Anyone ever had these symptoms?

[Duke Dive Medicine]

Wow. Double whammy. Did he try the Epley maneuver (movement of your head in a sequential pattern), and did he give you any idea as to why you might have BPPV? Re the gas, I guess the proof is in the pudding, so to speak, if the Gelusil is helping your symptoms. What were you prescribed for the vertigo?

 

[DocVikingo]

Hi Marineman,

Good news that your medical work up has started in earnest.

A few comments, if I might:

1.

Here is the latest:I went to the doc yesterday... He quickly diagnosed BPPV after neurological/reflex/balance testing. He prescribed some meds to help with the dizziness, and told me to do the Brandt-Daroff Exercises... He also said this one can potentially take a while to heal.

BPPV does not "heal" in the classic sense. Its symptoms often are reduced over time by such activities as the Brandt-Daroff exercises, but there is no guarantee of benefit. Alternative maneuvers, such as the Semont maneuver or Epley, may be more reliably effective, but still offer no guarantee. You do not specify what meds were prescribed for the dizziness, but no meds to date have proven terribly effective against bona fide BPPV.

2.

He told me to take Gelusil... This part seemed odd since I've never struggled with any kind of reflux, but it has been gurgling a lot and fitting other GERD-like symptoms as well.

While you may or may not have true GERD, you are reporting clear features of GI distress and if this med is providing meaningful relief, by all means stay with your physician's recommendation.

3.

He also told me I should be fine to fly and dive for vacation in the next week and a half, except that it is likely I'll still be a little dizzy

I'm not sure that prognosis can be put forward with great confidence at this time. The most prudent course of action might be to see how you're feeling just prior to flying or once you arrive at your vacation destination.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[marineman]

The BPPV med is Meclizine, 25 mg. I took some this morning and I'm still pretty dizzy and not totally with it mentally. Did it help? Maybe a little, but not much. From what he said, this may stick around for a while. I'm a bit disappointed to hear all the horror stories about how long this can last, if it really is the underlying problem. It is really NOT a good feeling being this dizzy all the time. It really is a significant dizziness and vision blur. As for the Semont or Epley exercises, neither were done. I looked them up online this morning and I assume these may be what he referred to when he mentioned therapy? Maybe I'll try them on my own or with help from my g/f? Thoughts? I wonder how much of what I'm feeling isn't derived from the constant head issues I'm experiencing.

Another question. Does the BPPV diagnosis really add up? My ear issues took place at a dive around 2:00 PM Saturday, I had a fair amount of pain and a similar "head in space" feeling until 8:00 PM so I have no doubts ear issues may well be the culprit. However, I dove again with no problems at 10:00 PM Saturday and twice Sunday before 2:00 PM. The dizziness didn't really set in until around 7-8:00 Sunday night. Again, this time frame thing is throwing me off. It seems this would have been pretty quick to rear its head. Or, maybe I was so into the diving and tearing down camp that I really didn't notice it until I was still in a car when I really needed my full focus?

The GERD symptoms are definitely lighter with the gas meds, especially right after eating. I still feel fair pressure right at the bottom of my sternum, especially if I bend forward. However, it isn't so much a gassy feeling anymore, but almost the same cringy, full feeling like when you have the flu. also, if I take in and hold a full breath, I have a feeling similar to someone pushing up on the bottom of my rib cage.

After bowling last night, I felt mostly decent. It seems activity is a good thing since the worst times are right before /after bed when I am calm, and best times are during and after sports. I really felt like crap the first couple hours this morning!

I gave myself until Wednesday of next week. I'm set to leave Saturday. If I don't feel much better at that time, I will postpone the trip and focus on getting squared away. I'm not risking ruining a much anticipated vacation over this illness. The way I feel right now, I really hate to even drive. There is no way I'd attempt to fly or dive. Sadly, I have no reason to believe I will feel any better in 6 days when not much has changed after 11 so far.

 

[Bubbletrubble]

Either way, it looks like my heart and lungs check out, and DCS does not seem like the culprit. He also told me I should be fine to fly and dive for vacation in the next week and a half, except that it is likely I'll still be a little dizzy.

I find this advice questionable. If you are at all dizzy, you shouldn't be diving. Period. It is unlikely to improve underwater, and it could get a lot worse, leading to all kinds of problems. Feel free to go on your trip, but I'd recommend abstaining from diving if the dizziness doesn't resolve.

Did your physician ask you questions about your visual disturbances? Describing them as "funny" really isn't helpful from a diagnostic perspective. I would expect a certain amount of nystagmus (linked to BPPV, if that's the correct diagnosis) which could very well be consistent with the vision "blur" you described. If you are experiencing "drop-outs" of your vision in certain areas of your field of view, then that's certainly more concerning.

With regard to the epigastric pain, did your physician entertain the possibility of subcutaneous emphysema or an occult pneumothorax? Either could occur in the setting of pulmonary barotrauma.

I like family practice docs. I know several really good ones. They see a diverse range of ailments in their patient population. It sounds as though the physician you saw thinks the BPPV might have been caused by inflammation secondary to barotrauma (sustained during the dive) which dislodged some of the otoconia inside your inner ear. If the visual issues are inconsistent with BPPV-related nystagmus, though, I'd be insistent about getting a referral to a good neurologist.

 

[marineman]

Did your physician ask you questions about your visual disturbances? Describing them as "funny" really isn't helpful from a diagnostic perspective. I would expect a certain amount of nystagmus (linked to BPPV, if that's the correct diagnosis), but if you are experiencing "drop-outs" of your vision in certain areas of your field of view, then that's certainly more concerning.

I'm not real sure I know what you mean by visual "drop-outs", and honestly, I've never felt anything that is as difficult to describe as what is going on right now. I have two very distinct issues and can't even figure out if they are at all related. Talking vision alone, I have full vision in the sense that it isn't tunnel vision in any way. The doc did ask about that, among other things. It's more like the entire field of view is a shaky, kind of like I just got off a carnival ride. I have to pick my focal point and stick to it, but if I was looking at Person A at 12:00, Person B at 3:00 couldn't hit me in the side of the head with a rock without me seeing it coming. I'm talking clock-face coordinates, not quantum physics. When focused on my focal point, it does kind of feel like my eyes want to dance around, or like the focal point is jittery. The "follow the finger" test was every bit as hard as some of my college drunk nights. I would still probably fail the sobriety test due to poor balance. I'm still really groggy feeling and everything is almost surreal like my head is in the clouds. Does this help?

FWIW, I just ate lunch and accompanied with an antacid/anti-gas. My stomach isn't 100%, but it is noticeably more relaxed than in my earlier posts. My stomach/lower chest feeling better after eating has NOT been a common thing lately, though I do feel/hear it gurgling around down there.

 

[Bubbletrubble]

How did you get Person A to stand still for 3 hours? Just kidding.

The "jittery" vision does sound consistent with nystagmus. There's a system called the vestibulo-ocular reflex (VOR) which is responsible for this phenomenon.

 

[marineman]

How did you get Person A to stand still for 3 hours? Just kidding.

The "jittery" vision does sound consistent with nystagmus. There's a system called the vestibulo-ocular reflex (VOR) which is responsible for this phenomenon.

I've been working through older Doctor Who, so obviously Person A just took a quick ride in the TARDIS, rock and hand, and WHAM. LOL!

I don't like nystagmus or VOR. At this point, I'm happy to have some ideas that MIGHT actually add up to something. Unfortunately it sounds like it may hang around for a while. This diagnosis seems to make more sense than the stomach/chest stuff, but gas cramps sound way more appealing than stroke, pulmonary embolism, cardiac arrest, or many of the other possibilities!

 

[Duke Dive Medicine]

Re the Epley maneuver: it's not something your girlfriend can do, it's done by a physician or other specially trained practitioner.

I'm stuck on the "not totally with it mentally" statement. That is not a symptom of BPPV. Did you mention this to your FP doc, and if so, did he consider it in making his diagnosis? If he couldn't explain it satisfactorily, then I think you need to follow up with a neurologist.

I'll also second Bubbletrubble's advice not to dive until this is cleared up.

 

[DocVikingo]

Another question. Does the BPPV diagnosis really add up?

Hi Marineman,

The BPPV diagnosis seems probable. However, you are experiencing signs and symptoms involving several body systems and they're yet to all be acceptably accounted for. Frankly, to me there's still uncertainty as to diagnoses and treatment.

Stay on it until it's sorted out to your satisfaction.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

PS: Semont and Epley Maneuvers to Treat Vertigo

 

[cutlass]

I presume that you've had a blood test with CBC and it was ok? Also presumably, no fevers? Has anything changed in where you live, work, commute; e.g. construction or demolition, change of drinking water or food source? On the day of the dive, did you exert yourself in any unusual way, especially in terms of lifting or twisting your torso or neck? And your jittery eyes; does it tend to be horizontal or vertical?