Vertigo?

BPPV.  I thought I had it.

Benign paroxysmal positional vertigo (BPPV) is a type of vertigo caused by a disorder in the vestibular system in the inner ear.  Occurring suddenly with a change in the position of your head, it is characterized by dizziness and loss of balance.

At the core of the problem are crystals found in the inner ear that become detached from the lining of the vestibular system.  When the head changes position, these crystals shift.  Since the vestibular apparatus is responsible for balance, dysfunction can cause vertigo.

Vertigo sends over 6 million people to the doctor every year.   Of those, almost half can be BPPV. 

About a week and a half ago, I woke up in the middle of the night and stumbled to the bathroom.  I felt like I was falling forward.  I managed to make it to the bathroom then back to bed and once I was lying down again, I was fine.

When I woke up a few hours later, I certainly seemed fine-normal, really.   So I headed in for my morning workout. 

One of the exercises on this particular morning had me lying on my back.   When I started to get up, my world went upside down again.  I had to stop.   About 20 seconds later, I was normal.

It took  me about 3 times to figure out that I really didn't need to be lying on my back and then getting up quickly (yeah, I'm a slow learner).

At that point, I was convinced that I had vertigo.  One of the physical therapists that I work with is Whitney Sharp, who has specialized in the treatment of vertigo.   Unfortunately for me, Whitney was in Oregon to watch her son play football (Tennessee Tech kicker Zach Sharp).   At our Springbrook office, is another physical therapist that is trained in the treatment of vertigo, Dr. Courtney Irons.  

So I took off to see her.  After a thorough examination, she decided that I didn't have vertigo.   Next stop: upstairs to see my personal physician, Dr. Kevin Turner.   Dr. Turner did his usual thorough job with an EKG (pretty normal) and blood work.

It was from the blood work that he discovered that I was dehydrated.   I had no idea.   This episode had started on a Tuesday night and I had a hard bike ride on Tuesday but I thought I had hydrated sufficiently.  Obviously not.

One of the problems with dehydration is dizziness and a form of vertigo.   I didn't really know that (and, quite frankly, I should have) but I sure do now.

I've had patients, friends, and colleagues with vertigo but I didn't really know what they were experiencing.   But when your world gets all topsy-turvy, it gets your attention.  I definitely have a greater appreciation for what they are going through.

And I know (and want you to know) that if you do have vertigo, there is something you can do.   For this episode, a combination of a physical therapist and a primary care physician fixed the problem quickly for me. 

And one thing you can be assured of:  I will drink more (written between sips from the water bottle that has become my constant companion).  I don't want to go down that path again.

Teens and Back Pain

Already this year, it seems as though the sports injury of the fall is a back or neck injury.   I've seen way too many of these and the fall sports season is young.

Teenagers aren't supposed to have back problems.   That's supposed to be for the middle-aged guy that tries to lift too much without using good body mechanics.  Or the senior citizen that has simply abused their spine for too many years.

Oh, I see enough bad posture among younger folks that I sometimes wonder why they aren't having more neck pain but then I do know that eventually they are going to have problems.   Sitting at a computer (which a lot more folks do for a job these days) will definitely take a postural problem and make it a significant medical problem.

And those backpacks.  I've ranted here more than once about the weight of the backpacks that our high school-aged kids are required to lug around every day.  It's obscene!

I weighed one of those backpacks, fully loaded, not too long ago.   It was 45 pounds.   And that one was carried by a 15 year old girl that might weigh 105, soaking wet.   That's over 40% of her body weight on her back.  Every day.

Something has got to be done about that one.   Those teens will be adults with serious back problems. 

But I'm also seeing athletic injuries to the spine that cannot be taken lightly.   Although not seen with the fear and gravity that concussions are, back problems among teenage athletes need to be evaluated by a health care professional.   For most teams, that starts with the team's Athletic Trainer.

One category of back problems, known as spondylolisthesis, is not uncommon in football linemen.   The mechanism of injury is often the repetitive nature of collisions with other large individuals, usually with the spine in extension.   Over time, a structural change can take place in the low back that only rest and no football can fix.

That's why offensive linemen with chronic low back pain should be seen by an orthopedic surgeon with x-rays done.

Protective equipment has gotten much better in the past few years, from better shoulder pads to fitted and padded undergarments that dissipate the force of a direct blow to the trunk and shoulders.

But still, a lot of times an injury to the back in football is from a direct blow, such as a receiver going up for a pass and being hit from behind.   Those usually aren't serious and require only time to be resolved.  Still, the kidneys are vulnerable and a potential kidney injury is something that cannot be ignored.  

That's why a medical evaluation is important.  If you remember one thing from today's column remember that if there is any blood at all in the urine (pink to red urine), then you need to see a doctor immediately.

As for those backpacks:  Parents, get involved.   Make sure that you help your teenager keep a proper fit with their backpack.   It should hit higher up the back than most of what I too often see, with the straps shortened and the bag fitting snugly against the back, not drooping down low.

When do you feel REALLY alive?

When do you feel really alive?   I mean, REALLY alive.   So alive that maybe you forget about everything else?   

This came up recently after I spent the afternoon swimming with my oldest grandchild.  She has discovered the joy of diving to the bottom of the pool with a mask on.  It seems simple but she really enjoys it.  I think she would do it for hours without stop.

And she allows me to share in that joy.  We will dive to the bottom, pose with our arms crossed, then drift to the top.  Or we will retrieve toys on the bottom just because we can.  We smile, we laugh, we hold hands, then down we go again.

When I saw photos of the two of us her dad took with an underwater camera, the thought popped into my mind--that's what being really alive is all about.  Joy.  Simplicity.  Lost in the moment. 

A great bike ride does that for me too.  When you're grinding up a steep hill, every thought, every bit of energy is put into that task.  It doesn't have to be something fun (some of those hills definitely aren't fun) but it reminds me that I'm alive. 

Did you ever laugh so hard that your stomach hurts?  At that moment, you really don't think about your problems, about life's difficulties.   You are in the moment. 

Really being alive isn't always the safe place.  Maybe my definition of really being alive doesn't amount to much more than being so engaged in what you're doing that you forget everything else.   That can include fear, heartache, and disappointment. 

But isn't that what tells us that we are alive?  The ability to feel, to experience?  We aren't promised that it will always be easy, just that we can get through good times and bad.

A friend sent me this quote:  "One of the biggest tragedies in life is to just settle...."

I like that.  We shouldn't "settle" for whatever is handed to us, the life that someone expects us to live.  It is up to us to explore new worlds, to dream our dreams, and to live our life to the fullest.  I believe that is what is expected of us.  And it requires us to often get out of our comfort zone.

I think another huge tragedy is to work at a job that you don't like.   A job that you dread.  That when the alarm goes off in the morning, you would rather do anything than go to work. 

Back in college, I wasn't interested in getting rich and famous.  I just wanted a job that I could enjoy.  At first, it was Wildlife Management but mostly because I thought I could hunt and fish for a living.  That didn't work out.

It took a knee injury to point me in the right direction (see "silver lining").  Now, when the alarm goes off, I can hardly wait to get to the office to see what patients are on my schedule, to discover the day's challenges.  I don't even know how the snooze button works.

So, back to my original question...what makes you feel really alive?

Maryville-Alcoa on ESPN

Unless you were totally not paying attention, there was a little game of football around these parts last Sunday.   One could make the argument that it was the biggest sporting event ever held in Blount County.

ESPN.  Sunday game.  Easily the biggest rivalry in Tennessee high school football.  (How many times do two teams only 6 miles apart with that many state championships play each other?)  Marine Corps All-American Rivalry Game.

An electric atmosphere.   A game that lived up to the hype.  An airplane trailing advertisements overhead.   A Kiowa Warrior helicopter on the practice field.  And a packed stadium of people, many of them a bit warm.  

OK, it was hot.   Not so hot that the game was in jeopardy of not being played.   We were way below that TSSAA threshold.   At game time, the temperature on the field was 89 and the humidity was 41%.  That produces a heat index of 90, well below the point where the game had to be changed.

But it was still hot.  For the players, we spent a lot of time and effort to make sure that the heat didn't affect them.   All week, Alcoa Athletic Trainer Peggy Bratt and I had been preaching hydration to our players.   We ask that they not pass a water fountain at school without stopping to take a drink and that they have a regular intake of sports drinks.

We practice in the heat, allowing them to acclimatize over several weeks before the first game.   The body can be conditioned to deal more effectively with hot conditions.

For the game itself, both sidelines had "misters," big fans with a spray of water that is very effective at cooling the players off.  Plenty of water and Gatorade were available at all times.   We broke out the ice towels (chamois towels soaked in ice water) early and even used them with the officials at times.  

I had a second athletic trainer on my sideline, Tracy Martin, and team physician Dr. Todd Griffith who helped me keep an eye on players that might be having difficulty with the heat.  And 10 student athletic trainers.  Peggy had Para-Medic Keith Amos and Alcoa team physician Dr. Mike Campbell on her sideline. 

The good news is that Peggy had only one significant problem with cramping but was able to effectively treat the athlete and return him to play without further problem.   And I only had one minor problem with heat cramps that didn't really interfere with his ability to play. 

The bad news is that the spectators didn't fare so well.    By reports that I have since heard,  Rural Metro transported six individuals to the hospital with heat-related problems. 

I would like to stop here and give kudo's to the Maryville Fire Department.   It seems like MFD Para-Medics and EMT's were everywhere on game day.   After the game, there were 3 spectators down with heat-related problems at once and there was at least 1 MFD employee with each of them.  

What could the spectators have done differently?   Drink more.   We think that we drink enough but probably don't.  I can tell you that the lines were already long when the gates opened at 9 and that means that by 3, folks had been out in the sun for a long time.

Fans that were passed out sure seemed to be popular.   Lack of moving air in the stands was a real problem.  Reflective clothing and hats would have helped.

But maybe the biggest thing is acclimatization.   Our football players benefited from having been out in the heat for long stretches of time in the preseason.  I suspect our spectators didn't have that advantage.

Please remember all that the next time you have to outside in the heat for an extended period of time.