Hi,
Had a rewarding experience today in GP world - a lady came in complaining of severe dizziness for the last month or so, and I managed to diagnose and treat the condition in about 10 minutes, leaving a very satisfied and surprised patient!
When patients complain of dizziness, it is important to find out what they mean by this - importantly separating out the symptoms of vertigo (feeling like the world is whirling around, like you have just stepped off of a fast merry-go-round)
Not all fun and games
She had these vertigo symptoms when looking up to do her mascara, and when turning over in bed. This is very suggestive of a disease called Benign Paroxysmal Positional Vertigo (BPPV) where there are little crystals in your ears which keep the fluid moving after you stop your head from turning, making it feel as though you are still moving/spinning.
A simple test for this is known as the Dix-Hallpike test, and simple involves having them sit on a couch looking at 45 degrees to one side, then rapidly lying them down - this makes them feel very dizzy and makes their eyes spin in circles (rotational nystagmus). A potential risk of this manoeuvre is you make the patient feel so poorly that they then vomit on you. fortunately this did not happen here!
Because this condition is due to the crystals in the inner ear, it can easily be cured by putting the patients head through a series of different positions (known as Eply manoeuvre). This basically shakes the crystals out of the inner ear and cures the problem.
This is exactly what I did - aided in part by good ol' Wikipedia on my phone by the bedside as I had never done these moves before. It worked wonderfully, these problems which had ruined this patients life for a month were gone after a few minutes of turning around and about. She was able to walk out of the practice cured and happy, very grateful for what I had done. It made my day, being able to cure someone with your bare hands (and the not-insignificant power of Wikipedia!)
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That is so impressive. I have yet to see someone do this test leave alone the treatment ( except on YouTube). Thank you that was an eye opener. Wish you all the best.
ReplyDeletePatients with BPV often re-present after Eply's - did she?
ReplyDeleteAnonymous - very astute question!
ReplyDeleteShe actually did re-present 3-4 days later with 'dizzyness' of a very different nature, and was Hallpike negative. She said the dizzyness was on and off at strange times, rather than when she moved her head as before. She was worried she had dislodged another otolith.
I wasn't really too sure what was going on this second time, whether her ears were sensitive still, whether she had become more aware of dizzy symptoms and was over-interpreting things but it didn't seem as though the problem was vertigo.
I asked her to leave it a week or two more and keep a symptom diary. Does this sound like a sensible course of action?