Vertigo?

BethMimi

When she is positioned on her side she thinks she is falling.  It's so sad I don't know what to do.  She calls out "help me please help me"  and calling out for her mommy, dad and her husband, my father.  No amount of reasoning or assurance she is okay doesn't help.  She gets a death grip on the rail on the bed and won't be moved.  Once she got a hold of my arm and I had a hard time to let her to let it go as she was digging into my skin.  It's only when she on her side.  She is in a facility and it's hard to get attention for this.  Thank you in advance for any advice.

SusanB-dil

That is frustrating and wrenching!  Get her eyes and ears checked.  There was another recent post for issues, and the eyes were mentioned.  and I have an inner ear imbalance, so when a bad cold gave me a bad ear infection years back, I about couldn't move without everything spinning, to the point of even being nauseous.

M1

Beth, Xanax might help for this--not for sedation in this case but it's a specific use for vertigo.  Maybe worth mentioning, might kill two birds with one stone.  Vertigo is a hard diagnosis to make, you might see eye motions, but in such a case it might be worth it to treat first and ask questions later.

harshedbuzz

My dad had vertigo with his dementia.

His PCP prescribed meclizine which seemed to help early on. 

HB

Ed1937

It might be worth seeing an ear, nose and throat doctor. My wife had Meniere's disease, and she had a very hard time with it. At her worst, she would lie on a couch, and if she even moved her eyes, vertigo would kick in, and she would be vomiting. Long story short, she finally lost her hearing in one ear through surgery (intentionally), and it was the best thing she ever did. Her symptoms were 95% relieved, with no more vertigo, but when she would have an attack, she would sleep long hours. Finally the symptoms completely disappeared.

She was thought to have Meniere's disease by a local doctor, and she was finally diagnosed at Washington University in St. Louis. Surgery was done at University of Chicago some time later.

hezazebra

Vertigo that is related to head position is likely Benign Positional Vertigo (BPV).  Look up the Epley Maneuver.  It can be done at home, lying down on a bed.  I would recommend that someone who knows the technique support her head through the process, especially if she is very frail.  I have experienced extreme vertigo while executing the maneuver.  I had to tell my lizard brain that I really could not fall off the bed and take deep breaths to calm myself.  It usually goes away the first time.  But sometimes multiple times are necessary.  If someone is going to do the maneuver for the first time, ask them to practice it on someone else.  Then you will be able to game plan how to do it with a frail PWD.  In my mother's final years, most of her joints were bone on bone and it was difficult for her to move or for someone to move her.  A young person is unlikely to be hurt by the Epley Maneuver.  But if someone has issues in the spine or in blood vessels in the neck, the risk increases.  I have successfully done it by myself in my 60s.  I would have hesitated to do it for my mother in her 90s.  

The other option is to have her avoid the position that causes vertigo.  For example, if it happens while lying on her right side, switch her to the left.  You might try raising the head of the bed.  

BPV is caused by loose crystals in the inner ear semi-circular canals.  They touch the hair like fibers that sense position.  The Epley Maneuver moves the crystals through and out of the canals, so they no longer cause problems.  If you know a small child who is willing to spin till dizzy, you can see the eye movements that indicate dizziness.  it is a drift in one direction followed by a flick back in the other.

Here is a video:  Epley Maneuver to Treat BPPV Vertigo - Bing video  

King Boo

Speak to the physical therapists at the facility.  If one of them is a PT that specializes (or has decent experience) with balance problems, this will be the easiest first stop (provided there is nothing more concerning going on and a stroke is not the cause).

Epley's will only help a certain type of BPPV.  There are 3 single types and some patients have multi-canal BPPV, which needs to be sorted out correctly.

If she is reporting dizziness while lying on one side, it could be BPPV of the lateral horizontal semi-circular canal, which requires an entirely different type of repositioning.

NOTE:  a person should be screened prior to any repositioning to make sure they can safely be repositioned. The basilar artery can be affected - a trained vestibular diagnostician can easily do this bedside.

Lastly - our elderly LOWD can suffer from a lot of other causal factors as there are 3 bodily systems involved in balance (somatosensory, vestibular and visual) and as neurology factors in too as ALZ is a neurological disease - it can get complicated.   

But a good diagnostician can catch peripheral causes (which can be treated).

NOTE:  preferable to have the diagnostics done prior to medication as meclazine, Klonopin and Xanax can impact the nystagmus used to diagnose as they are vestibular suppressants.

But of course, case management needs to be done in person.

King Boo

See if any of the Physical Therapists at the facility have vestibular expertise.

Assuming emergency medical causes have been ruled out (i.e. a stroke), they can cut to accurate diagnosis of BPPV the quickest (if vestibular is their area-and if the actual problem is really BPPV.  There are lots of causes of vertigo).  

A few comments:

Do not try Epley's or any other repositioning on your own, unless recommended a part of your treatment protocol after being seen.  A physical therapist can address any physical limitations of the patient without further damage.  They can also screen for basilar artery involvement (rare, but if a screening is positive, one does not want to stroke out your patient with compression of it during a repositioning).   The initial repositioning for BPPV can elicit very, very, strong symptoms and occasionally what is known as a drop attack.   A professional will know how to safely guide the patient through this.  A family member will not.   

Follow up at home exercises are fine if recommended by the treating professional.  

Physical therapists can team together with multiple clinicians to do a re-positioning if indicated, even with very immobile, debilitated and large patients.  They are truly amazing to watch.  

Epley's only help BPPV of the posterior canal.  There are several other kinds, including horizontal canal BPPV (which uses a different repositioning technique), as well as a multi-canal BPPV (which requires a very specific order of treatment protocol to be addressed).

Diagnosis can be done under goggles which increases accuracy of nystagmus(eye movement) identification so critical to accurate diagnosis.

This is best done prior or after stopping any vestibular suppressant such as meclizine, Xanax, Klonopin, etc .

There are also a lot of other sources of balance issues as the visual, somatosensory and vestibular system all provide critical input.  And some issues are cerebellar in nature rather than peripheral.

It breaks my heart when patients go years without having BPPV addressed because it is so easily treatable.   NOTE:   not all ENT's and PT's have an interest or skills to address all aspects of balance.  When this happens, things can be missed.  Balance is an interesting but frustrating diagnosis process, it's like putting a jigsaw puzzle together.

Hoping your Mom has something easily treated.  There's enough to deal with already.

Good luck.

MaryG123

Could she be positioned with pillows or bolsters so she isn’t on her side?  Or partially sitting up maybe?

Stuck in the middle

Sounds like BPV to me.

When I had BPV, I was so dizzy that I vomited in the car on the way to the doctor.  The Epley maneuver improved it immediately, and it went away entirely over a period of several weeks.  In the meantime, cocking my head such as hanging a picture made me so dizzy that I leaned against the wall to prevent a fall.

King Boo

Assuming a medical emergency is not in play (like a stroke):

Seek out the Physical Therapists available and find out if any of them has advanced training in vestibular therapy.

Please do not try to do an Epley on your mother.  Epley's can be a bad idea without accurate diagnosis.  There are a lot of potential causes of balance issues.

A good vestibular diagnostician has to

 1.  get a positive positional study for BPPV-meaning that it is the clinical diagnosis. 

2.  Determine which canal (horizontal, posterior or anterior) it is in as well as which side.

3.  Make sure it is not a multi canal BPPV (pretty common)

4.  Screen for basilar artery involvement so you don't stroke out your patient doing a repositioning

5  Do the correct positioning.  Epley's only help posterior canal BPPV. The wrong repositioning can migrate a BPPV and then you have more problems than when you started. 

6.  All the while with the correct equipment and if needed, second assistant to safely moved and adjust an elderly patient (and to protect against a drop attack, panic, or fall).  

If the therapist gives exercises for you to do afterwards, that's fine.

There are a whole host of other causes of vertigo and dizziness, peripheral, central, cerebellar origin, etc.    Not all PT's, ENT's and AuD's have an interest in this specialty area which is critical for accurate diagnosis.

BethMimi

Thank you everyone.  For being such a big help.  Yes we bolster her up with pillows and tried everything else.  The doctor put her on Buspar and it has helped tremendously.  I go everyday and I haven't seen this episode since.  So far so good.