Our sense of position of our head is derived from the interaction of the otoconia, also known as otoliths, which are calcite crystals (a form of complex calcium carbonate biominerals), and sensory receptors (the maculae) in the utricle and saccule in our inner ear. These apparatus are called the static labyrinth of the vestibular system. They allow us to maintain the centre of gravity between our 2 feet while standing, walking and running. The apparatus of the dynamic labyrinth of the vestibular system are the posterior, anterior and lateral/horizontal semicircular canals. The canals are filled with fluid (the endolymph) that moves when we rotate/tilt our head, thereby providing us with a sense of balance. The static and dynamic labyrinth is part of segmental awareness - knowing the position of the body in space - comprising 3 systems: visual, proprioceptive, and vestibular.
The occurrence of dizziness is due to the unfortunate random movement of the otoconia from the utricle into the endolymph of the canals, which gives us a spinning/whirling sensation. This random occurrence may be due to trauma, migraine, inner ear infection or disease, diabetes, osteoporosis, intubation (possibly when we lie in bed for too long) and reduced blood flow. For my cases of dizziness in February and May 2019, although I'm usually lying in bed outside of work and activities at my PC at home, I'm guessing the consumption of the wrong foods (liver and other internal organs), which might have changed my blood flow sufficiently to affect the levels of endolymph in the ear canal. This might have caused the capture of otoconia into the canals with the wrong tilt of the head. I'm guessing this because I could feel a slight dizziness (a dazed sensation) before I went to bed the nights before I woke up to more severe dizziness (severe spinning sensation).
My dizziness of February and May 2019 persisted through different medications from the doctors at the polyclinic, such as prochlorperazine, betahistine mesilate and cinnarizine. I even supplemented my western medications with the Traditional Chinese Medicine Lophanthus, to dubious effects. For the Feb 2019 case, my dizziness dissipated after 6 days. For the May 2019 case, my dizziness persisted for 11 days, until I tried and succeeded in using the Epley's manoeuvre/maneuvre to move the otoconia in my canals back into the utricles of my inner ear. I was told that I had BPPV on day 8 of my dizziness (10 May 2019) after consulting a doctor at a polyclinic, although he did not suggest using Epley's manoeuvre, but instead referred me to Singapore General Hospital's Otolaryngology (ENT) department to obtain specialist consultation. Obviously, these doctors do not take care of the well being of their patients' finances when healthcare costs are rising persistently. Specialist consultations are expensive even with government subsidies, especially for one taking home only about $800 per month, and who has various other medical conditions to attend to.
29 July 2019 Update
I was unfortunate to be hit with suspected food poisoning on 1 June 2019 Saturday when I had my dinner at the Koufu foodcourt at White Sands, which was a mixed rice dish with kangkong, beef and stewed peanuts. I had eaten mixed rice with kangkong and beef before without problems, but this time, I was unfortunate to have eaten peanuts which might have looked a little stale and bad on hindsight. I then did some light exercises after dinner for about 15 min, which is a regular event every Saturday when it's not raining, and I do not feel unwell. It is also my only formal exercise each week. When I got home, changed and removed my ischial ulcer dressing in the bathroom in order to bath, I completely lost memory and consciousness of what happened after that. I was only conscious that I was in bed vomitting some time later. My mother told me that that was my fourth time vomitting. Amazingly, I had vomitted 3 times without knowing about it, and even took some Chinese medication (Lophantus pills) for it. I was definitely severely weakened and dazed/dizzy, and the skin of my neck hurts (a sign of possible dermographism).
After the vomitting stopped, I slept on my hospital bed at home with elevated incline to reduce the dizziness and my chance of vomitting. I could not see a doctor at the polyclinics because they were closed for the weekend, and my mother did not think that it was serious enough for a visit to the emergency department of the hospital. Sleeping on an inclined bed left me with pain at my sacrum and coccyx area, and I could not sleep, walk or bend properly for several days. I tried the Epley's manoeuvre several times during that weekend, but this time, it failed to resolve the dizziness. I only saw a doctor on Monday 3 June 2019, and knowing that I will be visiting a dizziness specialist on 31 July 2019 and that I had a new stock of prochlorperazine, I was not prescribed any new dizziness medicine. I was prescribed Ketoprofen plasters for my sacrum and coccyx, and neck pain. Evidently, the doctor had no clear understanding of how my food poisoning could have resulted in so many problems. My current guess for the cause of my dizziness is ototoxicity.
Specifically on resolving my dizziness using Epley's manoeuvre, I tried again on 28 July 2019 Sunday on my bed, and realised that the displaced otoconia may be trapped and lodged onto my left posterior canal cupula, a sign of cupulolithiasis. This is because when I lie flat and turn my hanging head left in the first step of Epley's manoeuvre, there was a burst of positioning nystagmus (spinning sensation), and when I turned my hanging head right in the second step of Epley's manoeuvre, there was also a burst of positioning nystagmus. I completed my Epley's manoeuvre with no other nystagmus, but when I lie down and turn my head left again, there was another burst of positioning nystagmus. This may show that the otoconia could not move away from the posterior cupula and was just flapping about the posterior cupula when I turned my head while lying down. However, I tried Epley's again later in the day and it worked. There was only a very slight floating sensation when I move my head, until I brush my teeth in the morning of 29 July 2019. My dizziness recurred slightly due to the vibration of my teeth brushing and my looking and bending down towards the sink while brushing. These actions must have been enough to dislodge the otoconia from the utricle.
09 Aug 2019 Update
My seeing the specialist doctor at SGH on 31 July 2019 did not resolve my dizziness issue although the whole process took almost 2 hours, much of which was done waiting. The doctor first sent me for a basic hearing test and impedance audiometry, which I pass. When we finally met in her room, the doctor put me through some exercises/movements for testing dizziness and balance. The doctor also did the Dix-Hallpike test on me, which while i have some brief dizziness at the beginning of the test before the doctor could observe my eyes for nystagmus, there was no dizziness/nystagmus when she observed my eyes. The doctor also refused to consider research findings that a calcium imbalance might have caused the prolonging of my dizziness. This imbalance might have been triggered by my incidence of food poisoning, which is still questionable because the SFA Singapore Food Agency, which responded to my complaint of food poisoning, had checked and confirmed that food processes were fine at the Koufu food court's mixed rice stall. However, they could not check if the food on that fateful day might have been stale or bad. The doctor also explained that my encounter with repeated vomitting and loss of consciousness may be inexplicable scientifically because it is a one off incident. The doctor even proposed sending me for a $150-$200 test to test my nystagmus, which I rejected outright because it's too expensive.
From the website www.vitamindcouncil.org, I found an article which states that "BPPV is the most common cause of vertigo. Although this condition may result secondary to head trauma, migraines, prolonged bed rest and otologic surgery, 80% of all cases occur as an isolated event with an unknown etiology (idiopathic)". It is evident that my occurrence of "food poisoning" is one of these idiopathic cases. It also stated that "The researchers concluded, “The present study indicated that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.”" This implies that taking vitamin D supplements could help reduce BPPV recurrence. And taking vitamin D supplement (in the form of one pill of Coco Omega from Ocean Health) was what I did on the night of 30 July 2019, and which I continued from 01-07 Aug 2019. My dizziness was resolved starting 01 Aug 2019. I usually take one pill in the morning. When I stopped taking one pill in the morning on 08 Aug 2019 due to my taking of a bowel moving TCM medication, in the evening when I had to lie down for my dressing applications in a compromised position for dizziness, I could feel a floating sensation again. This is the beginning of dizziness. I immediately took one pill of Coco Omega at night before I sleep and recovered. Although Coco Omega contains only coconut oil and fish oil with smaller amounts of vitamin D, it was sufficient to resolve my dizziness. I will try cod liver oil capsules with more vitamin D when I finish my batch of Coco Omega capsules. The June dizziness spell took me 2 months in total to recover from.
References:
The occurrence of dizziness is due to the unfortunate random movement of the otoconia from the utricle into the endolymph of the canals, which gives us a spinning/whirling sensation. This random occurrence may be due to trauma, migraine, inner ear infection or disease, diabetes, osteoporosis, intubation (possibly when we lie in bed for too long) and reduced blood flow. For my cases of dizziness in February and May 2019, although I'm usually lying in bed outside of work and activities at my PC at home, I'm guessing the consumption of the wrong foods (liver and other internal organs), which might have changed my blood flow sufficiently to affect the levels of endolymph in the ear canal. This might have caused the capture of otoconia into the canals with the wrong tilt of the head. I'm guessing this because I could feel a slight dizziness (a dazed sensation) before I went to bed the nights before I woke up to more severe dizziness (severe spinning sensation).
My dizziness of February and May 2019 persisted through different medications from the doctors at the polyclinic, such as prochlorperazine, betahistine mesilate and cinnarizine. I even supplemented my western medications with the Traditional Chinese Medicine Lophanthus, to dubious effects. For the Feb 2019 case, my dizziness dissipated after 6 days. For the May 2019 case, my dizziness persisted for 11 days, until I tried and succeeded in using the Epley's manoeuvre/maneuvre to move the otoconia in my canals back into the utricles of my inner ear. I was told that I had BPPV on day 8 of my dizziness (10 May 2019) after consulting a doctor at a polyclinic, although he did not suggest using Epley's manoeuvre, but instead referred me to Singapore General Hospital's Otolaryngology (ENT) department to obtain specialist consultation. Obviously, these doctors do not take care of the well being of their patients' finances when healthcare costs are rising persistently. Specialist consultations are expensive even with government subsidies, especially for one taking home only about $800 per month, and who has various other medical conditions to attend to.
29 July 2019 Update
I was unfortunate to be hit with suspected food poisoning on 1 June 2019 Saturday when I had my dinner at the Koufu foodcourt at White Sands, which was a mixed rice dish with kangkong, beef and stewed peanuts. I had eaten mixed rice with kangkong and beef before without problems, but this time, I was unfortunate to have eaten peanuts which might have looked a little stale and bad on hindsight. I then did some light exercises after dinner for about 15 min, which is a regular event every Saturday when it's not raining, and I do not feel unwell. It is also my only formal exercise each week. When I got home, changed and removed my ischial ulcer dressing in the bathroom in order to bath, I completely lost memory and consciousness of what happened after that. I was only conscious that I was in bed vomitting some time later. My mother told me that that was my fourth time vomitting. Amazingly, I had vomitted 3 times without knowing about it, and even took some Chinese medication (Lophantus pills) for it. I was definitely severely weakened and dazed/dizzy, and the skin of my neck hurts (a sign of possible dermographism).
After the vomitting stopped, I slept on my hospital bed at home with elevated incline to reduce the dizziness and my chance of vomitting. I could not see a doctor at the polyclinics because they were closed for the weekend, and my mother did not think that it was serious enough for a visit to the emergency department of the hospital. Sleeping on an inclined bed left me with pain at my sacrum and coccyx area, and I could not sleep, walk or bend properly for several days. I tried the Epley's manoeuvre several times during that weekend, but this time, it failed to resolve the dizziness. I only saw a doctor on Monday 3 June 2019, and knowing that I will be visiting a dizziness specialist on 31 July 2019 and that I had a new stock of prochlorperazine, I was not prescribed any new dizziness medicine. I was prescribed Ketoprofen plasters for my sacrum and coccyx, and neck pain. Evidently, the doctor had no clear understanding of how my food poisoning could have resulted in so many problems. My current guess for the cause of my dizziness is ototoxicity.
Specifically on resolving my dizziness using Epley's manoeuvre, I tried again on 28 July 2019 Sunday on my bed, and realised that the displaced otoconia may be trapped and lodged onto my left posterior canal cupula, a sign of cupulolithiasis. This is because when I lie flat and turn my hanging head left in the first step of Epley's manoeuvre, there was a burst of positioning nystagmus (spinning sensation), and when I turned my hanging head right in the second step of Epley's manoeuvre, there was also a burst of positioning nystagmus. I completed my Epley's manoeuvre with no other nystagmus, but when I lie down and turn my head left again, there was another burst of positioning nystagmus. This may show that the otoconia could not move away from the posterior cupula and was just flapping about the posterior cupula when I turned my head while lying down. However, I tried Epley's again later in the day and it worked. There was only a very slight floating sensation when I move my head, until I brush my teeth in the morning of 29 July 2019. My dizziness recurred slightly due to the vibration of my teeth brushing and my looking and bending down towards the sink while brushing. These actions must have been enough to dislodge the otoconia from the utricle.
09 Aug 2019 Update
My seeing the specialist doctor at SGH on 31 July 2019 did not resolve my dizziness issue although the whole process took almost 2 hours, much of which was done waiting. The doctor first sent me for a basic hearing test and impedance audiometry, which I pass. When we finally met in her room, the doctor put me through some exercises/movements for testing dizziness and balance. The doctor also did the Dix-Hallpike test on me, which while i have some brief dizziness at the beginning of the test before the doctor could observe my eyes for nystagmus, there was no dizziness/nystagmus when she observed my eyes. The doctor also refused to consider research findings that a calcium imbalance might have caused the prolonging of my dizziness. This imbalance might have been triggered by my incidence of food poisoning, which is still questionable because the SFA Singapore Food Agency, which responded to my complaint of food poisoning, had checked and confirmed that food processes were fine at the Koufu food court's mixed rice stall. However, they could not check if the food on that fateful day might have been stale or bad. The doctor also explained that my encounter with repeated vomitting and loss of consciousness may be inexplicable scientifically because it is a one off incident. The doctor even proposed sending me for a $150-$200 test to test my nystagmus, which I rejected outright because it's too expensive.
From the website www.vitamindcouncil.org, I found an article which states that "BPPV is the most common cause of vertigo. Although this condition may result secondary to head trauma, migraines, prolonged bed rest and otologic surgery, 80% of all cases occur as an isolated event with an unknown etiology (idiopathic)". It is evident that my occurrence of "food poisoning" is one of these idiopathic cases. It also stated that "The researchers concluded, “The present study indicated that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.”" This implies that taking vitamin D supplements could help reduce BPPV recurrence. And taking vitamin D supplement (in the form of one pill of Coco Omega from Ocean Health) was what I did on the night of 30 July 2019, and which I continued from 01-07 Aug 2019. My dizziness was resolved starting 01 Aug 2019. I usually take one pill in the morning. When I stopped taking one pill in the morning on 08 Aug 2019 due to my taking of a bowel moving TCM medication, in the evening when I had to lie down for my dressing applications in a compromised position for dizziness, I could feel a floating sensation again. This is the beginning of dizziness. I immediately took one pill of Coco Omega at night before I sleep and recovered. Although Coco Omega contains only coconut oil and fish oil with smaller amounts of vitamin D, it was sufficient to resolve my dizziness. I will try cod liver oil capsules with more vitamin D when I finish my batch of Coco Omega capsules. The June dizziness spell took me 2 months in total to recover from.
References:
- Benign Paroxysmal Positional Vertigo (BPPV), vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
- Jean-Pierre Barral and Alain Croibier, Manual Therapy for the Cranial Nerves, Chapter 20, 2009
- Robert William Baloh, Kevin Kerber, Baloh and Honrubia's Clinical Neurophysiology of the Vestibular System, 2011
- Treating vitamin D deficiency may help reduce the recurrence rate of vertigo, according to study, www.vitamindcouncil.org/treating-vitamin-d-deficiency-may-help-reduce-the-recurrence-rate-of-vertigo-according-to-study