by Hillary Weston

Patients suffering from Vertigo are referred to a very comprehensive investigation in out-patient clinics of Otolaryngology, or, if admitted to a hospital-in Ear Nose and Throat departments. The main question is the possibility of having structural abnormality in the vestibular system with indication for surgery.

When all the relevant tests are within the normal range, most probably, the Doctor will say: "There is nothing to do" or "you have to live with it".

The outcome of such declaration is despair, frustration and most probably – increase in the severity of the symptoms – the vertigo and the other phenomena such as fear of fall, insomnia, fear of going out of home or going to work.

Our question is: How a vertigo patient can cope with his/her symptoms?

Shemesh Zecharya (M.D.) from "Hadassah Ein Kerem" Hospital in Jerusalem mentioned the common possibilities:

(1)On the basis of the theory that crystals in the inner ear and the hair cells are the main part in the mechanism of vertigo, it is possible to use a special physiotherapy in order to cause strong stimulation to the hair cells.

(2)Medications that are called: betahistine or cinnarizine,

(3)Sedative medications.

(4)If all the above is not effective, referral to metabolic intervention may help.

What treatments do you give your patients?

My patients come after failure of the physiotherapy, drug treatment such as Betahistine or Cinnarizine, given by Otolaryngologists or insufficient effect of sedative medications that were prescribed by a psychiatrist. I offer my patients metabolic intervention. In most patients it is very effective.

What about untreated patient or a patient that did not respond to any treatment: can he cope with his/her vertigo attacks or is it impossible?

When the level of symptoms is small or weak – the patient can cope with the vertigo. When he/she have/has severe spinning or worse - recurrent sever spinning, only strong sedation can decrease the symptoms. Such medication can be given only in the emergency room of a hospital.

If the patient is suffering from fear or anxiety that started during the period of the vertigo attacks – is it better to treat the fear besides the vertigo or is it better to focus on the vertigo?

It is important to distinguish between fear and anxiety. Fear is a psychological condition associated with life threatening situation. For example: if a terrorist with a knife in his hand is running after a potential victim in order to kill him, and the man who escapes is afraid – it is Fear. Example of Anxiety: when a man is suffering from the same symptoms of fear, but no one is running after him. The other symptoms of: sweat, palpitations, stress and shortness of breath can exist, but there is no life threatening situation.

The question is how to relate to the Vertigo? Is it a real threat or just imagination of the patient?

When there are no objective findings, some Physicians may say that they have doubts regarding the possibility that the patient is suffering from vertigo. I am sure that it is a grave mistake. The history of medicine include many stories about patients who came with fatal disease without any objective signs.

Even ML (Myocardial Infarction) may start as asymptomatic medical condition. A patient with head trauma and intra cranial bleeding may start as a conscious patient who suffer from headache.

A famous Israeli actor who was in jail, started with one suicidal attempt that was interpreted as "demonstrative suicidal attempt", and the following event was a fatal suicide act.

My approach is to listen to the patient and base the diagnosis on the medical history and clinical interview. It is important to take into consideration that there are many degrees of vertigo attacks. When the attack is very strong – there is a high risk for falling. In advanced age the patient may break a bone. The most common and problematic fracture is: the Neck of the Hip Bone.

The psychology of the patient is not related to the risk of trauma. Anxious patients and patients with low levels of anxiety have a similar risk. The dominant parameters are the intensity of the attack, sudden onset, duration of attack and the location of the patient.

For example: a patient that stays in bed, or is accompanied by a caretaker who knows about the risk of falling – is safer then a lonely man, a man that does not have any handle or object to lean on.

A worker standing on a high platform is also at risk. A lonely person felling on the floor, with nobody knowing about it, may suffer a more sever trauma and die.

The question - what kind of psychological condition is it: fear or anxiety? Can be answered now. The fear of falling is a fear of a real danger. This fear has a positive roll of protecting the patient from physical trauma as a result of falling. Such a vertigo sufferer will be more careful then a patient who is not afraid, but has the same degree of imbalance.

When a patient has a severe fear of falling and as a result of it he/she is afraid of going out of his/her home or even work at home, it is important to find effective treatment for reducing the fear, yet some of the fear can remain as a defense mechanism against falling, for as long as the vertigo attacks are still active.

• This article can not come instead of examination and treatment by an expert.