In this episode, Dr. Jeffrey Guild shares a story about a client suffering from severe positional vertigo.
He explains the symptoms, causes, and treatment process for positional vertigo.
The client’s condition was particularly severe, leaving her bedbound and unable to carry out her usual activities.
With the support of her husband, Dr. Guild was able to provide a repositioning maneuver to alleviate her symptoms.
He emphasizes the importance of staying hydrated and staying active during the recovery process.
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Dr. Jeffrey Guild (00:00:00) – On a tell a quick story about vertigo. And this is one of the most severe cases of vertigo that I’ve ever seen as far as someone’s response to it. And we’ll talk a little bit about why that may have been the case and then what you can do to prevent that from happening to you in case you get positional vertigo, which is actually the most common cause of vertigo. So my name is Dr. Jeffrey Guild, physical therapist, owner of Optimum Physical Therapy. And we empower people to remain active and independent in their home and the community. And what we really love to do is get information and stories out there to people. So to empower them to be able to solve mobility problems for themselves and their families. Okay, so onto the story. So basically I got to the home of our client’s house and she was referred by a friend. I got this friend who has vertigo and, you know, reach out to her. So we reached out to her and got a little bit of background was going on.
Dr. Jeffrey Guild (00:00:50) – I arrived there and she’s lying in bed and she’s obviously very dehydrated by this point. You could tell by her lips, like the look on her face. And she’d been lying in bed for a couple of days by this point. And of course, her symptoms were quite severe. And sometimes it can be that way with positional vertigo. So if you’re not familiar with positional vertigo, this is basically the most common cause of the symptom of vertigo. Vertigo as a symptom is basically rotational spinning. It can be caused by a stroke, a tumor, you know, cardiac arrhythmia problems, you know, dehydration. And but the most common cause of vertigo is called benign paroxysmal positional vertigo. It’s basically when crystals that are in your inner ear balance system that are supposed to be there, get into a place where they’re not supposed to be. So a little quick little background on positional vertigo. You basically have three canals on each side of your head, one for each ear. So our inner ear balance system has a main organ and those canals kind of go off of that main organ as well as in that organ are also basically crystals that we have a ton of them.
Dr. Jeffrey Guild (00:01:59) – And then what happens with positional vertigo is those crystals get into those canals again. Those crystals are supposed to be there. They tell our brain about acceleration. The canals basically tell our brain about head rotation. So when we’re moving our head side to side, then it tells our brain about that. So these are all normal things that are supposed to tell our brain about where we are in space, especially when we’re moving our head. So when the crystals get into the canals, they’re not supposed to be there and the person experiences abnormal rotational spinning sensation. That’s what this lady was experiencing. So you can imagine the fear of you rover in bed and the room spins. And sometimes along with that, you get nausea and vomiting and you can just feel very, very horrible as well as a whole host of other symptoms. I usually call positional vertigo, the elephant in the room that nobody can see because sometimes the person does not experience severe symptoms, especially if they’re older actually, and they’ll just get a bunch of other just kind of very random symptoms such as just imbalance and dizziness, but no rotational spinning.
Dr. Jeffrey Guild (00:02:57) – And then it can be very abstract when you start looking at people who are older. Now, in this case, this lady was younger. She was in her 60s, which is quite young for positional vertigo. And so she’s very dehydrated at this point. Her husband was there. He was absolutely fantastic. And they’re both very well supportive. But they needed help. They need a solution because here his wife is Bedbound. She’s not able to get up and move around. And she’s normally a very physically active person. She’s very tenacious. She’s getting after it. She’s just running, running, running, running all day long. And that’s what she does. And she works a lot. And she is very social and she’s just up and going all day long. So the fact that she’s now bedbound is completely inhibiting her life and it’s something she’s never experienced before. So what we’re able to do, of course, is test entry and confirm that, yes, indeed, this is positional vertigo, explain what’s going on and everything else and we can start treatment.
Dr. Jeffrey Guild (00:03:51) – The treatment is basically a repositioning maneuver that we do in the comfort and safety of people’s homes. And we’re able to get the crystals out of the canals and then to get the body to just flush them away so that they’re not in the wrong spot anymore. We start doing the course of the testing and repositioning everything else. And the most extreme part of this, of course, was when I brought her back up and we’d done the testing and all of a sudden now her body just just gets thrown to the side as if just some violent exorcist like experience. That’s the best way I can think to describe it. And basically what happens is and you’ll see this from time to time as a vestibular specialist, if you’re treating these things where the person’s body will literally get thrown to the side and what’s happening is their brain is interpreting that the bed all of a sudden just gets swung over or their brain is not interpreting where it is in space. And then the body just kind of tries to respond to it. And it can be a very violent, just kind of throwing.
Dr. Jeffrey Guild (00:04:52) – And that’s what was going on in this case. Now, as a visible specialist, you know that this is the case. So if you treat these things on a regular. You know, to put your body in a position where basically no matter what happens, no matter how big the person is, no matter how violent that throwing of their body is, you put your body in position to where they’re not going to get thrown off the bed. And of course, that was the case in this case. So it can be a very violent jolt. But my body is right there to build to stop that from happening. And, of course, this is a very terrifying experience for both this client and her husband. And, you know, she was in tears at this point. And this was a very horrible experience up to this point. And of course, the last couple of days had been a horrible experience. So positional vertigo can be very terrifying for people. And it’s something that we take for granted as we’re able to just walk and balance ourselves and not be dizzy and be able to turn our head side to side and build, do multiple things at one time and be well balanced.
Dr. Jeffrey Guild (00:05:50) – We just take these things for granted. So what happens when a wrench gets thrown into this wonderful balance system that we have and position? Vertigo is one of many diagnoses that people can have, and sometimes it can be it can come on very subtle. And then other times, such as in this case, not so subtle. And this was this is the most severe case that I’ve ever seen as far as a person’s response. Now, here’s the fun part. This couple was absolutely incredible. And the trust was there and they knew that they were in the right place and they’d seen that I had seen this before. And because based on my response and it’s important as a rehab professional, as a vestibular specialist, that we are calm in these types of situations. And of course, that helps reassure the family. And then they had the trust and the patience with me to be able to help get through this as well. So here the fun part is, of course, got her treated, you know, focus on hydration, drink lots of water, you know, let the doctor know what’s going on and send out that evaluation and fax that out to them and all that needs to happen.
Dr. Jeffrey Guild (00:06:51) – And so that way the doctors clued in on what’s going on as well. I also told her, you need to get up and moving. And one of the reasons why I believe that in this case she felt exceptionally horrible was because she’d been lying in bed for a couple of days with positional vertigo. And I do see a correlation as a clinician who’s treated positional vertigo thousands and thousands of times when people lie down more and they’re not up and moving, they tend to feel worse and worse and worse. Now, sometimes the reason that they’re lying in bed is not just because they choose to, but because their symptoms are so severe. So of course, the natural response is to lie down in bed or I’m sick or I just need to rest, or I’m terrified to be up and move, or I feel like I’m going to fall. So there’s a whole host of reasons why people will go to lying in bed as kind of at least a temporary solution until they get this figured out. But understand, so if yourself or someone you know is in this type of a scenario, the more that you’re moving is important.
Dr. Jeffrey Guild (00:07:50) – If you have positional vertigo and if you need to get a walker, get a walker, it’s perfectly fine. Just being up and moving can make a big difference. If you roll over in bed and the room spins or if you’re having a problem with dizziness and of course also good, let your doctor know. And then that way the doctor can rule out potential life threatening causes of dizziness or vertigo because sometimes the cause can be life threatening. It’s not always positional vertigo with the crystals getting loose. So you do want to reach out to your doctor and let them know what’s going on, and then your doctor might be able to get you to a vestibular specialist in your area as well. So if you like this helpful tip and you would like more like it and you’re suffering with spinning or rotational spinning or vertigo, download our Tips report on Vertigo and then you’ll be able to get powerful tips to help you or someone that you care about. Now, the conclusion of this was we’re able to work through a lot of these problems and she was able to get herself hydrate.
Dr. Jeffrey Guild (00:08:42) – She was able to get up and moving. And after the treatment, she had the confidence to get up and moving. We walked around some and just got her going and got her confident and of course, had her husband help her out with that as well and have him walk, you know, handhold around around the house and just kind of get up and moving again. Now, I saw her a week later because we usually wait for days to a week or so to allow the brain to kind of recover after the treatment. So here’s the fun part. I got to the door and this woman greeted me and she acted like she knew me. And I thought it was our client sister. In all honesty, I didn’t even recognize it was her. Our client answered the door. She was in such a wonderful mood because she’d been feeling so much better for now the past several days. And now she was back to her old self again. And so much so that I didn’t even recognize her when she answered the door.
Dr. Jeffrey Guild (00:09:35) – And so we went up and, you know, tested her. The position of vertigo was gone. One treatment session went from the most extreme case I’d ever seen as far as the response to being able to get rid of it in one treatment session. Now, that’s not always completely common. In fact, usually it takes 2 or 3 treatment sessions or I’ve seen upwards of nine, 10 or 12 treatment sessions. But in that case, if you’re in that type of a scenario. It can take different types of repositioning maneuvers because each person is different. The canals are not all the same. They’re not perfect little cylinders. They’re human organic structures. They’re not perfect. And the crystals are little tiny things and they’re very not dense compared to the fluid that they float around in. I’ve seen upwards to 9 to 12 treatment sessions, and that’s because positional vertigo can be a challenge from the standpoint that it’s not always what it shows in the textbook. And that’s very important for people to understand. And even for a single person from one type of treatment or one bout of vertigo to the next, it can be quite different.
Dr. Jeffrey Guild (00:10:38) – They can get vertigo in different canals. Again, we have six different canals. That is a possibility to get positional vertigo so we can get them in one canal and three canals and two canals, four canals each. Different bout of vertigo can be different and the way it presents can be different. And even the treatment that we have to go through can be different. So just because one person goes through positional vertigo treatment and then in one time it’s able to be gone, doesn’t mean that it’s going to take only one time. The next time it might take nine visits, the next time, six months later, if they get it again to treat even just one canal of positional vertigo. So and here’s the crazy part. So it’s not always the case that a person will get treated in just one time. It might take multiple sessions. I’ve seen upwards of 9 to 12 sessions. That’s more uncommon. But sometimes it can take that, and that’s because it can take multiple different types of maneuvers to treat a bout of vertigo.
Dr. Jeffrey Guild (00:11:32) – So it can be different from one bout of vertigo to the next, and it can be different from individual to individual. So if you like this story or others like it, subscribe to our channel, share it with a friend. The more that you subscribe and share this information with other people, the more it helps to spread this type of information around. So we really appreciate it and hope you like this story and others like it and we’ll get more out to you.