So, a couple months ago around noon, I was sitting at my computer. As I stood up to go over to my husband’s desk at the other end of the room, I suddenly felt the room spinning. “Whoa, I’m dizzy,” I said. I dropped down onto the couch, but that didn’t make it much better.
My husband turned around to look at me, saw me sitting safely on the couch, and seemed to think it was all over.
“I’m really dizzy,” I repeated.
“Oh, still?” he said.
I could walk, so we went downstairs. Hubby made lunch, as I remember, and I tried to eat it. I’d manage this, I figured. It would go away. But it didn’t. When I lay down, it just got worse. So, I’ll stand up till it goes away, I told myself. But it didn’t.
By around 6:30 in the evening, I suggested we go to Emergency (which, for me, is totally out of character. My son said, when hearing of this later, that it must truly be life-threatening for Mom to go to Emergency.) We took an Uber to Penn Hospital in downtown Philly.
I remember me holding on to the walls of the corridor as we walked toward Emergency. It was a Wednesday, and there didn’t seem to be anyone there. (no Saturday night shootings; no weekend overdoses). So, I got great treatment. They showed me to a room. They gave me some anti-vertigo medication, a few electrocardiograms, a lot of bloodwork. Several nurses and the resident neurologist checked me out over and over. I gave my history to anyone who asked: migraines, yes, but usually not too bad. Nausea always, but this was the first time with dizziness. Head injuries? No. Stroke? No. etc, etc.. (I think I seemed rational throughout, though I must have been confused, because I could have sworn the resident was of Indian extraction. When I saw him again at follow-up, he turned out to be Polish.)
The resident asked me to walk a line, turn around and walk back. I think I took the turn wide but managed, wavering, to return to the point of origin. Told me to close my eyes and touch my nose with my index finger. That was hard, but I’m pretty sure I found it. Follow his finger with my eyes. Whoa, that made my head swim. He tipped me back in the chair to see if that would make my vertigo worse. Yes it did!
Ultimately, I had an MRI, the arbiter of all things. They gave me a sedative when I confessed to claustrophobia, and I got through it with eyes closed, picturing myself on a beach. The good news: no stroke, no findings of acute intracranial hemorrhage, no acute ischemia. Sinuses clear. An incidental note was made of a 1.4 cm Tornwaldt cyst. (Long story here, but I’m not going to tell it.)
The resident came back in: ruled out all neurological problems. Probable diagnosis: Benign paroxysmal positional vertigo, better known as BPPV. (Though, sometimes, when you’re still disoriented as I was, you might call it BBPV or BPVV.) It’s the next option when they rule out neurological.
By this time it was morning. My vertigo was mercifully gone. I had a diagnosis, albeit questionable. We took an Uber home.
The following month was okay, though I felt maybe 5% off. A little dizzy if I turned too quickly. Still do, in fact.
I got checked out by an otorhinolaryngologist, whose specialty was BPPV. (My husband found a well-respected guy by searching the PennMed website for BPPV. Interesting how these days you can find a doctor whose expertise is the diagnosis you think you want. Of course, that entails making the diagnosis yourself before you have the specialist to make it.)
Anyway, the doctor said it wasn’t BPPV, which apparently entails a couple of minutes of vertigo and maybe ten hours of feeling shitty. I’d had vertigo for 8-10 hours. No, he said, it was probably vestibular (pertaining to the inner ear or sense of balance) neuronitis, caused by a virus which attacks the vestibular nerve.
But, Doctor, I objected, I didn’t have any evidence of a virus. No cold, no anything.
Sometimes that happens. You needn’t have felt anything other than the vertigo, he answered….
(Some handy deus-ex-machina kind of virus! No way of proving it, but without evidence to the contrary, that’s what we think it is. Kind of like the diagnosis you sometimes get of “idiopathic,” which means, “no known cause.”) But, I digress….
…Or maybe vestibular migraine, he conceded. If it never comes again, it’s vestibular neuronitis. If you get another episode, it’s probably vestibular migraine. Then come see me.
Meanwhile, in order to see the specialist, I had to undergo an audiology exam. This entailed listening to a never-ending series of tones in different ears, some loud, some very soft, to which I was supposed to press a button immediately upon detection.
Of course, it’s easy when you actually hear the tone. Complete certainty – press the button. On the other hand, it’s disconcerting when you hear nothing. You never know whether there’s actually nothing to hear or something that you don’t hear. You’re not sure whether they’re trying to trick you with some long episode with no tones at all, or whether they’re playing a symphony of very soft/very high ones and you’re just sitting there like a dope. I tended to press the button just in case.
…and then there was the portion where a man’s voice says, “You will say,” and some word. Like, “You will say PLAYGROUND.” Or, “You will say AIRPLANE.” I got most of those, though it pissed me off that some bully should be telling me what to say.
Anyway, the good news is I don’t need a hearing aid; I’m functional but poor at distinguishing high tones. The bad news is that the audiologist, who acknowledged at the beginning that I had a lot of wax in my ears, managed to smash it into my ear canals while inserting the earpieces. So, a few days later I was back in the ear-nose-throat doctor’s office to have my ears cleaned. (another otorhinolaryngologist who, incidentally, agreed with the first doctor that it was either vestibular neuronitis, or maybe vestibular migraine.)
UPDATE: I just had a follow-up with the resident neurologist I had seen in Emergency the night I had the vertigo. When he walked into the examining room, I thought he looked familiar. Same name on his nametag. But why wasn’t he Indian? Anyway, I told him the ENT said the BPPV diagnosis was wrong. He didn’t dispute that. I told him about the new diagnoses vestibular neuronitis and/or vestibular migraine. He was agreeable to either. (He’s a really agreeable guy. He commented, “cool shoes” on my leather high tops and remembered that I was a writer.)
Anyway, then came the interesting part. “Want to see your MRI?” he asked.
“Sure,” I said, getting up to look at the computer screen.
By now he was practically beaming. “You’ve got a pristine brain! Look!,” he said as he pointed out that I had no expanded sulci, no reduced volume or holes in the brain – all signs of aging and, maybe, worse. I had to admit my brain did look pristine. He asked me if I minded having his boss come in to confirm his diagnosis and meet me. Sure, I said.
Ten minutes later the two reentered. The older doctor was beaming, too.
“You’re 71?” he asked. I nodded. “Beautiful brain!” he declared, looking at the screen, not me. I felt like a celebrity.
The rest of the appointment was less memorable. The resident and I chatted a bit about my migraines, which I kept insisting were low grade. He gave me a prescription for Reglan, which I would later discover from the internet is primarily for gastroenterological distress and nausea, only used for migraines as an off-prescription use. It also has some heavy side effects like tardive kinesia, where the patient starts making involuntary movements like lip-smacking, tongue-darting, eye-blinking, body-jerking. So, no thanks. I think I’ll just get along without meds for my low-grade migraines that I never really complained about. And hope that the vertigo never comes back.
As we left, I asked my husband, “So, after all this, what did we learn?”
He grinned at me. “You’ve got a pristine brain!”