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  1. #1
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    Default Comments on recent Q&A podcast

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    Rip,

    In the spirit of trying to help I wanted to contribute some of my expertise to two of the questions you addressed on the podcast. (I'm a neurologist.)

    1) The 60-year-old man who wrote he can't bench press due to benign paroxysmal positional vertigo (BPPV) needs to find a doctor to treat his condition. That is a condition that is almost without exception curable with otolith repositioning maneuvers. The Epley is the standard and needs to be performed by a competent practitioner (many PTs know it) and is often curative immediately after. The half-somersault maneuver is one you can do at home yourself and may be of similar efficacy. You have to know which side your BPPV is for these, however. So again, he needs someone to actually diagnose and treat this curable condition.

    2) The man with "neuropathy" does need to be more specific about his condition. It is true that diabetes is the most common cause of peripheral neuropathy in the developed world (about 30-40% of cases), but there are many other important causes such as toxic (e.g. alcohol, drugs), hereditary, auto-immune, thyroid disease, and vitamin deficiencies. Somewhere between 20 and 40% of peripheral neuropathies are classified as idiopathic, meaning they have no known or confirmed cause. Some of these non-diabetic peripheral neuropathy types have quite effective treatments or even cures, which is where I spend much of my professional time. I've caught more than a few cases of very treatable CIDP where previous physicians told them nothing could be done. Whenever someone tells me they are numb only over the soles of their feet, however, I immediately suspect something else is going on. I've sent numerous people back to their primary doctor or podiatrist for plantar fasciitis causing burning or even tingling on the soles, usually after EMG rules out peripheral neuropathy.

    Your programs and publications are excellent. As a physician, I strive to never say stupid stuff.

  2. #2
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    I appreciate the help. Thanks for posting.

  3. #3
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    Quote Originally Posted by Mark Rippetoe View Post
    I appreciate the help. Thanks for posting.
    DF, Rip is a busy man of few words so let me expand. Please jump in more often. A perspective from a neuro is invaluable and like Rip said, we all appreciate anything you may want to post. We benefit when someone such a s yourself offers clinical experience to confirm or reject what we think. So again, thanks for the post.
    Heck of a first post!

    The SS audience always intrigues me, some of the most knowledgeable people out there.

  4. #4
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    Quote Originally Posted by dfclark68 View Post
    1) The 60-year-old man who wrote he can't bench press due to benign paroxysmal positional vertigo (BPPV) needs to find a doctor to treat his condition. That is a condition that is almost without exception curable with otolith repositioning maneuvers. The Epley is the standard and needs to be performed by a competent practitioner (many PTs know it) and is often curative immediately after. The half-somersault maneuver is one you can do at home yourself and may be of similar efficacy. You have to know which side your BPPV is for these, however. So again, he needs someone to actually diagnose and treat this curable condition.
    Who diagnoses this condition without treating it or referring it to someone who can? One of the most gratifying cases I've ever had was when I was in Tijuana at a free clinic. I treated a 10-year-old girl who was unable to walk for six months (I'm an internist not a pediatrician but it was an easy pick-up). A Dix-Hallpike revealed BPPV and I put her through the Epley maneuver. Her mother thought I was somehow abusing her and watched me like a hawk. When I was done, the child was able to walk normally. Her mother started wailing and thought I was a faith healer.

    As Dr Clark pointed out this guy needs to get this taken care ASAP...if the diagnosis is sound.

  5. #5
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    Quote Originally Posted by JFord View Post
    Who diagnoses this condition without treating it or referring it to someone who can? One of the most gratifying cases I've ever had was when I was in Tijuana at a free clinic. I treated a 10-year-old girl who was unable to walk for six months (I'm an internist not a pediatrician but it was an easy pick-up). A Dix-Hallpike revealed BPPV and I put her through the Epley maneuver. Her mother thought I was somehow abusing her and watched me like a hawk. When I was done, the child was able to walk normally. Her mother started wailing and thought I was a faith healer.

    As Dr Clark pointed out this guy needs to get this taken care ASAP...if the diagnosis is sound.
    Yup. I had a bout of BPPV several years ago. The doctor I saw happened to have his grandson (a med student) shadowing him that day, and got very excited when he diagnosed it...not something you see every day but the Epley works immediately and dramatically if the problem is simply the canaliths in the inner ear. A few years later I was able to perform the Epley on my now-wife and immediately cure her vertigo.

    There are other potential causes of vertigo of course, but it's worth ruling out the most obvious cause first.

  6. #6
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    Quote Originally Posted by JFord View Post
    Who diagnoses this condition without treating it or referring it to someone who can? One of the most gratifying cases I've ever had was when I was in Tijuana at a free clinic. I treated a 10-year-old girl who was unable to walk for six months (I'm an internist not a pediatrician but it was an easy pick-up). A Dix-Hallpike revealed BPPV and I put her through the Epley maneuver. Her mother thought I was somehow abusing her and watched me like a hawk. When I was done, the child was able to walk normally. Her mother started wailing and thought I was a faith healer.

    As Dr Clark pointed out this guy needs to get this taken care ASAP...if the diagnosis is sound.
    Iím not even a competent practitioner, but I can screen for and treat, if indicated, BPPV. This is a type of suffering that one simply does not have to suffer through. In all honesty, it can be fairly dangerous to try and live with. Falls are always a wild card.

  7. #7
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    Quote Originally Posted by JFord View Post
    Who diagnoses this condition without treating it or referring it to someone who can?
    Happened to me. Had BPPV (onset while bench pressing... that was an experience) this past summer. Didn't know what was happening at the time as I heard that Vertigo was extreme dizziness (I'd say that is a gross understatement). Ended up in the hospital for two nights, and I was released with a BPPV diagnosis and some papers on the Epley maneuver. I asked if there was anyone in the hospital that could help me with it and which side's canals had the issue, and I was told that no one in the hospital was capable and that I should just treat both sides myself following the handout.

    Two days after discharge, I went to another hospital for an ENT specialist's help. They didn't know how to assist me, and were going to refer me to an Audiologist for help (first available appointment in two weeks... hooray for government health "care") . Fortunately I got sick in the exam room (from the BPPV), and the Audiology department took me as a walk-in. Took two visits with the Audiologists to treat me well enough that I could function. Both Audiologists that worked with me explained that self-treatment (or treating the incorrect side) can cause more difficult issues (particles going into more difficult canals).

    Took three months and a Physical Therapist that specializes in TBI to cure the incident (the opposite side's canals had particles in the tough canals). The PT was candid about her experience with hospitals in the area (DC Metro) not being familiar with how to treat BPPV.

  8. #8
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    I have BPPV that occasionally reoccurs.

    I bought a gadget called a "DizzyFix", which is basically a funny-shaped liquid-filled tube that you clip to a hat. You tilt your head to move a bead from one end of the tube to the other, and by doing so you guide yourself through an Epley.

    You used to be able to buy them on amazon and ebay, but I don't see any right now. Worth tracking one down.

  9. #9
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    Damn, that sounds smart (I have a few relative who suffer from BPPV on occasion) -- so of course it is listed as "currently unavailable" on Amazon...

    *Though, as I look into it a bit, the "Home Epley Maneuver" described on this page doesn't look that complicated: Epley-CRP maneuver for BPPV

  10. #10
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    Quote Originally Posted by tallison View Post
    *Though, as I look into it a bit, the "Home Epley Maneuver" described on this page doesn't look that complicated: Epley-CRP maneuver for BPPV
    I got trained in it by a PT and was able to do it, but a year later after it recurred, I never managed to do it on my own. FWIW.

    Looks like the dizzyfix is only sold to doctors now, which makes me want to hoist the black flag and start slitting throats.

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