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.



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.



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.



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.



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?



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.



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.



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



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.



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.



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, (



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.



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.



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.



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.



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.