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!

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.

The Human Barometer on Father’s Day

I woke up this morning spinning and decided to go for a walk anyway. Second day in a row greeted with vertigo, a vertigo spell that began at about 3am while I was asleep, two nights ago. I had plans for yesterday that had to be canceled. That is par for the course. Today is Father’s day and I have plans for today as well. We’ll see if they happen or not after I get cleaned up from the walk.

I don’t know what has caused this three-day struggle with vertigo. It could just be the weather causing it. It’s Texas, the weather is always changing. If you don’t like the weather here, wait five minutes,¬†except in August when you wish it would change but it just stays hot for weeks on end. The Wife frequently refers to me as her human barometer. Every time a front moves through, I’m sure to notice first, sometimes even before the cloud cover changes.

I’ve been going to physical therapy for about a year now. The exercises have strengthened some muscles and reduced some physical pain. They have helped me regain some balance, but nothing has an effect on rotational vertigo once it starts aside from single-minded determination or medication. I can sometimes force active vertigo to stop if I can afford to lay still and stare at a fixed point in space for about an hour; but I’m left with a sense of disconnection, of mild dizziness, even if I manage to get the rotation to stop. As I managed to get it to stop this morning.

A lack of sleep can trigger something akin to the vertigo I experience with Meniere’s. It isn’t quite the same, and I know the difference even if the average observer or sufferer can’t tell the difference. I’ve been sleeping fine, so it isn’t a lack of sleep.

Every one of the simple things I do each day takes longer to do and requires more effort just because of the conflicting signals I get from broken and erratically firing balance mechanisms. Just writing these few simple sentences taxes my abilities to do… anything.

But I am determined. I will get back up out of this chair and take my shower. I will go to a movie today if I have to go medicated. Going to sit and at least pretend to listen to family and friends because that’s what I want to do. Catch ya’ll on the other side.

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