A Dizzying Exchange About Vertigo
Side Effects from the Virus and the Vaccine
November 1, 2021
Emergency Department
Stony Brook Southampton Hospital
Southampton, New York
To Whom It May Concern,
On a recent Saturday morning, I bent over to put on a sock and the bedroom spun 360 degrees three times. When I tried to tie a shoelace, the room spun three times again. And when fluffing up the pillows, I involuntarily tumbled back into the bed from which I had recently arisen.
Stroke? Aneurysm? TIA?
I drove to the Stony Brook Southampton Emergency Room. After a nurse took my vitals and asked if I had had anything to eat or drink (I had not), Dr. Michael Ameres asked me a series of questions. Aside from dizziness, there were no other symptoms. A battery of tests followed: blood, urine, Covid, EKG, head CT scan, chest X-rays. Everyone involved was polite and efficient. The tests seemed necessary and much appreciated by this puzzled patient, even if the results were not shared with me.
The dizziness kept me glued to the ER bed. Any ambulation felt as if I were walking down the aisle of a speeding bus, unsteadily, about to lilt either port or starboard. When I reached down for my phone, the emergency room spun three times. I reported this to the nurse. She thanked me.
Four hours later, Dr. Ameres, Emergency Medicine Specialist, returned to the room to say that the tests had shown nothing remarkable. “We think you have BPPV,” he said.
“BPPV?” I echoed.
“Benign Paroxysmal Positional Vertigo. Something is going on in your inner ear. You should see a neurologist or an ENT doctor.”
And that was that. The diagnosis and the dismissal. I handed in my gown and a nurse handed me some printed material. No medicine, no treatment, no instructions, no warnings, no briefing, no inquiry into my mode of transportation or what awaited me at home. And not a drop of water or a single Saltine cracker.
After driving home, I sat down with a cup of coffee to read the hospital handout. The first thing it said was “Do not drive home.” The second was “Do not drink coffee.” I did not laugh. I consulted Google and youtube. I learned that BPPV is a condition wherein calcium carbonate crystals (otoliths) become detached and then trapped in an inner ear canal. One’s sense of gravity and linear acceleration are distorted. Balance is thrown out of whack. Usually caused by injury, infection or age, in this time of Covid, both the virus and the vaccine have been known to disturb the vestibular system. Reported or not, there has been a dramatic spike in BPPV.
In a normal year, five percent of Americans experience positional vertigo, and more than 50 percent of all seniors will at some point — when rolling over in bed or picking up their reading glasses or reaching for a top shelf bourbon. BPPV is frightening and dangerous, especially during the initial stages, affecting your every waking and non-waking hour, and leading to accidents, anxiety, and depression. Tranquilizers are often prescribed, as well as certain exercises, pillow sizes, sleeping positions and beverages to avoid or indulge; hydration is highly recommended. Bourbon is not. Generally resolving within two months, BPPV may last longer and require surgical or medical attention. You never know until you know.
How is BPPV diagnosed? The Dix-Hallpike Test is a safe, quick, painless, inexpensive process. From a sitting position, you lay down on one side and your eye movement reveals the presence or absence of BPPV. What is the remedy? The Epley Maneuver is a safe, quick, painless method for instant amelioration; provoking the uncomfortable spinning sensation under supervision will dislodge the crystal and bring relief. “Poking the bear” is what professionals call it.
www.hopkinsmedicine.org/health/treatment-tests-and-therapies/home-epley-maneuver
With youtube help, I performed the Epley Maneuver on myself. The spinning stopped and never returned. It took five minutes. What remained was long-haul dizziness, a touch of nausea and a nagging question: Why did Stony Brook Southampton Hospital administer neither the test nor the treatments that are so readily and universally available?
Cardelli Hospital in Naples — ranked 79th best hospital in Italy by Newsweek Magazine — kept records of the 363 patients who entered their ER with symptoms similar to mine and published these findings:
…None of the 363 patients with a negative algorithm received a final diagnosis of BPPV, thus confirming the high reliability of Dix-Hallpike Test and Epley Maneuver…Therefore, in our study the sensitivity and specificity in the diagnosis and remedy were 100%. We conclude that the correct information and training and the close collaboration with the vestibologist specialist have enabled the emergency room doctors to identify patients affected by BPPV early and effectively, avoiding waste of time and significantly reducing costs for the healthcare system.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378380/
Unlike the 363 Napoletana, I was discharged from Stony Brook Southampton Hospital in the same condition I had entered. The results of the tests taken were a big relief, no question, yet I was, in the end, left on my own with a condition with which I was unfamiliar. Was the emergency staff overburdened or untrained or unconcerned about an ailment that was neither life-threatening nor progressive? The quality of care seemed, to this lay patient, less than exemplary, less than the Cardelli Hospital in Naples.
Making appointments with a neurologist and ENT doctor were fine suggestions, and I followed up, but the first available opening with either specialist was three weeks down the road. Had I not gone online, had I not found an excellent balance clinic in Riverhead, New York, had I not had access to Valium, I might have stumbled around for weeks in the dark — timorous, sleepless, nauseas, bewildered, perhaps taking a tumble, perhaps doing real damage to myself or others.
Once you have capsized for no apparent reason, the sensation is indelible and you anticipate another tumble at any moment, at every moment. You teeter when simply standing on flat earth. You have all the imprecision of three shots of bourbon with none of the euphoria. Turning your head left or right or up or down creates a visual and mental blur. Closing your eyes exaggerates the discomfort, especially when taking a shower, surrounded by slippery ceramics, stainless steel and unyielding porcelain.
As weeks go by, the sufferer of BPPV becomes so nervous about the possibility of sudden spinning that the anxiety itself triggers the disequilibrium and the two states meld and become as indistinguishable as any chicken-or-egg conundrum.
My dizziness remained at full force for many months, and continues to linger and makes surprise appearances despite specialists and therapists. Once the brain’s wires get crossed, time is needed to regain composure; the longer the crystal is lodged in the canal, the longer the post-vertigo trauma and remediation period. According to the National Institutes of Health, “the early recognition and treatment will reduce the longevity of residual dizziness.” Waiting three weeks to see a specialist only serves to extend and deepen both the vertigo and its aftermath.
Since many of my neighbors — members of your community — will no doubt be entering your ER with BPPV, I sincerely hope that you can speed up their diagnosis and recovery by upgrading the protocols at Stony Brook Southampton Hospital Emergency Department.
Thank you for your time and consideration. Best of luck.
Bruce Buschel
Patient/Citizen
________________________
November 5, 2021
Dear Mr. Buschel,
Thank you for your input concerning your stay in our Emergency Department. At Stony Brook Southampton Hospital, we take all concerns that are brought to our attention seriously, and we continue to look for ways to improve care and the patient experience
A thorough review of your case and the information you presented in your letter was complete on November 4, 2021. Your concerns were brought to the attention of our Emergency Department Medical Director, and he will be presenting them for discussion during the department quality review. While we don’t disclose results of these reviews, your encounter has begun a discussion on the treatment and care of patient diagnosed with beginning paroxysmal positional vertigo (BPPV), in both the Emergency Department and inpatient settings.
Again, thank you for your input. I hope you are feeling better.
Mark Strecker, Director of Patient Experience & Education
Cc: Robert Chaloner, CEO Southampton Hospital
Cc: Fred Weinbaum, Stony Brook Southampton Hospital
Cc: Darin Wiggins, MD, Chair of SBSH Emergency Department
Cc: Michael Ameres, MD, Emergency Department Trauma Liaison
Cc: Samantha Pulliam, RN, Trauma Program Director
________________________
A few months later, when my BPPV had calmed down and I felt my research was sufficient, I called the Director of Communications and Education at Stony Brook to find out if there had been any changes. She asked that my request be submitted in writing.
________________________
January 27, 2022
Barbara-Jo Howard
Executive Director of Communications and Marketing
Stony Brook Southampton Hospital
Ms. Howard,
Thank you for taking my call yesterday. You asked for a written account of my experience and any questions I might have, so I have enclosed the letter I sent to Mark Strecker et al on November 1, 2021. It details my bout with BPPV.
Since discovering the prevalence of BPPV, I have decided to write an article. So I am communicating with you as a journalist of four decades, not a patient of one day. And I pose this question: has there been any change in the protocol at Stony Brook Hospital in connection with BPPV since November, 2021?
Thank you for your time and effort in this regard. I look forward to your response.
Stay safe.
Bruce Buschel
Patient/Journalist
p.s. You can read some recent articles at medium.com/@brucebuschel and muckrack.com/bruce-buschel
_____________________
January 27, 2022,
Hell Mr. Buschel,
Please give me some time to follow up on this.
Take care,
bjh
Barbara-Jo Howard
Executive Director of Communications and Marketing
Stony Brook Southampton Hospital
240 Meeting House Lane
Southampton, New York 11968
Pronouns: she, her, hers
______________________________
January 27, 2022
Ms. Howard,
I think you left off the “o” in hello.
Or maybe not. Please take all the time you need.
Thank you.
Sincerely,
Bruce Buschel
Patient patient/Journalist
_____________________________
January 27, 2022
Oh my! Please forgive me. I sincerely apologize. (I have been having one of those days.) Please forgive the typo.
Take care,
Barbara-Jo
______________________________
January 27, 2021
Ms. Howard,
Don’t think twice, it’s alright.
______________________________
February 2, 2022
Dear Mr. Buschel,
Thank you for your recent inquiry. Per HIPAA I do not have access to your case. However, you expressed interest in our ED protocol. The mission of the Emergency Department is, and has always been, to immediately attend to critical conditions. Testing is administered, as appropriate, to help ensure proper diagnosis and treatment. Should a patient choose not to comply with the ordered testing, then at time of discharge the patient will be asked if they have a driver or car service to take them home and will receive recommendations for follow-up care.
Sincerely,
Barbara-Jo Howard
Executive Director of Communications and Marketing
______________________________________
February 7, 2022
Ms. Howard,
Thank you for your reply. However, I think you have addressed issues unmentioned and answered questions unasked. Sorry I was not clearer. I will try again.
Obviously, HIPAA regulations did not prevent your colleagues from consulting my record at your hospital. On November 5, your Director of Patient Experience and Education, wrote: “A thorough review of your case and the information you presented in your letter was complete on November 4, 2021…your encounter has begun a discussion on the treatment and care of patients diagnosed with beginning paroxysmal positional vertigo (BPPV), in both the Emergency Department and inpatient settings.”
Your email also focused on patients who “choose not to comply with the ordered testing.” I have no idea why this is mentioned because I took a series of tests and am now wishing there had been at least one more. I also wonder if it is true, as you say, that only those who refuse testing are asked about their ride home. Not someone on crutches or in a leg cast? Not someone still groggy from anesthetics or sporting a new eye patch?
You say the mission of the Stony Brook ED is to “ensure proper diagnosis and treatment.” ED’s around the world use the Dix-Hallpike Test for diagnosis and the Epley Maneuver as treatment because they are safe and effective and relieve the hospital of expense and precious person-power, not to mention the obvious benefits to the patients. Stony Brook Southampton used neither procedure during my visit. Nor the Semont Maneuver nor the Supine Roll Test (SRT) nor any canalith repositioning method.
While I appreciate your effort, I have to ask again if the diagnosis and treatment of nystagmus and/or peripheral vertigo has changed since my visit or was that just an unusual day in the life of SBSH and Dr. Michael Ameres?
Thank you again.
Bruce Buschel
Patient/Patient journalist
p.s. Feel free, by the way, to explore all my medical records at your hospital.
____________________________________
February 10, 2022
Dear Mr. Buschel,
Thank you for your follow-up inquiry. Testing and the course of patient treatment is determined by the attending physician and/or specialist(s).
Please take care and stay well,
Barbara Jo Howard
________________________________________
February 11, 2022
Ms. Howard,
The quality of care and the quality of communication at Stony Brook Southampton Hospital appear to be on similar levels. I thought the Director of Communications might take this inquiry seriously, but your response, alas, makes my head spin.
Truly,
Bruce Buschel
