- 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.
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San Diego School of Medicine,
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It is our vision that successful aging
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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)