- The Sam and Rose Stein
Institute for Research on Aging is committed to advancing
lifelong health and wellbeing through research, professional
training, patient care, and community service. As a nonprofit organization at
the University of California, San Diego School of Medicine, our research and educational
outreach activities are made possible by the
generosity of private donors. It is our vision that successful aging will be an achievable goal for everyone. To learn more, please visit our website at aging.ucsd.edu (upbeat music) - So my name is Maja Gawronska and I'm the program manager here at UCSD. And we are delighted to have you here to participate in the
Stein public lecture, hosted by the UC San Diego
center for healthy aging. Thank you so much for coming tonight. As many of you now, the UC San Diego center for healthy aging is committed to advance research on aging and to address the major challenges facing our aging demographics in terms of urban planning,
technology and health. Our topic tonight is
vertigo and dizziness, and we have a wonderful
panel of four speakers led by Dr. Kimberly Bell. And it's my pleasure
to introduce Dr. Bell. So you might remember Dr. Bell
from the last year's lecture on fall prevention. This time we're gonna talk
about vertigo and dizziness. Dr. Bell is a physical therapist with nearly 15 years of experience, and she specializing in treating patients with vertigo dizziness
and balance disorders. She's sought by patients worldwide, and her list of accomplishments
is really, really long and I'm just gonna give you two of them. She was named the public health champion by Aging and Independent Services in 2011. And she has been the clinical leader of the San Diego Fall Prevention
Task Force for 10 years. For more information on
Dr. Ben and our speakers, please refer to the flyers
that are at the table outside. And before I let Dr. Bella
introduce our panelists, please join me in the warm welcome. (crowd applause) - Well, hi, everybody. So great to see you all. See a lot of familiar faces in the crowd, and I'm so grateful that
you all made the effort to be here tonight. I hope that you get a lot
of value out of this talk. Myself and the panel have put
together a lot of information for you on dizziness and vertigo. And we only have an hour for the content. And then about a half an
hour for question and answer. So dizziness and vertigo is a huge topic. And I've written volumes of
training manuals and courses for physical therapists on the subject. But what we're trying to give you today is not the total
information on the subject, but enough information to, first of all, give you some
relief from your worries, hopefully. Second of all, give you some
practical tips that you can do. And third of all, help you figure out
where to go for more help if you are suffering with
dizziness and vertigo. So hopefully this is just the
beginning of this conversation for us tonight. I also wanna thank the
Stein Center here at UCSD for having me back for my second lecture, because this is a great honor. And I honestly feel that I've
been waiting my whole life to offer you this information. Before we go too far, I wanna thank my two clinical mentors, Dr. Kristen Johnson is
an associate professor at the University of St.
Augustine of Health Sciences in San Marcos. And she's a board certified therapist in neurologic physical therapy. Dr. Michael Schubert is
an associate professor at the department of otolaryngology,
head and neck surgery, and the department of physical
medicine and rehabilitation at Johns Hopkins hospital in Baltimore. And they have been
supporting me clinically as I have pursued this content
area, dizziness and vertigo as the focus of my career. I actually, when I started
off as a physical therapist in 2002, I had a lot of patients
with dizziness and vertigo, but I didn't target it as
the focus of my intervention. It was just sort of
something that was there that I didn't do anything
about to try to reduce it. And when I think back
to all those patients, I do feel a little heartbroken, but it makes me realize
how much I've grown as a clinician today. Dr. Johnson taught me my first course in evaluating the inner ear
and differential diagnosis of dizziness in February of 2006. And I went out and saw my
first patient that month, and I was able to fix her vertigo that she'd had for 20 years in two visits. And I was hooked, and I
haven't turned back since, because she was able to at 76 years old, go back to driving, go back to having coffee with her friends, meet me out for lunch and do things she hadn't been able to do since she was in her mid fifties. And it's a life changing thing if you can find a clinician
who's willing to work with you to target dizziness and vertigo as the focus of their intervention, instead of just some
kind of an inconvenience that's interfering with the treatment plan as I initially felt when I was a beginning physical therapist. So as I think these
two who've supported me and who continue to give me the confidence to take on some of the most complex dizzy patients in the world that are traveling to San
Diego to see me to get relief after 30 or 40 years of suffering, or more or less, depending on the case. And I go to these
clinicians, if I get stumped, and I know they've got my back, I know that they'll help me
work through the difficult cases that I have. And I wanna invite you to think
of someone who's helped you like that at some point in your life, maybe in the past or right now. And just hold that person in your heart, an image of that person, whoever that is, and take a few breaths with me right now, thinking of the feeling of
gratitude for their support. And let's just breathe together, thinking of those
individuals that support us and notice how you're
already starting to feel a little more calm. That's a secret weapon
that I'm gonna give you right in the beginning of this talk, something that you can do to prevent the mental health overlay that often co-occurrence
with dizziness and vertigo, the mental health overlay
of confusion and worry and nervousness and
despair and hopelessness. To think about all the things in your life that you're grateful for and all those who are supporting you because that right there is a first step towards shifting your
neurology towards recovery. This is the theme of the lecture tonight. Dizziness is usually multi-factorial. So dizziness is usually multi-factorial. What does that mean to you? I see someone pointing at
their ears, their eyes, their neck, their heart, their brain. You got it.
All right. We got some smart people
in the audience tonight. It means there's a lot
of reasons and things that can cause dizziness. It means that if you went to a doctor and they gave you a
pill for your dizziness, it's probably not the right
treatment plan for you unless a specific
targeted problem was found and that pill was for
that specific problem. But just to treat the symptom
of dizziness with a pill is something that I would hope that when you walk away from this lecture, that you feel you wanna
look a little deeper into the root causes and
the underlying factors that are contributing to the dizziness in order to not just treat
and mask the symptoms, but actually potentially
resolve the whole problem and move on with your life. Wouldn't that be nice? Yeah.
Okay. So dizziness is a geriatric syndrome. Now, what does that mean? I know there's some
clinicians in the room, geriatric syndrome. Well, another example of a
geriatric syndrome is frailty. Okay. These are conditions that occur with aging that are predictable series of changes, here's the key, across
multiple organ systems that present with a
particularly predictable set of signs and symptoms. Okay. And so the problem with
these geriatric syndromes and the reason why they're
falling through the cracks is because they involve
multiple organ systems. And in our medical care today, we've divided up the organ systems into different specialties. And that's why I feel with the methodology that I use for my patients, doing a holistic assessment
at the different organ systems and what might be
contributing to dizziness and then I treat my part
what's in my scope of practice, and then I quarterback my
patients to other providers so they can get hopefully
a complete recovery. And that's why I'm offering
you this panel today, because I know that if my patients are gonna get a complete recovery, it usually is gonna involve
more than one provider because typically dizziness is occurring from problems across
multiple organ systems. Does that make sense? Okay. Now this dizziness only
happened to older adults? No dizziness can happen
to young people too. I've been suffering with dizziness since I was five years old when I got my first childhood concussion. Then you have children with
multiple ear infections or migraines and things like this can happen even in childhood, that can cause dizziness for people. So it affects people across the lifespan, but it's the number one
reason why people over 75 go to their doctor, number one complaint. So especially in older people,
it's a really big deal. And especially it can cause
fear of falling and falls and serious injuries. And that's why I'm here to
talk to you about it today. If some of you knew what I'd been through in just the last couple of weeks with regards to my symptoms
of dizziness and vertigo, you might think I was having
some kind of midlife crisis, but I will smile to you and say, actually, I think I've been
having a whole life crisis. And the beautiful thing about it is the fruit of this experience for me is my ability to smile even if I feel dizzy. My ability to laugh in between
throwing up in my toilet and lying on my floor with vertigo and my ability to stand
here in front of you today with a lot more information
than an average clinician, because honestly my life depends on it. So it's with no further ado that I will introduce Camille Newton to help us with one of the
most common causes of dizziness in older adults, which is to understand
more about medications. Camille Newton is a medical doctor who cares for complicated
and elderly patients in their homes through
her medical practice, Home Excel Physician's Group. She is also an attending physician for camp Pendleton Naval Hospital residents in family medicine. She is board certified in family medicine and a member of the American
Academy of home care physicians and a Gulf war veteran. Dr. Newton is an Athena
pinnacle award winner, an honor given to exemplary
female executives in San Diego for women who champion women. Let's welcome Dr. Newton. (crowd applause) - Thank you, Dr. Bell. Hello everybody. I'm Dr. Camille Newton. I'm a home visiting physician. I've been doing house calls
in North San Diego County for about 10 years. And while performing house calls, I've seen firsthand, the effect longterm
medications have on people. There was a gentleman
named Malcolm Gladwell and Malcolm Gladwell wrote a book. And in his book, he said
that 10,000 hours of practice and a person can become an
international expert at anything. So an ordinary person like me, if I wanted to become an
international tennis star, if I focused and practiced
for 10,000 hours, I could become an international expert. Now, how does that happen? Well, when a person is
practicing something, myelin starts to build
up along their neurons and it's like a coat or a muscle, and the neurons get faster and faster. When you practice that piano, those neurons start to
get faster and faster. Every time the neuron fires, these little neurotransmitters
like serotonin and norepinephrine and
acetylcholine are released and the neuron gets better and
faster and better and faster. Has any of you ever broken a bone and had to wear a cast? And what did your limb look like when you took it out of that cast? - Scary and skinny. - Yeah, your limb, when you don't use it, it gets all skinny. Well it's because when those
muscles aren't contracting, when those neurons aren't firing, they start to atrophy. The same thing is
happening with our brain. When we're not practicing, when we stop using those neurons, the opposite of practice happens. And that neuro in that myelin, that beautiful thick layer
of myelin starts to regress and it gets thinner and thinner
and the brain quits working. What I'm going to talk about today is how medications we can take are kind of like the
opposite of practicing. Those medications we take are working by blocking the
neurotransmitters in the brain. So I wanna tell you about a patient that I had a few years ago. Her name is Jill. Her family said, we
want you to see our mom. She has dementia. A lot of my patients have dementia. And she's living in this memory
care facility in Fallbrook. They said, we know you're a good doctor, but we hear you always take
people off all their psych meds. And finally, we've got my mom where she's not trying to
hit people or run away. And so we don't want you to
take her off the psych meds. Well, I really wanted to help Jill and I wanted to help this family. They seem like nice people. So I compromised. And I said, I tell you what, I won't take her off any of
her psych meds for a month. Well, I went to see Jill. I tried to perform and actually performed a mini
mental status exam on her, she scored 14 out of 30, below 23 is considered dementia. She kept getting up, falling down. She fell twice on the day of my visit, staggering around, she was combative. She kept saying she didn't
need me to be there. So I started talking to her daughter and trying to find out what
was going on with Jill. Well, apparently two years earlier, Jill had been started on a
medication called detrol. And then over the next couple years, she had to move from her
own home into her son's home and live with her son and daughter in law, and then became
progressively more combative and finally had to move
into a memory care facility where she kept trying to hit
caregivers and try to run away and they had to send her to
a geropsychiatry hospital and they had her so loaded
up with medications, trying to make her behave. Well, I looked at the medications and I saw that she was on
risperidol, which blocks dopamine. She was on the detrol,
which blocks acetylcholine. She was on an antidepressant, which blocks serotonin and norepinephrine. She was on a benzodiazepine which increases GABA, which goes back and affects
other neurotransmitters. She was on a lot of medications and I knew they didn't want me to reduce her psychotropic
medications, but guess what? The detrol is for bladder. So I just quietly wrote a note, DC detrol and sent that to the nurse
and went about my business. Over the next few months, I slowly got Jill off of all of her
psychotropic medications. And then about three months later, I went to the facility to see her and the nursing director
comes to the door to greet me and says, Jill's family are
in the room waiting for you. And I'm like, oh, I'm in trouble. So I kind of, you know, try to
make myself small and humble. And I walk into the room
and they're sitting there ready to jump out of their chairs. And I was very pleasantly surprised to find out that they
were all there to ask me if it would be okay if Jill
moved from the memory care to the regular assisted living. So I started asking them some questions. Is Jill trying to run away? Is she hitting people? Is she letting them shower her? And they said, why don't you ask Jill? So I'm like, okay, Jill, this is the lady who basically
I'm was trying to hit me two months earlier. So I said, Jill, are you letting them give you a shower? And she said, well, I don't need any help taking a shower. But if they wanna help me, that's fine. I'm like, okay, are
you trying to run away? And she said, you know the director here has shown me a room in the
regular assisted living and I think it's really nice. And if I can move there, I would
have no reason to run away. So I said, all right, Jill, if the facility thinks that you're okay to move to your own room, then you're okay to move to your own room in the regular assisted living. I went to see Jill a month later. I walk into the room. I walked to her apartment
and she opens the door. She says, hello, Dr. Newton,
I've been expecting you. That's pretty pleasant. I walk into her room. I sit down on a chair
and I'm looking around. She said, you look like
you're looking for a place to plug in your computer. The outlet is on the wall behind you. Jill was completely normal. So I did a mini mental status exam on Jill and she was scoring 28 out of 30, 23 out of 30 is, below 23
is considered dementia. She was scoring 28 out of 30. Two months later, Jill moves back into her own home where she hadn't been able
to live for two years. So what happened to Jill? And how did this happen? How many other people
is this happening to? Well, what happened
was, two years earlier, Jill had gone to her physician and said, I'm having trouble with a leaky bladder. What should I do? When I cough or sneeze,
I get a little leaking. So the doctor starts her on detrol. Detrol is an anticholinergic medication. That means it stops this
neurotransmitter from working. Have any of you ever heard of
a medicine called aerosept? Aerosept is a medicine that people take because it's supposed
to help their memory. Guess how it helps the memory. We're paying a lot of money
for this medicine, aerosept, that increases acidicoline. And yet we're not being warned
when all these medicines that we can get over the
counter, from our physicians are blocking it. So she was on acidicoline. Her memory started to fail, then because of her memory and
her brain not working right, she was prescribed risperidol
which blocks dopamine. What severe disease do we
get when we block dopamine? Parkinson's. So it creates, that's why she's falling. Her neuro-transmitters aren't working. She's got her dopamine being blocked, and then she's put on an
antidepressant for behavior. Do you know a senior given
an SSRI like prozac or paxil, is three times as likely to fall. And then on top of that, she was put on adavan. A senior given adavan within three years is 2.7 times as likely to get dementia. So she was basically
guaranteed to have dementia. Now, what I can understand is the FDA makes the
pharmaceutical companies test every medicine to see
if it causes kidney failure, to see if it causes heart failure, to see if it causes liver failure. What about brain failure? You know, these medicines
are causing brain failure. Why aren't they making the
pharmaceutical companies test the medicine for
brain failure and label it? We know they do it as a class effect. We know anti-cholinergics caused dementia. Benadryl over the counter, zantac. These are anti-cholinergic medicines that people are taking with no warning. You know why they're probably not making the pharmaceutical companies
test for brain failure? It's because it's expensive. Well, Alzheimer's is the most
expensive disease in America. And I lost my father to Alzheimer's. It's devastating. You lose somebody, a few
brain cells every day until that person is no longer the person that you ever knew. So the moral of the story and what I suggest the
people here in this room do, is when you go to your doctor, don't look for a prescription. Don't think that that antidepressant is just gonna go to this
one tiny little center of your brain and cure depression. In fact, 50% of the clinical
trials on antidepressants are no better than placebo. These medicines work
around your whole brain. They're blocking all
those neurotransmitters, all the 10,000, a hundred thousand hours, those years of practice that you've been building up all that mile and in your brain, it's like putting a
psycho pharmaceutical cast on your brain. So don't ask for a medicine
to treat everything. And when you do have a medicine, when you do have that prescription, question it. Do I really need this? I mean, if you're psychotic, yes, take an anti-psychotic. We don't want you to be
dangerous to yourself or others, but we have a wonderful
group of people here, therapists, nutrition, vestibular rehab that
can fix a lot of problems instead of giving meclizine, which is very anti-cholinergic. For vertigo, you can have some head movements
or other exercises with Kim and not need that medication
for the rest of your life. And you can preserve your brain. You are what your brain is. It's a pretty important organ. Alright, thank you. (crowd applause) - All right. Thank you so much, Dr. Newton and I personally have almost had, well, you could say I almost lost my life from excessive use of
prescription medications about 10 years ago or so. And I wrote about it in my personal story, which has been published on the vestibular disorders
website, vestibular.org. If you wanna hear about my journey, recovering from over
prescribing medications, from multiple doctors, getting my prescriptions
at multiple pharmacies and trying to treat every single thing that's going on with me, with medications. And now I have a nice, I would say, a diversified approach
to dealing with things. And that's what I would encourage you to consider for yourselves. Along the lines of medications, I just wanted to mention the interactions especially with alcohol and medications. And I do see this a lot
especially in older adults, especially when people lose their spouse or have some kind of tragedy in their life and they turn to the drinking for relief. And then it does interact
with our medications. So that's causes dizziness
for a lot of people. So sometimes people come to me 'cause they think they
have a balance problem. And it turns out what they really have is an alcohol drinking issue. And so just would encourage you to think about if your balance
issues or your dizziness correlate with alcohol
consumption as well. And then as far as that goes, alcohol is also a great way to artificially induced
vertigo for yourself with a hangover, because alcohol is such
a strong dehydrator. It can actually give you
an artificial experience of vertigo if you're not
someone that normally has it. So now we're gonna get
into my content area a little bit more, which is my focus, which is rehabilitating people
who have inner ear conditions that cause vertigo. But most of all, what I do is
a comprehensive evaluation. A lot of times my patients
may not even see me for a followup visit if what I've discovered is
that they need a referral to someone else. But the evaluation piece is really my gift and really what I offer to people. So along those lines, what I do when I evaluate people, is I look at all the nearby structures, which were said by someone in
the audience to the inner ear, which is our balance system. So looking at this 3D x-ray right here, what structures do you see that would be near kind of the ear area? Just call out what you see. The eyes, exactly. So I'm looking at people's vision. Maybe they need to get their eyes checked. Maybe they need new glasses. Maybe they have an eye disease that no one's picked up on yet. Or maybe they have normal
changes with aging. So maybe they need to
see an ophthalmologist. What else do you see here? The nose, maybe they have a sinus problem and maybe they need to see an
ear, nose and throat doctor. What else do you see there? The brain. Yeah.
And I screen everybody to see if they have signs
of neurological disease in their brain. Maybe then they need to be
referred to a neurologist for an MRI or something like that, if we wanna investigate it further, what else do you see up there? The teeth, yes. And the teeth can be part
of dizziness and vertigo for people. So maybe they need to see a
dentist or an orthodontist if they're having issues with their teeth. What else? The jaw, the jaw joint. Exactly.
And that's something I really wanna highlight here because the vestibular system
is housed right in here. So take your fingers for me
and point to your ear holes and then come right in front of that and touch that bone right
there where it's nice and hard. Okay.
Now relax. That's the temporal bone. That's right around here. Okay, and that bone not only houses our inner ear vestibular system, which is sort of like a hydraulic system where we can sense changes
in the pull of gravity in relation to our head kind
of like an internal gyroscope, but at the very bottom of that bone, you can see right there that
it is part of the jaw joint. So people with issues with
their teeth, their jaw chewing, things like that, it can
affect the inner ear. If people have chronic sinus infections, it can affect the inner ear. Okay. People have hearing loss that
may give me an indication that maybe they've had
chronic ear infections and those ear infections can cause damage to the inner ear as well. That's what I had as a child also, chronic ear infections, which left me with
vestibular problems as well, in my inner ear. So we really need to look
at this whole complex and all of these things, including what's this guy right here coming up behind the jaw? The neck, okay. We need to look at that too. So all those things really
need to be looked at if we're gonna figure
out why someone's dizzy. And it's typically not just one reason, it's typically many, many reasons, but a lot of times they
can all be addressed in different ways. Now what I tell people
when they come to me to be evaluated for their
dizziness and vertigo, is I say, I'm confident we can reduce if not completely eliminate your vertigo, because with all the different factors, if we address one or two
factors, we'll reduce it. Perhaps we'll get lucky
and fix it all the way. And if not, I teach
them how to live with it in a way that allows them to
live a full and rewarding life. Now, this right here is a
closeup of the inner ear, courtesy of the Vestibular
Disorders Association. And this is basically what's located inside that temporal bone on both the right and
left sides of the head. Now these are called
the sensory end organs of the vestibular system. They're the ones that pick up the signals about the motion of the head in relation to the pull of gravity and send information to the brain. Now you can see these
little crystals down here in the bottom, right corner of the slide. Those crystals naturally
are supposed to live in this part of the inner
ear called the utricle, right there where you can see. Now through head injury,
trauma, car accidents, they can get knocked loose. And guess what? Normal aging is a
degeneration of the membrane where they live in the utricle. Are you surprised? Right.
Okay. So then what happens with normal aging even if you've never had
a head injury or trauma or fallen and hit your head, is that these little crystals, they just start flaking off the membrane. And then they float down
into the posterior canal. Most of the time, about 85 to 90% of the time we find them in the posterior
canal of the inner ear. If they can sometimes come on into the horizontal canal of the inner ear and that you would feel if
you were rolling over in bed. And then if the crystals got knocked loose during some kind of car accident, like say someone got in a car accident and hit their head on the dashboard, that force could be enough
to push the crystals upward into the anterior canal. That's this one up here. That's the least common
one to find the crystals. I have found that also
in a number of people who practice yoga and go upside down. You can have the crystals
loose in one of these canals, multiple on the same ear and you can even have them
on both sides of the head, which is really common with head injuries. So the worst case I've ever seen was a woman who had crashed
her car into a gas station. And she had hit her head
really bad on her dashboard. And she had crystals loose in
five, out of the six canals. So three on one side and two on the other. She'd had an MRI. She'd had a CT scan. She'd had everything under the sun. No one could figure out what was wrong. They put her on meclizine, sent her home, told her good luck. And luckily I showed up and said, you know what? Let's talk to your doctor. Let's switch your meclizine
prescription to as needed instead of every day. So you can take it when
you're feeling bad, but you can also skip a
day for me to come over and evaluate your vestibular system. And you know what, after
a number of treatments, 'cause that represents
a very complex case, she's vertigo free. She returned to work
as a real estate agent and she gave me a really nice
testimonial for my website. So the reason I'm telling you that is because she had gone and
had all these diagnostic tests. She had seen all these doctors and she'd just gotten information that we can't figure out
what's wrong with you. So you just have to live like this. The other thing that commonly happens to people with dizziness is they go to all these
different providers and they hear, "we can't figure
out what's wrong with you. So you should be fine." And that causes a lot of
problems inside households because the spouses think, "Oh, maybe you're just being lazy. The doctor said you were gonna be fine. You don't wanna go to work. You don't wanna help with the household. You don't wanna do the grocery shopping. The doctor said, you should be fine. They can't find anything wrong with you. What's wrong with you." Okay, and it creates a
misunderstanding amongst families and between spouses. And so I would encourage you, if you're someone in
that type of situation, you might wanna read some of my blogs because I talk a lot about, especially I just published one last week about how caregivers can
be more understanding and try to be, try to ask
their loved one questions more about how they're feeling instead of just focusing
on what the results were of the medical tests that they've had. Because medical tests are
not always very sensitive. They don't always show everything. And actually the literature
says that a hands on exam by a vestibular specialist is
superior to MRI and CT scan in many, many situations. So as far as the inner ear conditions and the brain conditions, what those are typically
gonna manifest as coming on in certain positions of the head and neck. Okay, so when you have
your head and your neck in certain positions, or you're moving in certain directions, that's when you're gonna feel the vertigo typically, if you have BPPV, which was what that
last slide was showing, those crystals breaking loose. And BPPV stands for benign
paroxysmal positional vertigo. What that means is when I move my head into this type of position,
I'm gonna feel dizzy, but then it's probably gonna go away. Okay. And I'm not gonna feel dizzy
for the rest of the day, but with that condition, you only feel the dizziness or the vertigo in the provoking position. But what you do have all the
time is difficulty walking, difficulty balancing,
unexplained repeated falls, and a cognitive impairment. That includes difficulty concentrating, reduced short term memory,
problems with executive function, decision making and a difficulty with what's called cognitive stamina. Meaning you get tired after thinking for a short period of time. The interesting thing is
when this BPPV is fixed, because it's identified
by a vestibular specialist and the canal that those
crystals have gone floating in is found, and the treatment is given, it can be fixed in one to two treatments about 90% of the time. So we wanna fix this crystal. We wanna get people off of the meclizine that's suppressing their vestibular system and suppressing their brain, or at least switch them to as needed with the support of their physician. Then do a good evaluation of
the inner ear and the brain and all the causes of dizziness that are from certain positions. Because if it is BPPV, it can
be fixed in one or two visits. And then you can just
move on with your life. Now, the other things
that can cause dizziness in certain head positions
had to do with the neck and the blood flow to the head. And Steven Moxey is gonna
talk more about that in his section. So the bottom line is that
if you're getting dizzy, when you're moving your
head into certain positions, you should see a vestibular specialist. That's what I would recommend, to at least get a
comprehensive evaluation. Typically, also people feel the BPPV first thing in the morning. They roll over and wake up with it very often in the morning. Now there are a whole lot of
other inner ear conditions and brain conditions that cause dizziness. And we could spend another couple hours talking about all of them. But the main thing I want you to know is usually they're related to the position of the head and neck or movement through space. Now let's talk a little bit
about the systems of balance. Basically we have three
systems of balance. Does anybody know what they are? Vision, our inner ear vestibular system, which we have one on
the right and the left. That's what I just showed you. And then we have what's
called proprioception, which is our ability to sense where we are in relation to the surface we're touching. So we have that proprioception
through our feet and ankles. We have it in our tendons,
our muscles and our joints. And especially we have it in our neck. And so what happens is the
eyes gather information, the neck gathers information, the inner ear gathers information and the feet and ankles
gather a lot of information. It all goes to the brain and the brain maps out
where we are in space by comparing all this. Okay. So if we have a disease or a pathology in any of those sensory systems, like we have problems with our eyes, we have problems with our feet, we have BPPV in our inner ear or we've had diabetes, which is affecting the blood
flow in all three areas, the eyes, the feet, and
the inner ear, for example, then that can cause an
impairment in the sensory system we need to create our balance. And so in my practice, I've developed an
intervention for the feet called the Bean Box, which I'll be launching as
an e-course I think in April, I just filmed it last weekend and it's to improve
circulation in the feet to improve balance. Of course the vestibular rehab piece is to improve the quality
of the information coming from the inner ear to the brain. And then if someone has a
problem with their eyes, we would send them to
get their eyes checked. The other thing is that
with quick head turns, people with vestibular problems have trouble keeping their eyes focused. And so there's a close
link between the eyes and the inner ear that's
important to be aware of. The thing is with the brain is that if the brain is impaired, then we're gonna have trouble interpreting all these sensory signals to create our balance. And that has a lot to do with what Dr. Newton
was just talking about. It also has a lot to do
with anxiety and worry and tension and stress because when we're stressed, we shift into what's
called the sympathetic nervous system state. Our body starts to panic. Like we're being attacked
by a tiger or a lion. Okay.
And we cannot heal. It's impossible to heal if
we're in a sympathetic state. And that's what happens if
there's errors in these signals and the brain is having
trouble interpreting it, is it can cause us to feel
vertigo, first of all, if we have a mismatch
in any of these signals, it can give us vertigo, but then that vertigo can also keep us in a sympathetic state. So it's sort of like a vicious cycle and they both have to be addressed. We have to address the nervous system to get it out of the sympathetic state, into a parasympathetic, which has to do with
the gratitude exercise, which has to do with smiling, which has to do with laughing and relaxing and turning off your
electronics and sitting outside and enjoying the day. Okay. That has a lot to do
with the nervous system. And it also, we also want to get a good
evaluation of the root cause of the vertigo by having all these
different systems assessed. Now, if you wanna artificially
induce vertigo for yourself, what you can do is go to
a stoplight like this, has this ever happened to you before? And you're sitting in the left turn lane and you're stopped, you have a red light. And then all of a sudden the
lane next to you starts to go, you know what I'm talking about? And what do you do? Jam on your break. And you feel like you're going and you kind of throw yourself back and you have a little panic, right? That's what vertigo feels like for people. That's a little bit of a taste and that one, two punch that you feel when you feel like you're moving and then you feel a
little panic as a result is what happens with people with vertigo. They both need to be addressed. The vertigo itself and the
nervous system reaction to it in order to have a complete recovery. On my website, I'm sorry,
on my YouTube channel, I do have a relaxation breathing video that you can use to just
help you with relaxing. But honestly, if you just sit
and breathe at a normal pace without distracting yourself, by looking at your phone or trying to do a whole lot of things, just sitting peacefully and breathing is a great way to calm
down your nervous system. It's very simple. It doesn't need to be complicated. This is a light switch to
show you in this example that no matter which
way you flip the switch, it's always on you. You see this? And that's what happens
to our nervous system if we're living with chronic
dizziness and vertigo for too long, is that that sympathetic
nervous system is always on. It's dysregulated. It's called autonomic dysregulation and it causes a lot of problems
with everything in our body. Because as I mentioned,
then we can't heal. Yes.
If you go to my website, betterbalanceinlife.com in the header, there's a link
to my YouTube channel there. Yup. Thank you for asking about that. So on my website for you, I
do have an educational blog. I have a link to my YouTube channel, which is all free, helpful
information for you. And then I also will be
launching online e-courses, multimedia e-courses on
improving foot circulation, improving bladder control, fall prevention and dizziness
and vertigo this year and I already have filmed them. So I'm in the process of
producing them for you right now, to try to help you get more information. The main thing I wanna
leave you with today is that a lot of people
think of physical therapy to just treat their
injuries after the fact, if they've had a fall and then they go for the
fracture rehab or whatever, I want you to start
thinking of physical therapy in more of a preventative
matter, I'm sorry, manner if you can. And think of finding someone who's skilled to evaluate your inner ear and evaluate the root causes of dizziness on the vestibular disorders
website, vestibular.org, because physical therapists can help improve the way you move, but not all physical therapists
are trained in dizziness as I shared with you. A lot of them don't target it as the focus of their intervention. So you wanna find a specialist
to help evaluate you. Now, I'd like to introduce Steven Moxey. He's been a physical therapist
for more than 15 years. He excels at treating orthopedic injuries from sprains to chronic pain, but has focused his career on treating complex orthopedic syndromes, TMJ disorders, which is the jaw joint, chronic pain, postural alignment disorders and injury prevention. He is board certified
orthopedic specialist and a fellow of the American Academy of Orthopedic Manual Therapy. Steve is the owner of
Moxey Physical Therapy in Encinitas, California,
and is an adjunct professor at the St. Augustine
university for health sciences in San Marcos. (crowd applause) - All right, tonight, we're gonna talk about
cervicogenic dizziness. And what that means, it's dizziness that's relating
to the sensitive structures in your neck. Kim mentioned earlier that
dizziness and vertigo, it's a multifaceted problem. And one of those big regions
that are sometimes overlooked because of the neurological
piece of dizziness is the neck. And cervicogenic means a spine related or cervical spine, which is your neck. And there's several theories, but we're gonna get to those in a minute. All right. So I wanna start out
with a little exercise and this is what I do with my
patients when I screen them. But I wanna see if all
of you can turn your head and touch your chin to your left shoulder, and to your right shoulder. Okay. Very good. It looks like almost all of
you are successful with that. Very good job. Now, those of you that could not do that, if you're feeling stiffness, if you're having pain in your neck and it causes you some dizziness, those are kind of a hallmark signs of cervicogenic dizziness. If you were just stiff
and you're not dizzy, then don't worry about it too much. But it's when those three
symptoms happen together, there's a potentially a problem. So let's talk about one of my patients. Her name is Anne. She came to me, referred from her doctor. Now Ann was a healthy,
active North County retiree. She enjoyed biking and ironically, she was
on a biking trip to Hawaii when her dizziness came on and most likely it was
related to the traveling. I don't know about you, but I've certainly had a stiff neck when I'm flying long ways. So, and got back to San
Diego and she was dizzy. She couldn't ride her bike. She was frustrated. She was in pain and her
doctor diagnosed her with BPPV as we just talked about, which she saw neurological specialist PT and her dizziness got quite better. So the spinning that she
was having got better. But Anne was still lightheaded
and her neck was still stiff and she still had some dizziness. So that's when she was
referred to my office because I'm an orthopedic specialist and I deal more with the neck. And upon evaluation Ann was nowhere close to touching
her chin to her shoulder. She was about halfway limited, both directions with her neck and it hurt. And she was dizzy. She couldn't stand on one leg. So that's a pretty common presentation that we see with these patients. And now, so why does this happen? Well, the concept is simple. You can see the diagram on the left. The head is vertically aligned and it's parallel with
the floor over our neck. The structures we're
talking about in the next specifically are the C1 and C2 vertebrae, which are the altlas and axis. And those are the two
bones that are responsible for the rotation in your neck. Now, when there's a malalignment in those upper bones in your neck, it can cause compression
on your spinal cord, on your brainstem, it can compress the arteries
that we have in our neck that provides blood flow to your brain. And also it changes our proprioception. So it changes our awareness
of where our head is in space. So if our head is tilted, we're gonna try to straighten
our body to look straight but then that's gonna throw off the tilt of where our body is in space. And I brought, I don't
know if you can see, but I brought a little,
here's our C1 bone, and you can see the holes on the side where our arteries run through and the main hole for our
spinal cord and brainstem. So it's a little bone, but it causes a lot of
problems when it's restricted and not in the right position. So here's a plain film x-ray. We're gonna look at, this
is another client of mine. And what I want you to appreciate here is the close correlation
between our neck bones. So there's our upper neck, as we just discussed the atlas and axis. Here's our TMJ joint or the jaw joint. And then our ear canal
is right above that. So our vestibular centers
are all very closely related. So any change or decreased
input information to that region can lead to dizziness. Let's take a look. This is another one of my clients. And if we go back to the
alignment discussion, so the alignment theory, look at this patient's neck alignment. Does that look straight to you? No. So this is a 3D camera system
that I use in my office. It's a great tool. It helps me get some data and objectify what the
tilt and shift is occurring in patients' spines. And you can see her head
is shifted two and three, to 2.3 inches to the left, and it's tilted three degrees to the left. So if you wanna try that, go ahead but it's not very pleasant
to try to walk around with your head shifted and tilted all day. You're gonna start to have some neck pain, and that's also gonna throw
off your ability to balance and how you see the world. Now her treatment, we're
gonna talk about in a minute, but it was essentially realigning that upper part of the neck
and improving her mobility. And you can see now
this is post-treatment, she's looking much better. So this is after several
sessions of manual therapy, orthopedic physical therapy, and this patient is back. She had regained full range
of motion in her neck, and her symptoms of
lightheadedness was resolved. So if you're having these
symptoms, what do you do? And essentially it's a physical therapist that specializes in orthopedic care, and that has training to
move the bones of your neck and treat your neck is
someone that you should see. It's usually a combined effort, Dr. Bell, she handles
the vestibular component of patient's care and an orthopedic therapist
can handle the neck alignment. I send my patients to vestibular
therapist all the time, and I also refer patients to neurologist because it's, I don't treat
that part of the spectrum, but it's really it's that
multi multidisciplinary team approach that takes to
get these patients better. Okay, so what can you expect? Well, the physical
therapist will start out with a physical exam and that usually involves
using their hands to check the mobility of your neck. They will probably do a balance assessment looking at single leg stance
or some other objective. And then of course, looking at your proprioception and that's how you're able
to stand with your eyes open eyes closed. And based on the exam, the treatment goals are
essentially the same and it's improving the
normal biomechanical function of the neck. So treatment will consist of the therapist stretching your neck. A lot of our muscles that connect
our head to our shoulders. So tightness in those regions also can lead to stiffness as well. So it's not just the bones of the neck, it's also the muscles. So treating the muscles
are very important. The therapist will give you exercises. Exercises for your neck are
helpful and also for your legs, because once you learn to
have your head moving better then you also usually have to
retrain the rest of your body how to walk and stand again. Alrighty. Well, what else can we do? As I mentioned before, cervical related dizziness
is typically an alignment or a compression problem
in the neck of some sort. And alignment issues just don't
happen a part of the time. It's usually all of the time, but there's things we
can do during the day that make a big difference. I don't know if you're aware of this, but sleeping on your stomach is actually very, very dangerous for the blood supply in your neck. If you're sleeping in your stomach, then you have to have your head turned. So the older you get, the
more risky that can be. So typically side sleeping is safer or sleeping on your back and you can see also
positioning the pillow. So your head is in
alignment with your body. I have patients bring in their pillows and you'd be surprised
it's just a thin pillow and they're sleeping with
their head crooked all night and they wake up and
they're having neck pain and some dizziness. So the simple thing as getting
the right pillow can help. Next, we're looking at our alignment when we're at the computer. So if you're straining
your neck looking forward, looking at the screen, eventually you're gonna lead
to some strain in your neck. And then I don't know if
anyone ever uses this thing, but using your cell phone. Has anyone heard of text neck before? There's been, yeah. So head down and twisted. If you're spending most of
a lot of time on your phone, that can cause a twist in your neck and eventually lead to some problems. So a simple fix there is just lift the phone up to your eyes, not your head down to the phone. So those are just a few examples of how our neck alignment
throughout the day can really affect our functioning and how how we're moving. - So she's doing the right
thing sleeping there. - Yes. - With her hand up there. - That's not ideal. What I wanted to illustrate is that her head is
straight with her body. - The hand is okay there, right? - It's okay.
Ideally you would want just the pillow doing all the support. All right.
Well, here we go. Here's Ann. Let's go back to Ann. Yeah, so after one visit
Ann is back on her bike, she doing a wheelie. So it took about one, it took a session to get her mobility back in her neck, and then it took about another week or so for the dizziness to resolve. So I'm happy to say she called
me a week later and said, doc, thank you. The dizziness is a lot better. I'm back on my bike. And I'm happy to have met you. So it those patients like that make me in love what I'm
doing with this career. So thank you very much. And we're gonna bring
out the next speaker. (crowd applause) - Thank you, Steve. And actually that x-ray
you saw, that was my x-ray 'cause I'm his patient. So he just didn't wanna share that, but I'll share that with you. You've now gotten to see inside my head. Okay, so our next speaker
is Diane Kusunose. She's a licensed physical therapist, a licensed biofeedback therapist and a certified nutritionist
with 35 years of experience in physical therapy. Diane became a licensed
biofeedback practitioner, so she could make food and
natural remedy recommendations to facilitate wellbeing. So please join me to welcome Diane, our a final panelist. (crowd applause) - Thank you, Kimberly. And thank you all for your
valuable information so far, it's been really great. My presentation today is
gonna be on the physiology of dizziness. It'll it will include just
some basic normal physiology. I'll also talk about five factors that can derail our physiology. There'll be underlying
causes of dizziness, and I'll also bring some
solutions to your attention, some food and supplement
solutions to your attention. And lastly, I'd like
to share some websites where you can actually seek a practitioner who may do physiological
assessments that I do, and also make nutritional recommendations if you're not in the area. So let's start by talking about the definition of physiology. Does anyone wanna give it a stab? Okay, I'll take over. The definition of physiology
is it's a branch of biology that deals with the function of the body. So we're gonna be talking
about function of the body and not just that, but
also the parts of the body. So we're gonna be looking at organs, the brain, cells and tissues. Okay.
So what does the body need in order to function normally? It needs, well, we need two functions. So we're gonna go for functions, but those are good answers. So two functions, first function is the body
needs to bring in healthy food. We have to eat healthy
food, healthy food choices, and we have to be able to
absorb that healthy food and bring it into ourselves because the purpose of eating
is enjoyment number one, but also number two, to create energy. It's our fuel, right? So the second function of the body is to clear toxic load away 'cause we, as a machine, we do create toxic load and
we breathe in toxic load and we eat toxic load. So our liver has a big job. It has to get rid of it. You have to clear toxic
load through the liver and then out the excretion
organs of the body. So what can happen to the
body that derails this? There's five factors that
I look at in my practice. I look at chemicals, heavy
metals, microbial challenges, I look at food sensitivities and including some
environmental allergies. And then I look at scar
tissue on the body. We have a very large excretion
organ called our skin and scars can actually interfere with the function of the body. So those are the five
factors that I assess. I have assessment tools that I use. I have a Zeto pro biofeedback system. I have questionnaires symptoms. I look at a lot of symptoms. Metabolic surveys, and I am a proficient
nutrition response tester. And I also look at some of the blood labs. I wanna look at the chemistry
and the energy of the body and see what's going
on when I assess people and assessing, you know,
for lots of things, but particularly for, as our
topic is today, dizziness. So I have this diagram
here regarding health and health is, maintaining
our health is not easy. It's a juggle act. We've got a lot of balls in the air. We have nutrition here on the bottom. And I like that because it's the base. If we don't have good nutrients in our health is gonna start to wane and we're gonna have, we're
gonna be dropping some balls. 'Cause it's gonna be
hard to hold them all up if we don't have a body
that's bringing in nutrition. So I'd like to acknowledge
at this point in time, a normal inflammatory
response of the body. So if you sprain your ankle
or you bruise your arm, there's gonna be an inflammatory response that happens locally. So you're gonna get a bruising. You're gonna get redness and
turn purple and so forth. Your ankle might swell. You do your ice elevation. You go to a physical
therapist and in time it heals and that swelling goes away. But there's also swelling in the body that's called a systemic
inflammatory response. And that means that if you
have inflammation in one area, it's not just local, it actually goes to other areas. And I'll bring to your
attention a wonderful book called a Grain Brain. It was written by David
Perlmutter and Christine Loberg. And it's about inflammation in the gut and its relationship to the brain. So if you're taking in sugars or taking in inflammatory grains that are inflammatory to you, 'cause they're not
inflammatory to everybody, but if we're taking in
some gluten and some sugars and we get gut inflammation
that will affect the brain. We have barrier systems in our
body, three barrier systems, the blood brain barrier system, the gut barrier system and
our upper respiratory system. Those are all mucosal linings that protect us from
environmental hazards. And if you have a fire, so to speak, or inflammation in one area, they can translate into
inflammation somewhere else. So grow Grain Brain is a great book because it correlates that for us and gives us a lot of
really great information. - Could you say that more clearly please. - Grain Brain. Grain G R A I N and then brain B R A I N. So if I impress upon you, anything else, we already had a little bit of information about how important the brain is. We only have one in a lifetime. We don't get another chance. There's no replacement parts for it. So we do need to make good
sensible choices, food choices, and try to keep the
chemicals out of the brain and really preserve our brain. This is a vertebral chart that
I use daily in my practice. It sits over my desk. And I refer to it often with my patients when I'm Zito testing, I'm looking at stressors in the body. The Zito biofeedback is
a stress assessment tool and it includes the vertebrae, the teeth, meridians and organs and
cross-references them. So I can see where stress
is going on in the body. And then I refer to this chart so people can see the
neurologic relationship of the vertebrae to the organs. And it's really fascinating. And I'm gonna refer back to Dr.
Steven's presentation of C1. So if we look at the very
top of the vertebrae, C1, what does it say right
next to it onto the side? It may be a little blurry, but it says it's food sensitivities. Food sensitivities and
environmental allergens. So as we are, you know, out
in the world, experiencing it, breathing in chemicals, taking
in electrical pollution, eating processed foods,
MSG, artificial sweeteners, genetically modified foods
that are inflaming our gut, we're gonna see C1 go out of balance. It can be subluxed, it can be rotated, it can be pulled off with the muscles like Dr. Steve was telling us, so we can also see some
of the other relationship to the organs. We've got the small
intestine at thoracic 10 and we've got adrenal
stress at thoracic nine, ileocecal valve, which
is in the gut at L1. So I'm gonna be looking at, you know, how the body
is presenting stress and then trying to find the
factors that are involved as well as the solutions. How do we fix this? How do we put in the right thing so that this body can start to repair. Back to the Grain Brain piece of it, I commonly see brain fog
as a symptom in my office. People go, I just can't think. I don't, you know, I can't
think like I used to, I can't remember things like I used to. So that's the part of
the food sensitivities. It's very well connected with
the brain fog and the gut. So how is this for your next meal? I wanted to put this up here because I do wanna bring
to your attention sugar. We have an ever growing industry of sugar in a lot of our foods and we are eating so much
and we have no concept of it. We don't just, you know,
consider it as candy and baked goods and cookies and so forth. If we start to label read, we're gonna find a lot of sugar in some of our common foods that don't require sugar, actually. So I'd like to encourage you to label read and try to keep the sugar content down. Sugar causes dizziness. It causes a lot of symptoms and we'll get into that
a little bit further. So when I'm looking at
and assessing dizziness, I wanna be looking at symptom pictures that come into my office. And some of the common things
associated with dizziness are going to be a blood pressure, either blood pressure too high, and actually blood pressure too low. Blood sugar levels. They can be hypo or hyper or
vacillating back and forth. That's the insulin
resistance, diabetes type two. People who have to eat
commonly every couple of hours because they get dizzy
and they can't think without food intake. There's adrenal dysfunction. So stress cortisol levels
either too high or too low 'cause our adrenals will
fatigue after a while. I will look at kidney function too. Sometimes simple dehydration
can cause dizziness. If we don't take in enough water. Also it can be water retention, swelling, swelling in the limbs and so forth. So we need to look at the kidney in relationship to dizziness. Also, I look at liver and gallbladder. The liver has a big job, right? It has to get all that toxic load out. And sometimes it doesn't
have the nutrition it needs in order to do that for us successfully. And the last thing I look at again is, we've already talked about a little bit, is the gut flora balance. If we don't have gut flora balance, if we're inflamed in our gut lining, we aren't malabsorbing, we're not bringing in
the nutrients we need for the machinery of the body to work. So now you're empowered. There's a fork in the road
and we have some choices. We can either go to the right fork, which is going to be organic
green food, organic fruits, but they're anti-inflammatory. So remember we talked about inflammation, so we have solutions. We can go green and healthy and organic, or we can go to the left fork, which is going to be inflammatory fats and no nutrients that all. So also to the right fork, it wasn't in the picture that I wanna add, is does anyone know what the one anti-inflammatory
supplement is for the body? The best one. Good job. Fish oils. Omega three, essential
fatty acid, fish oils, or flax seed oil is another
form of omega threes. So those are anti-inflammatory. So if I have people in
my office that come in and they have a lot of
inflammation going on, I'm gonna look at what are they taking in their essential fatty acids? Because our food intake has
too much of the left fork. We have fats that are inflammatory. They inflame us and we need to get the anti
inflammatory foods and fish oils or flax seed oil into our diets. They help our brain because our brain is like 80% fat, right? So we need to support it
with essential fatty acids. The keyword there, essential. Okay. It is essential for our brain health. I have two success stories that I would really
love to share with you. And there are simple. I like to keep things
simple in my practice, even though health is complex, correct? So the success stories that I have, the first one is actually
a young male, 30 years old. And he came in complaining
of like a glue ear. He described it as a glue ear. There wasn't a lot of
pain associated with it, but he felt like it was blocked and you could hear like
popping going on in his ear. And it was just disorienting, you know, causing him some dizziness and discomfort. So I analyzed him with the stress test on my Zito biofeedback, and I did nutrition response testing, which is muscle testing. So I have food kits that
I muscle test people with and found that he was very
sensitive to dairy and to gluten. So I redirected his eating program and gave him some optional foods to eat instead of those foods. Got them off of those and put
him on some digestive enzymes. So enzymes are, if you
take them with food, they help to break down the
food and make it micronutrients so you can absorb it, which is what we have to
do to get it in, right. So I put him on digestive enzymes, but I also put him on some enzymes, first thing in the morning
and last thing at night, because enzymes can be another
anti-inflammatory for us. So in about six weeks
with changing his diet and taking the digestive enzymes, he came back and reported that he had like a one
big final pop in the ear and then it was gone and he didn't have glue ear. He wasn't feeling dizzy. His disorientation had cleared. So that's just a really
simple one, but very powerful. Then my second success story is regarding an 82 year old gentlemen who was having a dizziness during the day, but primarily at night when he
needed to get up and urinate. So he had a frequency of
urination that was disturbing him. And then he, during the day and night and dizziness associated with it. So we talked about how much fluid intake he was taking in in the day and he admitted that since he didn't want to go to the bathroom so much, he was actually holding
back on his fluid intake. So we talked about the recipe
for your need for water. And that is half your body
weight in ounces per day. Give or take a few. But with him, what we did was
we put a pinch of sea salt into his eight ounce cups of water. So what is sea salt? It's a mineral. So we put a little bit of
minerals, just a pinch it. So it wasn't, you know,
didn't taste awful. And what that helps to do, those getting minerals in the body, it helps the body retain
or hang on to the water. So in a couple of weeks, he came back and he had,
his dizziness was gone. He had been drinking plenty of water. We kind of restructured
his drinking of the water so that it wasn't so disturbing
to him in the evening and the dizziness was gone. So sometimes it can be something
as simple as dehydration and not bringing in enough water and not having enough minerals. - Salt was in the first glass
of water in the day or all. - Each one, a pinch of sea salt. Yeah.
Very important. And even pink sea salt
or Himalayan sea salt is gonna be your better mineral source. Okay. So I'm gonna encourage you to seek help. We have a great panel here of people who work with
the structure of the body, the structure of the
vestibular system itself. Camille was amazing in advising us to stay
away from the chemicals and preserve our brains. In my practice, I have people I co refer, I have an organic skin care aesthetician , say that first three times. And she is amazing. She has all chemical free
facials and substances because what do we put into our body when we have our makeup in our skincare and our sunscreens and everything, it's chemicals right on our
biggest excretion organ. So we co refer together and then we also have Marnie Anna Reed who's a holistic health practitioner. And she works with the
anxieties and depressions and the counseling for, you
know, concepts of communication and family and relationships. So a lot of co referring there, and now I'm familiar with Dr. Moxey and it's gonna be great to co
refer for structural issues. So please seek, seek your professionals. They're out there. And the good ones will co refer because as practitioners, it's really difficult
for us to do everything, but if we're working as a team and you can find one of us, then you're gonna be
inducted into the team. So there is a new life. There is a new life waiting for you. There are answers. There are people that are seeking, practitioners that are
seeking information for you. The vertebral chart that I showed you is courtesy of Standard Process and a organization
called the international, IFNH. International Program
for Nutrition and Health. And they have a website that practitioners can order that. And they also do,
Standard Process and IFNH do programs to teach practitioners to assess people's
physiology for dizziness and bring nutritional
supplements into their practices. So there is hope out there. It's a growing industry. So thank you very much. I appreciate the opportunity. (crowd applause) - Okay. So, you've heard from myself
and three different panelists, and I just wanna be clear that dizziness is that feeling
of lightheadedness that they're sort of describing
that sort of brain fog. And then the vertigo is the piece that has to do with a
false sense of motion when you're otherwise still, or a distorted perception
of normal motion. So that's kind of the way
we distinguish the dizziness and vertigo when we talk about it. But a lot of times
people just say dizziness and they may mean either one, okay. So regardless, whether you think you
have dizziness or vertigo, I would highly encourage
you to number one, talk to your doctor about it, make sure your primary care doctor knows. Seek out a vestibular specialist to do a root cause evaluation for you. If you also have neck pain
or jaw clicking or jaw pain, certainly go to an
orthopedic physical therapist to have your neck evaluated,
your jaw evaluated, and perhaps look deeply
into your nutrition to see what you can do to
heal yourself with food or better food intake. Now I wanna finish tonight's talk with a story of a dear friend of mine and a very loving and amazing
man who did depart last year. He transitioned through the
end of his life last year. His name is brother Fop Dei. And one of my favorite quotes from him is when he would pick a
flower and look at it and say, I wonder who designed this flower? And I wanna share with you about his story because I've seen so many people
with dizziness and vertigo get angry and get bitter and start being mad at the world because they're so miserable. And I tell you, I've
gone through it myself. And if you read my personal story, you'll see I've struggled
with anger myself, because it is frustrating
not being able to go to work. It's frustrating not being
able to drive myself. It's frustrating not being
able to keep social plans with my friends and losing friends for multiple cancellations, right? It makes me angry sometimes, but brother Fop Dei taught me a lot about how to manage my anger. And I would highly suggest
if you're dealing with anger or despair, hopelessness,
worry, or nervousness about your dizziness and vertigo that you do talk to somebody about it, that you do talk to your doctor or seek out mental health
support, that is very important. But what I wanna share with
you about his experience with dizziness, is that he, first of all,
he called me right away. I was connected with him
through a friend right away. And as soon as I went to see him, I noticed a difference about
him than any other patient I'd ever seen. And the difference was he never
had a moment of self pity. He never had a moment
where he shed a tear. He never had a moment
where he said, why me? Why do I have to go through this? No, instead he kept his
attitude of one of curiosity. He kept an attitude of enthusiasm. He continued to advocate for himself. He, as soon as he started feeling better, and now when I went to see him, what do you think the
top two things I found that were making him dizzy? Medications side effects and multiple medication
changes in one week plus he had BPPV, right? So with Dr. Newton's help, we got his medication squared away. I treated his BPPV and it was resolved. And the thing that did
wonderful in his case is he went right back
to physical activity. And that's a really key point because dizziness causes people
not to be able to exercise. And it causes physical
deconditioning as a result. You have to stay strong to stay alive. And so the thing I loved about him was as soon as we got him feeling better, which we fixed his medications and we treated his inner ear BPPV, which is the biomechanical
problem of that crystal in your inner ear being out of place, he immediately went back to activity. He also had a plant based
diet that was very healthy. He focused on his friendships, which were a huge source of support. He kept a cheerful attitude
to avoid pushing people away. And so people just really
literally surrounded him with love through his whole experience. And then once we did fix his dizziness with the head motion he was
having, that was from the BPPV, he called me back later and he said, now I'm only getting dizzy
when I go rollerblading. And when I climb the stairs. And I know that sometimes people get dizzy when they climb stairs
or walk up inclines, if they have bifocals,
trifocals or progressive lenses. 'Cause that can cause dizziness
with walking upstairs, hills or inclines. But in his case he didn't
have bifocals or trifocals. So I knew it was from his heart because he was getting dizzy
with physical activity, rollerblading and the stairs. And he knew it too. And so we walked through
that journey together and I'll tell you, it was
such a beautiful experience. I learned so much from him that
inspired me to keep smiling, to keep cultivating my friendships, to keep approaching this
problem in my own life with enthusiasm, with curiosity
and with a smile on my face. And I would encourage
you all to do the same because it's a much better way to live than to be dizzy or spinning
and also be upset or angry. So it just encourage you to follow our brother's Fop Dei's lead and as you pursue the mystery
of dizziness and vertigo in your own life, and you unravel it, try to keep a smile on your face and try to be grateful for
those who are supporting you because you look fine to them. And so you need to tell
them with your words how you're feeling, and you need to say thank you to them because to them, it's very confusing when you look just normal and you look like your beautiful selves. So thank you all for your time. We really appreciate this attention and we hope that this
was valuable for you. If you have any questions, you can reach all of us
through our websites. Markcpt.com,
naturalbalancing.com for Diane. My website is betterbalanceinlife.com and now we'll take some questions. So what we'll do for the panel is I'll hear your question and I'll repeat it to
make sure I understand it. And then whichever
panelist wants to answer will come up and take the question. So let me, yeah, go ahead. So the question is when I go like this, now, if you said, I go like
this and I start spinning, I'd say, let me look at your inner ear, but you're saying you go like this and your neck bones are cracking
and it doesn't feel good. I think that's gonna be a
good one for Steven Moxey. - And that is what causes the fact that I don't see straight. - And that is what causes the fact that you don't see straight. Okay, so that's an orthopedic question. So let me step aside and
we'll have an answer here about audible cracks in the neck. - Yes.
You're not alone there. That's called joint crepitus. Sorry. Yes.
What you described it's very common. It's called joint crepitus. It can be a sign that
something is not aligned or there is a hypo or a
tightness in the neck. It can also just be a sign that the joint capsule is inflamed or part, there's some
inflammation in the neck. Now, when, is it all the time for you, or is it certain times of the day? - Mostly.
- Mostly. - Just not all the time. Okay. The next step would be
just to get an x-ray, like a plain film x-ray and have them. - The bones are not aligned, right. - Yeah. And then, come see someone like me or a manual therapist that
can evaluate your neck to see what the alignment and
the mobility disorder maybe. - Thank you Steve. So I think the key point there was to find what's called
a manual therapist. Okay, so I'm a musician. I play musical instruments with my hands. So I don't crank people's
necks like Steve does, okay. I fix their dizziness from their inner ear by moving their head around
and I give them exercises to fix that. But you wanna find a physical therapist that says they're a manual therapist that is able to with their hands assess all the bones in your neck and the relationship between those bones. So that's a specialty, it's a focus within physical therapy. Yeah. I'll actually answer that
if you don't mind real quick and then I'll have you answer it too. So the question is about when you're actually
having a vertigo attack, we've discussed meclizine
is anti-cholinergic which the key thing with meclizine is that in the short term, it is recommended to take
meclizine for the first 48 hours of an acute attack of vertigo, just so that you don't fall basically and you can have a decent quality of life and you're not throwing up the whole time. But the problem with
meclizine is short term, it's side effects are
dizziness, drowsiness, and blurry vision. So for a lot of people, it causes them to fall as soon as they start on meclizine, okay. And then the longterm problem, if you take it longterm
is the damage to the brain that can cause dementia. So it's not a bad thing to have around, to use as needed or
for the first 48 hours. It's just the problem I see is that I've seen people that
have been on it for 10 years. Okay, because nobody
ever thought to evaluate the root cause of their dizziness. That's the problem is really
the short term risk of falling because of the side effects and then the longterm
problem with the brain. It also, meclizine also limits
your final level of recovery in vestibular rehab. So if someone's on the meclizine, they won't have as good of a recovery because it suppresses the
central nervous system. That's how it works. Okay. So as far as the giving
of the valium or adavan for somebody like that, I have seen that also
in the emergency room. Sometimes they don't
give people a meclizine. They give them adavan and I
don't know a lot about that. So I'm gonna step aside
and let Dr. Newton answer that part of the question, okay. - Thank you, Kim. I agree with Kim a hundred percent that these medications are.. - Lean in the microphone. I agree with Kim, a hundred
percent that these medications are something that probably isn't going to cause a lot of problem if you give them rarely or occasionally. But what happens is when people have BPPV, they have a little crystals
in their middle ear, and there's really a
few treatments with Kim and they can be cured, but they could end up with 10
years of these medications. So if you're comparing a
benzodiazepine like adavan, one time use of Aadavan or a
couple of times of using it isn't a big problem, but these
medicines are very addictive. So the number one reason, or the top two medications
people break into pharmacies to steal are benzodiazepines
and narcotics, like vicodin, xanax, and vicodin. The other is that even
though they're addictive, they don't make people happy. So a senior taking a benzodiazepine is four times as likely to commit suicide. A young schizophrenia is five times as likely to commit suicide. These medications are
often used to treat people who have lost a loved one. I last year saw a lady whose
daughter died 20 years ago. She was on three different benzodiazepines and she cried every single day. It was like her daughter had just died. I saw this study that showed that when they gave young
soldiers a benzodiazepine and then tried to acclimate
them to a stressor for PTSD, they never acclimated. So this woman, her brain, her ability to accept her
daughter's death never happened. It took me months to get her
off the three benzodiazepines. A year later, I can visit her and I can go through the whole visit. And then she isn't crying
about her daughter's death. She has some dementia because the other problem
with benzodiazepines is a senior takes them within three years they're 2.7 times as
likely to get dementia. So that could all be avoided if somebody went to someone
like Kim for their BPPV and a few very simple treatments by a person trained in vestibular rehab, they basically just turn
their head and they cure them. It's and the people that I've sent to Kim, they think Kim is the greatest
miracle worker in the world. The reason I fell in love with Kim, is my favorite physical therapist ever is because she cured
so many of my patients and I didn't have to put them
on these types of medications. - I wanted to make a quick
comment to the first gentleman. So Dr. Moxey is talking
about the structural issues that are going on. So my job is to find out
why that degeneration or that inflammation is there. So I'm gonna look for underlying causes. So that's why we would team up, you know, really nicely together. 'Cause someone would be working
on the structural aspect, assessing that, and then someone will be going, well, why is there inflammation here? Why is that C1 or C4, is it a thyroid issue? Is it a food issue? Is it a chemical heavy metal? What's what's interfering with your body that inflammation is there. Okay. - So she says she's had
vertigo for over 20 years and she gets it when she
wakes up in the morning. So what does that sound like? BPPV, the inner ear crystals are the ones that are
gonna give you the vertigo when you wake up in the morning, okay. And that usually goes away as the day goes on because
your brain is just over it. Okay, but then as you go to sleep and your brain has a chance to rest, it notices the vertigo again when you wake up in the
morning, very commonly. So I'm not surprised
that you were diagnosed with crystals in your ears, okay. And that all makes sense
to me what you're saying and what I would say to you is remember the theme of the lecture. Dizziness is usually multifactorial, okay. So you probably do have those crystals, which we could probably reposition for you back to home base in one or
two treatments on average, if you have a difficult case, maybe a couple more
treatments than that, okay. You could have an inner ear condition that could cause you to have
what's called refractory BPPV. That's what I have in
both of my ears, okay. 'Cause I had chronic ear
infections as a child. So I have left hearing loss and right-side vestibular hypo-function. What that means is I have
damage in both of my ears and I get recurrent BPPV in both ears. So I wake up with it in the morning a couple of times a year, okay. And I just treat myself
and I move on with my life. So in your case, we would wanna find out, do you have refractory BPPV? Do you have just like
a single episode BPPV? And we wouldn't know that until we heard a little bit
more about your history, okay. But the BPPV should be able to be treated in a few sessions yes. But the other factors
that you may also have, like maybe your body
sympathetic nervous system is overstimulated 'cause you've
had this now for 20 years. There may be other things that
also may need to be addressed for you to have a complete recovery. And I can't tell you that unless I would have a chance to do a comprehensive assessment on you to come up with a list of all the things that are
contributing to your discomfort and then what we would do about it, whether we would address it
or refer you to someone else. Okay. And then your question about
if we did fix your crystals, would they be gone and fixed forever? And the answer is unfortunately, no. BPPV has a recurrence
rate of about 15% annually and it's cumulative year over year. So if I were to be able to
fix your vertigo this year, 15% chance you get it within a year, 30% chance you get it within two years, 45% within three years. And you can see basically there's almost a hundred percent chance you're gonna get it
again within seven years. Okay. But, I put together for
you the fact sheet on BPPV so you can learn more about it because what I've found is people like us that have BPPV and get it and they've had it for a long time, the more they know, the
less they worry, okay. So I would encourage you
to not worry about it because it's a biomechanical problem. It's not a disease process
and it can be fixed, but we wanna have that
comprehensive evaluation for you 'cause there's probably other
things also contributing to your dizziness. And we wanna educate you
on what you need to do to sort of screen yourself for BPPV or to be aware if it comes back so that you don't have it for
a prolonged amount of time and you can get it fixed right away within a few days, if it ever comes back. Okay. Does that make sense? Okay, great. Okay. And I thank you all so much
for your time and attention. We really hope this was valuable. (crowd applause) (upbeat music)
