tests annually, all free of charge.  As the test takes little time, it is cheap insurance to stop in once a season and get screened, pass, and get scheduled again for the following season.  Additionally, it should be noted that balance loss is the first sign of a neurologic problem with disorders such as multiple sclerosis, Parkinson’s disease, etc.  Please call our office at (732) 229-5250 to set up a free screening, or to discuss candidacy for treatment of a health concern.

Vertigo

By Dr. A. R. Scopelliti

Apr

14

Vertigo, for being one of the top reasons why an individual would go to a doctor, is an extremely misunderstood and frequently inappropriately treated disorder.  Vertigo in and of itself manifests as a symptom, not as a true disease entity.  It is often confused with dizziness, lightheadedness, presyncope, anxiety and cardiac problems.  Frequently, a myriad of diagnostic imaging and other tests are utilized in a futile effort to find an appropriate diagnosis, in lieu of a diligent examination having been performed in the first place.  By and large the most common cause of vertigo is due to a condition called benign paroxysmal positional vertigo.  However, it is important to see a properly trained doctor/therapist when seeking treatment.  Most doctors are not trained at all in treating this disorder, few are trained to correctly diagnose it.  This disorder is not something that will show up on an MRI examination.  This disorder occurs when otoconia, (calcium particles in the inner ear), get into the vestibular labyrinthine canal systems were they do not belong.  When this happens, vertigo occurs whenever there is a change in head position.  Vertigo can be severe but usually subsides as soon as head movements stop.  Treatment for the disorder is dependent on which canal is affected.  There are 3 canals on each side, 6 in total.  Treatment must be specific to the canal system afflicted.  Otherwise, treatment will just continue making you more vertiginous.  Making matters more complex, if the diagnosis is not positional vertigo, the treatment won’t work.  And if the diagnosis is positional vertigo and this specific treatment is not performed, any other treatment will not work.  So as you can see, an accurate diagnosis is of critical importance in obtaining the correct treatment, otherwise success will be low.  There are many causes of vertigo.  As such, there is no one main treatment for it.  Treatment varies pending on what is actually causing the symptom of vertigo.  For individuals who suffer from vertigo, bouts are no fun.  They are frequently associated with nausea and vomiting which can be severe.  Vomiting can lead to electrolyte disturbances and thus other medical problems.  Invariably individuals who suffer from vertigo, also suffer from dizziness and imbalance because of the natural compensation of the perpetual spinning sensation or vertigo.  Without appropriate treatment this can lead to a fall which typically changes the course of ones life.

ADD ADHD

By Dr. A. R. Scopelliti

Apr

3

After having completed specialty postdoctoral neurology course work a few years back in the treatment of children as well as adults with neurobehavioral disorders such as ADD, ADHD, autism, etc, I did not incorporate a plan to attract these types of patients into my office immediately.  Until recently, my office has largely focused in the management of patients with balance and movement disorder syndromes, such as vertigo, dizziness, dystonia, imbalance/fall risk, and patients with other brain injuries such as head traumas associated with accidents.  Recently however, in light of the endemic problems in school systems associated with children with ADD ADHD and other learning disabilities, we decided to incorporate patients with neurobehavioral disorders into our daily practice.  Since the inception of this program, we have taken in several patients with a diagnosis of ADD ADHD, most of whom have been children and most of whom had similar patterns exemplifying the disorder.  Our findings have been congruent with the findings of similar programs in other states in that we have met with a very high level of success.  These children no longer need to be medicated; their teachers have called us to see what we are doing as the children are notably improved, with demonstrable change in behavior and academia, etc.  As a result of our successes here, we are increasing the number of children that we accept into our program.  If you or someone you know is interested in our program, you can start by going to www.dcneuro.net/ADD.htm. From there, you can access a free informational report on the disorder, and also submit an electronic consultation form, which I personally will review.  If we feel you are a candidate for our program, we will let you know, (we will let you know either way).  Because we are currently limiting the number of children we accept into our program, even if we accept you, you may have to be placed on a waiting list, with which we appreciate your understanding.  Our office invests a great deal of time into this program and we spend 30 minutes to an hour with each patient.  As such, we must limit the number of participants.  If you prefer, you may contact my office directly at (723) 229-5250, and ask for Debbie.

What Is Health?

By Dr. A. R. Scopelliti

Mar

5

So what is health, and how would you define it? It seems that everyone has a different idea of what they consider it is to “be healthy”. Through the years, I have seen many patients, who consider health to quite simply be the absence of disease. You may even be surprised to learn that many patients consider being able to live with diabetes, hypertension, obesity and other disorders through a delicate balance of drug therapies to be healthy. I think it is safe to suggest that this type of “eyes closed” mindset to taking care of oneself is less than being healthy and certainly less than desirable. Now don’t misunderstand me. I am all for the appropriate management of health conditions. What concerns me however is abandoning healthy habits and adopting poor habits with the assumption that the drug companies will make everything right. This is a tremendous wrong doing in society today and in fact the main reason for the endemic problems of obesity, heart disease, diabetes, cancer, hypertension, etc. that we now have.  There is much information on my Healthy Eating Page regarding, well, healthy eating.  There are also exercises on my Fitness page from beginner to advanced, using a stability ball.  To truly be healthy, is a lifestyle choice with a  balance of healthy diet, exercises and nutrition, and addressing health problems before they take away your health.

Vestibular Rehabilitation Therapy

By Dr. A. R. Scopelliti

Mar

3

There is no question that vestibular rehabilitation therapy is the best way to manage most causes of vertigo, dizziness and imbalance. The downside is that there are very few trained specialists in this field competent in diagnosing these disorders and formulating appropriate treatment applications. This field is mostly the domain of the chiropractic neurologist, and there remain very few doctors sub-specialized in this field, especially in NJ. Further, just because a therapist of sorts offers vestibular rehabilitation therapy, it does not mean that it will be done correctly. My office sees a myriad of individuals with these conditions. Several have somehow managed to find a therapist who performs some variation of vestibular rehabilitation therapy. All have failed because the therapy provided was a “canned” approach, and was not formulated specific to the patient being treated. I find that canned treatment approaches, especially pertaining to vestibular rehabilitation therapy, are destined to fail. Treatment protocols must be specifically designed for the patient being managed. If this is not the case, some patients will improve, some will stay the same, and some will worsen.  You can look at an analogy of physical fitness.  If you want to get into shape and hire a trainer, if the trainer says on day one, ok, were going to start with bench pressing 200 lbs., you can see how that will end up for someone who cannot physically do that.  The same thing happens when you exceed someone’s functional capacity with rehabilitation.

Regarding our E News

By Dr. A. R. Scopelliti

Mar

2

Of interest, the following topics are discussed in this weeks newsletter, composed from recent findings in the medical literature. To receive a copy of our E-News, sign up on our Subscribe Today! page.

Statin Drugs Related To Decreased Brain Function
Memory Is Proportional To Fitness Level
Literacy Level Associated With Poor Portion Control
Mild Traumatic Brain Injury And Seizure Disorder

What Has Become Of Our Culture?

By Dr. A. R. Scopelliti

Feb

20

What has become of our culture?  TV is now inundated with drug commercials advocating drugs to treat just about everything, and during the part where they are required to list the side effects, a pretty young girl is in the background throwing rose pedals, with pleasant music playing, which apparently makes the drugs less dangerous.  Have we all gone mad?  When exactly did taking drugs to curb symptoms  become mainstream medicine, and actually treating the disorder becoming alternative?  I have been running an extremely successful balance center for years, and during this time I can count on one hand the number of patients I have seen who have not been ill-treated with drugs prior to seeing me, (unsuccessfully).  The medical profession at large has been ill-guided in the management of these disorders, prescribing drugs such as meclizine/Antivert, which not only do not treat the disorder, but actually cause dizziness and imbalance/dysequilibrium as a less than pleasant side affect.  This is particularly crazy as the vast majority of these conditions are quickly resolved if treated appropriately by able hands. You would have to agree that it is most illogical to use treatments destined to fail before using those with high probabilities for success.

First Blog Post

By Dr. A. R. Scopelliti

Feb

19

Well, I guess it was inevitable.  Being a technical fellow that I am, I think we all knew that having my own blog page was soon to happen.  So, here it is.  This is where I will publish new information, recent medical literature findings on health and treatment, patient success stories with difficult neurologic cases, the whole enchilada. Perhaps even the occasional recipe share, restaurant find, or wine extraordinaire. So check back frequently to see the most recent topics and to derive as much benefit as can be had from this new section of our website.

Here’s to your health…

Why am I Dizzy?

By Dr. A. R. Scopelliti

Nov

20

If you find yourself reading this and asking yourself the same question, why am I dizzy, you are certainly by no means alone.  Dizziness is one of the top three reasons why patients visit their primary care provider, with headaches and back pain as the other two.  In the old days, you would receive a prescription for meclizine, generic Antivert, which does nothing to correct the ailment, and little to reduce symptoms.  The drug actually makes you more dizzy and increases your likelihood of an unexpected fall, not only from dizziness, but also from decreased reaction time from the drug’s CNS depressant effect.  We now have much better ways of remedying vertigo and dizziness problems, and they do not involve drug therapies.  You cannot treat these types of disorders, (successfully, anyway) with drug therapies, as drugs only minimally affect the symptoms you are feeling, and do nothing to affect the real underlying problem.  A correct diagnosis must be made prior to undertaking any treatment regimen, which then must be specific to the correct diagnosis.  With respect to the dizziness family of disorders, treatment must include neurologic and/or vestibular rehabilitation to have any chance of being successful.  I should know.  I run a successful balance center and I see a myriad of patients who have been unsuccessfully treated.  Many are referred to me from their primary care provider, others, through former patients.  Unfortunately, most of the latter group is largely made up of individuals who have been very frustrated trying wrong therapy after wrong therapy, all the while worsening.  My office has seen several patients who have suffered, some for decades.  Needles to say, this can be most frustrating when you get better in a couple of treatments, as it is natural to angrily wonder, “why has no one sent me here before?”  Well, I wish that I could answer that, but I can’t.  But I can suggest that if you find yourself reading this, you probably are concerned regarding a history of dizziness, or have a friend or a loved one who suffers from vertigo, dizziness or imbalance.  If so, then this is your chance.  I would urge you to reference my website for more information on the disorders, which is actually my area of subspecialty.  Because of the overlap of brain-based disorders, my office successfully treats conditions including dystonia, ADD ADHD, traumatic brain injuries, etc.  We have several pages of detailed information regarding all of these conditions and our remedies for them on my website.  If you do not have access to the web, feel free to contact my office at 732 229-5250.  We can help you to decide if this is right for you.

“New 4 Weeks To Good Balance Program” Introduced For Seniors And Others Afraid Of Falling.

By Dr. A. R. Scopelliti

Oct

13

Falls have become a leading cause of death, especially amongst seniors.  Falls are also a leading cause of nonfatal injuries in all age groups, not just seniors.  Risk of fall is clinically measurable, and it is detectable long before you physically realize that there is a problem.  So, if you perceive that your balance is bad, the problem has already become severe.  The inability to perform the once normal activities of daily living, like walking, and simply moving about without a fear of falling is terrifying.  To make this worse, often those with risk of fall progress to the use of a cane, then to a walker, and ultimately to a wheelchair as the problem progresses.  At this point, dementia/Alzheimer’s is the most likely endpoint.  But it doesn’t have to go this way.  This is why we have created our new “4 Weeks To Good Balance Program” This program requires little or no money out of your pocket.  You will be accurately assessed for risk of fall before, during and after the program to demonstrate the improvement you have made.  We will also send this information to your primary doctor for you so that they may be kept abreast of your improvements, and also to demonstrate that you have been properly assessed for risk of fall as per current medical practice guidelines.  “There are no other programs like this one around” is what we are hearing from patients whom we have already had the opportunity to help, which has been life transforming when they find that their balance is dramatically improved, some in less than four weeks.  “I am so happy to have my life back” & “After only 4 appointments, the change is remarkable”, are common comments from our guest book on our website at www.dcneuro.net.  Life is too short to talk about the things you “used to be able to do” before you lost your balance, or worse still, “before you took your fall”.  For more information on getting started call our office at (732) 229-5250.

Accidents Happen

By Dr. A. R. Scopelliti

Aug

6

Well, I suppose that I must apologize for my most unexpected hiatus as I now have many readers anxious to read my weekly column on various health issues.  As ironic as it may be, as I run a rather successful balance center, the reason for my hiatus was from a fall.  I had broken my ankle tearing all of the connecting ligaments in an accidental fall, which occurred while I was watering plants in my family room.  I had apparently spilled some of the water on the floor, which I later slipped on causing the injuries.  So in addition to my apologies for missing several weeks of writing to you, why do I bring this up?   Simple.  The lesson to be learned here is how quickly accidents can happen.  Now in my case, I practice what I preach and check myself regularly for fall risk, something that takes less than a minute with the computerized equipment we use in my laboratory.  However, many more people will incur injuries such as mine, which will be more than purely accidental, attributable to an untreated balance problem, making accidents like mine somewhat inevitable.  This concerns me greatly having gone through this, as it is certainly no fun being incapacitated and completely reliant on others for a length of time.  And the lower the level of health you are in, or the more complicating factors you have, such as diabetes, the longer that period of time will be.  To complicate matters even further, many people with disturbed balance, think that they are normal because they have no way to determine otherwise without being tested.  In light of this endemic disabling problem, we screen as many individuals as we can get though our doors, for free, each day.  For those who pass the simple 30-second test, you are assured that your balance is as good as it should be.  For those who do not do so well, we can make treatment recommendations so that in short time, your balance will be as good as it should be and thus minimizing risk of fall and the incapacitating disability associated with falling.  Many more falls occur from disorders like vertigo and dizziness, things that are easily treated in my office.  If you have vertigo, dizziness, or an increased risk of fall from poor balance, you don’t need a wet floor to assist you in losing your balance and falling and injuring yourself, it will happen much easier without assistance.  Anyone who wishes to be screened can do so by calling our office and scheduling a screening.  There are absolutely no strings.  You pass, you go home with a congratulatory handshake.  For those who would like more information, our website has a myriad of information on dizziness and balance problems.  We even offer a free consultation questionnaire that you can submit for consideration to determine the nature of your particular problem should you have one.    I would like to thank my many readers for your support and I again apologize for my unexpected absence.  I hope to see many of you in my office for screenings.

New Guideline Says Simplest Treatment For Vertigo Is Also The Best

By Dr. A. R. Scopelliti

Jun

16

The next time the world starts spinning, Patti will know exactly how to make it stop.  But two months ago, when the 50-year-old Ocean County resident woke up spinning with vertigo for the last time, she had no idea what to do.  “I felt like I was drunk,” she said. “I couldn’t stand up. I kept falling over.”   Fortunately for her, she had a friend who also came to my office for vertigo, who has also been asymptomatic since.  They, as well as many others, are better thanks to a simple technique that neurology experts have verified as the best way to treat benign paroxysmal positional vertigo — BPPV — a common cause of severe dizziness.  A series of gentle head and neck movements known as the canalith repositioning procedure is the fastest, easiest way to cure BPPV, according to a new guideline developed by the American Academy of Neurology.  Although only recently gaining awareness, I have been using this technique for decades to successfully treat vertigo.  About 3 million new patients a year in the United States are diagnosed with the problem characterized by dizziness, lightheadedness, imbalance and nausea that can last for days — or even months. Traditional treatments have ranged widely, from drastic measures such as sedatives to nerve surgery to nothing at all.  “Instead of telling patients to ‘learn to live with it’ or having them take drugs, we can perform a safe and quick treatment that is immediate and effective.  BPPV is caused when tiny calcium carbonate crystals called otoconia dislodge in the inner ear and land in the sensing tubes that detect motion and gravity. When sufferers move their heads, those otoconia cause severe sensations of spinning or whirling.  It can be overwhelming as those afflicted just assume that they are having a stroke from the severity of the dizziness.  The condition is typically caused by head injury in people younger than 50, although it is far more common in the elderly, as aging causes degeneration in the structures of the inner ear.  The canalith repositioning procedure works by moving the calcium crystals out of the sensing tubes and into another chamber of the inner ear, where they’re safely reabsorbed. The maneuver, which resolves vertigo in our office in better than 90 percent of our patients, is widely used, but only among doctors who know about it. The technique is not taught in medical schools and most general practice doctors may have heard only rumors of a quick, easy way to treat vertigo.  In the early years, the technique was ridiculed by colleagues for suggesting that such a simple treatment could have profound effects on vertigo. Our office now sees many referrals from local internists for the procedure.

Preventing Falls: Fall Risk is Key

By Dr. A. R. Scopelliti

May

5

When I discuss falls and fall risk with people, their thought process is typically, “well, there is nothing wrong with me, I feel fine”.  That is exactly the inherent dangerous mindset that leads to fall related injuries.  Most people think that to have a high risk of fall means that they would be wobbly and unstable just standing and that they would realize that their risk of fall was elevated.  This is simply not true.  If you are this unstable just standing, your risk of fall has already gotten so high, that you are no longer ambulatory, as just standing and resisting the earths gravitational pull is too much for you.  Human beings have amazing redundancy in our brain circuitry, as a fail safe, so that if something goes wrong with one system, there is usually a backup system in place.  With balance, there are three main systems: vision, sensation from the feet and spine, (proprioception), and the inner ear, (vestibular labyrinth).  Each of these systems on their own should yield enough information for you to effectively stabilize yourself in the earth’s gravitational field. But what happens when we test that, which is exactly what we do when we test someone’s balance and thus risk of fall?  Well, first and foremost, what we see is that most individuals, especially the elderly, have become extremely visually reliant.  So once vision is eliminated by closing the eyes, we can measure the decrease in stability.  This is comparable to coming home at night in the dark, when most falls occur, as vision, which has become overcompensated upon, is poor.  Now lets look at proprioception.  Again, most elderly have some degree of arthritis, which reduces the amount of proprioceptive information reaching the brain.  Consider the same scenario of coming home in the dark, and stepping from a hard cement sidewalk, onto soft wet sod.  Again, enough to cause anyone with poor balance and stability to lose their balance and fall.  In this latter scenario, the vestibular labyrinth is entirely responsible for maintaining your balance.  If it is not working as it should be, your balance is compromised and a fall results.  Well, this is exactly how we test your balance in our office.  Using a CAPS computerized dynamic posturography platform, we can selectively eliminate one or more forms of balance, allowing us to test the remaining form.  Testing is thus extremely accurate and falls become readily predictable.  It is at this point where we would intervene with fall prevention treatment specific to your loss.  With this treatment, we typically see improvement of two full categories within one or two treatments.  This is outstanding as it is taking someone who was previously at an elevated risk of fall, who probably had little to no idea that they even had poor balance, and then improving their balance and reducing their risk of fall significantly.  So if you have not been screened, come in and get screened; it’s free.  And if you have been screened and do have an elevated risk of fall, for goodness sake, don’t disregard it, lets fix it!

“Your Problem Is In Your Head, Just Learn To Live With It”

By Dr. A. R. Scopelliti

Apr

29

Unfortunately, these words are heard by far too many people.  Although this may be true in that the problem really is in your head, (anatomically), one would anticipate that with the myriad of information on brain based disorders available today, that a far more specific diagnosis could be rendered, or, that a referral to a doctor appropriately trained would be offered.  Many of my patients who were told these exact words by their doctors prior to seeing me, are probably reading this article and chuckling, after receiving the needed treatment they so desired and being able to rerun to their normal lives.  You see, if you are being told that your problem is in your head, just learn to live with it, this is a copout for “I can’t find anything wrong with you”.   And not being able find anything wrong with you is not an excuse to put the problem back onto your shoulders by just telling you to learn to live with it. As an example, dizziness is in the top three reasons why one would go to see their doctor.  The primary treatment rendered more often than not is to offer vestibular suppressant medication such as Meclizine, despite the knowledge base, which suggests that this drug not only will not help, but also will actually hinder the natural course of recovery, and, will also cause imbalance associated with disequilibrium. It is often at this point that one is told to just learn to live with it.  Now, it is one thing to be told this, but it is an entirely different thing to actually abide by it.  In this age of providers who specialize in the most detailed areas of medicine and with highly niche practices, it is not difficult to find someone specializing and successfully treating any type of disorder imaginable. To not seek this provider out on your own and follow through with evaluation and treatment is most foolish.  It is most unfortunate when this information is not provided for you by your health care provider, but that does not mean that you should not pursue finding answers on your own.  The Internet is a literal wealth of information and can be used to find just about anything that you are looking for.  Many of my patients find me from our website, (below), performing searches for answers pertaining to vertigo, dizziness, ADD ADHD, brain injury, coma and other brain based disorders.  Most will in retrospect consider this the smartest time they have spent in pursuing treatment options.  Many area physicians refer their difficult cases to me, realizing that I have extensive training in areas that they do not, and that I can help many individuals that they cannot.  It is the ones that don’t know where or when to refer, or take the time to find out that really concern me, as they are the ones saying to just learn to live with it.  So if your doctor should tell you this, what they are really saying is that they have no idea what is wrong with you, what to do for you and that it is up to you if you want to pursue more genuine treatment options on your own, which is exactly what you should do.

More On Headaches

By Dr. A. R. Scopelliti

Apr

22

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Headaches comprise the top three reasons why one goes to the doctor. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative. As a chiropractic neurologist, I have been successfully helping patients rid themselves of headaches, oftentimes in as little as one treatment.  Research has demonstrated the value of manipulative therapy for a multitude of disorders including headaches. A report released in 2001 by researchers at the Duke University Evidence Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication. As a neurologist, we have many diagnostic capabilities at our disposal, as well as adjunctive therapies, which have proven to work very well for migraineurs as well as headache sufferers who have yet to be diagnosed. Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems. The other ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern. Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. Many find themselves in fluorescent lighting and/or in front of a computer monitor all day.  Many are on the telephone much of the day, which is very stressful on the muscles of the head, neck and shoulder. These scenarios are fuel for headaches. So what can you do? If you spend a large amount of time in one fixed position, such as in front of a computer, take a break and stretch every 30 minutes to one hour. Exercise may help relieve the pain associated with primary headaches, however, this will often aggravate headaches of migraineurs. As migraine headaches are vascular headaches, they should always be evaluated prior to entertaining any course of self-treatment. Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches. Naturally, I would recommend all headache sufferers to come see us for an evaluation, as most will be helped in a short amount of time without requiring drug therapies, which can often have deleterious side effects and consequences.  You will be referred for these types of therapies if felt to be warranted to be used as an alternative course of care, although this is certainly not the norm but rather the minority.  The vast majority of our headache patients share a common conclusion; they invariably wish that they had come in to see us sooner and avoided the years of unnecessary suffering.

Preventing Falls

By Dr. A. R. Scopelliti

Apr

14

Perhaps you know someone who’s been injured, disabled or even killed by a fall. Or maybe you’ve taken a spill yourself and are afraid the next one could be worse. As we age, time takes its toll on the bodily systems that keep us balanced and standing upright. For example, you may not see or hear as well, which can affect your balance and coordination. Inherent to the aging process, we see slowing of reaction time, making it more difficult to move away from oncoming pedestrians or adjust to icy patches on a sidewalk, etc. Normal declines in muscle strength and joint flexibility can hinder your ability to stand, walk and rise from chairs. In 2003, more than 1.8 million seniors were treated in hospital emergency rooms for fall-related injuries and of those treated, more than 421,000 were hospitalized. You needn’t let the fear of falling rule your life, however, as many falls and fall-related injuries are preventable. Researchers have identified a number of modifiable risk factors that increase the likelihood of a fall, including medication side effects, loss of limb sensation, poor eyesight, tripping hazards within the home, and lack of physical activity. At least one-third of all falls involve hazards within the home. Most commonly, people trip over objects on the floor. Work with a family member or health care provider to evaluate your home for potential hazards and minimize your risk of injury. Consider a general exercise program that includes activities such as walking, water workouts or tai chi, an exercise whose participants were almost twice less likely to experience a fall. Exercise reduces your risk of falls by improving your strength, balance, coordination and flexibility. Your risk of falling may increase if you take certain prescription medications to treat age-related medical conditions. Many medications have side effects that can affect your brain function and lead to dizziness or lightheadedness. The number one prescribed drug for dizziness, meclizine, comes to mind here. Taking multiple medications magnifies the risk, as does combining prescription drugs with alcohol, over-the-counter allergy or sleeping medications, painkillers, or cough suppressants. Ask your prescribing physician or pharmacist to review your medications and reduce your chances of falling by using the lowest effective dosage. Also, discuss the need for walking aids or supports while taking medications that can affect balance. Reduced vision increases risk of falls. Age-related vision diseases, including cataracts and glaucoma, can alter your depth perception, visual acuity and susceptibility to glare. These limitations hinder your ability to move safely. It is important to have regular check-ups with your ophthalmologist. Also, regularly clean your glasses to improve visibility. Osteoporosis makes bones less resistant to stress and more likely to fracture. Caused by hormonal changes, calcium and vitamin D deficiencies, and a decrease in physical activity, osteoporosis is a chief cause of fractures in older adults, especially women. To help limit the effects of osteoporosis, be sure to eat or drink sufficient calcium. Falls don’t have to be a part of getting older. Our office offers free fall risk screening. Don’t wait until you end up in the hospital to find out your fall could have been prevented. Take advantage of this offer, as the first part of preventing a fall in knowing if you are at risk.

ADD/ADHD:Children – Adolescents – Adults

By Dr. A. R. Scopelliti

Mar

31

In the past decade, prescriptions for Ritalin, a stimulant medication commonly used for attention deficit hyperactivity disorder (ADHD), increased five-fold, with 90 percent of all prescriptions worldwide consumed in the United States. As many parents grow leery of the traditional drug approach to ADHD, promising results with non-drug treatments that focus on postural stability, nutrition and lifestyle changes that affect brain activity are emerging.  Some children may simply have difficulty learning certain subjects, but the current system, in a sense, prompts school officials to encourage their parents to have the children diagnosed with ADHD.  The higher the number of disabled kids in the school, the more funding the school can apply for.  Some teachers might also have difficulty with students who have a different style of learning. If the child is a visual learner and the teacher is not, perhaps the child is not being taught in a way he or she can learn from. Before diagnosing the child with ADHD, several questions need to be answered, such as is the child too active? Bored?  Does the child suffer with dyslexia or a different learning pattern? It can be a behavior problem, problems at home, or frustrations with the teacher’s style. If we went to a conference where the speakers taught in a way we can’t learn, we would be frustrated and would misbehave, we’d get up and leave or chat to the person sitting next to us.  The traditional medical model, however, seems to follow the cookie-cutter principle. The diagnosis of ADHD is based on a questionnaire. But this is not enough.  True ADHD patients have other signs, tics, tremors, balance or postural problems, or unusual sensitivity to touch, movement, sights, or sounds. Unfortunately, although medications can keep ADHD under control, they don’t cure it. Eighty percent of patients have ADHD features in adolescence, and up to 65 percent maintain them in adulthood. Our office offers a non-drug and non-invasive integrative functional neurologic rehabilitative treatment alternative for ADHD patients that targets the underlying problems, not just symptoms.  Motor activity, especially development of the postural muscles, is the baseline function of brain activity. Anything affecting postural muscles will influence brain development. Musculoskeletal imbalance will create imbalance of brain activity, and one part of the brain will develop faster than the other, and that’s what’s happening in ADHD patients.  Chiropractic neurologists are trained to identify the under-functioning part of the brain and find treatments to correct the problem, to help that hemisphere grow.  On every patient, we perform a brain function exam. We test visual and auditory reflexes through, for example, flashing light in the eye, or asking patients to listen to music in one or the other ear.  When the problem is identified, patients are placed on a treatment program, and most of the therapies can be done at home. Patients are asked to smell certain things several times a day … or wear special glasses. We also focus on their individual problems. Some children, for example, have difficulty with planning, organization, and coordination, so they benefit from timing therapies.  They learn to clap or tap to the metronome, perform spinning and balancing exercises.  Although currently no studies comparing chiropractic neurological and drug treatment for ADHD are available, chiropractic neurologists are compiling the data. We test children before they start the treatment and then every three months. Within the first three months, the children get a two grade level increase on average, which is pretty dramatic.  With children on medications, the improvement in academic performance is short term and lasts only as long as they take the medication. Our programs change brain function and the improvement doesn’t go away.

Dizziness and Falls

By Dr. A. R. Scopelliti

Mar

25

Current statistics show that approximately 13 million Americans over the age of 65 suffer from some type of dizziness or balance problems that significantly interfere with their lives.  Consider that half of all falls among the elderly are the result of untreated or mistreated vestibular problems, (vertigo).  Currently, falls are the leading cause of injury death in persons over 65.  In the over 75 age group, 75% of visits to the emergency room are for injuries associated with falls.  This is by no means a problem only affecting the elderly, as the number one cause of non-fatal injuries, in all age groups, is from falls.  Many falls are unpreventable, such as falling off of a ladder when a stair breaks.  But most are preventable, coming from poor balance associated with neglect of these systems over the course of our life.  Balance is essentially a sense, derived from the integration of vision, the vestibular labyrinth, (inner ear), and the proprioception, (sensation) perceived from the feet.  Any compromise of any one of these systems lends itself to decreased balance sense and thus increased risk of fall.  Quite commonly, humans develop an over reliance on the visual system, allowing a sort of semi-neglect of the other systems.  When this occurs, fall risk increases when one is in the dark, or on soft or uneven ground, or by example, stepping from a solid surface like a sidewalk to a soft surface like wet turf.  Attempting this maneuver after dusk complicates balance greatly in those with a strong visual reliance, thus increasing risk of fall further.  As a typical scenario, one leaves a restaurant after dinner and a few drinks.  On leaving the restaurant, it is dark and raining.  When stepping from the walkway to the lower parking lot, or onto soft wet turf, the proprioceptive system from the feet is relied upon heavily to maintain one’s balance.  If one is strongly visually reliant, this system may fail, and the individual will fall.  Compounding this are disorders such as macular degeneration, cataracts, glaucoma and particularly diabetes.  In our office, all patients are checked initially, and at regular intervals for balance and risk of fall, using a computerized posturography system, which is extremely accurate at predicting falls associated with poor stability.  Testing takes less than a minute, and as such, we offer this fall risk screening free of charge as a community service. We also offer free informational booklets on vertigo, dizziness and dystonia.  You may request one by calling toll free, (24 hr. recorded message only): 1 888 685-8386 to receive a vertigo/dizziness booklet, 1 800 296-7504 to receive a dystonia booklet.  Lastly, use good sense in fall prevention.  Use nightlights in hallways, near stairs, between the bed and the bathroom, and anywhere else you may be walking at night.  Consider that you may need to walk anywhere in your home in the event of a fire, as such, nightlights illuminating all areas would be appropriate.