Latest Entries »

Neglected muscles

I recently experienced excruciating back pain every day for two weeks. It’s a long story, but suffice to say that this was unusual for me. I had a physical therapy evaluation last week and am now working on stretching some specific muscles that had become over tight. I already feel better!

During the evaluation, the PT asked me to flex and extend my back while standing. Although I regularly bend over (my hamstrings are in good shape!), I have not extended my back while standing upright for at least three years because tipping my head back was my most reliable trigger for vertigo. (In fact, a month ago in a different context, a nurse asked me to extend my neck while sitting upright, and I outright refused to do so.) But last week at PT, I leaned back without hesitation because my gut told me that I would be fine. And I was! It felt like seeing a familiar friend again, and I marveled at the flexibility I still had. The PT put me through a series of measures that had me standing, sitting, lying prone, lying supine, and lying on my sides. I moved through them all with no problem. My gut told me to take extra care moving from a prone position, so I did; otherwise, my movements were basically normal.

So that’s the good news. The bad news is that I couldn’t do even one sit up. Not one! The swinging head motion in sit ups is something that I have avoided for years due to vertigo. I’ve been exercising regularly for the past 15 months, but apparently certain ones of my core muscles still need work. For the first time, I realized the impact vertigo had on my overall body strength. Because I could not move and exercise normally, some of my muscles became weak. I modified exercises as best I could and managed to restart a regular exercise program, but still, problems remain. I’d like to see vestibular physical therapy include creative solutions for these types of muscle problems in patients with ongoing balance problems.

Last month I decided to complete a self-designed Balance Boot Camp to fine tune my vestibular system. For two days I did the balance exercises that my vestibular physical therapist gave me two years ago, and in addition, I walked up and down stairs without using the walls or handrail. (Especially at home, this had become a bad habit.)

After two days, I saw improvement and totally slacked off on the exercises. So much for boot camp! All month I continued to use my eyes–instead of my hands–while walking up and down stairs. It feels dicey sometimes, and that’s how I know it is good for me to push my limits. I’ve been turning on the lights in the stairwell at home to help me be more safe and secure. I avoid walking indoors in dim light or darkness because that is when my eyes “check out” and I rely on my hands instead.

When I look back, I realize that I was running into the walls a lot during June. I was off balance to some extent every day. Now that it’s August, I am pleased that these modest efforts improved my balance.



I am embarking on a self-created balance boot camp–join me!

My BPPV has been very mild for about a year. The last notable “improvement” I can remember is 13-14 months ago when I began a workout program. I was laying down on my back to do exercises a few times a week, and each time I felt nauseous and the room spun briefly. As the weeks passed, though, my symptoms improved until I could lie down without any vestibular nonsense. Success!

Since then things have stayed pretty stable, which is to say that I have a vestibular issue at least once a week. These episodes are short-lived and mild and for the most part do not interfere with my daily life. (I believe this is true; I need to check my notes to be certain that I am not wearing my rose-colored glasses here.) Periodically my symptoms worsen while remaining mild. During these times I have mild symptoms several days in a row while my vestibular system is obviously trying to sort itself out.

For the past several months, though, the increased symptoms have been my norm. I have been careening into door jambs with some regularity, and I lose my balance around the house fairly often. I decided that since I have had no major flare-ups for a year, it is time to clean up this mess. I am headed to BOOT CAMP!

I have pulled out the exercises that my vestibular physical therapist gave me and will be doing them throughout the month of July. I will tune my vestibular system as finely as possible and reach my maximum ability–which I hope will be “normal” (but I’ll settle for as good as possible). Beyond the exercises, I’ll be challenging myself to walk down stairs without using the handrails (it is so easy to “check out” with my eyes if my hands are telling where I am in space) and looking for other ways in which I am cheating my vestibular system. Wish me luck!

Hearing test

I had my hearing tested a few months ago because my wife felt that I was saying “What?” more often, and I myself felt that I wasn’t hearing as well. I knew I had some hearing loss in my right ear — this was officially diagnosed as part of the vestibular testing I had three years ago when all this started. I am pretty sure the hearing loss extends back to my teen years. I remember a school-sponsored hearing test in high school where the technician seemed puzzled and asked me if I had allergies. When I said yes, she relaxed. I didn’t think anything of it at the time, but in retrospect, I believed she was explaining away the hearing loss shown on the test.

In college I was aware of having a “better” ear. This is the one I used for the phone. But instead of viewing my right ear as damaged and my left ear as normal, I thought of my right ear as normal and my left ear as superior! I told myself that I used the phone on my left ear because I wanted my right hand available to write. I was a musician at the time, and I think I was in denial about having hearing loss. Additionally I’ve had phonophobia for most of my life, and I assumed that being sensitive to sound meant my hearing was perfect.

Anyway, back to my recent hearing test. According to the test, my hearing improved slightly. I’m awfully close to the normal range. While I’m happy that my hearing is not worse (I’m guessing that my perception that it is is simply due to my increased awareness–and acceptance–that there is a minor problem), I realize now that I interfered with the test to some extent. During the test, I focused with all my might on the sounds. I closed my eyes to “help.” Sometimes I wasn’t sure if I heard the sound or if my musical training was allowing me to imagine the next pitch, which are played in octaves. Basically, I created an unnatural situation that didn’t mimic real life. I don’t typically close my eyes and focus on sound to the exclusion of all other input. I’m sure we all would hear better if we did! So if I ever have my hearing tested again, I’ll try to strike a balance between “doing my best” and interacting realistically with the sounds.

Car sick

After months of very stable and very minor symptoms, I was surprised to experience several hours of nauseating vertigo symptoms earlier today. Contributing factors were a 30-minute yoga workout (even though I avoided problematic positions) and rushing around the house (i.e. eyes and body in constant motion) getting ready to leave. There was traffic, so my spouse’s driving was a bit on and off the accelerator. This taxed my vestibular system further, and I began to feel car sick for only the second time in my life. She took it easy at my request, and we ended up arriving on time for our engagement. 

Within an hour, though, I felt nauseous even though I had been sitting still. I laid down to rest my body and then sat on the floor with my back against the wall and both feet flat on the ground. (This position provides a lot of input points for the vestibular system.) After another hour, I felt better, though it took more time to return to normal. 

Before my 2013 vertigo episode started, I got in and out of bed in a very active way. I was in constant motion as I approached the bed, tucked my hands under the pillow, placed a leg on the mattress, and slid into bed nearly horizontally, ending on my right side. Getting out of bed was similarly fluid: a sudden movement to flip onto my left hip, raise the blanket, and lever upward, then an immediate step forward into walking away. (I should mention how startling this was to my cat if she happened to be sleeping on the comforter!)

All that changed with vertigo. Lying flat was my worst trigger, and going to bed became a nightly torture of nausea and holding on for dear life as the room spun. I got into and out of bed very carefully. Verrrry deliberately. I wake every night to use the bathroom, and I would walk with my arms out, ricocheting off the walls and doors jams as I made my way down the hall.

I believe it was summer 2015–around the time my tinnitus died down–that I found my self climbing into bed with my old habits. Not quite as vigorous, a little caution to be sure, but definitely a flowing move toward horizontal. I realized my nightly walk to the bathroom was more upright, more sure-footed. This was a clear sign of how far I’d come on my path to returning to health and normalcy. A small, but meaningful, sign.

Monday, Monday…

So this morning I got out of bed and noticed right away that I had some vertigo going on. The best way to describe it is to say my eyes felt wobbly. To be honest, things have been a little worse lately, if I can even say that with my symptoms being so mild. Not long ago I was rejoicing in my ability to pull a sweatshirt over my head while walking down stairs (!!) and to duck laterally under a barrier at the airport in order to retrieve my dropped boarding pass. But recently I fell out of balance twice in one day, hit the wall in my stairwell a few times (always when I am turning the corner), and even took off my sunglasses before going down steps. Clearly my vestibular system was struggling.

I decided to try my exercise video this morning and to stop if I couldn’t do it. The routine starts with jogging in place, and I took one step and almost burst out laughing. There was no way I could jog! So I followed the “modifier” on the video and marched in place. I modified many of the moves and found that by the end of the video, I was nearly back to normal. It seems that 30 minutes of familiar, controlled, and constant movement was enough input for my vestibular system to get its groove back.

Update: I noticed a pattern of having vertigo on three of the past four Mondays. At first I thought: gee, am I that stressed out about going to work on Mondays?! But then I realized that I do a yoga exercise routine on Sundays, and in that routine I bend over and put my head straight down for at least 30 seconds. I think that is the problem. I have had this happen before where the trigger and the symptoms are separated by a day. (Lying down in bed seems to exacerbate things.) So  next Sunday I’ll not put my head in such extreme positions, and we’ll see how I feel on Monday.

Later update: it worked! I haven’t had any “Monday trouble” since modifying my Sunday yoga workout.

Boating in the dark

Recently I went out in a kayak for an evening paddle. It was delightful and unremarkable from a vertigo perspective – except for one thing. As the sun set, I noticed that I felt unsteady when I turned my head. I guessed that, in the dim light, my eyes were not getting enough visual information to compensate for the rocking motion of the boat. I stopped turning my head – or at least not as quickly – and after awhile everything seemed back in calibration.

Exercise videos

I’ve been struggling with grief and depression this spring, and I realized at one point that I hadn’t exercised for five months! I hoped to do a triathlon with my Training Buddy in August, but even that was not motivating me. Figuring out my training schedule and dealing with gear and weather was more than I could manage.
I was looking for ways to take care of myself when a triathlon friend of mine announced an exercise accountability group. Perfect! I’ve been doing the 30-minute exercise videos every day and gradually building up my strength. Even dropped a few pounds! I love that the workouts are short, straightforward, indoors, and require minimal equipment. (A far cry from triathlon!)
When I started the video program, I still experienced vertigo every day, but it was mild and momentary. Thankfully, the pace of the videos was such that I could take a few extra seconds to transition between exercises, and sometimes (rarely) I held onto the wall for balance. Almost every workout includes lying on my back, which you might remember is my worst trigger for BPPV. Sure enough, I felt a little dizzy and nauseous when I lay back. Certain exercises with my arms and legs moving simultaneously were disorienting for a few seconds. But after six weeks or so, I felt the dizziness less often when on my back. It seems the short exposure to this trigger several days a week has helped me to improve!

My vestibular physical therapist told me in no uncertain terms that I was to never do backstroke again. She recommended against handstands and back bends. These are the movements that most reliably triggered nystagmus for me.

A year has passed. A few days ago I did a short yoga practice at home. (A co-worker recommended the Runner’s World Yoga Center, and I’ve found the online workouts are short, simple, and easy to modify.) I felt steady. I had the luxury of several days at home, so it wouldn’t matter if I triggered BPPV. I eased up into Urdhva Dhanurasana or upward bow pose. It looks like this:

Nina Mel doing the upward facing bow yoga pose

I don’t think I need to say that this is not me!

I didn’t stay upside down but for a moment, and then I eased back down. Success! Hard to believe it has been two years since I’ve done one of those.

Since I have a few days off of work, I was able to return to my favorite yoga teacher’s class. (I used to attend her evening classes, but now she teaches only in the morning.) I told her I had done a little back bend earlier in the week, so she worked it into the class. Again, I felt steady, and I had plenty of time. The first time I pushed up with too much vigor and felt disoriented. I came down quickly. I did the pose three more times, each time with no symptoms. I moved into the pose more gently, stayed for no more than about 4 seconds, and gently returned to the mat. I had no vertigo the rest of the class or the rest of the day. More success!