Dizziness – What Is It? Why Does It Happen? What Can Be Done About It?
Summary of a public talk given at a BC Balance and Dizziness Disorders Society (BADD) meeting at St. Paul’s Hospital in Vancouver on September 18, 2013.
Speaker: Dr. Neil Longridge. Dr. Neil Longridge received his MD at the University of Newcastle upon Tyne in the UK. Since then he has continued his medical education, keeping abreast of current research and techniques. In 1978 he joined the University of British Columbia (UBC), becoming a clinical professor. From 1977 until his retirement he was Medical Director of the Neuro-Otology Unit at Vancouver General Hospital (VGH). He also has a private practice in Vancouver.
Why is dizziness such a disastrous thing to have?
Partly it’s because you can’t describe your dizziness to others; you simply don’t have the words to adequately describe the sensation.
If you’re acutely dizzy, you have the body response to dizziness. This includes nausea and vomiting. And if you feel nauseated, nothing is pleasant.
You also get an autonomic fight-or-flight reaction: you get an adrenalin rush and your heart races. While the fleeting pseudo-dizziness provoked by fairground rides, galloping a horse or skiing fast can be wonderful, an adrenalin rush is miserable when it’s there all the time. And that’s one of the things you get with dizziness – this awful, constant feeling of panic.
Why is throwing up a part of dizziness?
Dr. Longridge explained that dogs and other primitive animals, such as a goldfish, get dizziness. The audience chuckled when he said, “What happens if you’re a goldfish with dizziness and you can’t swim straight? You get eaten by the passing shark.” He went on to explain that it’s the same with people. “If you’re sick, the last thing you should be trying to do is get food and forage because the passing lion will eat you.”
Dizziness is hugely intrusive. The dizziness produces nausea, the nausea means you’re not hungry. And because you’re not hungry, you don’t go out and forage. So the nausea and vomiting have a place – they are there for a purpose, to keep you safe.
What is meant by redundancy?
The balance system is dependent on information sent to the brain from three sources: the eyes; the vestibular organs in inner ear; and the sensory systems of the muscles and joints (proprioception). However there is vastly too much information coming in. Your balance system chooses which bits to use and which bits to ignore.
Redundancy means unnecessary information which you can discard, which still allows you to function and balance. For example, if someone is blind and their balance system is functioning well, they are able to walk about just fine; thus in a sense, for standard balance function, vision is redundant. Likewise, if you have no sensation in your legs and feel as though you’re standing on cotton wool, your vision and inner ears will keep you upright; that’s because the balance system in your feet is redundant.
There comes a point, however, when you can’t function properly – there simply isn’t enough information from your feet, your vision and your ears. You no longer have redundancy and you need all systems to be working fully in order to function. If the balance system is challenged at this point, you’ll fall over because you don’t have any reserves to call on.
And there’s not only the incoming side, there’s the outgoing one as well. Dr. Longridge used a bad knee as an example, saying, “Just imagine you’re starting to fall and your knee gives out. So now you have the orthopedic aspect added in; you try and move fast to avoid a fall and you can’t.”
Dealing with depression
When you have a single, miserable dizzy spell that lasts three weeks you feel terrible. But when it’s over, you feel fine and can get on with your life. It’s when dizziness just doesn’t go away that problems with depression arise. Dr. Longridge said that, “The added misery of depression is clearly a major component of not getting better.”
He expressed frustration with getting people to take anti-depressants saying, “Nobody will take them because it’s seen as a personal weakness that you need them. Taking anti-depressants won’t clear your disorder, but if you cope better with it, everyone’s better, including your spouse. At least give them a try.”
Why don’t you get better?
Sometimes people don’t get better because they have an episodic disease such as Ménière’s and the function of their balance system fluctuates – between bouts of extreme dizziness they are entirely normal.
The balance system deteriorates with aging and some people respond by moving less and spending too much time sitting. As Dr. Longridge said, “Your muscles rot off. So when you stand up to walk you’ve no muscles left and you fall over. And what happens when you fall over? You break your hip.” There’s a 4% death rate with hip fractures.
You can minimize the risk of breaking your hip by keeping active, maintaining muscle bulk, keeping calcium levels high and getting checked for osteoporosis – men as well. If your bones are weaker they break more easily.
If you have disease affecting the inner ear on both sides you don’t get better because there isn’t a normal side against which the brain can compensate. You can’t switch one side off and use the other one. Bilateral diseases are actually unbelievably more common than we used to think. It is assumed with many diseases that they are one-sided; this is not true, often both sides are malfunctioning.
What can we do about it?
One-sided disorders can be treated in a variety of ways including using the Epley maneuver, shooting “stuff” in the ear for Ménière’s, or operating on the ear if it’s bad enough. If the disorder can’t be treated, vestibular physiotherapy – vigorous exercise aimed at maximizing your function – is an option. Vestibular physiotherapy isn’t a cure; it makes the best of what you have. You need to do the prescribed set of exercises regularly and persistently in order to make the best of what you have and minimize the risks, because the risks are potentially lethal.