People often ask me: Why did you decide to do this? Why does your practice focus only on patients with dizziness, vertigo, balance problems or falls?
I respond that my specialty practice is powered by evidence and driven by empathy. The evidence behind Vestibular Rehab is the focus of my blogs, so I decided to write this blog to share with you the basis for my empathy.
The general concept that really motivated me to start my business of helping people with dizziness, vertigo and balance problems was seeing a population of patients that are completely falling through the cracks in our healthcare system today because the standard traditional medical model is not serving these patients adequately.
Patients I serve have often suffered for months or years with delays in care, inadequate evaluations, lack of proper diagnosis, inappropriate medications, unnecessary diagnostic tests, and with nowhere to really turn.
When I first got exposed to the vestibular population that I’m talking about, it was while I was working exclusively with geriatric patients because I had been doing home health physical therapy since 2004.
I took a course in Vestibular Rehabilitation in February of 2006 and I started assessing all of my home health patients for vestibular problems whether they were complaining of dizziness or not, in order to practice my new skills and to figure out how I could take better care of them.
What I found was that about 90-95% of my geriatric patients with any history of chronic falls, fall related injuries, dizziness, vertigo, or with complaints of imbalance or fear of falling, had undiagnosed vestibular problems.
I had never heard anything like that before, not even when I was in physical therapy school or from any of my colleagues. Seeing just how many older adults fall was the fuel for the initial fire that got lit inside of me to do something about this unrecognized and therefore underserved vestibular population.
The injuries are devastating. Injuries from falls are the number one reason that people stay in nursing homes without being able to return home or live alone after a hospital stay. Helping people with dizziness, vertigo, balance problems and falls in the geriatric population became my focus of advocacy work.
About 8 years ago, I had to take time off work and go on short term disabilty due to unexplained health problems. I was unaware at the time that I actually had vestibular related health issues. I didn’t even know at the time that I was a vestibular patient because nobody had diagnosed me with that.
I was seeing all these different healthcare providers, including different types of neurologists to try to get my symptoms treated which were primarily very severe migraines with vertigo and vomiting, motion-activated dizziness and other mysterious symptoms that were all related to vestibular issues and stress.
I went from one healthcare provider to the next but no one was able to determine the root cause of my disability.
Nobody really helped me.
Then I attended the first offering of Advanced Vestibular Rehabilitation physical therapy continuing education course by the Neurological Specialty Section of the American Physical Therapy Association (APTA).
There was a patient case study presented in that course that was exactly my story: a type-A, overworking, overachieving, high stress type personality with vestibular migraines, vertigo, vomiting episodes, dizzy spells, panic attacks, neck pain, and debilitating headaches.
My life was literally a vestibular patient case study and I couldn’t believe it! After about 25 years of having debilitating episodes of vertigo and dizziness myself that landed me in the emergency room repeatedly, I realized I was one of these patients!
I finally had an ah-ha moment and I realized not only are many older adults undiagnosed as vestibular patients, but I myself was an undiagnosed vestibular patient with a complex case that was causing significant disability!
Since I then understood how vestibular health problems could cause life-changing falls in older people and significant disability even in younger people like me, I was motivated to take action to help people with dizziness, vertigo, balance problems and falls who were being misunderstood and mismanaged.
On my own, I determined the source and root cause of my own health issues and my quality of life tremendously improved! After that, I realized that if I can help myself then I am more than capable of helping other people with vestibular problems… and I do, one at a time.
Disclaimer
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
Hi Dr Bell, I was recently diagnosed with vestibular migraines. I was prescribed Elavil but I am not sure it’s really helping. I wake up almost everyday with a slight dull headache. My neck always feels tight and bothers me. My dizziness/vertigo only lasts for a few seconds but many times a day. Not room spinning or vomit inducing, but more like an extreme pressure suddenly in my head and a zoned out feeling making it hard to concentrate. I notice it mostly when walking or when talking up close to people. I went to a vestibular PT for a while but that didn’t help much either to be honest. Does this sound familiar to you since you also have vestibular migraines? I recently read Heal Your Headache and have been on the diet for a few months. No change really. How and what did you identify was your major triggers? Thanks
Hi Jack,
I am sorry to hear what you are dealing with! I know it can be frustrating and disappointing when medications and vestibular rehab physical therapy are not helpful.
Your diet is a key part of minimizing vestibular migraine flare ups, so I am glad to hear that you are focused on that.
I share about my personal migraine triggers and strategies to avoid triggers in this blog.
I also share about strategies to stay hydrated in this blog, because dehydration is a common trigger.
I wrote this blog about migraine dizziness.
I used to have an arsenal of literally thousands of dollars of medications, including muscle relaxers, pain medicine, anti-inflammatory, triptans, and even injectables! I realized that the side effects were not worth it for me because honestly the medications did not even help me very much, so I worked with my doctors to wean off all my medications.
If you decide you want to stop taking your prescription because it is not helping you, I highly recommend that you work with your doctor, under his or her supervision, to transition off the medication. You should never stop a prescribed drug without consulting your physician.
I can share with you that the breakthrough that I had in reducing the frequency and severity of my vestibular migraines was when I consulted with a specialized physical therapist who adjusted my atlas bone (C1). That bone was out of alignment in my neck, causing constant neck tension and low grade ongoing headaches, which would flare up into major, debilitating episodes frequently.
I suggest for you to find a specialty provider in your area who is trained like my breakthrough PT and can address the alignment of your atlas bone, using this IPA referral list.
The other breakthrough for me was reading a book written by a Neurologist M.D. named Dr. Carol Bernstein, called “The Migraine Brain.” When her book was released, one of my friends bought me a copy and it was one of the most life-changing gifts I have ever received.
Dr. Bernstein’s book helped me realize that I have an ongoing neurological condition that must be managed everyday to prevent debilitating episodes, not only when I was having an episode, and it helped me understand how to engage my roommates, family, and friends in helping me avoid migraine triggers.
For example, certain cleaning products with noxious smells, LED lights which save energy by flickering at a rapid rate, and extremely loud music, etc. are now off-limits at my house!
On a positive note, I want to share with you an observation I have made through working with SO MANY people diagnosed with vestibular migraines. I make house calls to provide my specialty vertigo care, and I have been amazed at how my patients with vestibular migraines are so talented with art, poetry, film, photography, music, interior design, etc.
Seeing this pattern in my patients made me ask myself if there was a “hidden” creative artistic talent that my brain wanted to engage in – and I recently discovered a gift for composing original music! Now I am a singer-songwriter and I have recorded my first original music album which I plan to release soon.
I had a chance to treat a 14-year old young man with vestibular migraines last week and I reassured him that I believe he will discover some amazing, creative abilities he possesses due to his special “migraine brain.” So he replied that it was sort of like a trade-off, the creative talent comes with the challenge of having a highly sensitive brain! Yes, I agreed!
The final comment I will share is that you should be aware that people with migraines have a much higher rate of BPPV across the lifespan than people who do not get migraines. Therefore, I recommend for you to educate yourself about the symptoms of BPPV and the steps you should take it you experience BPPV. That way you can hopefully contain the episode into only a few days, and not develop chronic, untreated BPPV for years like many people I meet.
I hope that response was helpful!
If you want to share you experience writing to me on google, I would really appreciate a 5-star review on my business page.
Sincerely yours,
Kim Bell, DPT
Hello, Dr Bell—
I have confirmed bilateral bppv that was constant but now occurs intermittently. I was active in all 6 canals, including rare anterior. After 5 years of Epley chair treatment the bppv is better but I am swaying back & forth and in a clockwise motion (visible to my VPT).
I’ve had 18 drop attacks and a crises of Tumarkin. MAV ruled out. Only high-end hearing loss so no Meniere’s dx. Never dizzy or motion sick.
Drs at leading hospitals have said they are perplexed by my severe bppv & hypothesize utricle damage caused by an antibiotic (never had g’micin)
Would welcome fresh thinking on my case. I do daily balance work & take low dose diazepam to stop morning bppv.
Regards,
Julia
Hi Julia,
I am glad to hear that you have sought such expert care already. You have also clearly taken the initiative to educate yourself on this subject. Well done!
I definitely recommend tracking and documenting your symptoms according to my suggestions in this blog.
That type of data collection and reporting is what other professionals would need to properly analyze your case to determine root cause, to offer another opinion.
It is possible and common for people to have multiple root causes of their symptoms.
Whenever I meet someone with a case as complex as yours, I start from scratch with reviewing all test results, all symptoms from day one of the onset, all treatments provided and results from that care, all medications attempted and how they affect symptoms, etc.
I appreciate and value opinions by other professionals and specialists, but I do not “take their word for it” so to speak, since I have met too many people with inaccurate diagnoses even from excellent providers that I respect.
Vertigo is a very complex topic and often not limited to one body system. A multi-system approach can be valuable.
For a fresh perspective on your case, you may want to check out the list of root causes that I am routinely looking for on this page, listed underneath “What is the Bell Method?”
As an example of an unusual cause of vestibular issues, auto-immune issues can attack and cause damage to the vestibular system, including the utricle. Auto-immune problems can often be reduced by identifying food sensitivities and avoiding those foods.
That example is an “outside of the box” concept that some providers may not agree with me about, but I have seen great results when people cut out gluten or dairy in the case of suspected auto-immune inner ear issues.
I wish you all the best on your journey to determine and hopefully resolve the root cause(s) of your complaints. I encourage you to fully explore the possible root causes “in the box” of traditional medical care and also consider “outside the box” causes.
Sincerely,
Kim Bell, DPT
Would I be able to find a provider that does both vestibular rehab and could adjust my C-1?
Hi Angela,
You might find someone who says they can do both, but they probably won’t be at the level of skill that you need for both skills.
These are very different skillsets.
In published case studies where one physical therapist is treating BOTH the vestibular problem and the cervical issue for a dizzy patient, the patient did not get a full recovery. The case study is clear that the patient was still dizzy at discharge.
When I read those cases, I decided to find a reliable orthopedic clinical partner to treat my patients’ necks. And I have!
So we tag team these cases, and most of our patients recover 100%. That is what I want for you too!
To find an orthopedic manual PT, I suggest searching this directory.
To find a vestibular PT, use the online directories I mention in this article.
I hope that helps!
Sincerely,
Kim Bell, DPT