Rolling Stones

I lay down on the hard, gray flagstones of my backyard patio and stretched out the kinks and coils that lingered after my early morning exercise. My dog and I had just returned from a long walk, and she lounged in the cool waters of her wading pool, panting contentedly. Without warning, a violent, invisible whirlpool seemed to engulf me, dragging me into its swirling maelstrom. I grappled for an anchor on the smooth stones but came up empty-handed. Waves of fear and nausea washed over me for nearly a minute. Slowly, the storm subsided.

I sat up, baffled but relieved that the episode had passed. Suddenly, a different sensation ensued: Unseen forces gripped me, propelling me forward in the continuous loop of a nightmarish waterpark ride. The earth’s gravitational pull seemed to double, triple, and the watercoaster in my head took off, faster, faster. My eyes shut tight against the tumult. I cried out, startling my dog, who came to comfort me, panting and dripping wet. As all wet dogs do, she shook. The discordant jingle of her license tags and the cool spray of water launched me into a backyard version of sensory waterboarding.

My heart raced, my breathing quickened, and I broke into a sweat. On an intellectual level, I recognized the event as vertigo, a condition I’d heard of (and dismissed as minor). But on a more primal level, my brain recognized it as a serious threat to my survival.

Despite what we learn in school about the earth’s rotation, the common wisdom asserts that the ground under our feet remains immobile while we do the moving. We don’t call it terra firma for nothing. But vertigo defies those assertions and fools us into doubting our strongest convictions about the world around us.

Vertigo makes you feel like you’re spinning, swaying, or tilting when you’re not. Basically, it’s a type of hallucination – a mismatch between reality and the signals our eyes, inner ears, and sense of touch send our brain. Whereas some people with vertigo sense their bodies moving in space (even though they’re standing still), others sense their surroundings moving around them. Either way, something isn’t right.

A visit to my doctor revealed no epiphanies. “Your ears are full of fluid,” she announced.  “Fluid” seemed to define my condition. I felt like I was walking on water, and if I tapped my ears, the light drumming produced a sodden, muffled sound like I was under water. “You probably have benign paroxysmal positional vertigo.”

It didn’t feel “benign,” or harmless, to me, but it did feel “paroxysmal,” a mouthful of a word that means violent and sudden. She suggested I take an over-the-counter decongestant, and she prescribed Meclizine®, an anti-vertigo medication, and Augmentin®, an antibiotic. “Just in case,” she added cryptically.

Nearly a third of all adults over the age of 40 in the United States – roughly 69 million people – will experience vertigo at least once in their lives. Most cases of vertigo are transient, lasting only a few weeks to months, while some last for years.

Although vertigo is a serious health condition, it’s a symptom, not a disease. It’s an indication that something is wrong somewhere else in the body. Doctors classify vertigo as either central (originating in the brain) or peripheral (originating in the inner ears). Benign paroxysmal positional vertigo, or BPPV, is the most common form of the condition and is usually peripheral. Professional golfer Jason Day collapsed after a bout of BPPV during the U.S. Open during the summer of 2015, and basketball legend LeBron James has recurrent BPPV. Walking my dog doesn’t exactly qualify as a professional sport, but at least I was in good company.

In BPPV, certain head movements, like tipping it back or rotating it to one side, can trigger the episodes, which usually last less than a minute. The onset is often so sudden that people sometimes think they’re having a stroke. Others become disoriented and stumble while walking, and some even fall out of bed. People of all ages can get BPPV, but it’s much more common in older adults – as much as seven times more common in adults over the age of 60. And experts aren’t sure why, but women are almost twice as likely to experience BPPV than men.

I asked my doctor what caused my BPPV. Her bedside manner left a lot to be desired: “It can be caused by a tumor,” she replied. I blanched. Sensing my alarm, she added, “Or a virus. Or a bacterial infection.” Her last answer explained the “just in case” remark and the rationale for prescribing antibiotics. “But usually it’s caused by little stones in your ear that move.” Wait, I have rocks in my head? I wondered, but I was too rattled to ask. She handed me a piece of paper that described special exercises designed to treat BPPV and sent me home.

While BPPV can be related to some serious medical conditions, David Zee, a neurologist at the Johns Hopkins University and a specialist in treating balance disorders, says, “Vertigo can also be caused by a knock on the head, riding on a bumpy road, or even migraine headaches.” Even lying in the magnetic field of an MRI machine can cause vertigo for many people. Most cases, however, are due to those pesky little stones, called otoconia. “Otoconia create a lot of mischief,” says Zee. “They can get dislodged and kind of float around, producing a powerful false sense of spinning.”

ear
The vestibular system is comprised of the utricle, saccule, and semicircular canals. 

Otoconia are tiny limestone and protein crystals that live deep in your inner ear, in an area called the vestibule. In the vestibule, the otoconia attach to the gel-like surfaces of two tiny organs, the utricle and saccule, which help you sense gravity and movement in vertical or horizontal directions, such as riding in an elevator or moving in a car. The otoconia slide back and forth over the surfaces of the utricle and saccule in response to these movements and send the information to your brain.

Not far from the utricle and saccule lies a series of three looped tunnels, like waterpark tube slides, known as the semicircular canals. These fluid-filled canals sit at right angles to each other and sense speed and spinning motion. When you move, the fluid moves across hair-like structures in the canals called cilia. The cilia move the way wheat stalks swish in the wind and tell your brain you’ve turned your head and whether the movement was fast or slow.

The semicircular canals, the utricle, and saccule work jointly to keep you balanced. Together, they’re known as the vestibular system. Most of the time the vestibular system works without problem. Occasionally, however, rogue stones escape the utricles’ surface and wash up into one of the semicircular canals. Why the stones dislodge and relocate remains a mystery, and often doctors can’t pinpoint a specific cause. “As we get older, the otoconia are probably more easily sheered off,” says Zee. Most of us likely have a few renegade stones floating around in our semicircular canals, he adds, but it’s only when large clumps form that there’s a problem. The clumps aggregate in the canals, effectively converting the speed-sensing semicircular canals to gravity-sensing ones.

This is vertigo, and it’s enough to turn your world upside down.

Vertigo can cause anxiety, depression, and panic attacks. Some people with vertigo lose their jobs and can’t care for their children and families. At the very least, vertigo robs a person of their physical freedom. “The vestibular system is fundamental to our survival,” says Zee. “We wouldn’t exist without it. The brain needs to know where we are, relative to our enemies, and whether we are moving or still.” Vertigo threatens our sense of security.

I certainly felt threatened, but I also wanted to wretch every moment. “A person with BPPV can feel ill with nausea, vomiting, and other motion sickness-like symptoms,” says Zee. “[Drugs] like Meclizine®, or its generic form, Antivert®, might make you feel better if you have nausea, but they won’t cure your BPPV. You have to treat it with physical therapy.”

The physical therapy for BPPV is simple and involves exercises like the ones my doctor suggested. A few variations of the exercises exist, and some variants work better than others. The version I completed, a series of head movements referred to as “modified Epley maneuvers,” resolve vertigo in about two-thirds or more of people with BPPV.

Essentially, the exercises are human versions of those ball-in-a-maze games you played as a kid, where you roll a bead around in a maze, trying to get the bead to go into a hole. The goal is to roll the renegade stone (the bead) through the maze of canals and return it to the vestibule (the hole), where it can be recycled in a sort of inner-ear sustainability program. Of course, you can’t see the otoconia rolling around, so you hope for the best.

I faithfully performed my physical therapy for three days, and then, as suddenly as they appeared, my symptoms went away. When I rested my head on my pillow that night, I realized the tide had receded. Finally, I was symptom-free.

I’m not off scot-free, though. About one third of people who’ve had BPPV will get it again. As I get older I’m at greater risk for other types of vertigo, too, and my sense of balance will gradually diminish. According to Zee, as we age we lose neurons in our inner ears and in the part of our brain that controls coordination, we lose sensation in our feet, and we lose visual acuity. This trifecta of losses creates a perfect storm for balance problems. “It’s amazing we do as well as we do,” says Zee. But activities that challenge the vestibular system and improve balance, like tai chi, or dancing (especially the tango), or yoga, help maintain balance as we age.

When it comes to Zee’s advice, I’m all ears. I’ve added some balance exercises to my morning routine on the flagstones, and I’ve begun shadow boxing – the closest I’ll come to dancing.

My world is right side up now, and I hope to keep it that way.

~TLJ

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