Crazy night at the ER!

[MakingTheGrade]

Oof glad you’re ok.
It’s sadly a vicious cycle of pandemic leading to increased volume and short staffing, leading to burnout and people quitting, which just makes things worse, which leads to more burn out and more quitting.

Trust me, those of us working in the ED also don’t like what’s happening and don’t want us to be doing what we’re doing ( to quote a John Mulaney line)

Count me as one of those burnt out and taking a break from full time clinical care.

 

[DAF]

My only instructions where to follow up with my primary care if I still had it when my meds(Meclizine) run out, which is 5 days.
If that is the case which doctors should I ask him for a referral to?

Meclizine should be used only to help one get through the acute stage of the event. If you're still symptomatic on the meds, it does make me wonder if you might have BPPV (benign paroxysmal positioning vertigo, known as the crystal issue to the gen pop). Meclizine will not help for a dynamic (ever changing) issue like BPPV. BPPV is the most common cause of vertigo, and is remediable. But, it depends on which balance canal the otoconia (crystals) have worked their way into. Posterior or anterior canal involvement will usually elicit delayed vertigo when tilting head forward or back, or left and right when lying down. The vertigo should fatigue within 30 seconds if you maintain that head position. If you repeat the head maneuver that tests for it, the vertigo should be less intense. That's a hard thing to do because the ears, brain (interprets input and sends out commands to control eye position and postural control to muscles) and eyes work together to help us maintain balance. Horizontal canal BPPV can kick in with left or right head movements, and the response can be immediate or, in my case, delayed by 2.5 minutes when I had it. It may not fatigue over time. I have recurrent BPPV, and the otoconia have been taking the grand tour of my semi-circular canals over the years. I've only had to do maneuvers twice out of four times, they've cleared on their own the other two times, but it was at least a month.

So, using the info above, I would ask you to see what types of movement elicits vertigo. Also, I must clarify that you must be experiencing the sensation that either you or your environment is moving, as that is the true definition of vertigo. Dizziness or lightheadedness does not count.

If you're still VERTIGINOUS, at the time of your PCP appointment, and if it is positional, your doctor can refer you to PT for treatment. If you find that it's not positional as described above, you can ask your PCP to order a test called VIDEONYSTAGMOGRAPHY (VNG), which can evaluate you for both BPPV and a unilateral vestibular loss (loss of function of part of the balance system). You don't necessarily need to see an ENT first, the Audiologist will interpret the test and make recommendations to your PCP.

The VNG has three parts, ocularmotor eval, positional testing, and finally stimulation and assessment of the balance canals with cool and then warm air. For the ocularmotor tests, we want to see how your eyes move in response to different stimuli. Positional testing looks for BPPV and signs that there may be another non-specific (at that point) issue with the balance system. The caloric irrigations use thermal changes to assess the integrity of the actual motion sensing balance canals. The ear canal is irrigated with air for one minute (four times, cool for each ear, then warm, with a several minute break in between each one), which will change the density of the fluid in the balance canals and cause it to move. What the brain interprets from that is that you're rotating, and the brain will make corrective eye movements (called nystagmus) to try to help you maintain balance. How fast the eyes move (beat) gives us an idea of how healthy the balance canals are. You WILL perceive vertigo, but you'll be in the dark and lying on a table, completely safe. The vertigo lasts about a minute, and you will feel it lessen as the temporal bone returns to body temp).

Also, if you haven't had a hearing test in some time, that should be completed if your vertigo is not positional. And please make sure that your ear canals are clear of cerumen if indeed you go for the VNG test.

Hope that helps a little.

PS-many hospitals have audiology departments that can do the testing, and most ENTs have audiologists as well.

 

[Ibrakeforpossums]

Karl, if you schedule PT, make sure the therapist has the specialized training for vertigo. The therapists at our spine clinic don't and they would refuse to treat this. I'd have to send the patients to another practice.

 

[Karl_K]

Thanks @DAF
What it feels like is like being on a boat rocking side to side rather than spinning if that means anything.
After taking a pill I can if I move my head around bring on the feeling just very slight after a while.
I took the pill over 8 hours ago now and tilting my head side to side brings it on slightly but tilling my head up and down brings it on strongly

 

[Diamond Girl 21]

I'm glad you're ok. My mom had this issue. After the other possibilities for her symptoms were ruled out, she saw an ENT who prescribed meds for a short time, and treated her by maneuvering the position of her head. Apologies if this was already suggested.

 

[diamondringlover]

I am glad you are OK!!! I too suffer from vertigo, few years ago I was like that for about 4 months they ran every test under the sun...nothing showed up as wrong but I was a tad low on my sodium levels...I took meclizine like candy till I went to a ENT and they said DONT TAKE IT, he was very forceful about it lol, he said to only take it during acute stages, I still suffer from it but nothing as bad as that...I have suffered with this crap for the last 40 years it truly does suck.

 

[DAF]

Thanks @DAF
What it feels like is like being on a boat rocking side to side rather than spinning if that means anything.
After taking a pill I can if I move my head around bring on the feeling just very slight after a while.
I took the pill over 8 hours ago now and tilting my head side to side brings it on slightly but tilling my head up and down brings it on strongly

It does sound like BPPV. I missed at the beginning that you fell. Did you fall because you had vertigo or did the vertigo start after the fall (and if so, was it a good jolt or did you hit your head?).

 

[Karl_K]

It does sound like BPPV. I missed at the beginning that you fell. Did you fall because you had vertigo or did the vertigo start after the fall (and if so, was it a good jolt or did you hit your head?).

Fell because of vertigo, the first one I felt like I was going to fall down the stairs so pushed off the wall and basically sat down hard on the top step.
Was to off kilter to walk down the stairs, so scooted down the stairs.
Then went to stand up and just kinda folded back down catching myself on the railing.
Did not hit my head thankfully.

 

[MamaBee]

Fell because of vertigo, the first one I felt like I was going to fall down the stairs so pushed off the wall and basically sat down hard on the top step.
Was to off kilter to walk down the stairs, so scooted down the stairs.
Then went to stand up and just kinda folded back down catching myself on the railing.
Did not hit my head thankfully.

@Karl_K I feel so bad for you..My husband had a bad case of vertigo. He got his from using an inversion table. He went to the emergency room twice a day apart because he couldn’t stop vomiting. He got severely hydrated. The second time they admitted him because of his age. I hope you feel much better now..

 

[Daisys and Diamonds]

Oof glad you’re ok.
It’s sadly a vicious cycle of pandemic leading to increased volume and short staffing, leading to burnout and people quitting, which just makes things worse, which leads to more burn out and more quitting.

Trust me, those of us working in the ED also don’t like what’s happening and don’t want us to be doing what we’re doing ( to quote a John Mulaney line)

Count me as one of those burnt out and taking a break from full time clinical care.

Take it easy @MakingTheGrade .
Have lots of cuddles with Shale and play with pearls

 

[CMN]

Dear @Karl_K, just saw your thread now. I am so glad you are okay but also hoping the doctors can out what is going on so you have some resolution. Keep positive.

 

[Daisys and Diamonds]

How you going Karl ?
Has the room stopped spinning ?

 

[Karl_K]

How you going Karl ?
Has the room stopped spinning ?

Still having episodes when not on the pills at times.
One ear is now hurting a bit and feeling "presurey".
Im wondering if an ear infection is behind the whole thing.
I dont know if that would respond to the meclizine or not.

 

[Daisys and Diamonds]

WStill having episodes when not on the pills at times.
One ear is now hurting a bit and feeling "presurey".
Im wondering if an ear infection is behind the whole thing.
I dont know if that would respond to the meclizine or not.

Never having had a baby let me just say i think ear pain is some of the worst
I hope it sorts itself out or you get to your GP for some antibiotics to fight that infection
But that would certainly explain things
Take care Karl

 

[lulu_ma]

Hi Karl-I hope you are feeling better.

My MIL had a severe bout with vertigo for several months. If an ear infection is ruled out, PT may help-as others have mentioned. But get a referral to an ENT specialist as soon as you can to be safe. It took a while for us to find a good ENT for my MIL. After several frustrating months, she finally had to get cortisone injections in her ear. She's in good shape now.

As to your ER experience, I am sorry to hear that, but not surprised. My best friend was an ER nurse. She had to switch jobs because the hospital admin was stretching the nurses so thin. She was fearful of being put into a position that would jeopardize her nursing license.

 

[Karl_K]

Still about the same, have an appointment with my PCP on wed afternoon

 

[mrs-b]

Still about the same, have an appointment with my PCP on wed afternoon

I'm glad you're following up. I have postural vertigo and it's a bear of a thing.

Saying some prayers for you, my friend.

 

[Daisys and Diamonds]

Gary has it today
not baddly but enough

 

[Karl_K]

Gary has it today
not baddly but enough

That stinks.
Prayers outgoing.
I'm really surprised at how many people are dealing with it

 

[Daisys and Diamonds]

That stinks.
Prayers outgoing.
I'm really surprised at how many people are dealing with it

Thank you Karl
Much appreciated
Its a fairly mild case compaired to previous times and of course to your bout of it right now but he's stilll feeling pretry cr*ppy
Until i got it i honestly did not understand why he couldn't put up scaffold and paint the house

Year - its like its the last taboo condition which makes no sence with no excuse or risk of embarrassment so why we don't talk about it till someone else suffers from it i have no idea ?

Perhaps we think no one else will beleave how bad it is till they get it ?

 

[Karl_K]

Very unhappy with my pcp. Told him about earache which is worse, he looked in it and said it looks fine and dismissed it.
More meclizine pills and an ent referral, have to call tomorrow to see when I can get into the ent.

 

[Daisys and Diamonds]

Very unhappy with my pcp. Told him about earache which is worse, he looked in it and said it looks fine and dismissed it.
More meclizine pills and an ent referral, have to call tomorrow to see when I can get into the ent.

Oh that's BS Karl

 

[Mlh]

Oh that's BS Karl

Very unhappy with my pcp. Told him about earache which is worse, he looked in it and said it looks fine and dismissed it.
More meclizine pills and an ent referral, have to call tomorrow to see when I can get into the ent.

Wow.So dismissive! Hopefully the ENT will take you more seriously. So sorry Karl!

 

[Daisys and Diamonds]

Just before i left my reasonably well paying timber yard to move to our new home we both taught this terrible virus
it obvesouly wasn't overly contahouse because i only ever heard of other people with it, not actually knowing them
in retrospect we now think it was definatly some kind of covid -( just not covid 19)
We were both so sick
Amoung other things we both had very bad ear ache - like crying pain it was so bad, plus a terrible cough and generally feeling very unwell
the doctor couldn't even see in my ear it was so swelled up so she gave me antibiotics ... which did jack sh*t because it was a virus (i had not had antibiotics for years - we try not to take them unlese its really necessary due the worrying resistances of antibiotics)

Anyway we were zapped of energy, i had 3 weeks off work (2 weeks had been holiday)
Poor Gary ended up with what we want to call a version of long covid (just not covid 19)
But neither GP was all that intetested in finding out what was wrong with us -
it would have floored an older person

I'm now angry about Karl's doctor (i assume a PCP is what you call a GP - general practitioner- or old fashoned family doctor)

 

[Karl_K]

i assume a PCP is what you call a GP - general practitioner- or old fashoned family doctor)

Yes,
pcp is insurance speak for primary care physician.
They can be several different types but are generally family practice or Internal medicine doctors.

When the medical group the doctor I like a lot quit taking our insurance with less then 20 days notice, he was the one of only a couple from the other medical group that was taking new patients.
We have never really hit it off and he is to dismissive and abrupt.
I just avoid him if at all possible.
I was going to switch to someone else in the group then covid hit and they are not allowing patient transfers in the medical group.
I should check and see if they are allowing it now.

 

[Ibrakeforpossums]

Consider a nurse practitioner or PA, physicians assistant. They can prescribe, order tests, and I've found them to be more thorough and more open-minded.

 

[doberman]

Go to the ENT.

 

[Karl_K]

Go to the ENT.

Waiting for the referral to be processed then I can get an appointment.
Hopefully it will not be in 4 months.

 

[Karl_K]

First week in July is the soonest I could get an appointment but am on the list if they have a cancellation.
Scheduled for a hearing test then with the ENT right after.

 

[DAF]

Still having episodes when not on the pills at times.
One ear is now hurting a bit and feeling "presurey".
Im wondering if an ear infection is behind the whole thing.
I dont know if that would respond to the meclizine or not.

Meclizine won't help with the pressure sensation. It dulls the central nervous system so that you don't "feel" as vertiginous. Karl, is there any tinnitus in that ear? Now I really do recommend seeing an Audiologist for a hearing test.