May

21

Over the years I have authored several articles on vertigo, dizziness and imbalance, mostly pertaining to treatment, as treating these disorders is my specialty.  So how do you avoid getting them in the first place? Well, not so easily for some, quite easily for others.  Lets first talk about vertigo.  The most common causes of vertigo simply cannot be volitionally avoided outside of recommending that you do not bang your head.  Vertigo seems to attack everyone at some point or another, some being more predisposed to having repeat attacks.  The good news however is that the disorder is quickly remedied, at least in my office.  If you do get vertigo you do want to come in and get it treated quickly as it typically only gets worse, and more importantly it invariably leads to imbalance, which causes falls, which are much more difficult to recover from and often times you do not.  So the longer you wait to get vertigo treated the more a fall becomes imminent.  As some types of vertigo can be caused by swimming, particularly in lakes, cautions should be taken to avoid getting water in the ear canals. Dizziness, is actually different than vertigo, the latter having a rotary type feeling.  Causes of dizziness are vast.  It is the main side affect from any drug.  High or low blood pressure can cause dizziness as can variations high or low in blood sugar.  If you are taking drugs for high blood pressure, it is always a good idea to have a home unit so that you can monitor your pressure and maintain a log, which you can share with your doctor.  If you gain or lose weight and your daily recordings start to change, you need to inform your prescribing doctor immediately as the drug dosages may require titrating upward or downwards. Similarly, changes in blood sugar are associated with diabetes, which if not kept in check will cause dizziness. Alternatively, a pre-diabetic state where there is simply too much sugar in the diet, hypoglycemia, (low blood sugar), which many people are susceptible to from skipping meals too long or eating poor quality, (low nutritional value), foods can also cause dizziness.  If you do not have any of these conditions, it is a good idea to continue to do things in your best interest to keep it that way.  Eat healthy and exercise regularly.  See a doctor regularly to have your blood pressure checked and have blood work done annually.  It would be appropriate to mention eye exams as well as changes in vision as well as ocular diseases are a cause of dizziness. Imbalance, is usually a side effect of vertigo or dizziness.  However, it can occur without and typically does as we age although this needn’t be the case.  Imbalance is typically associated with aging primarily because the eyes and spine work differently together as the spine becomes arthritic, which is inevitable as we age.  If this is not corrected imbalance is the result.  My office offers free screening exams for imbalance and the test only takes twenty seconds, and it is the standard in the industry for fall risk analysis currently.  As with blood pressure and blood tests, fall risk analysis should be performed routinely every few months.  There is no downside as there is no prep required for the test and results are immediately available.  And if it means averting a fall the service is invaluable.

Jan

18

Dizziness and vertigo are among the top three reasons why patients visit a physician. Back pain and headaches comprise the other two reasons. Symptoms such as dizziness, vertigo and imbalance actually are estimated to affect 40% of patients 40 years of age and older. Of those age 65 years or older, 25% are estimated to suffer a fall and thus a fall related injury. Falling is typically a direct consequence of dizziness, primarily in this group of elder individuals and risk of falling can increase considerably when those individuals have other problems such as high blood pressure or diabetes, or any of the gamut of neurologic defects such as Parkinson’s. A sample report of US emergency room visits, from 1995-2004, confirmed that vertigo and dizziness were indeed high on the list of reported presenting complaints as reason for reporting to the emergency room. Data from the National Health and Nutrition Examination Survey demonstrated that individuals with symptomatic vestibular dysfunction have a 12-fold increase in the probability of incurring a fall. It has also been associated that more frequent medical consultation, sick leave, and interruption of daily activities in general, have been related to dizziness symptoms, particularly vestibular vertigo. Medical research on ill health is commonly disease focused as opposed to symptoms related. This generalized approach may actually underestimate the reality of such common symptoms as vertigo and dizziness, which as mentioned, rank high as patient complaints in primary care, yet evade accurate diagnosis and remain unexplained in 80% of cases. Making matters worse, even though symptoms of vertigo and dizziness can be associated with a wide variety of other conditions, all of which necessitate a multidisciplinary approach to management, said dizziness symptoms rarely prompt appropriate referral to a qualified specialist for proper evaluation. The most frequent conditions which cause such symptoms as vertigo and dizziness for the most part remain largely undiagnosed outside of specialty clinics such as my own. Because of the substantial risk of injury and the resultant decline in independence and/or quality of life following a fall, predicting who is at risk is most helpful, and for those who reduce that risk through a fall prevention program such as ours, falls and otherwise impending fall related injuries may be prevented. Our office does just that using computerized technology, which ironically, only takes seconds to perform. Balance is not a single physiologic function. The sensory inputs for balance include vision, vestibular, and proprioceptive feedback. While a person is walking, the brain must instantaneously integrate this information and execute appropriate motor planning. This function must be supported by an adequate neuromusculoskeletal system. All of these factors change with age. Further, any disease related decline in any of these systems further impairs balance. Bilateral vestibular loss is a significant contributor in 25% of elderly patients with imbalance. Untreated vertigo is a severe risk factor for falling as well. Our office, as a community service, does not charge for balance/risk-of-fall analysis. Call my office (below) to be screened.

Oct

6

So what is vestibular rehabilitation therapy, a.k.a.VRT?  Think about it like this.  Suppose you just had shoulder surgery.  Would you be all better, or would you now need to do physical therapy to rehabilitate your shoulder back to normal function?  Without rehab such as this, I can tell you that you will never regain normal use of your shoulder.  Well the same is rue of the vestibular labyrinth.  Whenever you have any affliction that causes any type of dizziness or vertigo, without vestibular rehabilitation therapy exercises, it is highly unlikely that you will just return to normal function.

Is There a Difference Between Physical Therapy and Vestibular Rehabilitation Therapy?

Yes.  Physical therapy involves exercise therapy primarily for the trunk and limbs.  This can oftentimes be useful for individuals with increased fall risk and imbalance.   However, it should not be confused with vestibular rehabilitation therapy which concerns itself with rehabilitation of the vestibular labyrinth, brain and oculomotor system.

How Does Vestibular Rehabilitation Therapy Work?

Just like physical therapy makes muscles grow stronger and more coordinated, vestibular rehabilitation therapy is a method of habituating neurons of the central nervous system, (primarily the brain), and the vestibular system so that neurologic function  may be enhanced thus improving the function of the balance systems. Because neurons respond and grow very differently than does muscle tissue however, vestibular rehabilitation therapy must be done very specific to your needs.  This is to say that a canned approach will not work.  Two individuals with the same exact problem may respond very differently to vestibular rehabilitation therapy depending on the extent of involvement of their disorder, their overall health going into treatment, and their level of stamina in their ability to perform the exercises in the first place. If this is not taken into consideration in the therapy plan, the treatment is destined to fail and will in all likelihood even worsen the patients status.  I see this all of the time in my own practice as it is a common occurrence and reason for referral to my office in the first place.

Sep

21

Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches). The overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it quickly reaches 40% in patients older than 40 years of age. The incidence of falling is 25% in people older than 65 years of age. Falling can be a direct consequence of dizziness in this group, and the risk is increased considerably in those suffering with other neurologic deficits. A report reviewing presentation to US emergency room departments from 1995-2004 indicated that vertigo and dizziness were quite prevalent and thus high on the list of presenting complaints.

These symptoms, particularly vestibular vertigo, are associated with more frequent medical consultation, sick leave, and interruption of daily activities in general.

Research into the burden of ill health usually focuses on specific diseases rather than symptoms. This diagnosis-based approach, however, may underestimate the burden of common symptoms such as dizziness and vertigo, which rank among the most frequent complaints in primary care but remain unexplained in as many as 80% of cases.

In addition, although dizziness and vertigo may be caused by a variety of conditions that often require a multidisciplinary approach, these symptoms rarely prompt referral to a specialist or hospital admission for investigation.  In example, the most frequent conditions which cause such symptoms as vertigo and dizziness remain largely undiagnosed outside of specialty clinics, (such as my own).

Data from the National Health and Nutrition Examination Survey found that those with symptomatic vestibular dysfunction have a 12-fold increase in the odds of falling.

Because of the substantial risk of injury and the resultant decline in independence and/or quality of life after a fall, predicting who is at risk is most helpful. Our office does just this using computerized technology, which ironically, only takes seconds to perform.   Balance is not a single physiologic function. The sensory inputs for balance include vision, vestibular, and proprioceptive feedback. While a person is walking, the brain must instantaneously integrate this information and execute appropriate motor planning.

This function must be supported by an adequate neuromusculoskeletal system. All of these factors change with age. Further, any disease related decline in any of these systems further impairs balance. Bilateral vestibular loss is a contributor in 25% of elderly patients with imbalance. Untreated vertigo can be a risk factor for falling as well.

Our office, as a community service, does not charge for balance/risk-of-fall analysis.  Call my office (below) to be screened.

Aug

18

The only thing worse than someone who suffers with fall risk and not doing anything about it, is someone who does do something about it but waits too long and winds up suffering the consequences of a fall.  This is so disheartening to see as we help so many people with severe risk of fall to improve their lives, their safety and their ability to live normally again.  Why I am I telling you this? Because I saw a new patient last week for the first time, who was referred to my clinic for dizziness and imbalance.  Unfortunately for several years up to this point nothing had been done for this patient with respect to her imbalance. By the time I saw her she had already been suffering for years, and steadily worsening.  You might say that I had my work cut out for me, however, I was confident that I could help this woman.  Well, I received a telephone call earlier this week from a family member of this patient, informing me that over the weekend she had fallen, fracturing her hip.  She is currently hospitalized, where she will likely remain for quite some time, awaiting surgery for her fractured hip, which, may never even be performed depending on whether or not she is determined to be of adequate health or not to even be a surgical candidate.  If she does not have the surgery, the likelihood of her waking again is not good, and if she does, it will be quite some time and effort, as well as much pain, before she may ever walk again.

Obviously the unfortunate circumstances here are that we could have prevented this fall had I seen this patient sooner.  There are so many people waking around that have increased fall risk, some who realize it as their imbalance has already gotten severe, and some who have a false sense of confidence because they don’t yet know that their balance is deteriorating.

My office tests individuals for risk of fall daily.  The test takes seconds to perform and is done without charge. It is extremely accurate at predicting fall likelihood based on overall stability, and is in accordance with hospital mandates requiring front line providers to have some methodology for screening individual patients for risk of fall.  For these reasons, everyone, without exception, should be screened.  If you pass, you go on with your life.  If you do not pass, wouldn’t you like to know that before you fall and break a hip?

Jul

27

Diabetes is becoming more common and more of a medical problem than ever before.  I am specifically referring to type 2 diabetes, which is invariably brought on entirely by ones eating habits.  This is why it has earned the designation “adult onset diabetes”.  The “juvenile” type, or type 1, occurs at an early age for other reasons entirely.  So let’s discuss type 2, since that is the big problem and since it is entirely in your control to remedy.  Quite simply, type 2 diabetes occurs associated with obesity.  For each pound of “extra” weight one carries, risk of diabetes rises, exponentially.  As an example, someone 30 pounds overweight has a 4000% increased risk in becoming diabetic.  (This is not a typo).

Heart disease and peripheral artery disease are the biggest complications that people face with uncontrolled diabetes. Approximately 65% of death from diabetes is due to heart disease and stroke.  Peripheral artery damage or nerve damage, also from uncontrolled diabetes, can lead to foot problems that can lead to amputations. More than 60% of leg and foot amputations not related to an injury are due to diabetes.  Diabetes is the leading cause of blindness in this country. Other problems include glaucoma, cataracts and diabetic retinopathy.  Studies show that regular eye exams and timely treatment of diabetes-related eye problems could prevent up to 90% of diabetes-related blindness. Recent studies correlate metabolic syndrome with marked increase in total fructose intake in the form of high-fructose corn syrup, beverage and table sugar.  Metabolic syndrome is a name given to a group of risk factors including heart disease.  If you learn to read labels, you will find that many products now contain high fructose corn syrup.

Dizziness, a common problem in and of itself, is often associated with deregulation of sugar.  Sugar levels, both too high, and too low, will lead to dizziness. Your body does a delicate balancing act trying to maintain as steady a level of blood sugar as possible.  You can help this cause  by maintaining a healthy diet that does not cause blood sugar levels to suddenly go through the roof, or conversely, waiting all day to eat causing them to plummet.  More information on healthy eating tips can be found on my website.  Much of the dizziness which I see clinically is ether caused by or complicated by extreme variations in blood sugar levels.

Of equal importance is exercise.  Humans were not meant to be sedentary, which unfortunately, is how many Americans spend their day. Exercise should be performed at the highest level of your ability.  If you are unsure of your ability, you should discuss it with your doctor.

Jul

20

High blood pressure affects about 1 in 4 American adults and is one of the most common worldwide diseases afflicting humans.  It increases the risk of heart disease and stroke for those afflicted, so it’s important to know how to lower high blood pressure. High blood pressure, aka hypertension risk factors include obesity, drinking too much alcohol, smoking, and family history of hypertension.  Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease.

Normal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg, (however, unusually low readings should be evaluated for clinical significance as well).  Prehypertension is a new category emphasizing that patients with prehypertension are at risk for progression to hypertension and that lifestyle modifications are important preventive strategies.  Home blood pressure predicts cardiovascular events much better than do office readings and can be a useful clinical tool. Anyone with hypertension should be monitoring their own BP at home.  BP kits are available everywhere, and they are inexpensive.  If your BP readings suddenly become low, you should tell your doctor to titrate downwards your medication so that you do not become syncopal, (passing out).  The following are the ranges of BP:

Normal – Systolic, (top number) lower than 120, diastolic, (bottom number) lower than 80.

Prehypertension – Systolic 120-139, diastolic 80-99.

Stage 1 hypertension- Systolic 140-159, diastolic 90-99.

Stage 2 hypertension- Systolic equal to or more than 160, diastolic equal to or more than 100

Recommendations to lower blood pressure and thus decrease cardiovascular disease risk include the following:

  • Lose weight if overweight. Even a few extra pounds will raise blood pressure.
  • Google DASH (Dietary Approaches to Stop Hypertension) for a reasonable diet, which is rich in fruits and vegetables.
  • Limit alcohol intake to no more than 1-2 drinks/day.
  • Increase aerobic activity (30-45 min most days of the week).
  • Reduce sodium intake, learn to read nutritional information labels on products you purchase.
  • Maintain adequate intake of dietary potassium, calcium and magnesium for general health.
  • Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.

Jun

28

So why is it that one can go to ten different specialists, get no diagnosis or effective treatment , and that same individual can then come to see me and get better in a few days?  Am I just very lucky?  Is it the power of suggestion?  Well, I can tell you, that’s not it.

Here is why.  Most specialists do what they do very well.  They excel in and have vast studies preparing for their particular area of expertise.  However, most human suffering is not always textbook.  That is to say that when a doctor studies disorders, they do not always match up with what we might see in our offices.  Further, most doctors tend to be trained such that they are examining you with a goal of matching up your symptoms with illnesses that are referenceable in a medical textbook.  Many disorders can be diagnosed in this manner; however, the vast majority of human suffering is not from these “named” diseases.  It is from “shades of grey” symptoms that do not typically match up well with any disorder, yet are real symptoms for the patient.  Since the doctor cannot find any disease that matches your conditions symptoms, you are simply told to “learn to live with it”, or worse, “it’s all in your head.”  Few doctors examine patients cumulatively just trying to get a grasp of what might be realistically happening with that person rather than just trying to find the matching diagnosis code to send to the insurance carrier.  Well when you think about this, you can see how easy it is to have no idea of what may be happening to explain your symptoms.  It is easy to see how all of the individuals with disorders that fall into the “shades of grey” area are just going to be brushed off as being odd or unrealistic problems.

The reason why my office has so much success in this area, is because when I examine patients, I do not have a predisposed opinion of what disease I am trying to rule out.  I look at them for what they are, a human being with symptoms, and I use logic to rationalize what neurophysiology is not working properly, and more importantly, what could be done to fix it.  My office has had great success treating patients with difficult disorders in this regard.  Because of our success, we routinely see patients who come from other states and spend a week with me so that they may get better.

So if you have been told to “learn to live with it”, or have been going from doctor to doctor without answers, you are my best patient.  We always offer a complementary consultation if you prefer one prior to examination as we understand that you may have many questions simply out of years of frustration in dealing with the medical system.

May

4

As a rule, the main types of disturbances that we feel as humans that present to the clinician as one form of dizzy feeling or another, are vertigo: a sense of spinning; disequilibrium: a sense of imbalance; or dizziness: a feeling of being off, or disoriented.  Dizziness is the vaguest of the symptoms.  Let’s talk about it this week.

Dizziness is in the top three reasons why individuals present to their doctors office.  It is often a confusing constellation of symptoms which patients find difficult to describe, and clinicians find difficult to diagnose.

Oftentimes, vertigo and disequilibrium will manifest such that the patient would complain to the clinician about dizziness.  It is up to the clinician to ask the right questions to discern between them to correctly diagnose the patient and refer to the appropriate specialist for neurologic or vestibular rehabilitation therapy, (what I do), vs. to an ENT for a sinus infection or similar.

So what then is Presyncope?  Well, syncope, means in medical terminology to pass out.  So presyncope is the sensation just before passing out, without progressing into actually passing out.  Most patients with presyncope will be referred to a cardiologist, assuming of course that they were even correctly diagnosed in the first place, which is not necessarily always the case.  This is not a bad plan as it rules out any cardiac problems as being causative, however, the patient gets cleared from cardiology and is still symptomatic.

Well here’s the deal.  Syncope/presyncope is almost always a neurologic condition.  Yes, it is caused by the heart, however, the heart only does what the brain is telling it to do.  To make some sense of this, imagine you are standing up.  Your heart has to pump blood up to your head sort of like a small water tower.  Now imagine lying down.  As blood gushes into your head, baroreceptors in the carotid vessels tell your brain to tell you heart to slow down so you don’t shoot your head off.  Conversely, when you arise from lying down, your carotid baroreceptors tell your brain to tell your heart it had better pick up and fast to get blood back up to your brain, (like a water tower again).  When there is a problem with this regulatory system, you are going to experience presyncope.  As this problem worsens, you will actually experience syncope, (actually passing out).  The irony to all of this is that this is actually very easily fixed more often than not; these are the types of problems that I spend much of my day fixing for people. As syncopal problems worsen, it is not uncommon for simple head movements or turns, or visual stimulus from driving to provoke an attack.  This also often precipitates into panic disorder and panic attacks, not only because of the fear and anxiety associated with the symptoms, but also because of the sympathetic nervous system and its hard wiring.  (The whole “fight-fright-flight thing you learned in school).

Again, there are many causes of dizziness and presyncope is just one of them, but it is a fairly common problem and finding the right specialist early on can make a big difference in how far your symptoms will progress and whether or not they will progress into other conditions over time until properly treated.

Apr

27

Over the past several months, we have been discussing imbalance, dizziness, vertigo, disequilibrium, etc., how to find out if you are at risk, etc.  We know that as part of the natural aging process individuals will become more prone to imbalance associated with changes in the spinal joints from degenerative joint disease, and the disturbances in the ocular reflexes which are preprogrammed to the spinal movements.  These disturbances can also lead to anxiety, changes in respiratory dynamics and changes in the digestive system as these systems are all hard wired and linked together, thus changes in one system affect the others systems as well.  Changes in breathing dynamics alone are probably responsible for half of the dizziness in society.  These changes not only create anxiety and panic disorder, but will eventually lead to a permanent change in your systemic pH, which can lead to all sorts of problems.

The good news is that these disturbances are not only reversible, but are actually quite easy to fix.  Inappropriate ocular reflexes are corrected through appropriate eye exercises, which are orchestrated to strengthen the specific ocular weaknesses, which need to be addressed.  This alone typically improves imbalance and disequilibrium immediately.  Breathing dynamics can easily be corrected by increasing rib excursion and thus increasing lung vital capacity.  This will immediately reverse aberrant changes in systemic pH, any panic disorder induced from such, gastric problems, which may be associated, etc.

Inasmuch as these problems are quite reversible and easily fixed, it is certainly with an understanding that treatment is provided under the guidance of a health care provider adequately trained in treating problems associated with imbalance and postural and gait abnormalities.

It is unfortunate that the vast majority of balance problems go unnoticed and untreated when they are easiest to correct, as most individuals don’t appreciate that they even have a problem because they do not take the time to get screened.  Society has been trained over time to obtain routine blood work, and other “routine” and “preventative” screening procedures, because we know that if we do not have them, we may miss something that would have been easy to fix had it been diagnosed early on but was ignored because no screening was ever done. Balance screening is no exception to this.  Simply put, the longer you wait, the longer it will take to fix, and the more likely you will incur a fall and thus have a serious injury to overcome. I have mentioned several times in my column that you cannot tell if your balance is impaired without screening.  If you can tell, it is only because it has already gotten so severe that it becomes apparent just standing or while walking about. If this is the case, not doing anything about it is like being diabetic and not taking your medication and not changing your diet.  It will just be a matter of time

Apr

5

Falls actually occur for many reasons. Falls occur simply out of shear accident. You slide on something slippery, you are knocked over by something, etc. When you fall because you lost your balance, this is more concerning as it alludes to the fact that there is more going on, i.e., a problem. There are many medical conditions which contribute to fall risk. Parkinson’s, Alzheimer’s, diabetes, cardiac problems to name a few. In the absence of disease, fall risk occurs as an affect of normal aging. This is insidious, and most do not perceive that their balance is poor until put to the test, at which point they fall. Some who fall will be fortunate and get a second chance to treat their poor balance, others nay not be so fortunate and suffer grave injuries that may even be fatal. As human’s age, the spine tends to degenerate as part of the normal again process. Because of this degenerative process, the proprioceptive systems that send information to the areas of your brain that regulate balance, tend to diminish over time, so that you have less proprioceptive information reaching the balance centers of the brain. When this happens, first off, you are at increased risk of fall. Now, amplify the situation by adding poor vision, or, being in a situation that requires good balance, like at night when it is dark, or being in a dark room. Consequential balance loss will be amplified. As these two systems fail, which is markedly common in the elderly, increased reliance on the vestibular labyrinthine system becomes necessitated. If there is any problem with this system whatsoever, a fall is imminent. We can easily check these three postural systems in our office, in fact, we do it free as a community service. Falls are endemic and a leading cause of accidental injury and accidental death. For this reason, we urge all individuals, especially those over 60 years of age, to be tested. If you think your balance is fine because you have not yet fallen, you are simply lucky. The simple fact is that you only know your balance is good if it has been tested and you pass your test. If you already know that you have poor balance, or, you have a history of falling, do yourself a huge favor and take advantage of our offer to test you for free. It will change the course of your life.

Mar

2

Obviously, the answer is one that is successful at treating patients with balance and dizziness type disorders.  Our office has been sub-specialized in seeing patients with balance problems and fall risk, in particular vertigo and dizziness for some time now.  It is well known that the simplest treatments for vertigo are the most useful, yet we continue to see patients inappropriately medicated with vestibular suppressant therapy, anti-anxiety drugs, and on and on.  The history of these patients typically includes that of a small fortune spent on diagnostic testing, which could have been avoided with appropriate clinical examination and management early on.  The last statistic I read in the medical literature estimated that almost 99% of the MRI’s performed on patients referred with vertigo are normal.  That’s a heck of a lot of money spent for a very small return, certainly not what I would consider an ideal use of the diagnostic dollar.  One of the main problems that I see everyday is that patients are first seen by their primary care provider, which is now the way with insurance HMO’s.  Being generalists, patients are managed such to rule out more threatening diagnostic entity’s, typically by imaging, (MRI).  Since treatment for patients with vertigo and dizziness typically responds very quickly in our office, it would seem this course of action to be a much more sensible initial management plan in the multitude of cases where no life threatening problems are suspected.  If no resolve is evident via this course, or, if on examination suspicion of more threatening diagnostic entities exists, then imaging can be performed.  This plan only delays potential imaging by maybe one week, certainly not enough to have missed the boat, especially, in light of the statistic of 99% of these tests returning as normal.  The one most important factor related to all of this is the initial examination.  The examiner should be so trained that it becomes readily apparent during the examination as to the urgency of specialized studies such as MRI, or not. In the latter, it should not be the next thing done.  Further, all patients need to be evaluated for fall risk.  Those with established fall risk should be managed with fall prevention and rehabilitative therapies congruent with their needs.  We see this as being overlooked more often than not. Our office currently is compliant with JCAHO goal and requirement re: falls-risk identification, assessment and prevention, effective 2005.   Simply put, everyone who walks through our office gets a balance screening test, which we perform free of charge as a community service.  If you or someone you know is suffering with balance loss or dizziness, we would strongly recommend going to our What Patients Had To Say page.  Or, simply call our office directly at (732) 229-5250.

Jan

20

Pretty much everyone knows at least one person who has fallen.  The fall may have been purely accidental, such as a slip and fall, or the fall may have been related to dizziness.  More than one in three people age 65 years or older fall each year. The risk of falling and thus fall-related injuries rises proportionally with age.  Each year, more than 1.6 million elderly go to US emergency departments for fall-related injuries. Among older adults, falls are the number one cause of fractures, hospital admissions for trauma, and accidental injury deaths. Fractures caused by falls can lead to hospital stays and oftentimes to long term disability. With this comes loss of independence.  Most often, fall-related fractures are at the arm, hand, ankle, spine, pelvis or hip.  Hip fractures are amongst the most serious type of fall injury.  They are a leading cause of loss of independence, particularly in the elderly.  Only 50% of the elderly hospitalized for a broken hip return home or are capable of living on their own after the injury.  There is high morbidity associated with hip fractures, mostly from complications.

Most people develop a fear of falling which increase with age.  This can become even more overwhelming for those with a previous fall.  As such, many will avoid activities of daily living such as walking, shopping, or taking part in social activities.

Many individuals have deceived themselves into thinking that they are not at risk of fall simply because they have never fallen, or because they do not feel imbalanced.  This could not be further from the truth.  You see, the problem with risk of fall is that by the time that you can tell that you have a problem; the problem has already gotten severe.  It is for this reason that the hospital administration mandated fall risk analysis in 2004.  My office checks dozens of patients weekly for risk of fall.  Most know they have a problem going into the test as that is why they are in my office in the first place.  Many others however feel confident that they will score high and are surprised when they do not.

If you are worried about falling, our office offers a simple 20 second test to assess your overall stability, and thus your risk of fall.  The test is accurate and currently the standard used to evaluate fall risk.  My office offers this testing free as a community service.  We will also send a copy of the report back to your doctor, so that they know both that you have been tested and whether or not you are high risk.  Those who are high risk will be accepted as patients and treated appropriately.  Of those treated, most will have reduced their risk to normal; the remainder will have improved by at least one or two categories.

Because of the human aging process, changes occur around the sixth decade that lead to diminished balance ability and thus an increased risk of fall.  These detrimental changes can be easily fixed with some simple exercises.  Since most people don’t ever get checked, they don’t ever fix these detrimental changes and fall risk just continues to rise with age.

Even though detrimental changes occur as an inevitable part of human aging, falls are not an inevitable part of human aging.  Getting rid of your risk of falling, as well as your fear of falling can help you to stay active, maintain your physical health, and prevent future falls.  Call our office today for more information on falls, fall risk screening, or balance/dizziness problems in general.  More information can be found on the main pages of this website, (www.dcneuro.net).

Jan

8

A simple thing like tripping on a carpet or slipping on a wet floor can change your life in a heartbeat.  Like the thousands of people who fall each year, you may suffer a broken bone. Broken bones are no picnic, and for older people, a broken bone can be the start of more serious health problems.

Sometimes falls are truly accidental.  Much more often however, falls can be attributable to deteriorating eyesight and hearing, weakened muscles, reflexes not being as sharp as they used to be, and in particular, increased visual reliance, a phenomena associated with aging. Most drugs will cause a reduced reaction time.  In fact meclizine, (aka Antivert), is notorious for this, and, it is the most frequently prescribed drug therapy for dizziness!  Many other disorders can play a role, such as diabetes, heart disease, etc.

Now let’s consider osteoporosis, an aspect of aging which makes bones weak and more likely to break easily. Women tend to suffer from this more than men.  Having osteoporosis can mean that even a minor fall might cause considerable damage.

By all means, my motive here is not to have a fear of falling prevent you from being active. In fact, quite contrary, having an active lifestyle is one of the most important things we can do for ourselves as we age.  There are simple ways you can prevent falls.  Most of the time, falls and accidents don’t “just happen.” Here are a few hints that will help you avoid falls and broken bones:

  • Get checked regularly for osteoporosis. Ask your doctor about a bone density test, which shows if your bones are weak.
  • Stay physically active. Plan an exercise program that is right for you. Regular exercise makes you stronger and improves muscle strength as well as joint integrity.
  • Have your eyes and hearing tested frequently. Deterioration in sight and hearing increases risk of fall. Wear your glasses when you are supposed to, and keep them clean.  Dirty glasses cause illusions which can cause sudden balance loss.
  • Ask your pharmacist about the side effects of any medicine that you take. The #1 side affect of most drugs, even those prescribed for dizziness, is dizziness.
  • Get enough sleep. If you are sleepy, you are more likely to fall. Don’t perform high risk activities if you are overtired.
  • Limit the amount of alcohol you drink. Even a small amount can affect your reaction time and cause a fall.  Keep this in mind if you are drinking alcohol of any type, and do not perform high risk activities.
  • If you feel faint on standing up, tell your doctor.  You may be hypotense, or, overmedicated for high blood pressure.  If you take meds for your pressure, you should be monitoring your pressure yourself with a home unit daily, and at the same time.  Keep a log to show your doctor.
  • Perhaps the best thing you can do is getting screened for risk of fall regularly.  My office offers this service free of charge as a community service.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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!

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.