I haven't posted in nearly a year. Why? I ask myself. I believe that I became depressed by some of my own observations regarding the field of medicine. So many changes and such a big machine to work within that it is easy to become frustrated.
So, yesterday I'm walking on the beach with my wife Cynthia and my daughter Elizabeth and I'm talking about how difficult it is sometimes to get pleasure from work. But, what's strange is I enjoy treating peo ple and solving their problems so why am I missing out on the pleasure of what I do? What I realized is that I need to spend more time talking about what I enjoy in medicine and less of what is both frustrating and nearly impossible to change. Therefore, what I plan on presenting in this blog is recollections of patient challenges and successes and to share the stories of what I experience on a daily basis. And I will mix in some of my other projects with some more chapters from Virestorm and any other unique and interesting stories I can summon. Of course I will be careful to protect anyone's privacy, names will pseudonyms and the stories may have some minor changes.
A very pleasant 60 year old woman with gray streaked hair and a kind smile arrived in my office with a 7 month history of dizziness. She couldn't roll over in bed without spinning and she was off balance with any rapid motion. She had no relief with antivert, a common vertigo medication, and she had been seen by her primary care physician several times. When we talked she was only a little frustrated by the persistence of her symptoms. She seemed to have accepted her condition as a given factor of aging.
On exam she was completely normal except when I rolled her over onto her right side and laid her down rapidly she had sudden and very intenese dizziness and I could see her eyes rotating. Slowly her symptoms subsided. While she was laying still I explained that she probably had a disorder called benign paroxysmal positional vertigo also known as BPPV.
I explained to her that some of the fine crystals in her ear that were part of her balance sensor that detects motion had broken free and landed in one of her three semicircular canals. The treatment was a physical maneuver performed in the office called the Epley Maneuver. She told me that someone had previously tried a maneuver without help but she was willing to give mine a try.
About 30 years ago Dr. Epley gave a talk I attended. He showed a video of these very fine particles under magnification floating around in the canal where they were wreaking havoc. He showed us his method of treatment which involved slowly rotating somebody like a marshmallow on a skewer. It was this treatment I took her through.
I did the maneuver a couple of months ago and didn't hear from her again. She showed up in the office last week finally for her recheck. She didn't explain what took her so long to follow up but with a big smile she told me she was cured of her dizziness. That she hadn't had another problem again from the moment she left my office that day.
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