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When The World Spins Around You

“My head feels light and I seem to be floating, as if the world is spinning round and round…” These are not the lines of a teenage love song. These are the words of somebody having a dizzy spell.And these words are echoed everyday in doctors’ clinics, oftentimes by the elderly and those with diabetes and hypertension. One out of every three persons above the age of 65 will complain of dizziness at some point. Just how important a symptom is dizziness? How is it different from vertigo? How can blood sugar and blood pressure derangements affect one’s sense of balance? The questions are endless and our ever-anxious patients need to be enlightened on the whys and the hows of dizziness.

The symptom of dizziness comes in various forms. Some describe it as a sense of giddiness and restlessness, lightheadedness, loss of balance, nausea and unsteadiness. Vertigo is a type of dizziness usually described as a spinning sensation. Dizziness is a frequent and important cause of falls and accidents in the elderly. Majority of patients who experience dizziness and vertigo have an underlying peripheral vestibular disorder that involves the delicate equilibrium apparatus of the inner ear. In a series conducted by Sakine on 626 patients in Tokushima, Japan (published September 2005), 65 percent of the subjects had dizziness due to peripheral causes such as Benign Paroxysmal Positional Vertigo and Meniere’s Disease. Central causes (dizziness originating from the brain) which included tumors and strokes accounted for 7 percent of the cases. Other causes of imbalance include circulatory disturbances (orthostatic hypotension*, arrhythmias*), metabolic derangements (blood sugar abnormalities) and even psychiatric disorders.

Individuals taking maintenance antihypertensive or blood-pressure lowering medications may experience lightheadedness particularly in the early morning. Those taking diabetic meds who miss their meals may have abnormally low blood sugar levels and then feel dizzy. On the other hand, hyperglycemia or high blood sugar may also cause unsteadiness and restlessness in some. Whenever the brain fails to receive its required supply of oxygen and glucose, it reacts by causing some form of dizziness.This is the reason why atherosclerotic* deposits on the walls of blood vessels leading to the brain may hamper circulation and may cause some balance problems as well. Associated symptoms that may spell out a more serious underlying disorder include hearing loss, tinnitus (ringing in the ears), facial numbness or pain, loss of postural balance, doubling of vision, etc.

It is important to remember that dizziness and vertigo are but symptoms and an underlying cause must be sought every time. Consulting an ENT doctor, a cardiologist or a neuurologist would be helpful so that proper diagnostic tests can be done and medications be started. These tests include a thorough physical, neurological and otological examination in the clinic. If needed, additional tests like blood chemistries, an MRI of the head, electronystagmography, tilt-table test, holter monitoring and other such examinations may be requested. Treatment is usually directed towards reducing the frequency and severity of dizzy spells (symptomatic treatment) as well as eliminating the underlying cause, if this is at all possible. Sometimes a patient’s blood pressure and diabetic meds are simply adjusted for proper timing. Behavior modifications
may be taught to lessen the dizziness attacks like sitting up and dangling the legs from the bed before rising in the morning and of course, taking proper meals on time.There are formal vestibular rehabilitation therapy programs available in some centers for chronically dizzy patients.

Dizziness is one symptom that cannot be neglected mainly because it is pretty common and uncomfortable, it may cause falls and accidents, and it may herald a more serious brain or heart condition on further examination. Remember …sometimes the world spins around you for a reason.

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