Diagnosing vertigo, unraveling the mystery

Pam Linn

Anyone who thinks vertigo is just a Hitchcock thriller simply hasn’t been there. But is it a disease or merely a symptom? A correct diagnosis could make the difference between a brief inconvenience and a debilitating malady. 

First, the chronology: Dec. 25, 1 p.m. I’m meeting a friend for lunch, but on the walk (no more than 100 yards) I start to feel weak and disoriented. At the dining room entrance I collapse into a heavy chair. The room begins whirling, and I hang on tightly to the chair; this without even a sip of cabernet. 

Cell phone on my belt, I call my daughter Betty. Then I know I’m sick. A clean towel and a plastic ice cream bucket arrive in the nick of time as I lose my breakfast. A nurse appears to take my vitals (nothing unusual except my eyes are doing a little dance from left to right). I can’t focus. This, I would learn later, is called nystagmus. A wheelchair appears and Betty pushes me back to my apartment. I want to get into bed. She wants me to go to the ER. On Christmas Day? No way. “Then it’s your doctor tomorrow, and I’m staying here. Okay?” 

My apartment is doing the same pirouette as the dining room. I go to sleep hugging the ice cream bucket. 

Next morning, at the doctor’s office, a P.A. pokes an otoscope in my ear and says I have benign (meaning it probably won’t kill me) viral vertigo, probably from an ear infection. I ask what virus that might be? She doesn’t know. “We just call it viral because we don’t know what else to call it.” This is not comforting. 

She writes a prescription for scopolamine patches (to tame the tornado) and a generic for Zofran (to quell the nausea). At the pharmacy, Betty picks up those wrist cuffs that control seasickness. 

Because my daughter leaves for California that afternoon and I need looking after, I wind up in the assisted-living wing of my building. There I chew ice chips to keep from getting dehydrated. Every day, her husband Mark calls or comes by toting his Blue Ray player and all the films up for Oscars. 

As usual, I react in an unfortunate way to the drugs. After a few days, my back and torso look like I’d rolled in poison oak. Bye, bye patch; Hello, Caladryl. 

Having taken only three generic Zofran tablets, I ditch those and resort to a homeopathic nausea remedy, which works. (Nux vomica; whoever thinks up these names has a macabre sense of humor). But nobody treats the cause, the ear infection. 

Eventually, I visit a naturopath, who agrees the infection is viral and gives me immune-boosting herbs to get rid of it. Soon I move back into my apartment, still bumping into things, but grateful to be home. Mark makes weekly trips with my organic foods and I try to return to normal. Still fuzzy, particularly in the mornings, I can get around with a walker or double poles (the relic of a hip fracture). My MacBook awaits. 

What I’ve learned: Vertigo is a symptom with several possible causes. Hillary Clinton’s was a brain concussion. Mine, and many others, involve ear infections. But one of the most interesting types is called Benign Paroxysmal Positional Vertigo or BPPV. This strikes most often when the patient rolls over in bed, dislodging otoliths (calcium crystals) from the utricle of the ear, which migrate into the semicircular canals with violent results. People describe crawling from bed to bathroom. Not a pretty picture. 

However, a simple repositioning called the Epley maneuver (after Portland ear surgeon John M. Epley) often solves BPPV in minutes. An article titled “Handling Vertigo” by Tom Valeo in the August/September issue of Neurology Now describes the procedure in detail. The trick is to get the correct diagnosis and treatment. According to neurologist Kevin Kerber, people with BPPV are often not being treated correctly. “They often get CT scans, MRIs and other unnecessary tests, but frequently they don’t get repositioning treatment,” he says. 

ER doctors often call vertigo Ménière’s disease, which is a misnomer. Named for French physician Prosper Ménière, it’s a syndrome, including dizziness. But for all we don’t know, vertigo is widespread. In five weeks, I’ve met four dozen people who’ve had it, and their treatments and outcomes varied widely. 

So I’ve been to the MD, the naturopath and my chiropractor, who is adjusting a few errant vertebrae. Guess I had two types of vertigo, but with luck there’ll be no recurrence.