Cervical :: Balance

[nopain]

The following is a quote from Dr. Thimothy Hain

http://www.american-hearing.org/diso...l_vertigo.html

Many patients who have vertigo in the context of neck disease have a BPPV type nystagmus on positional testing. This suggests that the neck afferents may interact strongly with vestibular inputs derived from the posterior canal.

I have episodes of vertigo that are not getting better with time (It's been 3 years). In fact they are getting worse.

My C6/7 is collapsed, C5/6 is collapsed, C4/5 herniated. I have had just about every test offered... multiple MRI's including upright, MRA, EKG/EEG, complete blood work 4 times, and testing at a dedicated balance center.

I have pain, but minimal compared to most. My forearms do "burn" on and off. But the Vertigo is the scariest as it can just come on and last for hours.

My vertigo is in fact positional with the worst cases happening at night and accompanied by night sweats. I awaken with the room moving and the back of my neck covered in sweat. I get up to use the bathroom and its all I can do to hold the walls and stumble to the toilet.

What makes the Vertigo subside is lying very still on my side with my right cheek and right hip on the bed/pillow. If I mirror this image to the left - left cheek on pillow, left hip on bed I will "spin" or feel like I am moving. Lying flat on my back puts uncomfortable pressure on the back of my head, but the spin will also subside.

My balance tests said "Central Vertigo" and mentioned the brain stem. I believe it to be SUBJECTIVE as it is worse with my eyes closed than open. My ears and vestibular system tested okay. So I have a diagnosis of sorts but not a "cause". So I go without treatment. I am considering Neurography Scans but I don't know if it would make any difference as I don't know if these kinds of nerves would even show up.

I have read what I can on "Cervical Vertigo" and while many believe this is a real entity, others do not. And the problem even when those who do believe it is for real - NO TREATMENT. Whats the point in a diagnosis without a treatment plan. I know I am sick, I feel it every day.

So where does that leave me? Sick without help. Honestly I have been to almost 25 different Doctors - Neurologists, Neurotologisit, Orthopedic and Neurosurgeons, ENT's, ND's, Physiatrists, and more. The problem is most do very little diagnosis. I don't need another Doctor to take my blood pressure and have me do the same reflex tests over and over. I need a Doctor who wants to figure this out or at least is willing to try and look beyond the same old 20 minute reflex tests.

I have read online about the ALAR LIGAMENT being unstable and causing Vertigo. This ligament attaches at C2 - known for Balance Problems. And while this seems to be accepted in the Chiro Community, it is not in the Medical Community. Where do I find a person who can test or image this ligament?

I do not believe that a simple Flexion and Extension XRay is sufficient to determine instability in the neck. I do believe in bad cases it would show, but what about mild cases where the neck could be stable in these extreme pictures but not stable as you tip the head to the right and towards the shoulder or any of 100's of other positions we encounter as we move about through out our day?

I have read of Digital Motion XRay but I wrote the company and they never responded. I guess they only want to sell equipment. They don't even maintain a list of where to get scanned.

So I am at a loss. How do I find a Physician with the skill set to figure out a Cervical Related Balance problem? How do I find a Physician that cares enough to take the time to actually investigate the problem? I'm very tired of waiting for hours to see a Doctor so he can look at the same plain jane MRI's and tell me I have a bad neck. I need to find someone who has a reputation for figuring out these "tough" cases. I have no insurance and I don't have money to throw at the wind any more.

And while it would be nice to go to Germany I simply don't have the resources to pull it off. I need to find someone on the West Coast - California, AZ, or NV. And that person may not even exist.

Any advise would be appreciated.

PS: I have 2 kidneys and will probably need to sell one to get help. But it would be better than dying and letting them both go to waste.

[mmglobal]

Nopain, I have a client in Seattle who recently got a digital motion xray of her neck. Very impressive study, but when all is said and done, it's just a moving flexion/extension study. Maybe there are certain conditions that will show on the motion study that will not on the traditional???

EDIT FOR CORRECTION.... digital motion study included full range of motion... lateral bending, twisting, etc. (end edit)

There are many causes for vertigo and I don't know the order that you should proceed in to rule them out. I would hope that your neurologist is very interested and has a plan, but from your frustration that comes through your post, I'm not sure where he/she has you headed.

I may be able to solicit input from some neurologists (local and not)... maybe you've already been through everything they would have to suggest... maybe not. Call me if you'd like to talk further about this.

Mark

[nopain]

I went to a Neurootologist which is a very rare disipline and very difficult to get into. He looked at my Brain MRI for about an Hour discussing what he found and did his examination. He said "We often don't determine a cause". He refused to look at my neck because he only works on the brain. So while the neck is tied directly to the brain (Go figure) he made no attempt to explain any vertigo as a result of neck problems. Odd because the brainstem extends into the neck for practical purposes.

So while not a waste (it confirmed what 3 ENT's already said, it's not your ears). The Neurotologist said that if I didn't get better in 3 months (That was more than a year ago) to come back and repeat the tests.

I chose not to do that as not only are the tests expensive ($500 to $700) they are about the most unpleasant experience you can have. They induce the vertigo with hot and cold water in the ear (Caloric Testing) 4 times!!! Each time you are spinning so violently (If you have a problem like I do) that you wish you would just die. I've been through a lot of unpleasant procedures but that is by far the worst. I'll take the needle long before that.

I have been to 4 Neurologists.

Neurologist #1. The first had his physcians assistant do all the testing. He looked at what she did and just nodded. Then I had to ask him to test me for Benign Postional Vertigo. It tested negative. Then that was it. He wrote me a prescription for Neurontin and sent me on my way. He told me to call him if it didn't get better. I did and he would never take the call.

Neurologist #2. Had a friend drive me to this one (a 200 mile round trip for me at the time). Showed up about 2:25 for my 2:30 appointment. At 4:30 that brought me into the patients waiting room, Weighed me all that kind of stuff. At 4:45 the Doc came in and put my MRI films up on the board and started to look at them. He showed me areas of problems (I had seen my films many times but a 2nd opinion was certainly welcome). He told me to walk back to his office. It was about 4:55 at this time. Then he looked at the Clock told me that he was not going to be able to do anything else that day and to schedule another appointment. Needless to say I left and did not return.

Neurologist #3 - Too long to mention. Did a pretty through work up. Somehow concluded that I had a spinal fluid leak. Because I told him I get headaches in the suboccipital area (I do) so scheduled me for a Bloodpatch for a "suspected leak". Bloodpatch was very unpleasant and made no difference. On a return visit to talk with him he told me to go see another Neurologist that he knew and when I got done seeing him to come back. I had no confidence in this guy after that. I knew another patient of his that he never diagnosed after 7 months, but finally they guys family practice Doctor figured out what was wrong with him.

Neurologist #4 - Same old reflexes tested. Told me he would have a surgeon friend look at the MRI's. Never happened, I drove out and got my films so I could take them to a surgical consult.

I'm not a Doctor shopper. But my experience has been very poor with picking Doctors out of the Phone Book. And almost no one will see me because I don't have insurance even though I do have the ability to pay. One even told me to drive her over $300 cash before they would schedule me an appointment.

So I just sit here and suffer. Because I can not afford 20 minute $300 office visits. They just look at me and say I don't know and send me packing.

Thats the reality. I've burned through $50,000 in these "pretend" Doctors. And I haven't really worked in 3 years now. So it's not intended to be a sob story. It's intended to point out the reality of a person who does not have insurance trying to get medical care. And if you don't have insurance the rates are sky high as almost everyone jacks up your price even though you can pay. And I always pay at the time of the visit up front.

I have found a Pain Doctor I kind of trust and that's about it. But so far what he has asked me to do I've done but it has made no real difference.

That's it. I'm not stubborn I'm easy to work with but I'm also not stupid and I'm not interested in Anti Depressants they all want to push on me. I've been on many meds and none of them did anything for me but make me worse. When I am in very high levels of pain I will take a Norco. I have about 5 5mg pills left from a subscription that is a year old. I get tired of trying to fight to get a prescription filled for the only Med that brings me any relief at all. And in a months time I may or may not take a single pill. I save them for the very worst days; those days when the pain really flares up. Usually my pain is mild and burning; it's the Vertigo that is the killer.

I saw the Digital Motion Xray is just flexion and extension. And I know there is no real 3D imaging technology. But you would think that because the neck actually does move to the left and the right that it is certainly possible that the instability could be created in a plain other than up and down.

Anyways thanks Mark. I appreciate what you do. Hopefully I'll be in the box soon and this will all be moot. Until then I just keep doing what everyone else seems to be doing. Suffering through every day.

So if you could pm me a name or two of Neurologist you trust I would try and take it from there.

[mmglobal]

Correction on the digital motion xray... there was lateral bending, twisting, etc... full range in a long video.

Please give me a call (n/c) to discuss neurologists.... are you in So. Cal?