By Carina Salvemini
What is in a name?
What is in a name, or in this instance, what is in a word?
Rather a lot when that word is ‘Vertigo’. The word itself carries all sorts of meanings, but, assuming for a moment that we are all talking about the same vertigo (that which is characterised by a disturbance in the vestibular system), the experience of this vertigo can be experienced in infinitely different ways.
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The meaning of the word vertigo is vague… at best! It could mean;
- The sensation of dizziness,
- A confused, disoriented state of mind,
- A sensation of whirling and loss of balance, associated particularly with looking down from a great height,
- A sensation caused by disease affecting the inner ear or vestibular nerve; giddiness. Giddiness is also not a helpful descriptor in this circumstance, for some this could simply mean too much ‘Christmas cheer’.
Central to successful treatment is accurately determining the cause of the symptoms, of which vertigo may be one, however Vertigo is not a diagnosis. My mother experiences an exaggerated fear of heights AND a B12 deficiency for which she receives vitB12 injections, both cause vertigo, neither require my expertise as a physio. When a person does arrive to see me for treatment of ‘vertigo’ as diagnosed by their GP, neighbour, sister, cousin etc my first move is to ask them to describe to me as fully as they can, in their own words, the problem they are having, how long they’ve been having the problem, what makes it better and what makes it worse. Once I have heard someone’s experience of their ‘vertigo’ freed from the pseudo-medical jargon that they feel expected to use I am in a much better position to delve further into specifics to help me get to the root of their problem.
A person seeking treatment may complain of;
- loss of balance
- fullness in the ears
- cotton wool in the head
- disconnectedness between head and body
- feeling drunk
- motion sickness
- unbalanced on one side
& the list goes on. People may experience one or multiple of these symptoms, their pattern of presentation is what helps me to determine their cause.
Our most frequent culprit for sudden and violent dizziness and nausea is BPPV (benign paroxysmal positional vertigo), but other less transient, likely contributors must not be discounted such as; Labrythitis, vestibular neuronitis, and Menier’s disease. Moving away from the inner ear, another very guilty suspect is the neck, even in the cases where it is not the primary cause, rarely does the neck remain uninvolved.
Here is a brief example of listening and thoroughly assessing rather than assuming that the diagnosis already provided is correct. A lady came to me for treatment of intermittent, yet crippling dizziness that meant she no longer drove as she could not predict when the dizziness would occur, she would require time off from work, would cease exercising and most importantly was distressed by the erratic onset of the symptoms that left her feeling vulnerable and anxious. She was brought to me by another physiotherapist who asked me if I could treat her “vertigo, probably BPPV”. Furthermore, the client had been diagnosed with MS several years earlier adding the possibility of central causes for her symptoms. A thorough subjective and objective assessment, with close attention to the details of her symptoms allowed me to accurately and successfully treat her neck and devise a suitable rehabilitation and habituation program that has her happily driving and ‘episode’ free today.
My take home message? As a physio, look beyond the diagnosis. Really listen and find out if that person’s interpretation of ‘vertigo’ is the same as your interpretation of vertigo. Consider all causes. Of course some diagnoses will jump out at you, be thankful for those ones, but always be aware that there is A LOT in a name.
As a client, remember that your ‘vertigo’ may be different from that time that your neighbour had vertigo and that the treatment might also differ. It’s best to seek the advice of a trained professional.