Femoral Nerve Injury

I have a client who is recovering from a viral attack 6 months ago which left her with sensory nerve damage to her femoral nerve on the right leg, particularly affecting the knee and ankle. She currently walks with a stick and her goals are to build up her mobility and strength in the right leg. In addition to walking on the treadmill and using the bike (including single leg to work focus on the movement on the right leg), I’d be grateful for any other exercises you think would be appropriate. Many thanks Liz

 

 

Liz,

This is quite and issue that you are being presented with. Before I can give you some recommendations, I have some questions that need clarification. I am asking you, but these should be asked of yourself in order to dive deeper into this situation of healing your client.

 

1.      How do you know she has lost sensory innervation to her LE in those areas? Is this per the MD or PT’s evaluation? Have you done any dermotomal testing?

2.      Of course there are myotomal issues as well. Have you done a myotomal test for the LE’s?

3.      What type of virus did your client have? This can help us with additional referrals, nutritional work, lab testing, etc.? I have seen it damaged through compression, adhesion, tumors, diabetes, pelvic injuries and from issues with the psoas muscle. So for the reader’s education, knowing what virus would be another great piece to the learning puzzle.

4.      You say it affects her knee and ankle..how? Is she locked in a certain movement, is there a lot of hypomobility in these joints, are they hypermobile, are they flaccid, do they have edema and so forth?

5.      Have you done any other physical, movement, length-tension, primal pattern, inner unit, outer unit, SIJ tests, etc with this client?

6.      What other disciplines is she working with and what info can they present which will help dictate your recommendations and treatment?

 

As you can see there are a lot of questions and missing information for us to provide comprehensive/individualized recommendations. What I always tell my students when I teach or lecture is this: “You can’t treat dysfunction if you don’t understand function, if you can’t find it you can’t fix it and everything that we are provided with is the “branch” to your client’s tree. We need to ask the WHY questions in order to get to their “root.”

 

From my point of view, nutrition and lifestyle principles are the foundation for everyone’s healing. “You are what you eat,” as Paul Chek says in most of his programs. I would start with the basic nutrition and lifestyle principles in order to create a foundation for facilitative healing.

 

1. THOUGHTS: Everyday you wake up, the first thing that is turned on is your thoughts. If you follow the Law of Cause and Effect (thoughtsàwordsàdeeds), then it should all make sense. If you begin the day with good thoughts, then your words and deeds for that day will be positive and lead to success. Within the process of healing, you are what you think having become what you thought!
2. BREATHING: After you wake up and have a thought, the second thing you do is breath. Most of us yawn, as well as have an increase in respiratory rate secondary to the release of Cortisol (a stress and awakening hormone). The average person breaths 20K times/day. If you are stressed or you are a chest breather, you breathe 40K times a day. It has been shown that 70-75% of most visits to the MD are all related to incorrect breathing patterns. Something simple as breathing can create upper quarter dysfunction (neck and shoulders), which will snake its way through the body. This can inhibit any healing or realignment below.
3. HYDRATION: Most wake up and race for the coffee. What you should do and need to do is go for WATER! You have been dehydrated for 8hrs and coffee with just exacerbate that leading to headaches, constipation, decreased concentration and performance. Water helps to stimulate digestion, eliminate toxins and hydrate the body.
4. FOOD: The next thing most do is or think about is food. This is simple; focus on the quality (organic vs. conventional) and quantity (do you eat or skip meals, as well as what are your ratios of protein, carbs and fat). But most people wake up late and are too lazy to cook a meal, so they grab a bar. All nerves are surrounded in myelin which is a proteolipid layer (protein and fat). So the higher quality the food she is taking in, as well as the more protein and fat in relation to carbs, the better the chance of her CNS healing.
5. EXERCISE: This is the most confusing area for many. Some work out too much and some don’t work out at all. As a society, we work, sit, and eat more, but move less! Whether it is Qi Gong, Yoga, Tai Chi or just plain old exercise, get out there and move!
6. CIRCADIAN RHYTHMS: This is a fancy word for sleep. I would have to say the most common complain of all my clients, is that they are fatigued and want more energy. A great place to start is here with sleep. When you sleep, you release hormones to repair and regenerate. Up to 24% of the population falls asleep at the wheel each year.

 

When it comes to her rehabilitation, I can give you some general recommendations. I don’t know too much about your client, so to give you extensive individualized recommendations is not possible. I am going to give you some brief areas to look into and you can do the leg work from there.

 

With this type of injury, the myelin sheath and nerve cells tend to become damaged. Nerves tend to take up to 5x longer to heal than muscles do. So keep this in mind when creating your plan with your client. This is not going to be a 1 month deal. She has to be in it for the long hall.

 

1.      The main goal is improving or maintaining function and mobility. This can be done by referring out or working along with her PT and OT.

2.      You should refer her out initially to get a brace for her LE. This will help create functional mobility until she starts to gain back some LE control. Most people with this dysfunction have issues with LE extension, so walking, getting up stairs, etc is quite a task. The brace will help to create some stability, but also mobility.

3.      When it comes to training your client, you have to remember that you have to train her software, not hardware. As Bobath states, “the body knows nothing of muscles, it only knows movements.” So if you train your client on machines or try to isolate muscles, you will only create a beautiful muscle. But this will do nothing to train her software or CNS. Doing single leg work, etc is quite advanced to start with. I can see your train of thought, but if she has difficulty standing on two legs, is lacking intrinsic stability and global muscle coordination, standing on one leg will help her to create compensations.

 

You have to begin to think of what movement patterns your client is required to do in her everyday life (push, pull, bend, twist, lunge, walk, squat, and rotate). These are what are considered a primal standard, but what is her primal standard? As well, you can still begin with these patterns but in a more regressed pattern. Example: A squat is a primal standard, maybe for her a SB with DB against the wall. If we regress it, we can go to a Gravity machine squat and then to a supine hip extension back on back. So you have to think of the place of where she needs to start from in order to get her where she needs to be.

 

The only technique I have seen that actually trains the CNS is what is called DNS by Kolar. This is the work of Janda, Lewitt and Voijta out of Prague and Germany. It is the study of infant/ontogenic development and how CNS development through primitive reflexes, primal movements, stereognosis (recognizing objects through touch), somatognosis (body awareness),  motivation, and desire create morphology. This is done through palpating reflex locomotion points on a person’s body and using supine and prone infant positions to tap into the nervous system. This influx of afferent stimulation taps into the cortical level rewiring faulty movement patterns. You can learn more about this technique and to find a practitioner in your area at www.rehabps.com.

 

As for exercise, my best recommendation at this point if you can’t find a DNS practitioner in your area, would be to find a CHEK Practitioner Level 4 or have your client work initially with a Feldenkrais Practitioner. As all of these will work with regressed primal patterns and infant development patterns on the floor. They will increase body awareness by tapping into the CNS through sensory stimulation on the floor focusing on breathing, homologous, homolateral, contralateral and primal pattern movements.

 

You will see in most my posts I always talk about the healing totem pole and when people come to us, we might not be first on the pole. This is a good example. Keeping this client and doing machine work will do nothing but detrain the CNS. As well, just focusing on floor work with no plan or understanding of what you are doing will create reinforce faulty motor engrams. You can learn a great deal from working with these practitioners. I know this might not be the answer you are looking for, but in the end our goal is for client healing.

 

Good luck!

Joshua Rubin

www.eastwesthealing.com

 

Holistic Aproach to Retinopahty

Retinopathy

Helpful Natural Supplements and Treatments
 

OVERVIEW

Retinopathy is an eye disorder of the small blood vessels (capillaries) of the retina. The two main causes are diabetes and hypertension (high blood pressure).

With diabetic retinopathy, there are two kinds (nonproliferative and proliferative). Nonproliferative retinopathy is characterized by leaky capillaries, whereas proliferative retinopathy has increased capillary formation.

Hypertensive retinopathy develops from a thickening of the small arteries (arterioles), decreasing their response to light. As the disease progresses, the arterioles can also become leaky, further affecting vision.

Symptoms of retinopathy include blurred and fluctuating vision, difficulty adjusting from bright to dim light, poor night vision, and floating specks in the eye. If left untreated, retinopathy can lead to blindness.

SUPPLEMENTS FOR RETINOPATHY

There are several natural supplements that can help with retinopathy. Consult with your healthcare provider to see which of the following supplements may be appropriate for you. PLEASE NOTE: It is very important to make sure that supplements do not interfere with your medications or an existing health condition.

Vitamins & Minerals

No vitamins or minerals stand out as being particularly helpful for retinopathy.

Less Helpful: vitamins B1, B3, B6, A, C, E, and minerals magnesium and selenium.

Other Supplements

Polyphenols – A class of polyphenols, called proanthocyanidins (OPCs), may help to prevent or slow the progression of retinopathy. Good sources are grape seed extract and pine bark extract (French maritime pine).

Less Helpful: quercetin, rutin.

Herbs

Bilberry – This relative of the blueberry has several research studies supporting its benefit for both diabetic and hypertensive retinopathy.

Ginkgo biloba – One of the most popular therapeutic herbs in the world, one clinical study showed that ginkgo significantly improved color vision in patients with early diabetic retinopathy.

Less Helpful: butcher’s broom.

COMMENTS

Treatment includes more closely regulating blood sugar levels (if diabetic) or reducing blood pressure (if hypertensive). Laser treatment (photocoagulation) and surgery (vitrectomy) are also available. If you are a smoker, quit.

References
Jellin, JM, editor. Natural Medicines Comprehensive Database, 2007.
Pillepich, JA. The Nutraceutical Reference Guide, 2005.

www.eastwesthealing.com

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Benign Paroxysmal Positional Vertigo (http://www.american-hearing.org/disorders/bppv/bppv.html)

As I have found many different reasons for vertigo, stemming from severe food intolerance, poor nutrition and hypoglycemia, atlas subluxations and home/office toxic exposure, this article below has some great information summation the “branch” from all the “roots” above.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is thought to be due to debris that has collected within a part of the inner ear. This debris can be thought of as “ear rocks,” although the formal name is otoconia. Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the utricle (Figure 1). While the saccule also contains otoconia, they are not able to migrate into the canal system. The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age. Normally otoconia appear to have a slow turnover. They are probably dissolved and reabsorbed by the “dark cells” of the labyrinth (Lim, 1973, 1984), which are found adjacent to the utricle and the crista, although this idea is not accepted by all see Zucca, 1998, and Buckingham, 1999)

The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and nausea. Activities that bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common problem motions. Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called “top shelf vertigo.” Women with BPPV may find that the use of shampoo bowls in beauty parlors brings on symptoms. An intermittent pattern is common. BPPV may be present for a few weeks, then stop, then come back again.

What Causes BPPV?

The most common cause of BPPV in people under age 50 is head injury. In older people, the most common cause is degeneration of the vestibular system of the inner ear. BPPV becomes much more common with advancing age (Froeling et al, 1991). In half of all cases, BPPV is called idiopathic, which means it occurs for no known reason. Viruses affecting the ear such as those causing vestibular neuritis , minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome, and Ménière’s disease are significant but unusual causes. Occasionally BPPV follows surgery, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear (Atacan et al 2001).

How is BPPV Diagnosed?

Your doctor can make the diagnosis based on your history, findings on physical examination, and the results of vestibular and auditory tests. Often, the diagnosis can be made with history and physical examination. Infrared goggles can assist in the evaluation as this is able to minimize visual supression of nystagmus. The diagnosis is established through a Dix Hallpike test revealing mixed torsional and vertical nystagnus with the upper pole of the eye being toward the dependent ear and the vertical nystagmus being toward the forehead. Typically this begins after a 1-2 second latency lasting 10 – 20 seconds and typically is associated with a sensation of rotational vertigo. This finding is fatiguable over time (Furman and Cass. 1999). Most other conditions that have positional dizziness get worse on standing rather than lying down (for example, orthostatic hypotension). Electronystagmography (ENG) testing may be needed to look for the characteristic nystagmus (jumping of the eyes). It has been claimed that BPPV accompanied by unilateral lateral canal paralysis is suggestive of a vascular etiology (Kim et al, 1999). For diagnosis of BPPV with laboratory tests, it is important to have the ENG test done by a laboratory that can measure vertical eye movements. A magnetic resonance imaging (MRI) scan will be performed if a stroke or brain tumor is suspected. A rotatory chair test may be used for difficult diagnostic problems. It is possible but very uncommon to have BPPV in both ears (bilateral BPPV).

How is BPPV Treated?

The following treatment options are available:

• Office Treatment
• Home Treatment
• Surgical Treatment

BPPV has often been described as “self-limiting” because symptoms often subside or disappear within six months of onset. Symptoms tend to wax and wane. Motion sickness medications are sometimes helpful in controlling the nausea associated with BPPV but are otherwise rarely beneficial. However, various kinds of physical maneuvers and exercises have proved effective. Three varieties of conservative treatment, which involve exercises, and a treatment that involves surgery are described in the next sections.

Office Treatment of BPPV: The Epley and Semont Maneuvers

There are two treatments of BPPV that are usually performed in the doctor’s office. Both treatments are very effective, with roughly an 80% cure rate, according to a study by Herdman and others (1993). If your doctor is unfamiliar with these treatments, you can find a list of knowledgeable doctors from the Vestibular Disorders Association (VEDA).

The maneuvers, named after their inventors, are both intended to move debris or “ear rocks” out of the sensitive part of the ear (posterior canal) to a less sensitive location. Each maneuver takes about 15 minutes to complete. The Semont maneuver (also called the liberatory maneuver) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other. It is a brisk maneuver that is not currently favored in the United States.

The Epley maneuver is also called the particle repositioning, canalith repositioning procedure, and the modified liberatory maneuver. It is illustrated in Figure 2. Click here for an animation. It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30% at one year, and in some instances subsequent treatments may be necessary. While some authors advocate use of vibration in the Epley maneuver, we have not found this useful in a study of our patients.

After either of these maneuvers, you should be prepared to follow the instructions below, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear.

Instructions For Patients After Office Treatment (Epley or Semont Maneuvers)

1. Wait for 10 minutes after the maneuver is performed before going home. This is to avoid “quick spins,” or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don’t drive yourself home.

2. Sleep semi-recumbent for the next two nights. This means sleep with your head halfway between being flat and upright (a 45-degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see Figure 3). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist, or engage in exercise that requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eye drops are required, try to put them in without tilting the head back. Shampoo only under the shower.

3. For at least one week, avoid provoking head positions that might bring BPPV on again:

• Use two pillows when you sleep
• Avoid sleeping on the “bad” side
• Don’t turn your head far up or far down
• May need soft cervical collar to maintain head position

Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means that you should be cautious at the beauty parlor, dentist’s office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No sit-ups should be done for at least one week and no “crawl” swimming. (Breast stroke is all right.) Also avoid far head-forward positions such as might occur in certain exercises (for example, touching the toes). Do not start doing the Brandt-Daroff exercises immediately or two days after the Epley or Semont maneuver, unless specifically instructed otherwise by your doctor.

4. At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can’t fall or hurt yourself. Let your doctor know how you did.

Massoud and Ireland (1996) stated that post-treatment instructions were not necessary. While we respect these authors, at this writing (2002), we still feel it best to follow the procedure recommended by Epley.

What if one has bilateral BPPV?

There is some concern in this situation that treating one side followed by treating the other might “undo” the positive effects of the first. Therefore, a common approach is to treat the most symptomatic side first, and move on to the other a week later. Nevertheless, some physicians treat both sides in the same session, with good results. In either case, a follow-up visit is usually needed at roughly a week from the initial attempt.

What if the Maneuvers Don’t Work?

These maneuvers are effective in about 80% of patients with BPPV (Herdman et al, 1993). If you are among the other 20%, your doctor may wish you to proceed with the Brandt-Daroff exercises, as described below. If a maneuver works but symptoms recur or the response is only partial (about 40% of the time according to Smouha, 1997), another trial of the maneuver might be advised. When all maneuvers have been tried and symptoms are still intolerable, then surgical management (posterior canal plugging) may be offered.

BPPV often recurs. About 33% of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence (Hain et al, 2000; Nunez et al; 2000). If BPPV recurs in our practice, we usually re-treat with one of the maneuvers above, and then follow this with a once a day set of the Brandt-Daroff exercises.

In some persons, the positional vertigo can be eliminated, but imbalance persists. In these persons it may be reasonable to undertake a course of vestibular rehabilitation, as they may still need to accommodate to a changed utricular mass or a component of persistent vertigo caused by cupulolithiasis. This is best managed by a well trained therapist. Fujino et al (1994) reported conventional rehabilitation has some efficacy, even without specific maneuvers.

Home Treatment Of BPPV: Brandt-Daroff Exercises

Click here for an animation

The Brandt-Daroff Exercises are a method of treating BPPV, usually used when the office treatment fails. They succeed in 95% of cases but are more arduous than the office treatments. These exercises are performed in three sets per day for two weeks. In each set, one performs the maneuver as shown five times.

1 repetition = maneuver done to each side in turn (takes 2 minutes)

Suggested Schedule for Brandt-Daroff exercises
Time	Exercise	Duration
Morning	5 repetitions	10 minutes
Noon	5 repetitions	10 minutes
Evening	5 repetitions	10 minutes

Start sitting upright (position 1). Then move into the side-lying position (position 2), with the head angled upward about halfway. An easy way to remember this is to imagine someone standing about 6 feet in front of you, and just keep looking at their head at all times. Stay in the side-lying position for 30 seconds, or until the dizziness subsides; if this is longer, then go back to the sitting position (position 3). Stay there for 30 seconds, and then go to the opposite side (position 4) and follow the same routine.

These exercises should be performed for two weeks, three times per day, or for three weeks, twice per day. This adds up to 52 sets in total. In most persons, complete relief from symptoms is obtained after 30 sets, or about 10 days. In approximately 30% of patients, BPPV will recur within one year. If BPPV recurs, you may wish to add one 10-minute exercise to your daily routine (Amin et al, 1999). The Brandt-Daroff exercises, as well as the Semont and Epley maneuvers, are compared in an article by Brandt (1994), listed in the reference section.

Surgical Treatment of BPPV:

Posterior Canal Plugging

If the exercises described above are ineffective in controlling symptoms, the symptoms have persisted for a year or longer, and the diagnosis is very clear, a surgical procedure called posterior canal plugging may be recommended. Canal plugging blocks most of the posterior canal’s function without affecting the functions of the other canals or parts of the ear. This procedure poses a small risk to hearing, but is effective in about 90% of individuals who have had no response to any other treatment. Only about 1% of our BPPV patients eventually have this procedure done. Surgery should not be considered until all three maneuvers and exercises (Epley, Semont, and Brandt-Daroff) have been attempted and failed. See the article by Parnes (1990, 1996) in the references for more information.

There are several alternative surgeries. Dr. Gacek (Syracuse, New York) has written extensively about singular nerve section. Dr. Anthony (Houston, Texas), advocates laser assisted posterior canal plugging. It seems to us that these procedures, which require unusual amounts of surgical skill, have little advantage over a canal plugging procedure. Of course, it is always advisable when planning surgery to select a surgeon who has had as wide an experience as possible.

There are several surgical procedures that we feel are inadvisable for the individual with intractable BPPV. Vestibular nerve section, while effective, eliminates more of the normal vestibular system than is necessary. Labyrinthectomy and sacculotomy are also both generally inappropriate because of reduction or loss of hearing expected with these procedures.

Where Are BPPV Evaluations and Treatments Done?

Most otolaryngologists can effectively evaluate and treat BPPV. The Vestibular Disorders Association (VEDA) maintains a large and comprehensive list of doctors who have indicated a proficiency in treating BPPV. Please contact them to find a local treating doctor. In addition to physicians, well trained physical therapists and occupational therapists can perform this therapy as well.

How Might BPPV Affect My Life?

Certain modifications in your daily activities may be necessary to cope with your dizziness. Use two or more pillows at night. Avoid sleeping on the “bad” side. In the morning, get up slowly and sit on the edge of the bed for a minute. Avoid bending down to pick up things, and extending the head, such as to get something out of a cabinet. Be careful when at the dentist’s office, the beauty parlor when lying back having your hair washed, when participating in sports activities and when you are lying flat on your back.

What is Atypical BPPV (Lateral Canal BPPV and Anterior Canal BPPV)?

There are two rarer variants of BPPV that may occur spontaneously as well as after the Brandt-Daroff exercise, or the Epley or Semont maneuvers. They are thought to be caused by migration of otoconial debris into canals other than the posterior canal (that is, the anterior or lateral canal). There is presently no data reported as to the frequency and extent of these syndromes following treatment procedures. It is the author’s estimate that they occur in roughly 5% of the time after the Epley maneuvers and about 10% of the time after the Brandt-Daroff exercises for a significant BPPV. In nearly all instances, these variants of BPPV following maneuvers resolve within a week without any special treatment. If they do not, there are procedures available to treat them.

In clinical practice, atypical BPPV arising spontaneously is first treated with the same maneuvers as for typical BPPV, and the special treatments as outlined below are entered into only after treatment failure. When atypical BPPV follows the Epley, Semont or Brandt-Daroff maneuvers, specific exercises are generally begun as soon as the diagnosis is ascertained. In patients in whom the exercise treatment of atypical BPPV fails, especially in situations where onset is spontaneous, additional diagnostic testing such as MRI scanning may be indicated.

Lateral canal BPPV is the most common atypical BPPV variant, accounting for about 3% of cases. Most cases are seen as a consequence of an Epley maneuver. It is diagnosed by a horizontal nystagmus that changes direction according to the ear that is down. The side with the most severe symptoms is likely the involved ear. There are numerous treatments but most recently the 360 barbeque rotation toward the side with the less intense nystagmus done 2-4 times is typically the maneuver of choice (Fife, 1998).

Anterior canal BPPV is extremely rare and likely transient when it does occur. It is diagnosed by a positional nystagmus with components of downbeating and torsional movement on taking up the Dix-Hallpike position, or a nystagmus that is upbeating and torsional when sitting up from the Dix-Hallpike. The upbeating nystagmus on sitting may be very persistent as the debris settles on the cupula of the anterior canal. Anterior canal involvement is probably transient because debris naturally works its way out of the anterior canal with the head in the upright position.

Research Studies in BPPV

Considerable research is ongoing regarding BPPV. This is an exciting area as considerable progress has been made once the mechanical etiology of BPPV has been appreciated. Areas of particular interest include methods of improving the results of treatments, and preventing relapses.

At the American Hearing Research Foundation (AHRF), we are interested in projects that might lead to a better understanding of the basic mechanisms involved in BPPV, and improved treatment. Click here if you would you would like more information about contributing to the AHRF’s efforts.

Acknowledgments

Illustrations are courtesy of Northwestern University.

References

• Amin M, Giradi M, Neill M, Hughes LF, Konrad H. Effects of exercise on prevention of recurrence of BPPV symptoms. ARO abstracts, 1999, #774
• ATACAN E, Sennaroglu L, Genc A, Kaya S. Benign paroxysmal positional vertigo after stapedectomy. Laryngoscope 2001; 111: 1257-9.
• Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980 Aug;106(8):484-485.
• Brandt T, Steddin S, Daroff RB. Therapy for benign paroxysmal positioning vertigo, revisited. Neurology 1994 May;44(5):796-800.
• Buckingham RA. Anatomical and theoretical observations on otolith repositioning for benign paroxysmal positional vertigo. Laryngoscope 109:717-722, 1999
• Epley JM. The canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992 Sep;107(3):399-404.
• Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol 1998 May;19(3):345-351.
• Furman, J and Cass S: Benign Paroxysmal Positional Vertigo. The New England Journal of Medicine. 1999: 1590-1596.
• Fujino A and others. Vestibular t
• raining for benign paroxysmal positional vertigo. Arch Otolaryngol HNS 1994:120:497-504.
• Froehling DA, Silverstein MD, Mohr DN, Beatty CW, Offord KP, Ballard DJ. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 1991 Jun;66(6):596-601.
• Hain TC, Helminski JO, Reis I, Uddin M. Vibration does not improve results of the canalith repositioning manevuer. Arch Oto HNS, May 2000:126:617-622
• Harvey SA, Hain TC, Adamiec LC. Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. Laryngoscope 1994 Oct;104(10):1206-1212.
• Herdman SJ. Treatment of benign paroxysmal vertigo. Phys Ther 1990 Jun;70(6):381-388.
• Herdman SJ, Tusa RJ, Zee DS, Proctor LR, Mattox DE. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1993 Apr;119(4):450-454.
• Lanska DJ, Remler B. Benign paroxysmal positioning vertigo: classic descriptions, origins of the provocative positioning technique, and conceptual developments. Neurology 1997 May;48(5):1167-1177.
• Lempert T, Wolsley C, Davies R, Gresty MA, Bronstein AM. Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: a placebo-controlled trial. Neurology 1997 Sep;49(3):729-733.
• Lim DJ (1984). The development and structure of otoconia. In: I Friedman, J Ballantyne (eds). Ultrastructural Atlas of the Inner Ear. London: Butterworth, pp 245-269.
• Massoud EA, Ireland DJ. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J. Otolarynglogy 25(2):121-5, 1996
• Nunez RA, Cass SP, Furman JM. Short and long-term outcomes of canalith repositioning for benign paryxosmal positional vertigo. Otol HNS, May 2000:122:647-52
• Parnes LS, McClure JA. Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1990 May;99(5 Pt 1):330-334.
• Parnes LS. Update on posterior canal occlusion for benign paroxysmal positional vertigo. Otolaryngol Clin North Am 1996 Apr;29(2):333-342.
• Parnes LS, Price-Jones RG. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993 May;102(5):325-331.
• Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988;42:290-293.
• Smouha EE. Time course of recovery after Epley maneuvers for benign paroxysmal positional vertigo. Laryngoscope 1997 107(2) 187-91
• Welling DB, Barnes DE. Particle Repositioning maneuver for benign paroxysmal positional vertigo. Laryngoscope 1994 Aug;104(8 Pt 1):946-949.

Literature

• A 4-page, 4-color BPPV handout as is used in Dr. Hain’s practice is available at a small cost (click here for details).
• VEDA has recently published a patient-oriented book on BPPV.

Links

• http://www.charite.de/ch/neuro/vertigo.html — This is a self-treatment Epley protocol.

B. Joseph Touma, M.D. is a clinical instructor at the Marshall University School of Medicine in Huntington, West Virgina. He earned his M.D. from West Virginia University School of Medicine, Morgantown.

Hysterectomy and Recs after Surgery

My client, who is 43 years old, has had a hysterectomy carried out 8 weeks ago, and has been given medical clearance to return to training. While I’m aware of the importance of reconditioning the abdominal wall after this procedure,I have no previous experience of working with a client who has had this type of surgery.

There are a lot of components that go with this:

1.       After this surgery most women are given synthetic estrogen. Why you might ask…I ask the same thing! If you know the body, women produce more hormones than just estrogen and with this surgery why do MD’s just supplement with estrogen. According to Dr. Lee in the book Hormone Balancing Made Simple, the body stops producing progesterone 100% in the mid to late 40’s (can even be lower now a days secondary to the pill, medications, poor nutrition and lifestyle, plastics and pesticides). As well, most women only stop producing 60% estrogen by their mid 40’s and keep producing it in their adrenal glands and fat cells (this is very common because most people in our society today are overweight). So, if you are still producing it, why supplement with estrogen…why not supplement with other hormones that the body is not producing after this surgery or from menopause? What about progesterone, pregnenolone, DHEA, etc? For a client such as this, I would run the #205V from BioHealth Diagnostics (full hormone and adrenal profile) to see where all her hormone levels are at. These are saliva labs and not blood, which are more accurate as they test for the active form of the hormone. As blood only tests for the inactive forms..what is used up. From there, you will know what to supplement with, either herbs, bio-identicals,etc.

2.       Women with this surgery who do not supplement correctly with the above, typically end up with HPATGG axis dysfunctions (Hypothalamus-pituitary-adrenal-thyroid-gut-gonadal) according to Jeff Bland. What does this mean? Well assessing your client on all levels in order to get her nutrition and lifestyle in order to bring these axis’s closer to homeostasis.  I am not saying you should supplement all of these and test all of these, but keep your eye on them and treat them initially with the 6 Foundational HLC principles.

3.       You will commonly see weight gain and emotional issues as well from this surgery (midsection and depression). These are common side effects from a hysterectomy = estrogen dominance. These need to be addressed with labs, bio-identical and possibly and NT lab test from Metametrix to see where she might be off.

4.       What I have seen clinically (not diagnosing or doing research) is women who have this surgery and go on estrogen have a higher incidence of cancer (breast, cervix, etc).

5.       Focus as well on some NMT for her scar, as this will help with your physical work and inner unit function.

6.       Work on any energy work, etc to the 3^rd chakra, solar plexus, or SP/ST area, as this area is the mother of the 2^nd charkra, etc. That is where all her symptoms showed up.

 

Joshua Rubin

www.eastwesthealing.com