Visual and Vestibular

It has been a while since my last post. I have been travelling a lot and doing tons of reading.  Learning about the plasticity of the human brain has been truly fascinating. We are very complex organisms and we are only beginning to understand how the brain guides the whole body. Not one of our systems function in isolation.

Today, I had a very good case.  I have heard this scenario many times before. This gentleman woke up one morning and had a terrible case of vertigo.  He  had the Epley maneuver performed and that seemed to help the vertigo but he was left with a feeling of lightheadedness and mild headache. These symptoms increase dramatically upon walking especially in a mall or big box store.

This patient had a very clear case of VH.  The vestibular problem was able to be treated, but there was still an underlying visual component that needed to be addressed.  He had a very slight vertical misalignment with a very subtle head tilt.  When the proper prismatic correction was found his symptoms decreased dramatically within 20 minutes.  He once again felt grounded while he was walking. Again, we see how the vestibular and visual systems are connected. This case was a wonderful example of the power of prism!

My Teacher and Mentor

I would like to say a few things about my teacher and mentor Dr. Debby Feinberg. Dr. Debby is the most kind, humble and caring person I have ever had the pleasure to know. She still gets overjoyed when she can help a suffering person, even after 20 plus years of doing this work. So many of her patients,  and now mine, feel like they have lost hope. Coping with dizziness every day can destroy a persons life.  I learned from her that I my job is not only to address the visual systom, but also to find other practioners  to help our patients with other issues that are contributing to the symptoms. It is often a team effort to help heal this population.

 I am truly blessed to have found Dr. Debby. She has changed my life and my practice. I am hoping to really make an impact on people's lives, just like her.

Are You A Klutz?

A common theme that I have been hearing lately from my patients with VH is that they have always been clumsy. Walking into walls, knocking things over, stumbling all the time. One patient told me she always knew something was wrong because she would hit her shoulder into a door frame a few times a day. Ouch!

When the two eyes are not pointing to the same place our stereo vision is poor. Judging where our bodies are in space becomes very difficult.  These patients are constantly walking into things, tripping, and misjudging distances. It is wonderful how coordination can improve by aligning the eyes. Now I am not saying that all clumsy people have VH or binocular vision problems but some do.   Something to investigate if you always walk into door frames!

The Case of M

Today I would like to tell the story of patient M. M was a healthy active young woman with a wonderful life. Two and a half years ago she went on a family vacation. The vacation turned into a nightmare when everyone on the trip got a terrible fever virus, including M. Thankfully, the family recovered from this illness and all was well, That lasted a short period of time. Poor M happened to contract the stomach flu right after the last horrible virus.

After she successfully fought the flu, the dizziness began. She felt unbalanced and had a pressure compression type of pain in her left eye and on the side of her head.  She also feels a crackling in her left ear at times.  These symptoms interfered with every aspect of her life. She struggled through work and was losing all enjoyment of life.  Every ENT, neurologist, primary care doctor, she consulted found nothing wrong with her. Eventually, she was put on an antidepressant. Then she read about VH.

I actually think M had VH her whole life from her facial structure. One eye is clearly higher than the other and she has an extreme head tilt. Her brain was able to compensate for the misalignment and fuse the images before the two severe illnesses hit her back to back. I like to use the analogy of a tripod. The legs of the tripod consist of 3 systems. We need all 3 to be strong in order to be balanced. First is the ankles, feet, core all working together. Second is our vestibular system in the inner ear and last (but not least!) is our binocular visual system. If one leg is wobbly maybe a person can function, but if two of those legs on the tripod get wobbly, the tripod can't stand. This is what I believe happened to M. Her visual system leg was always wobbly but she was able to get by, then she had some type of damage to the vestibular leg of the tripod. The two wobbly legs were too much for her brain to deal with and all the systems of vertical heterophoria emerged.

The good news is that M's symptoms are decreasing as we are aligning her eyes. It is taking some time but progress is being made. I still believe there is an inner ear issue that needs to be addressed but I am very hopeful M will be able to enjoy her life again!

Everyone Does Not See A Shadow

A patient of mine reported yesterday seeing a shadow overlapping image. She has been noticing this since childhood. This was a very intelligent woman, who is now in her 30's. She couldn't believe that everyone didn't see this way. It is so interesting to me to think about  a person's perception of their visual world. If someone saw a particular way their whole life, of course they would believe that was the view for everyone. It is like a person who is nearsighted and never had glasses. The first time they get glasses they are amazed at the details in the world. It is like that for a person who has vertical heterophoria. When the eyes are aligned, the shadow image goes away.  The patient experiences clarity, detail and depth perception sometimes for the first time in their lives!

This just drives home the point that as a good doctor, I need to ask questions and listen to the answers. How many times do I hear from a patient that they suffer from headaches but it isn't their eyes. Then I discover that it was their eyes all along. They were never asked the right questions.