My Friend Xanax

Third day in a row. Taking Xanax for light vertigo and playing World of Warcraft slightly stoned. This is what the bad days are like. It beats worshipping at the porcelain altar for six hours at a stretch. I’ll take it.

January 26th – Finally it passes again. So close to the dizziness that persisted through most of December and early January that I almost thought it was the same bout of dizziness. Who knows? I don’t think so, but then I don’t know what caused that long stretch of dizziness either (still taking the iron) What I do know is that you can have my Xanax over my cold, dead body. You can have it over my cold, dead body, because taking it from me will kill me as surely as a drunken rock star chokes on his own vomit when he is so out of it that he (or she) doesn’t know which way is up. The difference is, I didn’t do this to myself. Nature did.

…But then nature made them musicians, artists, with all the baggage those labels entail. Maybe nature did it to them too.

Anemic Dizziness

I’ve been dizzy for several weeks now, in an unbroken chain of dizziness. During this period of dizziness I had blood drawn for my semi-annual blood tests, tests that came back showing that I was anemic. I wasn’t anemic by much according to the normal ranges for iron in the blood; but still it was low enough that my doctor was concerned about it and thought to mention it to me.

I basically blew the concerns off at the time. I mean, anemia? Right? What is anemia? It means low levels of red blood cells in your blood. It wasn’t critical. It wasn’t like I was four pints low on blood and I really needed a transfusion (I’ve heard that reported by others who have had anemia over the years) I was a few points low on the percentages of iron in my blood in one test. I figured, no big deal, I’ll just start ingesting a bit more iron in my diet. I shifted to taking the Wife’s daily vitamin for a week or so (her’s has iron in it. Men generally don’t need iron supplementation, women do) but after that I went back to my same old Men’s One-A-Day that doesn’t have iron in it, and I forgot all about it.

Until today. Today, as I’m standing there with the world in a fog of dizziness around me, not actually spinning but always worried that the general dizziness might turn into vertigo, it suddenly occurred to me. Brain function. Oxygen carried by red blood cells. Red blood cells distinguished by their ability to carry oxygen because of the ability to bond with the iron that is in them (that is what makes them red after all) is it possible that this prolonged bout of dizziness is caused by the anemia and not the Meniere’s?

To answer this question I turned to Dr. Google, like most of us do these days. As usual, Dr. Google was not a useful source of information on the subject of anemia and related dizziness. This image is the summary that Dr. Google offered me for the search phrase dizziness low iron. See what is second on the list? It took a minute for the reality of the situation to sink home.

Dr. Google on dizziness low iron

Acupuncture. Acupuncture is second on the list of recommended treatments for dizziness. I was almost apoplectic with outrage while reading this summary. Acupuncture has no proven use for dizziness, and yet it is second on the list of what to do about dizziness from anemia. Why? Why is this on the list at all? Why does Dr. Google think that medicalnewstoday.com is a reliable medical news source? Why is this unknown resource cited in a summary that purports to offer solutions to a particular problem? Cited at the top of a list of other possible answers to the question.

I’d like to thank Dr. Google for putting the word anemia back in my vocabulary today (words keep disappearing on me when I’m dizzy like this) put the word back in my vocabulary list so that I can hone the question I want to ask, but seriously? Why is is this website quoted as a source? In Dr. Google’s defense, Healthline is the first resource offered on the page, but the clarification block appears directly under that resource. Healthline’s value as a resource is also questionable. I wouldn’t take their advice as being rock solid without checking facts in other places first. When you read symptoms off a list of symptoms and you start saying “yeah that sounds right” even though you haven’t been complaining about that particular symptom, it’s time to find a second resource.

Using the search phrase dizziness anemia proved to be even less revealing than the previous search phrase. The top resource on that results page was yet another poorly written questionable source that I wouldn’t trust to give me advice about which direction was North, much less give me advice on how to treat chronic health issues.

After a few hours of fruitless searching I decided to quit looking and simply treat the problem that I know exists and see if that helps. I already know I’m anemic because my general practitioner told me I was. I was anemic when this dizziness started. I’m going to approach the problem as if I was suffering from anemia, and simply start by taking some iron supplements to see if the dizziness recedes or not. I have also been listless and tired a lot lately. Maybe it is anemia after all? Stay tuned.


Several days later, after a few days of adding iron to my diet (The Wife’s supplement didn’t have iron in it contrary to my prior statement) I’m already starting to notice less dizziness. Which is good. I didn’t want to have to go back to the ear, nose and throat doctor and get steroids injected into my inner ear again.

I will only be adding iron to my diet for a few weeks at most. I don’t want to overdo it and cause other types of damage that can be caused by having too much iron. I’ve never suffered from anemia before. At least, no anemia that I know of. The doctor who told me I was anemic also told me that blood donation could not have caused the anemia, but I’m at a loss to explain why I would suddenly be anemic outside of the blood donation that I had just given the day previous to getting the blood tests done. I guess I will go back to him and get an order for another blood test and see if the anemia is still present, after I’ve finished my few weeks of iron inclusion.

Weather and allergies frequently mess with my vestibular system. These are a known triggers for Meniere’s in some people. I thought the dizziness was coming from weather and allergies, but then it lasted through several changes in both. I tried the vestibular therapy exercises, as I mentioned previously on the blog, and they helped for a few hours but the next day the dizziness would be back. This is a last-ditch effort. I did not want to take iron supplements because I know that iron can be quite toxic at high doses.

I don’t know what caused the dizziness and I won’t know, possibly ever. This is the problem with chronic illness and common complaints like dizziness. If the dizziness that I’ve had for a solid month goes away, and I get a blood test that shows the anemia is gone, I will have demonstrated correlation. An interesting set of facts that might be related. If I get extended dizziness several more times and each time taking iron makes it go away, I’ve demonstrated a possible causal link. At least for me.

Dizziness is one of the most common symptoms/complaints that doctors hear. Almost anything can cause it. Dizziness is not just one thing, either. It can be a mental fog. It can be a feeling of imbalance. It can be active rotation and when it is active rotation it should be referred to by its real name, vertigo or rotational vertigo. Every time I get a symptom these days I’m always wondering if it is Meniere’s or if my thinking it is Meniere’s means something more serious is going on and I’m missing it.

What I do know now is that next time I donate blood I will be sure to include more iron in my diet before and afterwards. I don’t want to do this again and blood donation is still my only explanation for the anemia. If I become anemic again even with these precautions, then I’ll get concerned.

Vestibular Physical Therapy

I had been seeing a Physical Therapist for years before the time of COVID. I have a recurring issue with the lower back, a common complaint among older people, come to find out. I’ve also messed up my neck and shoulders in car accidents over the years, so I have plenty of things to work out with my physical therapist. Or did have before the time of COVID. I haven’t been back to Symmetry Physical Therapy since before March of 2020, because as painful as my joint and muscle problems are, they pale in comparison to the kinds of problems catching COVID would mean to someone like me.

Back in 2019, when the lack of plague allowed me to leave my house for things other than the essentials, I just happened to be at my Physical Therapy appointment when I mentioned that I was having recurring problems with minor vertigo and dizziness that lasted for weeks or months at a time. He got a quizzical look at that point asked me if I had ever tried any vestibular training exercises.

I had never even heard of vestibular training before, much less tried any of the exercises. He then demonstrated a few of them for me and had me work through them. I don’t know that they had any positive effect, but the knowledge that there was PT for my vestibular problems started me on a mission to find out more about the subject.

After mentioning the subject to my Ear, Nose and Throat doctor (ENT) on my next visit (she was mortified that we had never discussed the subject before) She gave me a referral for and I went to see the specialists over at 360 Balance, which just happened to be the people that my PT had been to a seminar with and had put the bug in his ear about retraining the vestibular system after injuries like the ones that Meniere’s inflicts on sufferers.

Over the course of the next six months or so we set up a set of exercises that addressed the issues that arise from the inner ear damage that Meniere’s causes. The exercises did, in fact, stop the nagging dizziness problems that I had been experiencing all that summer of 2019, and I have not had a recurrence of those symptoms since then. Did not have them again until a few days ago.

I’ve been slacking off my exercise regimen lately. The allergens outside the house have kept me sequestered indoors more often, and even the little bit of pollen and dust that get into the house are enough to make me feel like I’ve got a permanent head and chest infection. A feeling that can persist for weeks on end. Starting sometime last week I started to feel like I was heading into another bout of vertigo, so I started taking my meds in response. I’ve managed to avoid worshipping at the porcelain altar so far (knock on wood) but I have had that nagging bit of dizziness and nausea that comes along with it that has persisted for almost the whole week since I first noticed the warning of oncoming vertigo.

So today I decided it was time to break out the PT routines and see if I was going to finally worship the god of the toilet bowl or if I was going to stop feeling this stupid constant dizziness. The results are mixed. I do feel slightly less dizzy just sitting here typing. Any kind of movement does make the dizziness worse though. There is something different about the way my inner ears are working at the moment. I can determine that much. I don’t think I’m quite through the woods with this re-arrangement that my vestibular system is going through.

At least I can sit here and type words without feeling like the room is going to take off spinning like a top. That is a good thing. I think I will go walk the dog once I’m finished writing (I did) but in the meantime I’ll outline the exercises the therapist has me doing to help ease the dizziness.

  • Dynamic Standing Balance – I have a pillow that is so damn firm that it doesn’t give under the head when you lay on it. The Wife and I both hate the thing, but now I have a use for it. I place it on the treadmill near the grips in case I fall over and stand on it. Then I close my eyes trying to maintain balance for 30 seconds.
  • Kick the pillow out of the way and stand with your ankles touching. Close your eyes and try to maintain balance. If you can do that for 30 seconds, move your head from side to side at a moderate pace and try to maintain balance for 10 back and forth movements.
  • Vestibular Ocular Reflex (VOR) Exercise/ Gaze Stabilisation Exercise – I do both back and forth and up and down with these exercises. I set a metronome to 150 beats a minute and try to keep the mark on the wall steady for at least 15 seconds of head movement. I had to slow the metronome down today for the first set. I could not keep the mark still at that pace.
  • I can’t find a name for this one. I hold my thumbs out at eye level and maintain my gaze on them. This should be done against some kind of busy background. Bookshelves or blinds are both good choices. Rotate your torso to the left and to the right, back and forth, repeatedly, maintaining eye focus on your thumbs while the background moves behind them. I find this to be one of the best exercises for quieting the periodic dizziness that I get between vertigo spells. Making the world spin on purpose while focusing on a still object counters the feeling of spinning when it hasn’t yet turned into active vertigo.
  • Walking with head movement is the last exercise that they had me doing. Not just side to side, as the video demonstrates, but also up and down and diagonally (high left, low right/high right, low left) if you can pull that off without tripping all over yourself, try giving yourself mental tasks to do like naming groups of things or counting backwards from different starting points.

The hard part is making yourself do these things every other day or so. You feel fine and you think I have better things to do, so you don’t do the exercises that day. Before you know it a month has passed and you wake up dizzy for no apparent reason. Then you have to get back on the bandwagon and deal with the dizziness and the nausea until the exercises have the intended effect and you start to feel better. Now I’ve done my exercises and walked the dog. Time to reward myself with some more video gaming!

Normal Saline Causing Vertigo?

I learned something new. I love it when that happens. When I was hospitalized for the night after having my angioplasty last year,

…I started to experience vertigo. I didn’t think too much of it, other than the irritation that I felt while trying to wheedle a Xanax out of the nurse because of the vertigo. The stress of having to argue with the nurse about a medication that the hospital could see on my charts as being a medication I have been prescribed adding to the anxiety of an approaching vertigo spell. Yeah, that was fun.

But still. I couldn’t figure out why I had that sudden bout of vertigo. No warnings, none of the normal patterns (not that surgery is normal) But then I remembered that they had me on an intravenous drip of normal saline for most of the day and the night, about 16 hours of normal saline by the time I started to feel the spinning. For a lot of Menerieans salt=vertigo and saline is definitely salt. I have been on a reduced sodium diet for decades now because reducing salt is also what they recommend for people with hypertension, another chronic illness that I enjoy.

Sixteen hours of saline fluid introduced into my system. Surely that wouldn’t cause vertigo, right? I mean, normal saline is the same sodium levels as blood, right? Why else call it normal saline? It turns out that this is not the case. Normal saline just means the saline solution most frequently used in hospitals, and the salt levels are not the same as the levels in the blood.

Each bag of saline contains the same amount of sodium as 20 snack-sized bags of potato chips.

webmd.com

I haven’t eaten an entire bag of salted potato chips in… well, it has to be at least a decade. I occasionally (once a month or less) get a snack bag of air-fried chips from Schlotzsky’s (another Austin original) along with my regular original sandwich (hold the cheese and add the guacamole, please) and unsweetened iced tea, and that is almost more salt than I need in a day. I know they changed that bag at least twice while I was there, which is a lot more salt than I needed.

The assumed harmlessness of introducing normal saline into the bodies of all of their patients has been a point of worry for many doctors. So much so that there have been trials conducted using other replacement fluids than saline solution,

For more than a year, the emergency room and intensive care units at Vanderbilt rotated the IV fluid used to hydrate patients. On even-numbered months, they used saline, and on odd-numbered months, doctors could choose between either lactated Ringer’s or Plasma-Lyte-A. Both Ringer’s and Plasma-Lyte have less sodium than saline, along with other electrolytes. Most of the patients on balanced fluids in the study got lactated Ringer’s.

webmd.com

When I read the phrase lactated Ringer’s I heard it in one of the voices from the show Emergency! from way back when. That was the show that first got me interested in medicine and emergency care. My mother would probably be horrified to learn that I was indoctrinated into the evidence-based medical system by a TV show that she let me watch as a child.

Facts VerseEmergency! Behind the Scenes Facts & Secrets – Aug 26, 2020

Lactated Ringer’s or the Plasma-Lyte appears to be the better way to infuse fluids into patients. Not world’s better, but statistically measurable improved results from not relying on normal saline for all the patients admitted into the hospital. If you also need lower saline you might ask for one of those two the next time you find yourself needing surgery. Here’s hoping that time isn’t in the near future.

Flying in the Bathtub

I was going to make spaghetti. That was my resolution. I was going to make spaghetti because the Wife had declared that her spawn and I were on our own for dinner since she had fed herself. The Son is in town for the New Years holiday, and I remembered that he loves spaghetti. So I thought “I’ll cook spaghetti tonight.”

Then I turned around in the shower to get my towel to dry off, and my feet left the floor of the tub. I slipped. As I’m suspended in midair I think to myself, “So this is how I die.” Naked, tangled in a shower curtain, with water raining down from the still-running showerhead. Neck broken, maybe? They’ll find me dead on the floor of the tub and they’ll say that I died due to a lack of adhesive ducks.

My second thought was “I’m not dying in this tub, motherfucker!” Ask the Son, he heard the cursing as I hit the edge of the tub and then hit my head against the wall so hard I thought I had broken it. Broken the wall. I was pretty sure I broke my head as well, because I lost vision for several seconds after the impact of skull against wall. I also mashed my left shoulder against the tub edge and jammed my left knee into something even more painful but I don’t recall what that was. Soapdish? Who knows. Somehow I managed not to drag the shower curtain down into ignominy with me.

This was on December thirtieth, the day before New Years. I spent several quality hours sitting in the hospital emergency room as they did a CT scan of my head and then waited to get back results. The CT scan was required because I’m still on blood thinners after getting the stents put in my chest in May 2019. Internal bleeding is a frequent problem when you are on blood thinners. I get bruises all the time for no good reason these days, much less accidentally trying to kill myself in the tub. So a brain bleed from whacking oneself so hard that you are certain the tile wall might have broken under your head (it didn’t) was a very likely possibility.

I got lucky there. No internal bleeding in the head. I wish the same could be said of my knee, shoulder and backside. All of which have impressive bruises all over them. The shoulder is finally starting to feel better today (the third of January) and the knee is strong enough to let me get up and down the stairs a few times so that I can write on the blog for the first time since the accident. The bruises on the backside are still going to require more heat to get them to be less pronouced and painful. Here’s hoping that they respond to heat treatment. If they don’t I’ll have to be asking medical professionals to look at my ass.

…and really. Does anyone want to do that? “Check out my butt Doc.” I’ll pass, thanks.

Weather & Meniere’s

I missed raiding again tonight. Thunderstorms started rolling through Austin at about 5:30 pm and persisted until about 7:00 pm. After the first flicker of the house power during a storm we tend to turn all the electronics off. We turn them off and wait until the storm has passed. This is how we’ve approached dealing with power surges in Austin Energy’s lines ever since we lost electronics a number of years ago to a lightning strike that hit a transformer in the neighborhood.

But it wasn’t just the fact that I would have had to reboot the computer and do updates in a few short minutes that kept me from raiding tonight. I’ve been uncoordinated all day. Dropping things, knocking things off the counter that I knew were there and thought I would miss. Just a general sense of dizziness and disorientation that had me wondering if I would make it to raid tonight or not. When the thunder started rolling and the lights started flickering, I not only knew I would probably miss raiding tonight, but I knew that the reason I was feeling so unstable was the atmospheric pressure had changed with the storm front moving through, and that was probably why I was feeling so dizzy. This happens pretty reliably. I’ve tried tracking the barometric pressure in the past, but it doesn’t seem to be highs or lows that are the trigger, but the simple fact that the pressure changes rapidly.

When I went to do the new vestibular exercises that my physical therapist has me trying out, I could not do one of them properly, and this is the first time I’ve had this problem since starting the exercises. I can’t find any Youtube videos that replicate the exercise that was was given to me, the specific exercise that I’m having trouble with today. However, this video illustrates the basic mechanics.

Michigan MedicineCorrective Saccades – Feb 12, 2011

I use my thumbs, and I close my eyes after centering on the target. Then I’m supposed to move my eyes to where I think the other thumb is and then open them again. If I’ve missed the second target I’m supposed to focus on the correct position, recenter, and then close my eyes again before moving my eyes back to where the first target was, repeating as many times as I think necessary.

I could not find the second target today. Dozens of repetitions and the target is never where I think it should be. Never happened before. I started doing this exercise a few weeks ago, and when my physical therapist showed me this exercise I was thinking I don’t need to do this, I know where my thumbs are. Using peripheral vision, I’ve managed to track back and forth between the two targets without a hitch every time I’ve tried the exercise. Then today, I open my eyes and I’m not looking where I thought I was.

I have the explanation for why I’ve been such a clutz all day now. It just doesn’t make me feel better knowing what the problem is. I’m going to have to do a better job of doing the exercises as often as needed and not just when I think I’m having a problem. At least the dizziness didn’t progress into a full-blown vertigo attack today.

Grandmother

I had the weirdest dream last night. When I’m having dizzy spells like I’ve been having all summer, I tend to have really strange dreams, and this one was a doozy.

I was in my maternal grandmother’s house. It was exactly how I remembered it. The lime green living room walls. The floral patterned couches that I used to lay on and trace the patterns with my fingers. When I looked up I noticed that grandmother was crying. I asked her what was wrong? Why was she so upset.

“I’m sorry Tony. We left you a world that was so broken and we never knew how badly we had broken it.”

I tried to comfort her. I got her to sit down and I hugged her. But I was only a small boy and so my arms wouldn’t go around her. I couldn’t reach her shoulder to rub it consolingly. I’m thinking to myself “why is she so huge? I’m not a child anymore.” and then I woke up. weird dream.

I’d like to think I won’t owe my children an apology for the world we leave them. Hope springs eternal.

Rotational Vertigo

I’ve had several requests to describe what Rotational Vertigo feels like to me.  It is actually quite hard to describe in a way that the average person might be able to visualize. When I’m pressed for time I frequently say something like imagine the worst drunken binge you’ve ever been on. Most people who casually ask the question are satisfied with this response.

But that really doesn’t do the symptom justice.  For me, being drunk (even mildly intoxicated) can be vertigo inducing, has always been vertigo inducing.  I don’t drink and go to sleep anymore. That almost never happens.  If I feel like having a glass or two of brandy or cognac or other alcohol including a single beer, I’m generally up for the duration of the effect (8 hours or so) because lying down makes the vertigo worse.

So what is rotational vertigo really like?

First, imagine you are at the center of a merry-go-round.  The merry-go-round is spinning. It doesn’t even have to spin fast, it can spin quite slowly, just enough that you can’t fixate on a single point in the background.

This is the key problem with the spinning. It isn’t real, but your body doesn’t know this.  Your body doesn’t know that the balance mechanism in the ears is broken. So your eyes try to track the spin that isn’t there, causing your vision to dance back and forth (this is why reading can be a chore when you have a problem with vertigo) mimicking the spin the balance mechanism says is occurring.

So you are on a spinning merry-go-round. Now imagine that every stationary object you want to interact with is spinning at the same rate. There is no fixed point to anchor to (if you concentrate really hard you might just be able to override this. Maybe) so the handrails on the stairway, the walls of the shower, the glass of water to wash your pills down with dance madly around you while you try vainly to grab them from thin air.

Now imagine that this dance continues for the rest of your life; figuratively, if not in reality. Because it feels like forever. I’ve fought this thing for days at a time in the past, just because I’d already slept for what felt like days and I just couldn’t sleep anymore no matter how many pills I took.

I can’t describe it better than that. I don’t dare go looking for video to describe it.  Just seeing video that includes rotation in the theater can bring on sympathetic feelings of spinning.  I frequently must look away from films with rapid rotation (Gravity was torturous. Loved that film, couldn’t watch half of it. Go see Gravity in the IMax and sit real close with your hands trapped at your sides) or I have to hold my hands up in front of my face so that I can see that there is a stationary object in view while the rotation on screen persists.

The real answer is you don’t want to know.  You can trust me on this subject.


So how should I treat it? is the question you are probably left with if you have this symptom. My treatment article is here:

However, dizziness and vertigo are so common that they rate a separate discussion from the general Meniere’s regimen that I describe in that post. Dizziness is the most common complaint that doctor’s hear (I recently had a month-long bout of mild dizziness. It looks like it might have been anemia. -ed.) and can be caused by dozens of different maladies. Take your pick. If the cause of your dizziness is one of those maladies, nothing I can say will likely help you with that form of dizziness. My apologies in advance.

Still, there are reasons why the ears themselves might be causing the dizziness, and if that is the cause then you can do things as simple as chewing gum or popping your ears by putting pressure on the eardrum (forcing air up through your eustachian tubes. Carefully) to make the dizziness recede. I usually do those two things before trying anything else.

If that doesn’t help, then there are various treatments for re-aligning the otoconia in the inner ear. Otoconia are little calcified rocks inside your inner ear that move with the fluid and the motion of your head. Sometimes they get stuck in one of the labyrinths of the inner ear and can be dislodged by performing various exercises that I’m not going to try to describe here. But the otoconia being out of place is frequently the cause of otherwise inexplicable dizziness and some forms of vertigo. Benign paroxysmal positional vertigo (BPPV) is one of the types of dizziness caused by the otoconia being out of place. I’ve tried a few of these treatments for persistent dizziness (dizziness that lasts several days) with limited success. The half-somersault maneuver looks like one of those kinds of treatments. That linked video or any number of other videos on youtube will give you an idea of how you might try addressing the problem yourself.

If the problem is the otoconia of the inner ear then this kind of treatment should alleviate the problem. If it isn’t the rocks in your head (I just wanted to type that sentence one time) then those exercises won’t solve anything and may make the dizziness worse. It is pretty straight-forward to just try these procedures if the vertigo doesn’t let up after a few hours. You are liable to find that it won’t help for meniere’s vertigo and dizziness. If you still feel dizzy it is probably a good idea to see a specialist before ruling this kind of treatment out entirely. An ear, nose and throat doctor will be able to visually tell if the problem is the otoconia by observing you during treatment. I have given up on them unless it is a specific kind of dizziness that I recognize as being different from the Meniere’s.

The one thing I have found that helps for vertigo and dizziness aside from drugs is finding a head position and/or a focus point to stare at. I personally find that turning the head slightly to my right and looking slightly downward is the best position for me. I have a catbus that sits near the correct position next to the bed. A friendly catbus that smiles its cheshire grin at me while I try desperately not to spin.

Staring at a fixed point in space, preferably staring at an object that is crafted to inspire trust and happiness, helps quell the spinning long enough for the drugs to kick in, or until the spell passes. One or the other of these two things will occur eventually. I hope you find relief from these miserable symptoms if you are having them. I really hope that if you are reading this right now that you discover what is causing your symptoms and that they stop for good. It is what all of us hope for.