April 13, 2025 • 49 mins
TAKE THIS PERSONALLY WITH MORGAN: Vestibular Specialist Holly Cauthan is the one person who could help Morgan after she was diagnosed with BPPV (positional vertigo). Holly helped her understand the diagnosis, the cause, prevention, and living with it so now she's helping everyone else with all the information Morgan received. Plus, Holly is debunking some myths around vertigo for fellow sufferers in hopes they can understand their diagnosis better.
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Episode Transcript
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Speaker 1 (00:13):
Take personally.
Speaker 2 (00:16):
With Orgame Fuelsman in twenty twenty five. Vertigo effects about
one in ten people worldwide, with women being more prone
to it than men. Additionally, fifteen to twenty percent of
adults experienced dizziness annually. That's why we're doing an episode
all about vertigo. I am, unfortunately part of the one
in ten. I was diagnosed with BPPV last year after
(00:37):
my first positional vertigo episode in February of twenty twenty four.
It was my first time ever knowing or experiencing vertigo.
But after posting several moments of my BPPV diagnosis and journey,
several people online have come forward with similar ailments and issues,
so I wanted to dedicate an episode to all of
the vertigo sufferers. Holly Coothin joins me this episode. She's
(00:59):
a friend and a vestibular specialist at Vanderbilt and the
reason that I'm operating at one hundred percent again after
both of my BPPV episodes, So you'll hear some of
my experiences, but through the lens of Holly, the actual
expert on this particular topic. I am bringing on not
(01:22):
only one of my good friends, but also a good
friend by way of vertigo. Her name is Holly. Holly
is a vestibular specialist in the physical therapy world, and
she's basically saved my life on multiple occasions. Now, Hey Holly,
thanks for joining.
Speaker 1 (01:37):
Hey Morgan, thanks for having me.
Speaker 2 (01:39):
How are you feeling right now in this moment.
Speaker 1 (01:40):
I'm good, I'm good.
Speaker 2 (01:42):
Ready to talk all about all things vertigo? Yes, okay,
I want to know how you got into this line
of work because it's so specific and you yourself don't
have vertigo.
Speaker 1 (01:53):
No, that's true, I don't. One of my clinicals actually
canceled on me in physical therapy school, so I ended
up going to a clinic that was about an hour
away from Mobile, Alabama, which is where I went to
PET school, and my clinical instructor happened to be a
vestibular specialist, and so it just fell in my lap.
I was good at it, and I loved it, and
(02:13):
it's all I've ever done. For thirteen years. I've never
done a single day of ortho. So I can't help
you with your shoulder, I can't help you with your
knees or ankles, but I can do anything.
Speaker 2 (02:23):
Balance in dizziness, okay, in vestibular give us the breakdown
of what all that encompasses. When I say you're a
vestibular specialist.
Speaker 1 (02:32):
Yeah, so it's the inner ear. It's really that easy.
All things balance, all things dizzyness, and then also concussions
fit in with that. Vestibular migraines in.
Speaker 2 (02:42):
Like tonightis, maneirs are both some of the things that
you work with.
Speaker 1 (02:45):
So tonightis is the one thing we can't touch really
in the vestibular world. There's nothing we can do about that,
but mineirs and other things like labyrinthiitis weaknesses of the
inner ear that I can help with.
Speaker 2 (02:59):
Okay. Obviously verdio which for me what I dealt with
and stumbled onto you was BPPV, which is benign positional paris.
I could never say the second.
Speaker 1 (03:11):
Piece, benign paroxysmal positional.
Speaker 2 (03:14):
Vertio, thank you. Yeah, I just always in upsameing positional vertical.
Speaker 1 (03:17):
Yeah no, And that's a good way to put it.
So it's the number one vestibular diagnosis, and it's actually
my specialty and the easiest to treat.
Speaker 2 (03:25):
Okay, you say easiest to treat, and I remember my dreams.
I was like, this is not easy, but it's so funny,
Holly and I as a patient doctor situation, if you will.
It was always funny because Hollywood always reference things. She'd
be like, this is so robust, Oh my gosh, Morgan,
this is beautiful or like it just like this moment,
and I'm like, ohly no, it's not.
Speaker 1 (03:44):
That's so true.
Speaker 2 (03:46):
But you were experiencing like, okay, this is like something
I can work with and something I can treat. Where
I was sitting here and I was like, I don't
want something to be beautiful in my eyes and in
my ear.
Speaker 1 (03:56):
I'm staring like closely into your eyes.
Speaker 2 (03:59):
Yes, okay, BPPV vertigo this situation? How does it happen
for people like I stumbled into your office because there
was a listener of the Bobby Bone Show who reached
out to me on Instagram. What was her name?
Speaker 1 (04:13):
Katrina?
Speaker 2 (04:13):
Katrina my colleague, and she was like, I have a
friend who can work wonders on you. I was like,
oh my gosh, do anything to help me right now.
I got set up with you, had no idea somebody
like you even existed, which is why I brought you
on here. The best kept secret you are, but you
shouldn't be a secret, Like you are helping people who
(04:34):
have a debilitating illness all the time, So how does
somebody end up one with vertigo or BPPV. What are
the kind of different variations that would make somebody land
in your office with this?
Speaker 1 (04:46):
So let's start kind of with what is BPPV. It
is room spinning vertigo that happens with position like positional changes.
So laying down, rolling over in bed, sitting up, all
of those things make your world go round and round
and you can't figure out which ways up. So that's
the definition of it.
Speaker 2 (05:05):
In the little crystals in your ears and they move
from the rocky wall, I will always remember you telling
me that, yees.
Speaker 1 (05:10):
So they're called odconia little calcium carbonate. They are super
small little rocks that come out of your utricle so
that's your balance organ, and they go into one of
your six semi circular canals and they send false signals
to your brain that you're like going upside down and
again it makes the world go round and round.
Speaker 2 (05:30):
Which is I describe in two ways, Like when I
experienced a vertigo, it was I was either on a
Tiltera whirl or I was like had a blackout drunk
moment in the world will not stop spinning. Those were
like the two similarities I could relate it to. It's
a crazy experience. And then but why does it happen
for some people? Why does it not happen for others?
And like, how can it happen? Can it happen to anybody?
(05:52):
Give me the breakdown?
Speaker 1 (05:53):
Okay, the breakdown. So it usually happens to people from
ages fifty to seventy years old. You are rare. I
rarely see it in someone in our early thirties, So
that's different. Welcome to my life, exactly. You're special, always
been special. In the doctor's office, it's usually idiopathic. We
(06:13):
actually don't really know why it happens to some people
and not others. Now, it can be attached to things
like migraines and things like if you have an inner
ear problem already, it's going to attach on to that
and you're gonna be at a higher risk for BPPV.
But for majority of people, it just happens one day
when you wake up and it's terrifying. It's actually really scary.
(06:36):
So most people think they're having a stroke or even
a heart attack, and they run to the emergency room.
Speaker 2 (06:41):
And from what I've learned, running to the emergency room
is only going to get you some medicine, send you
on your way and say you have here some nausea
medicine that'll help you not feel like that side effect,
But it doesn't actually treat the symptom, which is vertigo.
Speaker 1 (06:56):
The medicine that they give you, so it's usually something
called mechlasen or antivert. It really it's like a drama
me on steroids. It really doesn't do anything to help
the underlying cause. So it's a bit of a band aid.
It might take the edge off a little bit, but
it's not going to stop the world from spinning around you.
Speaker 2 (07:12):
And what does actually stop the world from spinning around
you is maneuvers. Yes me, Yes, That's how people get
to Holly by way of typically earns and throat doctors
who then recommend to her. So the maneuvers. But tell
people how you diagnose, because every time I show these
crazy videos of you putting the goggles on me and
my eyes going crazy, everybody's I didn't even know this
(07:34):
is wild technology. Tell people what happens when somebody comes
in and you're treating them for verdigo.
Speaker 1 (07:40):
So I put you in different testing positions, and I
watch your eyes when the crystals move within those semicircular canals,
there's little hairs in there, and again the signals are
sent to the brain and they actually make your eyes
move in certain directions. And so I watch the eyes
and that tells me where the crystals are located, and
(08:01):
that helps me choose the maneuver.
Speaker 2 (08:02):
And then to treat you how many maneuvers are actually
out there, because it's is a very controversial thing, because
I remember you're like, I told you I did the
Epley maneuver, and you're like, oh, dear gosh, no, not
because the Epley is bad, but because it's not a
vertigo is not a one size fits all, and people
use Eppley in that capacity.
Speaker 1 (08:23):
Correct, So most people have heard of something called the
mod fied Epley, and that treats the posterior and anterior
canals now greater than ninety three ninety five percent of
the time. That's probably gonna work. But I see BPPV
all day every day, and so of course it's it
doesn't fix everyone's so we gosh, I don't even I
(08:45):
don't even know how many maneuvers there are, but there
are a lot there are.
Speaker 2 (08:50):
And even when we were going through my treatment, I
remember you pulling out the book and you're like, I
think we need to do a different maneuver that I
don't typically have to do.
Speaker 1 (09:00):
I think I had to do three on you.
Speaker 2 (09:02):
And I remember telling people that you did the barbecue
roll on me. I'm like, you know, like you were rotamn,
Like yeah, it was a literal skewer on a barbecue
is what basically she did to me.
Speaker 1 (09:11):
You were a special case, so because you started out
in one canal and then you switched to another canal,
and so it got a little bit muddy. So that's
why we had to use so many maneuvers.
Speaker 2 (09:21):
And how often do you see like that happen where
you're a you called me a multi canal VPPV.
Speaker 1 (09:27):
I see it quite frequently.
Speaker 2 (09:28):
See. Okay, so I'm special, but I'm not like so
special that I have to become a case study, right right?
Speaker 1 (09:34):
Cool?
Speaker 2 (09:34):
I appreciate, Yeah, no case studies, really glad. But the
thing that was so hard for me when I was
going through this, and I cried in your office and
you're like, oh gosh, Morgan, it'll be okay, we got this.
But what was so terrifying for me was not the treatment,
not the maneuvers you were doing, nothing like that. It
was I'm gonna have to deal with this for the
rest of my life, because once you've had it, you're
(09:57):
likely to get it again. When I first walked into
your office for the very first time ever February of
twenty twenty four, we were like, Okay, this potentially came
from a bounced fitness class, and this may never happen again.
Hopefully this is it one time in ten years from now.
Maybe we're hoping it was a one off. And fast
forward to this year, twenty twenty five, and it happens again,
(10:20):
and I was like, no, this means it's gonna happen more,
and I do not want this in my life. And
so I was having this huge panic, which I think
anybody who deals one with a chronic illness, one with
an invisible illness, three with a debilitating illness that people
don't understand on any of those levels, you feel just
(10:42):
overwhelmed with what your life is going to be like indefinitely.
And so when I was sitting in there and I
was crying, You're like, oh, no, like we're gonna treat this.
I was like, no, no, no, this is not you.
This is like me realizing that my body's kind of
betrayed me and I now have to do this all
the time to get better, and it's so debilitating.
Speaker 1 (11:03):
It is. Yeah.
Speaker 2 (11:04):
Do you see a lot of your patients come in
and they have this kind of same experience where it's like,
is this for real? This is what I'm gonna have
to keep dealing with.
Speaker 1 (11:11):
One of the number one questions that I hear is
how do I prevent it from happening again? And there's
a really bad joke in the vestibular world that we
say that's job security for us. There there is no
way to prevent it. Things like high intensity aerobic activity,
which is probably why it happened to you in the
first place. You were at the bounce class, so a
(11:33):
lot of impact on the floor probably made those crystals
come loose. But other things like going into surgery and
then being sedentary for a while, going to the dentist,
going back and getting your hair done, things like that
can also make BPPV reoccur, and can they also be.
Speaker 2 (11:51):
The reason it starts. Like all of those.
Speaker 1 (11:53):
Absolutely, yeah, So usually it's idiopathic. But also a large
majority of BPPV patients come in post concussion or a
hit to the head or even like a whiplash injury
postcar accident. So usually, like my younger patients are going
to have some sort of blow to the head.
Speaker 2 (12:13):
But when I came in and you're like, oh, you did.
Speaker 1 (12:15):
A fitness what is happening Yours was a high intensity
aerobic fitness class that likely made it happen.
Speaker 2 (12:22):
Oh my gosh. And see that's what's so crazy about it.
And when I talk to people and they're like, you're
good now, I'm like, I'm good until it chooses to
happen again. And that's what's so scary because it can
happen again, and it can happen you have no warning,
you have no way of preventing it. Just like you said,
it's just and then you're knocked out. Like when it
first happens to me, I am stuck in my bed
(12:44):
for three days waiting until whatever the moment of the
episode started subsides to then start trying to heal. And
that's what's so scary about BPPV and vertigo itself. But
like that experience I had where it was like, again,
we're not sitting there, and I was like, oh my gosh,
(13:05):
I could be driving, I could be on a road trip,
I could be miles away from Holly, I could be
getting married, and I literally could have like this Vertigo
episode happen. And that experience was just everything came washing
over me in that moment where I was like, this
is now my life and now I'm like on this
mission to be like, how can I get the healthiest
I've ever been in the potential that it somehow impacts
(13:27):
this is the goal, right, Like I just hope that
I inadvertently do something to help it.
Speaker 1 (13:34):
Yeah, And there's really truly nothing out there that is
proven to help prevent it, except potentially vitamin D levels.
So we do have our patients get their vitamin D
levels check because if you're on the lower side, it
can lead to recurrence. But other than that, there's no
special diet. There's no we don't tell you to give
(13:54):
up coffee or alcohol. There's nothing from this food related
that will help prevent it from happening or from occurring
in the first place.
Speaker 2 (14:04):
And that's what I see a lot because the internet
is a dangerous place it is, and you see a
lot of things of I went gluten free and my
vertigo stopped, or you see someone who goes, I went
to a chiropractor, I've never had issues again, these kind
of gambit of things. But like truly medical sense, is
any of that proven or is it just like potentially
(14:27):
happenstance that those connected.
Speaker 1 (14:29):
I think we need to realize that vertigo is not
just BPPV. Vertigo can come from a multitude of vestibular
diagnoses that actually create this same room spinning symptoms. It's
not always super super easy to treat, which BPPP is,
(14:49):
but other things like vestibular migraines or a vestibular neuritis,
which is a weakness of the inner ear, they actually
create the same symptoms that positional vertigo us.
Speaker 2 (15:03):
Okay, so when people are having these experiences of things
helping them, it's likely that something else is going on
that those help them. But BEPPV itself, if you just
have like me, potentially we're still working through my understanding
of what the heck is going on in my anatomy.
But say I just end up having BPPV, there is
(15:26):
nothing besides the potential of vitamin D levels that I
could do that would prevent it from happening.
Speaker 1 (15:32):
Right, that's correct, and you're so young, it's likely going
to happen again, and I do.
Speaker 2 (15:37):
I've heard of a lot of people who get this.
This is the craziest part to me because when this
first happened and I found out about you and you
were treating me and I was slowly getting better, there
were so many people that reached out and they were like,
I live with this every day for months on end,
and they get a little bit better because that's the
process of vertigo, which also you taught me that vertic
(16:00):
itself is just the symptom, and then you have the diagnosis.
So just like you're mentioning, vertigo can be caused by
multitude of different things. But what I'm aligning here with
is the BPPV, which is my diagnosis.
Speaker 1 (16:13):
That's correct. You are your special and I say that
in a way that your system is actually really sensitive
to the BPPV. So not everyone that comes to me
has to be in bed for three days. There are
people that actually still are able to get up and
go to work and function no problem at all. But
(16:33):
that is because their BPPV is not as what I
call robust as yours. So it's likely that the crystals
are either really small, so they range from three microns
to thirty microns. Wow, that's really tiny, and.
Speaker 2 (16:49):
Which you also told me you can't even see them
on you can't pull them out and see them on
a microscope.
Speaker 1 (16:53):
But they're so small. So if you, let's say you
have a cluster of three three micron odiconia that are
going through your canals, your eye movements and your symptoms
are not gonna be as intense as if the odiconia
or size thirty microns and they're moving fast through the canals.
(17:13):
So that's going to create a much more intense situation.
So it's not always gonna make people vomit and make
them sick to their stomach or make them miswork. But
in your case, you're just one of the lucky ones
and you've had really good boots.
Speaker 2 (17:31):
Yeah, really really lovely bouts. I'm so lucky. Yeah. So
when we talk about this though, and people hear like
they'll have a dizziness spell, is that potentially vertigo or
is it like dizziness and vertigo are separated? Because I
was having this conversation with somebody online and she was like,
if you get motion sickness and then you have dizziness,
(17:52):
it can be connected to vertigo. Is that all intertwined
or are they kind of separate entities?
Speaker 1 (17:57):
Dizziness is an umbrella term, so so dizzeyness is usually
used to describe swimmy headed, lightheaded feelings, whereas vertigo is
actually the room spinning. But also you can have vertigo
where people say that they're spinning within their own head,
and so that can happen as well. Okay, but no,
(18:18):
dizzeyness is the umbrella term, and then vertigo usually fits
underneath that.
Speaker 2 (18:21):
Okay, but specifically, if somebody's having a vertigo episode, typically
the world is spinning typically versus like you're just like
a little bit nauseous, queasy, lightheaded as kind of the
dizziness experience. Is motion sickness vertigo connected at all? Is
there some because that's an Internet thing where it's like
if you get motion sickness in the car, or you
get motion sickness on rides, which I've had my entire life,
(18:44):
and I never had vertigo until now, are those connected
at all? Is there something to that?
Speaker 1 (18:50):
Motion sickness is not connected to BPPVKA particular.
Speaker 2 (18:54):
Okay, I know connection. I know that's a crazy thing.
But like I'm when I was going through this experience,
and I'm going online searching for all kinds of answers,
I'm just trying to find anything to understand what's happening
to me, because when it does happen to you, you're
terrified and you're like, it's all I know is the
world just went spinning and I can't move my body upright.
And you're like what does that mean? And you google
(19:16):
and you have vertigo? And then I'm like, what the
heck is vertigo? And you just go down this rabbit
hole of trying to understand what's happening to your body.
Because in my day to day life, my entire life,
there's only one person, a good friend of mine, who
actually has some hearing loss, and she has vertigo. She's
the only person I've ever known in my life that
(19:37):
has had it, or at least that's talked about having it.
But of course now that I talk about it, everyone
has it. Yeah.
Speaker 1 (19:43):
Usually if you mention it to one person, they're like,
oh my mom had it, my sister had it. My
aunt had it, and it may or may not have
been BPPV, but yeah, still they're describing as vertigo.
Speaker 2 (19:54):
So people who do have potentially like this room spinning
vertigo BPPV, do they have to live with it? Like
you see something often that people are like, I live
with this for my entire life, and I'll have an
episode and then it gets a little bit better, and
then it'll happen again. Because to my understanding, you've gotten
me to one hundred percent again twice and ever since,
(20:16):
like only when I'm having those episodes? Am I living
with it? Once the episode has cleared, as you call it,
it's over. It's supposed to be over. You're not supposed
to have any no underlying. It's like it's gone. Am
I right?
Speaker 1 (20:31):
Yes? Okay, let's say that you would have never found me.
Chances are high that in a couple of weeks it
probably would have resolved on its own. Probably so we
don't know if the crystals are reabsorbed by the body
or if they're put back in the utricle where they belong,
we don't know, but it generally does resolve on its
own after a period of time. I will say that
(20:52):
last week, I saw a patient and she was in
a car accident eight years ago. She has never seen
a physician for her room spinning vertigo, and she just
now got to me eight years and I put her
through all the testing positions, and sure enough, it was
straightforward post to your canal what we call candalathiasis. So
(21:14):
those odconia, those little crystals were just hanging out in
the canal. And I cleared her in one session.
Speaker 2 (21:19):
And now she doesn't have any episodes of this at
least until it happens again.
Speaker 1 (21:24):
Wow.
Speaker 2 (21:24):
But she dealt with it for eight.
Speaker 1 (21:26):
Eight years and we cleared it in one session.
Speaker 2 (21:28):
See, it's so crazy because I hear this of so
many people who write me and they're like, yeah, I
deal with this, and I'm just like, you're not supposed to.
You're really not like you're supposed to be able to
do these maneuvers and get the treatment, and then your
life is supposed to go back until, of course, another
episode happens, and.
Speaker 1 (21:45):
It may not happen, so it could happen again tomorrow,
it could clear and happen in two weeks. I had
a patient today that it cleared for twenty five years.
Speaker 2 (21:55):
And then it just came back, and it came back.
It always comes back with a vengeance too. It just
hey honey, I'm home. Yeah, yeah, Wow, I'm back. That's
what's so wild too about Vertigo BPPV. There's just you
guys are the specialist in it, but there's still so
much unknown about how it exists. It's true, what's that
(22:18):
experience like for you? Where like you're just in this
field that's constantly evolving because you don't have every single
detail truly to understand what's happening.
Speaker 1 (22:30):
I feel so honored to be a part of it.
We do a lot of research at Vanderbilt and we're
trying to add to the literature and help figure out
all of these answers. But you're right, there's just so
much that is unknown. I will say there are some
studies going on I believe overseas that they're working on
a medication. It's in very early stages, but we're trying
(22:53):
to find answers and some we're trying to find the
magic pill. Right, that's what everyone who comes to physical
therapy wants. They want that magic pill. They don't want
me to put them through the maneuvers that make them sick.
And vomit, and they just want that magic pill and
hopefully one day we'll have that, but until then, it's
just I'm kind of your best.
Speaker 2 (23:12):
It is And it is crazy you say that about
the maneuvers, because every time I did have a treatment
with you, I would get better. But I don't know
also that people understand that when you do the maneuvers,
even if you're doing like the applay at home, you're
inducing the vertigo. You're moving the crystals around, right, So
it's you're literally what you are trying to avoid happening.
(23:33):
You're doing, you're moving you in the positions to try
and get them to move back to where they're supposed
to be. And every time I would get done with
one of our sessions and like I'm out for the cows.
You guys tomorrow, I'll get better. That was just so
crazy to people, because it's like you went to an appointment,
You're supposed to be better. I'm like, no, I will,
But it's just a little bit different of how that works.
Speaker 1 (23:54):
Yeah, and do you remember one of the number one
things I told you, So we encourage movement. We don't
want you to avoid any positions except for right after
the repositioning. Then we want you to stay pretty still
for a short period of time, but we don't want
you to be fearful. We don't want you to not
roll on your right side.
Speaker 2 (24:13):
We don't.
Speaker 1 (24:13):
We don't want you to be scared to get up
out of bed. So we encourage movement and it's important
for the inner ear.
Speaker 2 (24:21):
Yeah, And what's funny is there was a moment because
again when I was going through all these moments, like
I had you, but I still have the internet. I
was still trying to figure out what was happening, and
I was like, I'm going to get a neck brace,
and you're like, do not get a neck brace?
Speaker 1 (24:33):
Yeah, we used to give neck braces out like twenty
years ago, but it's no longer practice because again, like
that's encouraging the fearful, avoidant behavior that we discourage.
Speaker 2 (24:45):
And there is also the side of this like that
I also didn't realize when it first happened because it
was all first experience. Everything was new to me. But
going through it a second time, my body has PTSD
from this experience where I'm like, do we need a movement?
I'm like, okay, we're gonna go spinning be prepared and
(25:06):
it doesn't. But my body's anticipating and almost like it's
like a placebo is happening where my body thinks it's
spinning but it's not really. That's another side to this too. Okay,
you heal the episode, but your body is still storing
everything that happened to you all goes back to the
body keeps its score, but your body is like still
(25:27):
in the movement. And you've had to help me on
that side of things too, and that gets into more
of the physical therapy. So can you share your little
expertise on that side too.
Speaker 1 (25:35):
Yeah, so when you have Okay, let's say I can't
remember what your exact symptoms were, but let's say every
time you roll on your right side, the room goes crazy.
So then your brain actually gets so used to it
that after we clear out the mechanical reason for the vertigo,
so the crystals, when you roll on your right side,
the brain actually thinks that you're gonna spin, but again
(25:59):
there's no mechanical reason, and so you don't truly spin.
But that's that kind of PTST that you're talking about.
Speaker 2 (26:05):
And maybe that's not the right word, but it feels
that way in my body, Like that's a good description.
It's like a lingering or Okay, my body's still dealing
with the trauma of whatever happens, Like here we go.
And we had to retrain my body this last time
to literally roll over on its side, because every time
I rolled over, I was like, I think I'm having
an episode. You're like, I, you're not. You're cleared, but okay,
(26:26):
we have to retrain your body to understand that you're
okay and you're safe, like in your own body again.
Speaker 1 (26:31):
And so I would have you do it ten times.
Speaker 2 (26:33):
And the headshake, I have to stare at an X
on the wall and just shake my head back and
forth while staring at it. I'm like I would do
them at work and everyone's like, what are you doing.
I'm like, don't worry about it, don't worry about it.
I'm trying to get better.
Speaker 1 (26:44):
And you also you also had li sensitivity too, so
you would have to wear their spit glasses.
Speaker 2 (26:50):
Yes, which also saved my life. Turn into a partnership
with them too.
Speaker 1 (26:54):
They're amazing.
Speaker 2 (26:55):
Yeah, like shout out code Morgan, you get easy. You
can get fifteen dollars off. But they were so helpful
because when I was having my episodes and they were
so intense and I had to go to work because
I can't take a month and a half off work
every time this happens. Right, the their respects allowed me
to be in very lit rooms, much like this podcast
room where we have lights, and so those specs and
(27:18):
I was wearing them on the podcast too because it
dimmed everything around me. Yeah, what is that technology of
Like why you guys use those when people have the
light sensitivity? Because people are asking and I don't know.
I just know they helped.
Speaker 1 (27:29):
I know just enough about this to tell you actually
have the rose color lenses and they block out twenty
five times more of whatever it is they block out
than blue light. Okay, so I can't tell you that,
And now I can tell you that again. Shout out
their respec like they have all different color lenses that
you know, if you've got sensitivity just sunlight, you may
(27:50):
need this color lens, or if you have sensitivity to
fluorescent lights, you need this color lens. They can be
really helpful.
Speaker 2 (27:57):
And this is also something that I newly learned, was
how connected my eyes were to my balance and inner ears,
which was why I was light sensitive because I wasn't before,
but because I was going through this, Like all of
that connects in there right, yes, in my head.
Speaker 1 (28:15):
So I have to be able to see your eyes
in order to tell where the crystals are in the canals.
So again, if let's say they beat, there's like an upbeat,
that means post to your canal, down beat into your canal,
so things like that. So yeah, they're a window to
the inner ear.
Speaker 2 (28:31):
It's so crazy. It reminds you how connected everything is.
No different, how like your skin is your biggest organ. Yeah,
you put stuff on that, it's absorbed in your body.
It's all of that, and you're I'm learning all of
this and I'm just like, oh, it really is all connected,
and holy crap, this sucks, but yeah, we are.
Speaker 1 (28:48):
Gosh, when you have an episode, it really is horrendous.
But what I tell my patients is that when you've
had it once, you now know what it is and
it's going to be less scary than next time around
because you know that there is a quick fix.
Speaker 2 (29:03):
Yes, and that was exactly what happened the second time.
I knew exactly what to do. I need to call you, yeah,
or I don't tell you yeah, I was like, Holly,
I need help. This happened again, but I also knew,
so the second time it happened, I was like, Okay,
this is vertigo. I knew that I was about to
have this experience. It didn't make it any less easy,
Like I was still like, couldn't get out of bed.
(29:24):
I still was like literally laying naked on the bathroom floor.
Oh my god, I'm sweating. This is painful and not
in the way that you think, but painful, like my
body is just like going through it. But I knew
that I needed you to do these maneuvers and to
understand what was happening. So it was a at least
easier process than me having zero information, which is why
(29:46):
the podcast was so important because there's so many people
out here that are dealing with this. Yeah. So in
speaking of all of these people, there were some people
that put in some questions, and we've talked about some
of them, but we'll have you reiterate because they ask
the question, Okay, she had. One lady says she has
a patient with maneirs who has tried everything any suggestions
(30:10):
to potentially help her, and that's the only context I have,
So I have no idea what all they tried, but
I don't know if this is anything you can help with.
Speaker 1 (30:18):
So maneirs it. It can also present with vertigo, look
and persent with disneyness, balance impairment, all all of the
vestibular symptoms, but the repositioning maneuvers that take it away
immediately aren't going to work. So we always start with
diet and lifestyle modifications for maneirs. So you really want
(30:42):
to decrease the salt intake and decrease the fluid behind
the ear. That's where we start. And then you need
a good vestibular therapist that actually knows what mineirs is.
And also a lot of times patients are misdiagnosed as well.
A lot of times patients come in with the diagnosis
of manears and it's actually vestibular migraines.
Speaker 2 (31:03):
So what is the similarities? Tell me what each one
is to you and your like expert opinion.
Speaker 1 (31:10):
They just share a lot of the same symptoms. Okay,
is the problem.
Speaker 2 (31:14):
So I'm thinking vestibular migraines are like very intense headaches,
like very painful, and maybe you have some lightheadedness dizziness
with it maneers. If I remember my research correctly is
like you have like something's happening within your ear anatomy
that's causing the vertigo to happen.
Speaker 1 (31:34):
Correct, Yes, yes, son, there's a lot of fluid going
on behind the ears. One day the person can walk
down the hallway just fine, and the following day they
can have an attack and literally be falling into the walls.
It's a wild presentation. Vestibular migraine is very different. And
the fact that you actually, I believe it's greater than
(31:57):
sixty percent, don't actually have the head component.
Speaker 2 (32:01):
Interesting.
Speaker 1 (32:02):
You just have the vestibular symptoms. You can have the
visual auras and all of that, but there's actually no pain.
So that's why it goes mistagnosed a lot.
Speaker 2 (32:13):
Wow. Okay, that's super interesting because I associate migraine with
headache pain because migraine is just like an amplified headache
to my understanding. So when you said that, I was like, oh, yeah,
that's what's that's crazy. Okay, So hopefully that's some helpful things.
Maybe guys have it, but again I don't have any
other context like what all I've tried and what I've done.
Speaker 1 (32:34):
Let's say, in that case, just find your nearest vestibular.
Speaker 2 (32:37):
Pet Okay, yeah, that's good information. Can stress cause vertigo
to flare up?
Speaker 1 (32:44):
Not from a crystal standpoint, Okay, so it can. It
is one of the triggers for say, vestibular migraine. So
a lot of times patients will have to be medically
managed with medications things like that because they can't avoid
the stress of a really hard job, or their in
laws just moved into their home, so things like that.
(33:07):
It can trigger symptoms of dizzyness. Absolutely, but it will.
It's not connected to BPPV.
Speaker 2 (33:15):
Okay. See, And this is crazy about just all these
different areas, is like there can be so much happening
in there, and you really need someone like a Holly
to understand the anatomy and what's going on in there
because it can go so mis diagnosed on multiple levels.
To your point, like not just manures, but all of them.
(33:38):
At least, this is how it's sounding to me. Why
does vertigo benign happen out of nowhere during perimenopause for
some people? Do you know any connection to that?
Speaker 1 (33:48):
Great question? We are still looking into that. So we
know that hormones are they have an effect on the
vestibular system. But we just we don't know enough.
Speaker 2 (33:57):
See that's so crazy. Yeah, but it is connected. There
is something that's happening with we think.
Speaker 1 (34:02):
So Okay, I can't completely be sure yet. Yeah, it's
And also you've got to think though the average person,
the initial onset of BPPV is from age fifty to seventy.
Speaker 2 (34:14):
Im peramenopause is happening around them.
Speaker 1 (34:17):
So is it just coincidence or is there actually a connection?
Speaker 2 (34:21):
Wow? Okay, And that's also hard if you're experiencing both
at the same time.
Speaker 1 (34:25):
I know, sweet ladies, I know that hurts.
Speaker 2 (34:31):
Do some exercises, which we touched on this, but do
some exercises such as burpies or handstands bring on vertigo so.
Speaker 1 (34:38):
They can They absolutely can. High intensity aerobic workouts kind
of like a similar like blow to the head can
make the crystals come loose. Now again worrying you are
a bit of a special one. We just generally don't
see it in someone as young as you. But that
(34:59):
we made that direct connection. You went to that class,
you woke up the next morning. It was hard to
not be able to connect those two.
Speaker 2 (35:07):
Yeah, And because I then did that and knocked it loose,
I was more likely for it to happen again. Yeah,
that was that connection, correct, stupid trampling class. Don't work out.
That's what I've learned in all this.
Speaker 1 (35:20):
Don't work out, No curdio.
Speaker 2 (35:24):
Meanwhile, I'm over here, I doing like hit workouts and
welcome to my life. But what you have also always
told me is you can't be fearful and you can't
live your life fear of it happening. Because this is
something so important to say, and I want you to
say in your own words, but like, it's gonna happen
no matter what.
Speaker 1 (35:40):
Yeah, So whether you are sitting on the couch or
you were out having fun with your friends and living
your life. If those crystals come loose, they come loose.
It's going to happen, whether you like it or not.
Speaker 2 (35:53):
Yeah, And that was an important thing for you to
tell me because that made me not fearful because it
didn't matter what I was doing. Yes, things like hit
workouts could potentially aggravate it and make it happen quicker,
but you telling me that was like, Okay, this happening regardless.
I can go out and have my life and it'll
be fine. It's gonna happen regardless, so I might as
(36:15):
well enjoy what I can't do in the moment.
Speaker 1 (36:17):
Yeah, and we don't know who it's gonna happen to,
So just because your mom had it or your aunt
had it, it doesn't mean that you're going to have it.
Speaker 2 (36:24):
It's not genetic either, not which wasn't important detail. You
also told me because nobody in my family ever had it,
And you were like, yeah, it's not you just you
get picked out of the letter.
Speaker 1 (36:36):
You're just one of the lucky ones. We were meant
to be friends.
Speaker 2 (36:39):
That's why we were That's exactly why I was supposed
to happen. Okay, and some of these other ones came
in here, but they're funny. You'll make you laugh. Yes,
why like why does this happen?
Speaker 1 (36:50):
We don't know.
Speaker 2 (36:51):
We're learning about our systems and everything. Then another one
was why does my vestibular system hate me? Girl with finears? Oh,
so maybe you can give her some words of wisdom
or some something to make her feel better, because you
made me feel better in a lot of hard moments
for me.
Speaker 1 (37:07):
So with any vestibular diagnoses, life gets better. You just
have to have the right treatment. And it's so for
me as a vestibular specialist, it's so frustrating when patients
come in like this week, girl. I can help you,
my colleagues, we can help you. There's treatment. We can
make you live a normal life. We can make you
(37:31):
have funny it and not be fearful. Yeah, there is treatment.
There's not a magic pill. It's a little bit of work.
BPPV is a quick fix. We love BPPV one quick maneuver.
Speaker 2 (37:43):
Say we I don't and also it was not quick
for me, so don't look at me.
Speaker 1 (37:49):
So other vestibular therapiuse we love bpp it's super straightforward.
It's again, you come in with these possessional changes. We
do a quick maneuver and you're done. Other diagnoses like
vestibular hypo functions, weaknesses, HER's, vestibular migrants, they require a
little bit of work, a lot of homework actually, yeah.
Speaker 2 (38:08):
And it sounds like some of them come with lifestyle changes,
which is some of the hardest illnesses to deal with.
Speaker 1 (38:13):
Bea and migraine. I'm sorry, diet and things like.
Speaker 2 (38:16):
That, changing things in your entire life. Whereas mine, I
just have to come in and you have to keep
working me through treatment. And then one day it'll be
over and until the next time kind of thing. I
do understand that side of it too. And this is
another one we had already answered, but he had asked,
how do I get rid of reoccurring BPPB? Although mild,
sometimes I'm just tired of it? I understand how do.
Speaker 1 (38:37):
You get rid of it?
Speaker 2 (38:38):
You come see me, you get treatment, because isn't it
also possible too, because this was something I had to learn,
Like just going to a regular physical therapist, although incredibly
helpful in so many scenarios, I had gone to one
and the only maneuver he knew was EPLE and for
me specifically, Epley was not going to help me.
Speaker 1 (38:56):
Yeah, sometimes the modified Apley just doesn't work in your case.
It it just isn't the magic ticket. So I think
we think we tried to lead maneuver on you. The SMONT.
There are a couple of different things, but again it's
not always post your anterior. So if you go to
a general orthopedic physical therapist and they put you in
(39:18):
the testing positions, they may not have the equipment that
I have. Specifically, I have these video goggles. They help
me see your eyes without letting your brain fixate. So
if your eyes can fixate on something, your brain can
shut down the nastagnus or the eye movement that I'm
looking for, and that helps us with diagnosis. And if
(39:39):
you go to an orthopedic peach, they may not have
that specialty equipment and then they may not be able
to see what they need to see and they won't
be able to treat you.
Speaker 2 (39:47):
Which that was so helpful for you in understanding which
maneuvers you had to do on me and not just
having the one repertoire of Eppily you need in multiple
which was so important. And again that was a part
of my learning journey because I had somebody do an
Eppley mover on me and I was like, I'm not better. Okay,
you guys are all lying on the internet.
Speaker 1 (40:06):
I feel like crap, and your canal's converted to so
you were again like one canal and then it converted
to another, and so we had to switch it up.
Speaker 2 (40:14):
And how often, like I know, you say I'm special,
but that's not just me. There's a lot of people
out there that have those experiences, and they could be
seeing the things online that were like we can do
this and this will work when in reality, like, it
always helps to have an expert like a Hollie. If
you're not in Nashville or around Nashville, find a vestibular specialist.
(40:34):
That is the key to looking for right like It's true,
So finding a youth somewhere else.
Speaker 1 (40:39):
Yeah, you can give it a shot at home by yourself.
So you can look up the modified deptly online and
fifty to fifty guests the correct side and try to
treat yourself. The problem with treating yourself is that you
can actually make it a little bit.
Speaker 2 (40:52):
Worse, which is what I did.
Speaker 1 (40:55):
So if you make it worse, it can actually convert
to a more difficult canal like the horizontal canal, and
even worse than that, the crystals can actually go from
the canal to the cubula, which is a jelly like
material where the crystals get stuck. And then what do
you have to do when something get stuck, You have
to knock it loose. So then we've got to knock
(41:16):
out the crystals and then clear them from the canal.
Speaker 2 (41:19):
Which I also had experience with this, and you called
the cubula jelly like substance, So I really used a
lot of normal people terms like rocky wall and jelly
like substance and crystals and those are not the medical terms.
Speaker 1 (41:33):
Yeah no, but that's what we use. That's how I
describe it. Like in the utricle, in that balance organ
where the odconia sit, it is just this really rocky
wall and that's where they come off. They just fall
right off.
Speaker 2 (41:50):
But honestly, when you were using all of those, it
gave me the best understanding of what was happening.
Speaker 1 (41:54):
To me because a whush is my favorite word.
Speaker 2 (41:56):
Yeah, you do love to use bushes and I had
a lot of those, so I'd be like, I'm having
a wash.
Speaker 1 (42:00):
Yeah, like that's not normal.
Speaker 2 (42:01):
Okay, let's figure this out. And that was an easy
way to also describe it. But it did because it
and it was funny when we talked about it on
the show. Everybody's we're talking about crystals. This is so
like woo stuff. I'm like, no, you all have them.
I'm just the only one that's actually dealing with them.
Speaker 1 (42:15):
That's true. So everyone has them. They are. So you've
got two balanced organs on each side, so you have
a utricle on a secule on both the right and
the left side. And so you've got your three semi
circular canals. Let's say we're talking about the right side,
and the utricle sits like this, the saccule sits like this.
So you've got crystals in here and in here, but
(42:37):
the utrical blocks the saccule, So the crystals are only
going to come out from here into the canals.
Speaker 2 (42:43):
Which is where the maneuvers come into play. And that's
why I get rotated like I'm askew on a group
bibercu rol because you're literally moving those crystals through these
canals in the ways that they can be moved.
Speaker 1 (42:55):
That's correct, because if you do it.
Speaker 2 (42:56):
The wrong way, they're not gonna move.
Speaker 1 (42:58):
They're going to go into that jelly like yeah.
Speaker 2 (43:00):
Which was not fun. Let me tell you. That was
probably the worst experience. I literally like to Holly as
like I'm gonna vomit gets sick.
Speaker 1 (43:07):
Yeah, there's one day which happens from time to time.
Usually I can catch it, but it does happen.
Speaker 2 (43:12):
Yeah. And to Holly's credit, and Vanderbilt is so awesome,
they not only had a.
Speaker 1 (43:19):
A what is Norman called our facility dog Norman.
Speaker 2 (43:24):
Yeah, he has a service dog.
Speaker 1 (43:26):
I love Norman.
Speaker 2 (43:26):
Yeah, so I had a service dog with me and
so many of these treatments. But then on top of that,
like when I'd get super sweaty being induced with the verdigo,
they'd come in and they just like weigh me down
with all of these packs of.
Speaker 1 (43:39):
It's true, yeah, because it helps with nausea. Oh, it's
a magic trick.
Speaker 2 (43:42):
Okay, talk about the magic trick that is the rubbing
alcohol by the nose.
Speaker 1 (43:47):
Okay, yeah, same. It's like the same as an ice pack,
So it has an effect on you and it decreases
the nausea. So you're just amazing.
Speaker 2 (43:54):
Get a little like piece of paper and you put
rubbing alcohol. Is that what it is?
Speaker 1 (43:58):
We have the little rubbingcohol pads Okay, just and I
just held it up against your nose.
Speaker 2 (44:05):
And it stopped the nausea. If I'm coming. Can that
happen with all kinds of nausea or specifically related to this? Yeah?
Speaker 1 (44:11):
Absolutely, that's so crazy.
Speaker 2 (44:13):
I learned about that too. See all the things that
I learned in this experience.
Speaker 1 (44:16):
And ice pecs, So icepecs are my go to and
then I use okay, the rubbing alcohol.
Speaker 2 (44:22):
Yeah, because the ice pects do feel really good because
your body is like heating up. It's like you're kind
of like a core and it's gonna.
Speaker 1 (44:27):
Yeah, it gets so clammy and sweaty. And again people
do get sick, which.
Speaker 2 (44:31):
Is yeah, you guys sent me home with one of
those throw up. I'm pretty sure it's still in my car.
I'm like, somebody ever sees this, like, well, what is
wrong with this woman? It's fine, just in case.
Speaker 1 (44:43):
It's so interesting to me though, some patients come in
with a lot of nausea and they're super super sensitive
to the maneuvers like you, And then other patients that
come in they just have zero nausea, zero, zero complaints,
will I'm doing it, and then they just run on
their way. It's fascinating to me that everyone's system is
(45:04):
so different.
Speaker 2 (45:05):
I do wonder too, if there's a connection for me
and that because I have like growing up, I've always gotten.
Speaker 1 (45:10):
This is why I hate roller coasters.
Speaker 2 (45:12):
They made me so ill, so ill, but also I
hate the drop that you get in your builth. But
more than that, like I get literally violently ill, and
I get car sickness. I get sick on boats. I've
had always had a this dizziness, and like, whenever I've
gotten sick just a freaking common cold, I have nausea
or I have lightheadedness. Also I think about in the
(45:34):
course and if I ever were to have a child,
and that's gonna be freaking sick all the time. Yeah,
So I think about those things because this is my
symptom of anything is oh, you're gonna be vomiting. You
got a little stuff, you knows, vomit. That's just my life.
And so I do wonder if you have sensitivity in
your life, then like something like this happens, and all
it does is yeah, maybe it has to because not
(45:57):
everybody feels that way in all of those experiences, right right, No,
it's true. So then you get two different people with vertigo,
one like me and one that doesn't, and they're like, no,
it's fine, where my body's like, yeah, no, we hate this,
We're good. Systems are so weird, which is also why
I wanted to bring you on and just talk about
just the craziness of all of this. So many people
deal with it. You don't have to be alone in
(46:18):
dealing with it. You can also get treatment, like you
don't have to live with this and I.
Speaker 1 (46:23):
Think that's the take home of today, and that's what
you and I wanted to get across to everyone, is like,
there is hope, there is an answer, there is treatment,
and there's in BPPV alone specifically, there's quick treatment. You
just have to go to the right therapist. Not all
physical therapists are created equal. Just like I said earlier,
you're not going to come to me for me to
(46:45):
fix your shoulder.
Speaker 2 (46:46):
Yeah, you are a very specific thing. So the thing
that we always do and leave on this podcast is
like whether it be a piece of advice and motivation,
and that might have just been it. We might have
just had our closure. Is there anything that we haven't
talked about that you wanted to make sure you've shared
in this whole kind of experience of our friendship and
vertico treatment.
Speaker 1 (47:11):
I think it's important to me as a vestibular specialist
that all my patients know that they don't have to
be scared, and like you said, they're not alone. So
many people suffer from vestibular diagnoses and illnesses, but there's
(47:31):
treatment and you have to find the right therapist. So
I just kind of want to give like a little
shout out if you are watching this podcast and you
don't know where to go. There is a website called APTA,
and if you type in APTA vestibular map up Providers,
then it's going to pop up all the states and
all the vestibular providers that are part of the APTA,
(47:54):
so American Fiscal Therapy Association. So that's a really easy
way to find a therapist that's specialized. Is in vertigo,
or you can come to Vanderbilt and see me and
my colleagues. We are at Pibet Defier Rehab and we love.
Speaker 2 (48:08):
What we do, which you should absolutely see Holly and
her colleagues if you are in the area. But if
you're not, Dang, that tool is awesome. I didn't know
that existed.
Speaker 1 (48:16):
It's the best resource. And so I just really want
everyone to know that you don't have to come eight
hours to see us. They are particular specialists all over
the country.
Speaker 2 (48:26):
Yeah, oh, Holly, you did so good. I know you
were nervous about doing this. We did so great, ye
And I appreciate you coming on and like sharing all
of your wisdom and expertise, because as much as you
pie don't want ad minute, you are an expert in
what you're doing, and you're you're doing like the work
that matters, and you're changing people's lives.
Speaker 1 (48:45):
That's really sweet. I love what I do. It makes
me happy every day.
Speaker 2 (48:50):
Yay, thank you for coming on. I appreciate it. Thanks
so many takeaways during this episode. Our health is such
a huge part of our lives and BPBV is debilitating
and so I would not wish on anyone. So if
you're a fellow sufferer or anything impacted by vertigo, I
hope this episode helps you find some very deserved relief.
Thank you all for being here, and as always, I
(49:11):
love you.
Speaker 1 (49:12):
I'll talk to you next week.
Take personally.
Speaker 2 (00:16):
With Orgame Fuelsman in twenty twenty five. Vertigo effects about
one in ten people worldwide, with women being more prone
to it than men. Additionally, fifteen to twenty percent of
adults experienced dizziness annually. That's why we're doing an episode
all about vertigo. I am, unfortunately part of the one
in ten. I was diagnosed with BPPV last year after
(00:37):
my first positional vertigo episode in February of twenty twenty four.
It was my first time ever knowing or experiencing vertigo.
But after posting several moments of my BPPV diagnosis and journey,
several people online have come forward with similar ailments and issues,
so I wanted to dedicate an episode to all of
the vertigo sufferers. Holly Coothin joins me this episode. She's
(00:59):
a friend and a vestibular specialist at Vanderbilt and the
reason that I'm operating at one hundred percent again after
both of my BPPV episodes, So you'll hear some of
my experiences, but through the lens of Holly, the actual
expert on this particular topic. I am bringing on not
(01:22):
only one of my good friends, but also a good
friend by way of vertigo. Her name is Holly. Holly
is a vestibular specialist in the physical therapy world, and
she's basically saved my life on multiple occasions. Now, Hey Holly,
thanks for joining.
Speaker 1 (01:37):
Hey Morgan, thanks for having me.
Speaker 2 (01:39):
How are you feeling right now in this moment.
Speaker 1 (01:40):
I'm good, I'm good.
Speaker 2 (01:42):
Ready to talk all about all things vertigo? Yes, okay,
I want to know how you got into this line
of work because it's so specific and you yourself don't
have vertigo.
Speaker 1 (01:53):
No, that's true, I don't. One of my clinicals actually
canceled on me in physical therapy school, so I ended
up going to a clinic that was about an hour
away from Mobile, Alabama, which is where I went to
PET school, and my clinical instructor happened to be a
vestibular specialist, and so it just fell in my lap.
I was good at it, and I loved it, and
(02:13):
it's all I've ever done. For thirteen years. I've never
done a single day of ortho. So I can't help
you with your shoulder, I can't help you with your
knees or ankles, but I can do anything.
Speaker 2 (02:23):
Balance in dizziness, okay, in vestibular give us the breakdown
of what all that encompasses. When I say you're a
vestibular specialist.
Speaker 1 (02:32):
Yeah, so it's the inner ear. It's really that easy.
All things balance, all things dizzyness, and then also concussions
fit in with that. Vestibular migraines in.
Speaker 2 (02:42):
Like tonightis, maneirs are both some of the things that
you work with.
Speaker 1 (02:45):
So tonightis is the one thing we can't touch really
in the vestibular world. There's nothing we can do about that,
but mineirs and other things like labyrinthiitis weaknesses of the
inner ear that I can help with.
Speaker 2 (02:59):
Okay. Obviously verdio which for me what I dealt with
and stumbled onto you was BPPV, which is benign positional paris.
I could never say the second.
Speaker 1 (03:11):
Piece, benign paroxysmal positional.
Speaker 2 (03:14):
Vertio, thank you. Yeah, I just always in upsameing positional vertical.
Speaker 1 (03:17):
Yeah no, And that's a good way to put it.
So it's the number one vestibular diagnosis, and it's actually
my specialty and the easiest to treat.
Speaker 2 (03:25):
Okay, you say easiest to treat, and I remember my dreams.
I was like, this is not easy, but it's so funny,
Holly and I as a patient doctor situation, if you will.
It was always funny because Hollywood always reference things. She'd
be like, this is so robust, Oh my gosh, Morgan,
this is beautiful or like it just like this moment,
and I'm like, ohly no, it's not.
Speaker 1 (03:44):
That's so true.
Speaker 2 (03:46):
But you were experiencing like, okay, this is like something
I can work with and something I can treat. Where
I was sitting here and I was like, I don't
want something to be beautiful in my eyes and in
my ear.
Speaker 1 (03:56):
I'm staring like closely into your eyes.
Speaker 2 (03:59):
Yes, okay, BPPV vertigo this situation? How does it happen
for people like I stumbled into your office because there
was a listener of the Bobby Bone Show who reached
out to me on Instagram. What was her name?
Speaker 1 (04:13):
Katrina?
Speaker 2 (04:13):
Katrina my colleague, and she was like, I have a
friend who can work wonders on you. I was like,
oh my gosh, do anything to help me right now.
I got set up with you, had no idea somebody
like you even existed, which is why I brought you
on here. The best kept secret you are, but you
shouldn't be a secret, Like you are helping people who
(04:34):
have a debilitating illness all the time, So how does
somebody end up one with vertigo or BPPV. What are
the kind of different variations that would make somebody land
in your office with this?
Speaker 1 (04:46):
So let's start kind of with what is BPPV. It
is room spinning vertigo that happens with position like positional changes.
So laying down, rolling over in bed, sitting up, all
of those things make your world go round and round
and you can't figure out which ways up. So that's
the definition of it.
Speaker 2 (05:05):
In the little crystals in your ears and they move
from the rocky wall, I will always remember you telling
me that, yees.
Speaker 1 (05:10):
So they're called odconia little calcium carbonate. They are super
small little rocks that come out of your utricle so
that's your balance organ, and they go into one of
your six semi circular canals and they send false signals
to your brain that you're like going upside down and
again it makes the world go round and round.
Speaker 2 (05:30):
Which is I describe in two ways, Like when I
experienced a vertigo, it was I was either on a
Tiltera whirl or I was like had a blackout drunk
moment in the world will not stop spinning. Those were
like the two similarities I could relate it to. It's
a crazy experience. And then but why does it happen
for some people? Why does it not happen for others?
And like, how can it happen? Can it happen to anybody?
(05:52):
Give me the breakdown?
Speaker 1 (05:53):
Okay, the breakdown. So it usually happens to people from
ages fifty to seventy years old. You are rare. I
rarely see it in someone in our early thirties, So
that's different. Welcome to my life, exactly. You're special, always
been special. In the doctor's office, it's usually idiopathic. We
(06:13):
actually don't really know why it happens to some people
and not others. Now, it can be attached to things
like migraines and things like if you have an inner
ear problem already, it's going to attach on to that
and you're gonna be at a higher risk for BPPV.
But for majority of people, it just happens one day
when you wake up and it's terrifying. It's actually really scary.
(06:36):
So most people think they're having a stroke or even
a heart attack, and they run to the emergency room.
Speaker 2 (06:41):
And from what I've learned, running to the emergency room
is only going to get you some medicine, send you
on your way and say you have here some nausea
medicine that'll help you not feel like that side effect,
But it doesn't actually treat the symptom, which is vertigo.
Speaker 1 (06:56):
The medicine that they give you, so it's usually something
called mechlasen or antivert. It really it's like a drama
me on steroids. It really doesn't do anything to help
the underlying cause. So it's a bit of a band aid.
It might take the edge off a little bit, but
it's not going to stop the world from spinning around you.
Speaker 2 (07:12):
And what does actually stop the world from spinning around
you is maneuvers. Yes me, Yes, That's how people get
to Holly by way of typically earns and throat doctors
who then recommend to her. So the maneuvers. But tell
people how you diagnose, because every time I show these
crazy videos of you putting the goggles on me and
my eyes going crazy, everybody's I didn't even know this
(07:34):
is wild technology. Tell people what happens when somebody comes
in and you're treating them for verdigo.
Speaker 1 (07:40):
So I put you in different testing positions, and I
watch your eyes when the crystals move within those semicircular canals,
there's little hairs in there, and again the signals are
sent to the brain and they actually make your eyes
move in certain directions. And so I watch the eyes
and that tells me where the crystals are located, and
(08:01):
that helps me choose the maneuver.
Speaker 2 (08:02):
And then to treat you how many maneuvers are actually
out there, because it's is a very controversial thing, because
I remember you're like, I told you I did the
Epley maneuver, and you're like, oh, dear gosh, no, not
because the Epley is bad, but because it's not a
vertigo is not a one size fits all, and people
use Eppley in that capacity.
Speaker 1 (08:23):
Correct, So most people have heard of something called the
mod fied Epley, and that treats the posterior and anterior
canals now greater than ninety three ninety five percent of
the time. That's probably gonna work. But I see BPPV
all day every day, and so of course it's it
doesn't fix everyone's so we gosh, I don't even I
(08:45):
don't even know how many maneuvers there are, but there
are a lot there are.
Speaker 2 (08:50):
And even when we were going through my treatment, I
remember you pulling out the book and you're like, I
think we need to do a different maneuver that I
don't typically have to do.
Speaker 1 (09:00):
I think I had to do three on you.
Speaker 2 (09:02):
And I remember telling people that you did the barbecue
roll on me. I'm like, you know, like you were rotamn,
Like yeah, it was a literal skewer on a barbecue
is what basically she did to me.
Speaker 1 (09:11):
You were a special case, so because you started out
in one canal and then you switched to another canal,
and so it got a little bit muddy. So that's
why we had to use so many maneuvers.
Speaker 2 (09:21):
And how often do you see like that happen where
you're a you called me a multi canal VPPV.
Speaker 1 (09:27):
I see it quite frequently.
Speaker 2 (09:28):
See. Okay, so I'm special, but I'm not like so
special that I have to become a case study, right right?
Speaker 1 (09:34):
Cool?
Speaker 2 (09:34):
I appreciate, Yeah, no case studies, really glad. But the
thing that was so hard for me when I was
going through this, and I cried in your office and
you're like, oh gosh, Morgan, it'll be okay, we got this.
But what was so terrifying for me was not the treatment,
not the maneuvers you were doing, nothing like that. It
was I'm gonna have to deal with this for the
rest of my life, because once you've had it, you're
(09:57):
likely to get it again. When I first walked into
your office for the very first time ever February of
twenty twenty four, we were like, Okay, this potentially came
from a bounced fitness class, and this may never happen again.
Hopefully this is it one time in ten years from now.
Maybe we're hoping it was a one off. And fast
forward to this year, twenty twenty five, and it happens again,
(10:20):
and I was like, no, this means it's gonna happen more,
and I do not want this in my life. And
so I was having this huge panic, which I think
anybody who deals one with a chronic illness, one with
an invisible illness, three with a debilitating illness that people
don't understand on any of those levels, you feel just
(10:42):
overwhelmed with what your life is going to be like indefinitely.
And so when I was sitting in there and I
was crying, You're like, oh, no, like we're gonna treat this.
I was like, no, no, no, this is not you.
This is like me realizing that my body's kind of
betrayed me and I now have to do this all
the time to get better, and it's so debilitating.
Speaker 1 (11:03):
It is. Yeah.
Speaker 2 (11:04):
Do you see a lot of your patients come in
and they have this kind of same experience where it's like,
is this for real? This is what I'm gonna have
to keep dealing with.
Speaker 1 (11:11):
One of the number one questions that I hear is
how do I prevent it from happening again? And there's
a really bad joke in the vestibular world that we
say that's job security for us. There there is no
way to prevent it. Things like high intensity aerobic activity,
which is probably why it happened to you in the
first place. You were at the bounce class, so a
(11:33):
lot of impact on the floor probably made those crystals
come loose. But other things like going into surgery and
then being sedentary for a while, going to the dentist,
going back and getting your hair done, things like that
can also make BPPV reoccur, and can they also be.
Speaker 2 (11:51):
The reason it starts. Like all of those.
Speaker 1 (11:53):
Absolutely, yeah, So usually it's idiopathic. But also a large
majority of BPPV patients come in post concussion or a
hit to the head or even like a whiplash injury
postcar accident. So usually, like my younger patients are going
to have some sort of blow to the head.
Speaker 2 (12:13):
But when I came in and you're like, oh, you did.
Speaker 1 (12:15):
A fitness what is happening Yours was a high intensity
aerobic fitness class that likely made it happen.
Speaker 2 (12:22):
Oh my gosh. And see that's what's so crazy about it.
And when I talk to people and they're like, you're
good now, I'm like, I'm good until it chooses to
happen again. And that's what's so scary because it can
happen again, and it can happen you have no warning,
you have no way of preventing it. Just like you said,
it's just and then you're knocked out. Like when it
first happens to me, I am stuck in my bed
(12:44):
for three days waiting until whatever the moment of the
episode started subsides to then start trying to heal. And
that's what's so scary about BPPV and vertigo itself. But
like that experience I had where it was like, again,
we're not sitting there, and I was like, oh my gosh,
(13:05):
I could be driving, I could be on a road trip,
I could be miles away from Holly, I could be
getting married, and I literally could have like this Vertigo
episode happen. And that experience was just everything came washing
over me in that moment where I was like, this
is now my life and now I'm like on this
mission to be like, how can I get the healthiest
I've ever been in the potential that it somehow impacts
(13:27):
this is the goal, right, Like I just hope that
I inadvertently do something to help it.
Speaker 1 (13:34):
Yeah, And there's really truly nothing out there that is
proven to help prevent it, except potentially vitamin D levels.
So we do have our patients get their vitamin D
levels check because if you're on the lower side, it
can lead to recurrence. But other than that, there's no
special diet. There's no we don't tell you to give
(13:54):
up coffee or alcohol. There's nothing from this food related
that will help prevent it from happening or from occurring
in the first place.
Speaker 2 (14:04):
And that's what I see a lot because the internet
is a dangerous place it is, and you see a
lot of things of I went gluten free and my
vertigo stopped, or you see someone who goes, I went
to a chiropractor, I've never had issues again, these kind
of gambit of things. But like truly medical sense, is
any of that proven or is it just like potentially
(14:27):
happenstance that those connected.
Speaker 1 (14:29):
I think we need to realize that vertigo is not
just BPPV. Vertigo can come from a multitude of vestibular
diagnoses that actually create this same room spinning symptoms. It's
not always super super easy to treat, which BPPP is,
(14:49):
but other things like vestibular migraines or a vestibular neuritis,
which is a weakness of the inner ear, they actually
create the same symptoms that positional vertigo us.
Speaker 2 (15:03):
Okay, so when people are having these experiences of things
helping them, it's likely that something else is going on
that those help them. But BEPPV itself, if you just
have like me, potentially we're still working through my understanding
of what the heck is going on in my anatomy.
But say I just end up having BPPV, there is
(15:26):
nothing besides the potential of vitamin D levels that I
could do that would prevent it from happening.
Speaker 1 (15:32):
Right, that's correct, and you're so young, it's likely going
to happen again, and I do.
Speaker 2 (15:37):
I've heard of a lot of people who get this.
This is the craziest part to me because when this
first happened and I found out about you and you
were treating me and I was slowly getting better, there
were so many people that reached out and they were like,
I live with this every day for months on end,
and they get a little bit better because that's the
process of vertigo, which also you taught me that vertic
(16:00):
itself is just the symptom, and then you have the diagnosis.
So just like you're mentioning, vertigo can be caused by
multitude of different things. But what I'm aligning here with
is the BPPV, which is my diagnosis.
Speaker 1 (16:13):
That's correct. You are your special and I say that
in a way that your system is actually really sensitive
to the BPPV. So not everyone that comes to me
has to be in bed for three days. There are
people that actually still are able to get up and
go to work and function no problem at all. But
(16:33):
that is because their BPPV is not as what I
call robust as yours. So it's likely that the crystals
are either really small, so they range from three microns
to thirty microns. Wow, that's really tiny, and.
Speaker 2 (16:49):
Which you also told me you can't even see them
on you can't pull them out and see them on
a microscope.
Speaker 1 (16:53):
But they're so small. So if you, let's say you
have a cluster of three three micron odiconia that are
going through your canals, your eye movements and your symptoms
are not gonna be as intense as if the odiconia
or size thirty microns and they're moving fast through the canals.
(17:13):
So that's going to create a much more intense situation.
So it's not always gonna make people vomit and make
them sick to their stomach or make them miswork. But
in your case, you're just one of the lucky ones
and you've had really good boots.
Speaker 2 (17:31):
Yeah, really really lovely bouts. I'm so lucky. Yeah. So
when we talk about this though, and people hear like
they'll have a dizziness spell, is that potentially vertigo or
is it like dizziness and vertigo are separated? Because I
was having this conversation with somebody online and she was like,
if you get motion sickness and then you have dizziness,
(17:52):
it can be connected to vertigo. Is that all intertwined
or are they kind of separate entities?
Speaker 1 (17:57):
Dizziness is an umbrella term, so so dizzeyness is usually
used to describe swimmy headed, lightheaded feelings, whereas vertigo is
actually the room spinning. But also you can have vertigo
where people say that they're spinning within their own head,
and so that can happen as well. Okay, but no,
(18:18):
dizzeyness is the umbrella term, and then vertigo usually fits
underneath that.
Speaker 2 (18:21):
Okay, but specifically, if somebody's having a vertigo episode, typically
the world is spinning typically versus like you're just like
a little bit nauseous, queasy, lightheaded as kind of the
dizziness experience. Is motion sickness vertigo connected at all? Is
there some because that's an Internet thing where it's like
if you get motion sickness in the car, or you
get motion sickness on rides, which I've had my entire life,
(18:44):
and I never had vertigo until now, are those connected
at all? Is there something to that?
Speaker 1 (18:50):
Motion sickness is not connected to BPPVKA particular.
Speaker 2 (18:54):
Okay, I know connection. I know that's a crazy thing.
But like I'm when I was going through this experience,
and I'm going online searching for all kinds of answers,
I'm just trying to find anything to understand what's happening
to me, because when it does happen to you, you're
terrified and you're like, it's all I know is the
world just went spinning and I can't move my body upright.
And you're like what does that mean? And you google
(19:16):
and you have vertigo? And then I'm like, what the
heck is vertigo? And you just go down this rabbit
hole of trying to understand what's happening to your body.
Because in my day to day life, my entire life,
there's only one person, a good friend of mine, who
actually has some hearing loss, and she has vertigo. She's
the only person I've ever known in my life that
(19:37):
has had it, or at least that's talked about having it.
But of course now that I talk about it, everyone
has it. Yeah.
Speaker 1 (19:43):
Usually if you mention it to one person, they're like,
oh my mom had it, my sister had it. My
aunt had it, and it may or may not have
been BPPV, but yeah, still they're describing as vertigo.
Speaker 2 (19:54):
So people who do have potentially like this room spinning
vertigo BPPV, do they have to live with it? Like
you see something often that people are like, I live
with this for my entire life, and I'll have an
episode and then it gets a little bit better, and
then it'll happen again. Because to my understanding, you've gotten
me to one hundred percent again twice and ever since,
(20:16):
like only when I'm having those episodes? Am I living
with it? Once the episode has cleared, as you call it,
it's over. It's supposed to be over. You're not supposed
to have any no underlying. It's like it's gone. Am
I right?
Speaker 1 (20:31):
Yes? Okay, let's say that you would have never found me.
Chances are high that in a couple of weeks it
probably would have resolved on its own. Probably so we
don't know if the crystals are reabsorbed by the body
or if they're put back in the utricle where they belong,
we don't know, but it generally does resolve on its
own after a period of time. I will say that
(20:52):
last week, I saw a patient and she was in
a car accident eight years ago. She has never seen
a physician for her room spinning vertigo, and she just
now got to me eight years and I put her
through all the testing positions, and sure enough, it was
straightforward post to your canal what we call candalathiasis. So
(21:14):
those odconia, those little crystals were just hanging out in
the canal. And I cleared her in one session.
Speaker 2 (21:19):
And now she doesn't have any episodes of this at
least until it happens again.
Speaker 1 (21:24):
Wow.
Speaker 2 (21:24):
But she dealt with it for eight.
Speaker 1 (21:26):
Eight years and we cleared it in one session.
Speaker 2 (21:28):
See, it's so crazy because I hear this of so
many people who write me and they're like, yeah, I
deal with this, and I'm just like, you're not supposed to.
You're really not like you're supposed to be able to
do these maneuvers and get the treatment, and then your
life is supposed to go back until, of course, another
episode happens, and.
Speaker 1 (21:45):
It may not happen, so it could happen again tomorrow,
it could clear and happen in two weeks. I had
a patient today that it cleared for twenty five years.
Speaker 2 (21:55):
And then it just came back, and it came back.
It always comes back with a vengeance too. It just
hey honey, I'm home. Yeah, yeah, Wow, I'm back. That's
what's so wild too about Vertigo BPPV. There's just you
guys are the specialist in it, but there's still so
much unknown about how it exists. It's true, what's that
(22:18):
experience like for you? Where like you're just in this
field that's constantly evolving because you don't have every single
detail truly to understand what's happening.
Speaker 1 (22:30):
I feel so honored to be a part of it.
We do a lot of research at Vanderbilt and we're
trying to add to the literature and help figure out
all of these answers. But you're right, there's just so
much that is unknown. I will say there are some
studies going on I believe overseas that they're working on
a medication. It's in very early stages, but we're trying
(22:53):
to find answers and some we're trying to find the
magic pill. Right, that's what everyone who comes to physical
therapy wants. They want that magic pill. They don't want
me to put them through the maneuvers that make them sick.
And vomit, and they just want that magic pill and
hopefully one day we'll have that, but until then, it's
just I'm kind of your best.
Speaker 2 (23:12):
It is And it is crazy you say that about
the maneuvers, because every time I did have a treatment
with you, I would get better. But I don't know
also that people understand that when you do the maneuvers,
even if you're doing like the applay at home, you're
inducing the vertigo. You're moving the crystals around, right, So
it's you're literally what you are trying to avoid happening.
(23:33):
You're doing, you're moving you in the positions to try
and get them to move back to where they're supposed
to be. And every time I would get done with
one of our sessions and like I'm out for the cows.
You guys tomorrow, I'll get better. That was just so
crazy to people, because it's like you went to an appointment,
You're supposed to be better. I'm like, no, I will,
But it's just a little bit different of how that works.
Speaker 1 (23:54):
Yeah, and do you remember one of the number one
things I told you, So we encourage movement. We don't
want you to avoid any positions except for right after
the repositioning. Then we want you to stay pretty still
for a short period of time, but we don't want
you to be fearful. We don't want you to not
roll on your right side.
Speaker 2 (24:13):
We don't.
Speaker 1 (24:13):
We don't want you to be scared to get up
out of bed. So we encourage movement and it's important
for the inner ear.
Speaker 2 (24:21):
Yeah, And what's funny is there was a moment because
again when I was going through all these moments, like
I had you, but I still have the internet. I
was still trying to figure out what was happening, and
I was like, I'm going to get a neck brace,
and you're like, do not get a neck brace?
Speaker 1 (24:33):
Yeah, we used to give neck braces out like twenty
years ago, but it's no longer practice because again, like
that's encouraging the fearful, avoidant behavior that we discourage.
Speaker 2 (24:45):
And there is also the side of this like that
I also didn't realize when it first happened because it
was all first experience. Everything was new to me. But
going through it a second time, my body has PTSD
from this experience where I'm like, do we need a movement?
I'm like, okay, we're gonna go spinning be prepared and
(25:06):
it doesn't. But my body's anticipating and almost like it's
like a placebo is happening where my body thinks it's
spinning but it's not really. That's another side to this too. Okay,
you heal the episode, but your body is still storing
everything that happened to you all goes back to the
body keeps its score, but your body is like still
(25:27):
in the movement. And you've had to help me on
that side of things too, and that gets into more
of the physical therapy. So can you share your little
expertise on that side too.
Speaker 1 (25:35):
Yeah, so when you have Okay, let's say I can't
remember what your exact symptoms were, but let's say every
time you roll on your right side, the room goes crazy.
So then your brain actually gets so used to it
that after we clear out the mechanical reason for the vertigo,
so the crystals, when you roll on your right side,
the brain actually thinks that you're gonna spin, but again
(25:59):
there's no mechanical reason, and so you don't truly spin.
But that's that kind of PTST that you're talking about.
Speaker 2 (26:05):
And maybe that's not the right word, but it feels
that way in my body, Like that's a good description.
It's like a lingering or Okay, my body's still dealing
with the trauma of whatever happens, Like here we go.
And we had to retrain my body this last time
to literally roll over on its side, because every time
I rolled over, I was like, I think I'm having
an episode. You're like, I, you're not. You're cleared, but okay,
(26:26):
we have to retrain your body to understand that you're
okay and you're safe, like in your own body again.
Speaker 1 (26:31):
And so I would have you do it ten times.
Speaker 2 (26:33):
And the headshake, I have to stare at an X
on the wall and just shake my head back and
forth while staring at it. I'm like I would do
them at work and everyone's like, what are you doing.
I'm like, don't worry about it, don't worry about it.
I'm trying to get better.
Speaker 1 (26:44):
And you also you also had li sensitivity too, so
you would have to wear their spit glasses.
Speaker 2 (26:50):
Yes, which also saved my life. Turn into a partnership
with them too.
Speaker 1 (26:54):
They're amazing.
Speaker 2 (26:55):
Yeah, like shout out code Morgan, you get easy. You
can get fifteen dollars off. But they were so helpful
because when I was having my episodes and they were
so intense and I had to go to work because
I can't take a month and a half off work
every time this happens. Right, the their respects allowed me
to be in very lit rooms, much like this podcast
room where we have lights, and so those specs and
(27:18):
I was wearing them on the podcast too because it
dimmed everything around me. Yeah, what is that technology of
Like why you guys use those when people have the
light sensitivity? Because people are asking and I don't know.
I just know they helped.
Speaker 1 (27:29):
I know just enough about this to tell you actually
have the rose color lenses and they block out twenty
five times more of whatever it is they block out
than blue light. Okay, so I can't tell you that,
And now I can tell you that again. Shout out
their respec like they have all different color lenses that
you know, if you've got sensitivity just sunlight, you may
(27:50):
need this color lens, or if you have sensitivity to
fluorescent lights, you need this color lens. They can be
really helpful.
Speaker 2 (27:57):
And this is also something that I newly learned, was
how connected my eyes were to my balance and inner ears,
which was why I was light sensitive because I wasn't before,
but because I was going through this, Like all of
that connects in there right, yes, in my head.
Speaker 1 (28:15):
So I have to be able to see your eyes
in order to tell where the crystals are in the canals.
So again, if let's say they beat, there's like an upbeat,
that means post to your canal, down beat into your canal,
so things like that. So yeah, they're a window to
the inner ear.
Speaker 2 (28:31):
It's so crazy. It reminds you how connected everything is.
No different, how like your skin is your biggest organ. Yeah,
you put stuff on that, it's absorbed in your body.
It's all of that, and you're I'm learning all of
this and I'm just like, oh, it really is all connected,
and holy crap, this sucks, but yeah, we are.
Speaker 1 (28:48):
Gosh, when you have an episode, it really is horrendous.
But what I tell my patients is that when you've
had it once, you now know what it is and
it's going to be less scary than next time around
because you know that there is a quick fix.
Speaker 2 (29:03):
Yes, and that was exactly what happened the second time.
I knew exactly what to do. I need to call you, yeah,
or I don't tell you yeah, I was like, Holly,
I need help. This happened again, but I also knew,
so the second time it happened, I was like, Okay,
this is vertigo. I knew that I was about to
have this experience. It didn't make it any less easy,
Like I was still like, couldn't get out of bed.
(29:24):
I still was like literally laying naked on the bathroom floor.
Oh my god, I'm sweating. This is painful and not
in the way that you think, but painful, like my
body is just like going through it. But I knew
that I needed you to do these maneuvers and to
understand what was happening. So it was a at least
easier process than me having zero information, which is why
(29:46):
the podcast was so important because there's so many people
out here that are dealing with this. Yeah. So in
speaking of all of these people, there were some people
that put in some questions, and we've talked about some
of them, but we'll have you reiterate because they ask
the question, Okay, she had. One lady says she has
a patient with maneirs who has tried everything any suggestions
(30:10):
to potentially help her, and that's the only context I have,
So I have no idea what all they tried, but
I don't know if this is anything you can help with.
Speaker 1 (30:18):
So maneirs it. It can also present with vertigo, look
and persent with disneyness, balance impairment, all all of the
vestibular symptoms, but the repositioning maneuvers that take it away
immediately aren't going to work. So we always start with
diet and lifestyle modifications for maneirs. So you really want
(30:42):
to decrease the salt intake and decrease the fluid behind
the ear. That's where we start. And then you need
a good vestibular therapist that actually knows what mineirs is.
And also a lot of times patients are misdiagnosed as well.
A lot of times patients come in with the diagnosis
of manears and it's actually vestibular migraines.
Speaker 2 (31:03):
So what is the similarities? Tell me what each one
is to you and your like expert opinion.
Speaker 1 (31:10):
They just share a lot of the same symptoms. Okay,
is the problem.
Speaker 2 (31:14):
So I'm thinking vestibular migraines are like very intense headaches,
like very painful, and maybe you have some lightheadedness dizziness
with it maneers. If I remember my research correctly is
like you have like something's happening within your ear anatomy
that's causing the vertigo to happen.
Speaker 1 (31:34):
Correct, Yes, yes, son, there's a lot of fluid going
on behind the ears. One day the person can walk
down the hallway just fine, and the following day they
can have an attack and literally be falling into the walls.
It's a wild presentation. Vestibular migraine is very different. And
the fact that you actually, I believe it's greater than
(31:57):
sixty percent, don't actually have the head component.
Speaker 2 (32:01):
Interesting.
Speaker 1 (32:02):
You just have the vestibular symptoms. You can have the
visual auras and all of that, but there's actually no pain.
So that's why it goes mistagnosed a lot.
Speaker 2 (32:13):
Wow. Okay, that's super interesting because I associate migraine with
headache pain because migraine is just like an amplified headache
to my understanding. So when you said that, I was like, oh, yeah,
that's what's that's crazy. Okay, So hopefully that's some helpful things.
Maybe guys have it, but again I don't have any
other context like what all I've tried and what I've done.
Speaker 1 (32:34):
Let's say, in that case, just find your nearest vestibular.
Speaker 2 (32:37):
Pet Okay, yeah, that's good information. Can stress cause vertigo
to flare up?
Speaker 1 (32:44):
Not from a crystal standpoint, Okay, so it can. It
is one of the triggers for say, vestibular migraine. So
a lot of times patients will have to be medically
managed with medications things like that because they can't avoid
the stress of a really hard job, or their in
laws just moved into their home, so things like that.
(33:07):
It can trigger symptoms of dizzyness. Absolutely, but it will.
It's not connected to BPPV.
Speaker 2 (33:15):
Okay. See, And this is crazy about just all these
different areas, is like there can be so much happening
in there, and you really need someone like a Holly
to understand the anatomy and what's going on in there
because it can go so mis diagnosed on multiple levels.
To your point, like not just manures, but all of them.
(33:38):
At least, this is how it's sounding to me. Why
does vertigo benign happen out of nowhere during perimenopause for
some people? Do you know any connection to that?
Speaker 1 (33:48):
Great question? We are still looking into that. So we
know that hormones are they have an effect on the
vestibular system. But we just we don't know enough.
Speaker 2 (33:57):
See that's so crazy. Yeah, but it is connected. There
is something that's happening with we think.
Speaker 1 (34:02):
So Okay, I can't completely be sure yet. Yeah, it's
And also you've got to think though the average person,
the initial onset of BPPV is from age fifty to seventy.
Speaker 2 (34:14):
Im peramenopause is happening around them.
Speaker 1 (34:17):
So is it just coincidence or is there actually a connection?
Speaker 2 (34:21):
Wow? Okay, And that's also hard if you're experiencing both
at the same time.
Speaker 1 (34:25):
I know, sweet ladies, I know that hurts.
Speaker 2 (34:31):
Do some exercises, which we touched on this, but do
some exercises such as burpies or handstands bring on vertigo so.
Speaker 1 (34:38):
They can They absolutely can. High intensity aerobic workouts kind
of like a similar like blow to the head can
make the crystals come loose. Now again worrying you are
a bit of a special one. We just generally don't
see it in someone as young as you. But that
(34:59):
we made that direct connection. You went to that class,
you woke up the next morning. It was hard to
not be able to connect those two.
Speaker 2 (35:07):
Yeah, And because I then did that and knocked it loose,
I was more likely for it to happen again. Yeah,
that was that connection, correct, stupid trampling class. Don't work out.
That's what I've learned in all this.
Speaker 1 (35:20):
Don't work out, No curdio.
Speaker 2 (35:24):
Meanwhile, I'm over here, I doing like hit workouts and
welcome to my life. But what you have also always
told me is you can't be fearful and you can't
live your life fear of it happening. Because this is
something so important to say, and I want you to
say in your own words, but like, it's gonna happen
no matter what.
Speaker 1 (35:40):
Yeah, So whether you are sitting on the couch or
you were out having fun with your friends and living
your life. If those crystals come loose, they come loose.
It's going to happen, whether you like it or not.
Speaker 2 (35:53):
Yeah, And that was an important thing for you to
tell me because that made me not fearful because it
didn't matter what I was doing. Yes, things like hit
workouts could potentially aggravate it and make it happen quicker,
but you telling me that was like, Okay, this happening regardless.
I can go out and have my life and it'll
be fine. It's gonna happen regardless, so I might as
(36:15):
well enjoy what I can't do in the moment.
Speaker 1 (36:17):
Yeah, and we don't know who it's gonna happen to,
So just because your mom had it or your aunt
had it, it doesn't mean that you're going to have it.
Speaker 2 (36:24):
It's not genetic either, not which wasn't important detail. You
also told me because nobody in my family ever had it,
And you were like, yeah, it's not you just you
get picked out of the letter.
Speaker 1 (36:36):
You're just one of the lucky ones. We were meant
to be friends.
Speaker 2 (36:39):
That's why we were That's exactly why I was supposed
to happen. Okay, and some of these other ones came
in here, but they're funny. You'll make you laugh. Yes,
why like why does this happen?
Speaker 1 (36:50):
We don't know.
Speaker 2 (36:51):
We're learning about our systems and everything. Then another one
was why does my vestibular system hate me? Girl with finears? Oh,
so maybe you can give her some words of wisdom
or some something to make her feel better, because you
made me feel better in a lot of hard moments
for me.
Speaker 1 (37:07):
So with any vestibular diagnoses, life gets better. You just
have to have the right treatment. And it's so for
me as a vestibular specialist, it's so frustrating when patients
come in like this week, girl. I can help you,
my colleagues, we can help you. There's treatment. We can
make you live a normal life. We can make you
(37:31):
have funny it and not be fearful. Yeah, there is treatment.
There's not a magic pill. It's a little bit of work.
BPPV is a quick fix. We love BPPV one quick maneuver.
Speaker 2 (37:43):
Say we I don't and also it was not quick
for me, so don't look at me.
Speaker 1 (37:49):
So other vestibular therapiuse we love bpp it's super straightforward.
It's again, you come in with these possessional changes. We
do a quick maneuver and you're done. Other diagnoses like
vestibular hypo functions, weaknesses, HER's, vestibular migrants, they require a
little bit of work, a lot of homework actually, yeah.
Speaker 2 (38:08):
And it sounds like some of them come with lifestyle changes,
which is some of the hardest illnesses to deal with.
Speaker 1 (38:13):
Bea and migraine. I'm sorry, diet and things like.
Speaker 2 (38:16):
That, changing things in your entire life. Whereas mine, I
just have to come in and you have to keep
working me through treatment. And then one day it'll be
over and until the next time kind of thing. I
do understand that side of it too. And this is
another one we had already answered, but he had asked,
how do I get rid of reoccurring BPPB? Although mild,
sometimes I'm just tired of it? I understand how do.
Speaker 1 (38:37):
You get rid of it?
Speaker 2 (38:38):
You come see me, you get treatment, because isn't it
also possible too, because this was something I had to learn,
Like just going to a regular physical therapist, although incredibly
helpful in so many scenarios, I had gone to one
and the only maneuver he knew was EPLE and for
me specifically, Epley was not going to help me.
Speaker 1 (38:56):
Yeah, sometimes the modified Apley just doesn't work in your case.
It it just isn't the magic ticket. So I think
we think we tried to lead maneuver on you. The SMONT.
There are a couple of different things, but again it's
not always post your anterior. So if you go to
a general orthopedic physical therapist and they put you in
(39:18):
the testing positions, they may not have the equipment that
I have. Specifically, I have these video goggles. They help
me see your eyes without letting your brain fixate. So
if your eyes can fixate on something, your brain can
shut down the nastagnus or the eye movement that I'm
looking for, and that helps us with diagnosis. And if
(39:39):
you go to an orthopedic peach, they may not have
that specialty equipment and then they may not be able
to see what they need to see and they won't
be able to treat you.
Speaker 2 (39:47):
Which that was so helpful for you in understanding which
maneuvers you had to do on me and not just
having the one repertoire of Eppily you need in multiple
which was so important. And again that was a part
of my learning journey because I had somebody do an
Eppley mover on me and I was like, I'm not better. Okay,
you guys are all lying on the internet.
Speaker 1 (40:06):
I feel like crap, and your canal's converted to so
you were again like one canal and then it converted
to another, and so we had to switch it up.
Speaker 2 (40:14):
And how often, like I know, you say I'm special,
but that's not just me. There's a lot of people
out there that have those experiences, and they could be
seeing the things online that were like we can do
this and this will work when in reality, like, it
always helps to have an expert like a Hollie. If
you're not in Nashville or around Nashville, find a vestibular specialist.
(40:34):
That is the key to looking for right like It's true,
So finding a youth somewhere else.
Speaker 1 (40:39):
Yeah, you can give it a shot at home by yourself.
So you can look up the modified deptly online and
fifty to fifty guests the correct side and try to
treat yourself. The problem with treating yourself is that you
can actually make it a little bit.
Speaker 2 (40:52):
Worse, which is what I did.
Speaker 1 (40:55):
So if you make it worse, it can actually convert
to a more difficult canal like the horizontal canal, and
even worse than that, the crystals can actually go from
the canal to the cubula, which is a jelly like
material where the crystals get stuck. And then what do
you have to do when something get stuck, You have
to knock it loose. So then we've got to knock
(41:16):
out the crystals and then clear them from the canal.
Speaker 2 (41:19):
Which I also had experience with this, and you called
the cubula jelly like substance, So I really used a
lot of normal people terms like rocky wall and jelly
like substance and crystals and those are not the medical terms.
Speaker 1 (41:33):
Yeah no, but that's what we use. That's how I
describe it. Like in the utricle, in that balance organ
where the odconia sit, it is just this really rocky
wall and that's where they come off. They just fall
right off.
Speaker 2 (41:50):
But honestly, when you were using all of those, it
gave me the best understanding of what was happening.
Speaker 1 (41:54):
To me because a whush is my favorite word.
Speaker 2 (41:56):
Yeah, you do love to use bushes and I had
a lot of those, so I'd be like, I'm having
a wash.
Speaker 1 (42:00):
Yeah, like that's not normal.
Speaker 2 (42:01):
Okay, let's figure this out. And that was an easy
way to also describe it. But it did because it
and it was funny when we talked about it on
the show. Everybody's we're talking about crystals. This is so
like woo stuff. I'm like, no, you all have them.
I'm just the only one that's actually dealing with them.
Speaker 1 (42:15):
That's true. So everyone has them. They are. So you've
got two balanced organs on each side, so you have
a utricle on a secule on both the right and
the left side. And so you've got your three semi
circular canals. Let's say we're talking about the right side,
and the utricle sits like this, the saccule sits like this.
So you've got crystals in here and in here, but
(42:37):
the utrical blocks the saccule, So the crystals are only
going to come out from here into the canals.
Speaker 2 (42:43):
Which is where the maneuvers come into play. And that's
why I get rotated like I'm askew on a group
bibercu rol because you're literally moving those crystals through these
canals in the ways that they can be moved.
Speaker 1 (42:55):
That's correct, because if you do it.
Speaker 2 (42:56):
The wrong way, they're not gonna move.
Speaker 1 (42:58):
They're going to go into that jelly like yeah.
Speaker 2 (43:00):
Which was not fun. Let me tell you. That was
probably the worst experience. I literally like to Holly as
like I'm gonna vomit gets sick.
Speaker 1 (43:07):
Yeah, there's one day which happens from time to time.
Usually I can catch it, but it does happen.
Speaker 2 (43:12):
Yeah. And to Holly's credit, and Vanderbilt is so awesome,
they not only had a.
Speaker 1 (43:19):
A what is Norman called our facility dog Norman.
Speaker 2 (43:24):
Yeah, he has a service dog.
Speaker 1 (43:26):
I love Norman.
Speaker 2 (43:26):
Yeah, so I had a service dog with me and
so many of these treatments. But then on top of that,
like when I'd get super sweaty being induced with the verdigo,
they'd come in and they just like weigh me down
with all of these packs of.
Speaker 1 (43:39):
It's true, yeah, because it helps with nausea. Oh, it's
a magic trick.
Speaker 2 (43:42):
Okay, talk about the magic trick that is the rubbing
alcohol by the nose.
Speaker 1 (43:47):
Okay, yeah, same. It's like the same as an ice pack,
So it has an effect on you and it decreases
the nausea. So you're just amazing.
Speaker 2 (43:54):
Get a little like piece of paper and you put
rubbing alcohol. Is that what it is?
Speaker 1 (43:58):
We have the little rubbingcohol pads Okay, just and I
just held it up against your nose.
Speaker 2 (44:05):
And it stopped the nausea. If I'm coming. Can that
happen with all kinds of nausea or specifically related to this? Yeah?
Speaker 1 (44:11):
Absolutely, that's so crazy.
Speaker 2 (44:13):
I learned about that too. See all the things that
I learned in this experience.
Speaker 1 (44:16):
And ice pecs, So icepecs are my go to and
then I use okay, the rubbing alcohol.
Speaker 2 (44:22):
Yeah, because the ice pects do feel really good because
your body is like heating up. It's like you're kind
of like a core and it's gonna.
Speaker 1 (44:27):
Yeah, it gets so clammy and sweaty. And again people
do get sick, which.
Speaker 2 (44:31):
Is yeah, you guys sent me home with one of
those throw up. I'm pretty sure it's still in my car.
I'm like, somebody ever sees this, like, well, what is
wrong with this woman? It's fine, just in case.
Speaker 1 (44:43):
It's so interesting to me though, some patients come in
with a lot of nausea and they're super super sensitive
to the maneuvers like you, And then other patients that
come in they just have zero nausea, zero, zero complaints,
will I'm doing it, and then they just run on
their way. It's fascinating to me that everyone's system is
(45:04):
so different.
Speaker 2 (45:05):
I do wonder too, if there's a connection for me
and that because I have like growing up, I've always gotten.
Speaker 1 (45:10):
This is why I hate roller coasters.
Speaker 2 (45:12):
They made me so ill, so ill, but also I
hate the drop that you get in your builth. But
more than that, like I get literally violently ill, and
I get car sickness. I get sick on boats. I've
had always had a this dizziness, and like, whenever I've
gotten sick just a freaking common cold, I have nausea
or I have lightheadedness. Also I think about in the
(45:34):
course and if I ever were to have a child,
and that's gonna be freaking sick all the time. Yeah,
So I think about those things because this is my
symptom of anything is oh, you're gonna be vomiting. You
got a little stuff, you knows, vomit. That's just my life.
And so I do wonder if you have sensitivity in
your life, then like something like this happens, and all
it does is yeah, maybe it has to because not
(45:57):
everybody feels that way in all of those experiences, right right, No,
it's true. So then you get two different people with vertigo,
one like me and one that doesn't, and they're like, no,
it's fine, where my body's like, yeah, no, we hate this,
We're good. Systems are so weird, which is also why
I wanted to bring you on and just talk about
just the craziness of all of this. So many people
deal with it. You don't have to be alone in
(46:18):
dealing with it. You can also get treatment, like you
don't have to live with this and I.
Speaker 1 (46:23):
Think that's the take home of today, and that's what
you and I wanted to get across to everyone, is like,
there is hope, there is an answer, there is treatment,
and there's in BPPV alone specifically, there's quick treatment. You
just have to go to the right therapist. Not all
physical therapists are created equal. Just like I said earlier,
you're not going to come to me for me to
(46:45):
fix your shoulder.
Speaker 2 (46:46):
Yeah, you are a very specific thing. So the thing
that we always do and leave on this podcast is
like whether it be a piece of advice and motivation,
and that might have just been it. We might have
just had our closure. Is there anything that we haven't
talked about that you wanted to make sure you've shared
in this whole kind of experience of our friendship and
vertico treatment.
Speaker 1 (47:11):
I think it's important to me as a vestibular specialist
that all my patients know that they don't have to
be scared, and like you said, they're not alone. So
many people suffer from vestibular diagnoses and illnesses, but there's
(47:31):
treatment and you have to find the right therapist. So
I just kind of want to give like a little
shout out if you are watching this podcast and you
don't know where to go. There is a website called APTA,
and if you type in APTA vestibular map up Providers,
then it's going to pop up all the states and
all the vestibular providers that are part of the APTA,
(47:54):
so American Fiscal Therapy Association. So that's a really easy
way to find a therapist that's specialized. Is in vertigo,
or you can come to Vanderbilt and see me and
my colleagues. We are at Pibet Defier Rehab and we love.
Speaker 2 (48:08):
What we do, which you should absolutely see Holly and
her colleagues if you are in the area. But if
you're not, Dang, that tool is awesome. I didn't know
that existed.
Speaker 1 (48:16):
It's the best resource. And so I just really want
everyone to know that you don't have to come eight
hours to see us. They are particular specialists all over
the country.
Speaker 2 (48:26):
Yeah, oh, Holly, you did so good. I know you
were nervous about doing this. We did so great, ye
And I appreciate you coming on and like sharing all
of your wisdom and expertise, because as much as you
pie don't want ad minute, you are an expert in
what you're doing, and you're you're doing like the work
that matters, and you're changing people's lives.
Speaker 1 (48:45):
That's really sweet. I love what I do. It makes
me happy every day.
Speaker 2 (48:50):
Yay, thank you for coming on. I appreciate it. Thanks
so many takeaways during this episode. Our health is such
a huge part of our lives and BPBV is debilitating
and so I would not wish on anyone. So if
you're a fellow sufferer or anything impacted by vertigo, I
hope this episode helps you find some very deserved relief.
Thank you all for being here, and as always, I
(49:11):
love you.
Speaker 1 (49:12):
I'll talk to you next week.
Hosts And Creators
Bobby Bones
Amy Brown
Lunchbox
Eddie Garcia
Morgan Huelsman
Raymundo
Mike D
Abby Anderson
Scuba Steve
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