Tag Archives: dizziness

Enough is Enough

As the list of my illnesses continue to grow, I question the motivation behind all of these test, I am a very compliant patient, but there comes time when you say Enough is Enough, After having the smart pill test and diagnosed with gastroporesis. My pain continues to hurt so bad on my rib cage due to the gastritis and esophagitis and the pain is radiating through my ribs so bad I thought I was having a heart attack. So I go get checked. No Heart attack thank god, But the ER Doctor said to me you keep coming in and we can’t help you why isn’t anybody getting down to the bottom of this. So with that being said, still no food, continuous heart burn and rib pain and I had to even take pain meds which I don’t do. I tried heating pads, everything, So the GI Doctor says he wants to order two more invasive tests, So I asked why am I doing another radioactive test on my digest system when the first test was fine and I would have to go off my meds again the only thing allowing me to even eat a little shake, then have a tube down my nose into my stomach to measure the ph balance. Going off my meds again. I thought about it and I decided no more tests, every test makes me worse. So If Stanford can’t go by the past tests then I will attempt the test but I have had enough.  I know Dr’s offices make money off of test being done in their offices and I know that’s a huge influence, but, it’s making me worse.  I called my ENT and told him I am going to come see him to check in to be compliant but no hearing tests.  Going into the little box for the testing causes so much pressure in my head it throws my vertigo beyond and ear pain.   Enough is Enough and for each patient that will be different.  For me 10 years and it’s enough, I continue my meds but cut some in half for less effects.  I won’t tell the Dr’s because then you are non compliant but I am extremely sensitive, so I have to do what is right for me.  If your feeling that same feeling, Stand up for yourself, listen to your gut and follow it.  Just remember you can always reschedule the test if you change your mind or increase your meds to original prescription, you have to listen to your self.

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What is PPPD?

Persistent Postural-Perceptual Dizziness

HISTORY
In 1986, German neurologists Thomas Brandt and Marianne Dieterich first described a condition that they called phobic postural vertigo (PPV). Symptoms included postural dizziness without vertigo and fluctuating unsteadiness provoked by environmental or social stimuli (e.g. crowds), which could not be explained by some other neuro-otologic disorder. Triggers included a pre-existing vestibular disorder, medical illness or psychological stress.
Behavioral criteria of PPV included the presence of an obsessive-compulsive personality, mild depression, and anxiety. Studies on PPV showed that it was NOT a psychiatric disorder, but rather a neuro-otologic condition with behavioral elements.
In the early 2000s, the American team of Jeffrey Staab, Michael Ruckenstein, & their colleagues performed studies to update the concept of PPV and described the clinical syndrome of chronic subjective dizziness (CSD).  The symptoms of CSD included non-vertiginous dizziness and unsteadiness that was increased by a person’s own motion, exposure to environments with a complex or moving stimuli (e.g., stores, crowds), and performance of tasks that required precise visual focus (e.g., reading, using a computer). 
Other vestibular experts described space-motion discomfort and visual vertigo, symptoms that overlapped to some extent with PPV and CSD.
In 2010, scientists from around the world began a process of identifying the most important features of these syndromes.  In early 2014, they reached a consensus on the key symptoms and defined a diagnosis of Persistent Postural-Perceptual Dizziness (PPPD).  
The World Health Organization has included PPPD in its draft list of diagnoses to be added the next edition of the International Classification of Diseases (ICD-11) in 2017.
Symptoms
The primary symptoms of PPPD are persistent sensations of rocking or swaying unsteadiness and/or dizziness without vertigo lasting 3 months or more; 
Symptoms are present on more days than not (at least 15 of every 30 days); most patients have daily symptoms.
Symptoms are typically worse with:
Upright posture (standing or sitting upright)
Head or body motion
Exposure to complex or motion-rich environments
PPPD typically starts shortly after an event that causes acute vertigo, unsteadiness, dizziness, or disruption of balance such as:
A peripheral or central vestibular disorder (e.g., BPPV, vestibular neuritis, Meniere’s disease, stroke)
Vestibular migraine
Panic attacks with dizziness
Mild traumatic brain injury (concussion or whiplash)
Dysautonomia (disease of the autonomic nervous system)
Other medical problems, such as dysrhythmias and adverse drug reactions that manifest with acute bouts of vertigo, unsteadiness or dizziness are less common triggers of PPPD.
PPPD rarely starts slowly and gradually without a triggering event, although it is not always possible to sort out the cause.
Anxiety or mild depression may be present as comorbidities. However, they are not symptoms of PPPD, as they were with PPV.
PPPD may coexist with other vestibular disorders, which can confuse the diagnosis since patients may exhibit other symptoms, including vertigo.
Patients with PPPD may have a history of vertigo, suggesting a previous vestibular dysfunction. Patients typically exhibit chronic symptoms due to accumulated exposure to motion stimuli, making them more susceptible to recurrence of symptoms.
Patients with PPPD avoid situations that may exacerbate symptoms because they don’t want to feel worse physically.  Some patients also avoid these situations because they are afraid that something terrible might happen. Thus PPPD is a physiological disorder that can have psychological consequences.
DIAGNOSIS
Physical exams, laboratory tests, and neuroimaging are NOT used to diagnose PPPD itself, but to identify potentially comorbid conditions, which can lead to a suspected diagnosis of CSD. Physical examination and laboratory testing are often normal or may show a current or previous vestibular problem that does not fully explain the patient’s symptoms.
What to look for:
Primary symptoms (unsteadiness &/or dizziness, present 3 months or more); fluctuate in severity depending on triggers;
Primary symptoms are related to body posture – symptoms are most severe when walking or standing, less severe when sitting, and minor or absent when lying down.
Factors that provoke or exacerbate symptoms: 
Active or passive motion of self not related to specific direction or position; 
Exposure to moving visual stimuli or complex visual patterns; performance of precision visual tasks (e.g. reading, computer).
Triggering events:
Acute or recurrent peripheral (more common) or central (less common) vestibular disorder;
Medical problems or psychiatric disorders that produce unsteadiness or dizziness.
BEHAVIORAL FACTORS
Behavioral assessment of PPPD patients may be normal and/or show low levels of anxiety and depression. Other psychiatric disorders may also present.
Behavioral factors contribute to PPPD in three ways:
Individuals with anxious, introverted temperaments or a pre-existing anxiety disorder may be predisposed to PPPD after a precipitating event;
Individuals who exhibit a high level of anxiety while they are experiencing vestibular symptoms may be more likely to develop PPPD;
A primary predictor of PPPD is when a patient who first experiences an acute vestibular episode displays high levels of anxiety and caution, coupled with expectations for a negative outcome. This heightened anxiety is like a self-fulfilling prophesy, in that the result is generally a poor rate of recovery.
High anxiety intensifies postural instability and reactivity to motion stimuli during acute vestibular trauma and slows recovery by preventing the patient from developing adaptive strategies.
Anxiety and depression can increase the likelihood of developing PPPD.
60% of patients with PPPD had clinically significant anxiety;
45% of patients had clinically significant depression;
25% of patients had neither.
TREATMENT
By 2014, no large scale, randomized, controlled trials of therapeutic interventions for CSD had been conducted, but several smaller studies have been completed around the world.
Medication
In clinical trials for the use of SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors) on patients with CSD:
Primary symptoms were reduced by at least half in 60%-70% of patients to entered the trials and 80% of patients who completed at least 8-12 weeks of treatment;
Dropout rates due to medication intolerance averaged 20% (adverse effects included nausea, sleep disturbance, and sexual dysfunction).
Patients who do not respond to one SSRI have a good chance of responding to another one. Increased dizziness was rarely observed, and comorbid anxiety and depression were improved. Treatment must be maintained for at least one year or more to minimize relapse.
Benzodiazepines and other vestibular suppressants are NOT effective as a primary treatment for PPPD.
Vestibular Balance Rehabilitation Therapy (VBRT)
Vestibular/balance rehabilitation therapy works to desensitize or habituate patients to motion stimuli.
In 2014, the first small study on the efficacy of VBRT specifically for PPPD patients was completed. Its results support previous clinical experience and suggest the following:
VBRT reduces  the severity of vestibular symptoms by 60%-80%, resulting in increased mobility and enhanced daily functioning;
VBRT may be effective in reducing anxiety and depression in PPPD patients;
Patients should continue VBRT for 3-6 months to receive maximum benefit from the treatments.
Counseling
Psychotherapy is not a very successful treatment for fully established, longstanding PPPD, but it may be able to reduce the chances of developing PPPD if used early. Older trials showed that cognitive behavioral therapy (CBT) had a moderate effect for reducing dizziness in patients with PPPD, but, unfortunately the benefits did not last after therapy was finished.  More recent trials showed that just three CBT sessions resulted in significantly reduced dizziness and dizziness-related avoidance symptoms when treatment was started within 8 weeks of the triggering event (i.e., as PPPD symptoms were starting, but before they were fully established).  Under those circumstances, the benefits seemed to last. 
MECHANISMS
Research studies are beginning to uncover physiologic processes associated with PPPD.  Investigations have provided hints about alterations in postural control, visual perception of space, and processing of vestibular and visual stimuli in the brain.  More details should be forthcoming over the next few years. 
REFERENCE
Staab JP. Chronic Subjective Dizziness. Continuum (Mineapp.Minn.). 2012 Oct; 18(5 Neuro-otology):1118-41.
2 World Health Organization, International Classification of Diseases, ICD-11 beta draft, http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f2005792829
Click here to download the complete pdf of this publication.

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Autonomic Neuropathy

Autonomic neuropathy

By Mayo Clinic Staff

Autonomic neuropathy occurs when the nerves that control involuntary bodily functions are damaged. This may affect blood pressure, temperature control, digestion, bladder function and even sexual function.

The nerve damage interferes with the messages sent between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels and sweat glands.

While diabetes is generally the most common cause of autonomic neuropathy, other health conditions — even an infection — may be to blame. Some medications also may cause nerve damage. Symptoms and treatment will vary based on which nerves are damaged.

Signs and symptoms of autonomic neuropathy vary based on the nerves affected. They may include:

  • Dizziness and fainting when standing caused by a sudden drop in blood pressure.
  • Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the bladder, which can lead to urinary tract infections.
  • Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men and vaginal dryness, low libido and difficulty reaching orgasm in women.
  • Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.
  • Sweating abnormalities, such as sweating too much or too little, which affects the ability to regulate body temperature.
  • Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
  • Exercise intolerance, which may occur if your heart rate stays the same instead of adjusting in response to your activity level.

When to see a doctor

Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes and it’s poorly controlled.

If you have type 2 diabetes, the American Diabetes Association (the Association) recommends annual autonomic neuropathy screening for people with type 2 diabetes as soon as you’ve received your diabetes diagnosis. For people with type 1 diabetes, the Association advises annual screening beginning five years after diagnosis.

Many health conditions can cause autonomic neuropathy. It may also be a side effect of treatments for other diseases, such as cancer. Some common causes of autonomic neuropathy include:

  • Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.
  • Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain-Barre syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).
  • Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
  • Injury to nerves caused by surgery or radiation to the neck.
  • Treatment with certain medications, including some drugs used in cancer chemotherapy.
  • Other chronic illnesses, such as Parkinson’s disease, multiple sclerosis and some types of dementia.
  • Certain infectious diseases. Some viruses and bacteria, such as botulism, Lyme disease and HIV, can cause autonomic neuropathy.
  • Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.

Factors that may increase your risk of autonomic neuropathy include:

  • Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You’re at greatest risk if you have had the disease for more than 25 years and have difficulty controlling your blood sugar, according to the National Institute of Diabetes and Digestive and Kidney Diseases.Additionally, people with diabetes who are overweight or have high blood pressure or high cholesterol have a higher risk of autonomic neuropathy.
  • Other diseases. Amyloidosis, porphyria, hypothyroidism and cancer (usually due to side effects from treatment) may also increase the risk of autonomic neuropathy.

First, you’ll probably see your primary care physician. If you have diabetes, you may see your diabetes specialist (endocrinologist). However, you may be referred to a specialist in nerve disorders (neurologist).

You may need to see other specialists depending on the part of your body affected by neuropathy: for example, a cardiologist for problems with your blood pressure or heart rate, or a gastroenterologist for digestive difficulties.

Arrive at your appointment well-prepared. Here are some tips to help you prepare yourself and know what to expect from your doctor.

What you can do

  • Ask about any restrictions before the appointment. Find out if you should do anything in advance, such as fasting before certain tests.
  • Write down any symptoms you’re experiencing, even those that may seem unrelated to autonomic neuropathy.
  • Make a list of all medications (including over-the-counter), vitamins or supplements that you take.
  • Ask a family member or friend to come with you. Bring someone who can help you remember the information you and your doctor discuss. Family members can learn more about autonomic neuropathy if they attend appointments with you. For example, if you don’t know when your blood pressure is too low, you may pass out (faint). Your family members will need to know what to do.
  • Write down questions to ask your doctor.

Since appointments can be short, prepare a list of questions before you go. Some basic questions to ask your doctor about autonomic neuropathy may include:

  • Why did I develop autonomic neuropathy?
  • Could anything else cause my symptoms?
  • What kinds of tests do I need? Will I need to do anything to prepare?
  • Is autonomic neuropathy temporary or chronic?
  • What are the available and recommended treatments for autonomic neuropathy?
  • What are the treatment side effects?
  • Are there any alternatives to the treatment that you’re suggesting?
  • Is there anything I can do on my own to help manage autonomic neuropathy?
  • I have other health conditions. How can I best manage those with autonomic neuropathy?
  • Do I need to follow a special diet?
  • Are there any activity restrictions that I need to follow?
  • Do you have any printed materials or recommended websites that you can share with me?

Don’t hesitate to ask additional questions that may come up during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared to answer these types of questions to allow more time for your own:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Autonomic neuropathy is a possible complication of a number of diseases, and the tests you’ll need often depend on your symptoms and risk factors for autonomic neuropathy.

When you have known risk factors for autonomic neuropathy

If you have conditions that increase your risk of autonomic neuropathy (such as diabetes) and have symptoms of the condition, extensive testing may not be necessary. Your doctor may perform a physical exam and ask about your symptoms.

If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.

When you don’t have risk factors for autonomic neuropathy

If you have symptoms of autonomic neuropathy but don’t have risk factors, the diagnosis may be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.

Your doctor may perform tests to evaluate autonomic functions, which may include:

  • Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
  • Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.A simpler way test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
  • Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
  • Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through four capsules placed on your forearm, foot and leg, while a computer analyzes the response of your nerves and sweat glands. You may feel warmth or a tingling sensation during the test.
  • Thermoregulatory sweat test. During this test, you’re coated with a powder that changes color when you sweat. While lying in a chamber with slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern may help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
  • Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary symptoms, a series of urine tests can evaluate bladder function.
  • Ultrasound. If you have bladder symptoms, your doctor may do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.

Treatment of autonomic neuropathy includes:

  • Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you’ll need to tightly control blood sugar to prevent autonomic neuropathy from progressing.
  • Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms

Your doctor may recommend:

  • Modifying your diet. You may need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also may help. Slowly increase fiber to avoid gas and bloating.
  • Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication may cause drowsiness, and its effectiveness wears off over time.
  • Medications to ease constipation. Over-the-counter laxatives may help ease constipation. Ask your doctor how often you should use these medications. Increasing dietary fiber also may help relieve constipation.
  • Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines. Medications usually used to treat high blood pressure and cholesterol may also be prescribed for managing diarrhea.
  • Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil), can help treat nerve-related abdominal pain. Dry mouth and urine retention are possible side effects of these medications.

Urinary symptoms

Your doctor may suggest:

  • Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder’s capacity and retrain your bladder to empty completely at the appropriate times.
  • Medication to help empty the bladder. Bethanechol is a medication that helps ensure complete emptying of the bladder. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
  • Urinary assistance (catheterization). During this procedure, a tube is guided through your urethra to empty your bladder.
  • Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction

For men with erectile dysfunction, your doctor may recommend:

  • Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and changes in color vision.If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution and medical discretion. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
  • An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor may recommend:

  • Vaginal lubricants. Vaginal lubricants may decrease dryness and make sexual intercourse more comfortable and enjoyable.

Heart rhythm and blood pressure symptoms

Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:

  • Medications that help raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor may suggest a drug called fludrocortisone. This medication helps your body retain salt, which helps regulate your blood pressure.Other drugs that can help raise your blood pressure include midodrine and pyridostigmine (Mestinon). Midodrine may cause high blood pressure when lying down.
  • Medication that helps regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if it goes too high with an activity level.
  • A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure. This is generally only recommended for very severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs.

Sweating

If you experience excessive sweating, your doctor may prescribe:

  • A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headaches, loss of taste and drowsiness. Glycopyrrolate may also increase the risk of heat-related illness (such as heatstroke) from a reduced ability to sweat.
  • Posture changes. Stand up slowly, in stages, to decrease dizziness. Sit with your legs dangling over the side of the bed for a few minutes before getting out of bed. Flex your feet and grip your hands for a few seconds before standing up, to increase blood flow.Once standing, try tensing your leg muscles while crossing one leg over the other a few times to increase blood pressure.
  • Elevate the bed. If you have low blood pressure, it may also help to raise the head of your bed by about 4 inches by placing blocks or risers under the legs at the head of the bed.
  • Digestion. Eat small, frequent meals to combat digestive problems. Increase fluids, and opt for low-fat, high-fiber foods, which may improve digestion. You may also want to try restricting foods that contain lactose and gluten.
  • Diabetes management. Try to keep your blood sugar as close to normal as possible. Tight blood sugar control can help lessen symptoms and help to prevent or delay the onset of new problems.

Several alternative medicine treatments may help people with autonomic neuropathy. Remember to discuss any new treatments with your doctor to ensure that they won’t interfere with treatments you’re already receiving or cause you any harm.

Alpha-lipoic acid

Preliminary research suggests this antioxidant may be helpful in slowing or even reversing neuropathy that’s causing blood pressure or heart rate problems, but more study is needed.

Acupuncture

This therapy, which uses numerous thin needles placed in specific points in the body, may help treat slow stomach emptying. More studies are needed to confirm what acupuncture’s role is in treating autonomic neuropathy.

Electrical nerve stimulation

Some studies have found that this therapy, which uses low-energy electrical waves transmitted through electrodes placed on the skin, may help ease pain associated with diabetic neuropathy.

Living with a chronic condition presents daily challenges. Some of these suggestions may make it easier for you to cope:

  • Set priorities. Accomplish the most important tasks, such as paying bills or grocery shopping, and save less important tasks for another day. Stay active, but don’t overdo it.
  • Seek and accept help from friends and family. Having a support system and a positive attitude can help you cope with the challenges you face. Ask for or accept help when you need it. Don’t shut yourself off from loved ones.
  • Talk to a counselor or therapist. Depression and impotence are possible complications of autonomic neuropathy. Seek help from a counselor or therapist in addition to your primary care doctor to discuss possible treatments.
  • Consider joining a support group. Ask your doctor about support groups in your area. If there isn’t a specific group for people with neuropathies, you may find that there’s a support group for your underlying condition, such as diabetes.Some people find it helpful to talk to other people who truly understand what they’re going through. Support group members can offer camaraderie, as well as tips or tricks to make living with autonomic neuropathy easier.

While certain inherited diseases that put you at risk of developing autonomic neuropathy can’t be prevented, you can slow the onset or progression of symptoms by taking good care of your health in general and managing your medical conditions.

Follow your doctor’s advice on healthy living to control diseases and conditions, which may include these recommendations:

  • Control your blood sugar if you have diabetes.
  • Seek treatment for alcoholism.
  • Get appropriate treatment for any autoimmune disease.
  • Take steps to prevent or control high blood pressure.
  • Achieve and maintain a healthy weight.
  • Stop smoking.
  • Exercise regularly.
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Let’s talk Vestibular Dysfunction

Dizziness is a general term that describes sensations of imbalance and unsteadiness, such as vertigo, mild turning, imbalance, and near fainting or fainting. Feelings of dizziness stem from the vestibular system, which includes the brain and the parts of the inner ear that sense position and motion, coupled with sensory information from the eyes, skin, and muscle tension.
Description

Because dizziness is a general term for a variety of feelings of instability, it spans a large range of symptoms. These symptoms range from the most dramatic, vertigo, to the least severe, imbalance. Included in these feelings is fainting, which results in a loss of consciousness.

Vertigo is an acute feeling of violent rotation. People with vertigo often feel as if they are tilting or falling through space. Vertigo is most often caused by problems with the vestibular system of the inner ear. Symptoms can be brief, or may last for extended periods of time and may be accompanied by changes in pulse and blood pressure, perspiration, nausea, and a type of rapid eye movement called nystagmus.

Mild turning is a less violent type of vertigo. People with mild turning are still able to function in normal daily routines. However, a feeling of turning may continue for weeks. Mild turning is usually a symptom of inner ear dysfunction. It may also result from transient ischemic attack , or a lack of blood flow to the brain. People who have suffered from strokes may feel mild turning for periods of time. Mild turning may also be associated with multiple sclerosis , AIDS , or head trauma.

Imbalance is a feeling of instability or floating. It is associated with many general medical problems such as the flu or infection. Imbalance can also be associated with arthritis, especially in the neck, or another neurological problem.

Fainting is a sudden loss of consciousness and near fainting is a feeling of extreme light-headedness with a sinking or falling feeling. Vision usually becomes hazy or dimmed and the extremities become weak. Both fainting and near fainting are caused by lack of blood flow to the brain. Anything that causes a rapid drop in blood pressure, such as a heart attack or an insulin reaction in a diabetic, can result in fainting or near fainting. Panic attacks that cause a person to exhale a lot of carbon dioxide can cause fainting or near fainting.
Vestibular system

The vestibular system is the sensory system located in the inner ear that helps the body to maintain balance. Balance in the human body is coordinated by the brainstem, which, with speed and precision, collects information from other parts of the brain and sensory organs throughout the body. It is the brainstem that sends neurological instructions to the muscles and joints. The sensory organs that play critical roles relaying information to the brain-stem include the skin, eyes, muscles and joints, and the vestibular system in the inner ear. Dizziness may result with dysfunction in any of these components or in the nerves that connect them.
Brain

The cerebellum , which is responsible for coordination and the cerebral cortex, provides neurological information to the brainstem. For example, the cerebellum is the organ that informs the body how to shift weight when going down a flight of stairs and how to balance on a bicycle. These processes are accomplished without conscious thinking.

In order to maintain balance, the brainstem depends on input from sensory organs including the eyes, muscles, joints, skin and ears. This information is relayed to the brainstem via the spinal cord. The combined neurological receptor system, which involves the brainstem, spinal cord, and sensory organs, is called the proprioceptive system. Proprioceptive dysfunction may result in dizziness, and people with problems with their proprioceptive system may fall often. Additionally, as people age, problems with proprioception become more common.
Sensory organs

Visual information is of particular importance to maintaining balance. The visual systems most involved are the optokinetic and pursuit systems. The optokinetic system is the motor impulse responsible for moving the eyes when the head moves, so that the field of vision remains clear. The pursuit system allows a person to focus on a moving object while the head remains stationary. Both of these systems feed information about the person’s position relative to the surroundings to the brainstem. A specific type of eye movement called nystagmus, which is repetitive jerky movements of the eye, most often in the horizontal direction, may cause dizziness. Nystagmus may indicate that neurologic signals from the optokinetic or pursuit systems are not in agreement with the other balance information received by the brain.

Sensory information from muscles, joints, and skin plays a key role in balance. The muscles and joints of the human body are lined with sensory receptors that send neurological information about the position of the body to the brainstem. For example, receptors in the neck muscles tell the brain which way the head is turned. The skin, in particular the skin of the feet and buttocks, is covered with pressure sensors that relay information to the brain regarding what part of the body is touching the ground.
Peripheral vestibular system

The ear, particularly the inner ear, plays a critical role in maintaining balance. The inner ear contains two major parts: the cochlea, which is mostly used for hearing, and the vestibular apparatus, also known as the peripheral vestibular system, which is important in balance. A set of channels connects the two parts of the ear and therefore any disease that affects hearing may also affect balance, and vice versa.

The peripheral vestibular system consists of a series of canals and chambers, all of which are made of membranes. This membrane system is filled with a fluid called endolymph. The peripheral vestibular system is further embedded in the temporal bone of the skull. In the space between the temporal bone and the membranes of the peripheral vestibular system resides a second fluid called perilymph. Endolymph and perilymph each have a different chemical makeup consisting of varying concentrations of water, potassium, sodium, and other salts. Endolymph flows out of the peripheral vestiubular system into an endolymphatic sac and then diffuses through a membrane into the cerebrospinal fluid that bathes the brain. Peri-lymph flows out of the peripheral vestibular system and directly into the cerebrospinal fluid. When the flow pressures or chemical compositions of the endolymph and perilymph change, feelings of dizziness can occur. These types of changes may be related to Mèniére’s disease.

The vestibular apparatus is made up of two types of sensory organs: otolith organs and semicircular canals. The otolith organs sense the direction of gravity, while the semi-circular canals sense rotation and movement of the head.

Two otolith organs in each ear are called the saccule and the utricle. The saccule is oriented in a vertical direction when a person is standing and, best senses vertical motion of the head. The utricle is nearly horizontal when a person is standing, so it best senses horizontal motion of the head. Each organ consists of calcium carbonate crystals embedded in a gel. Special hair-producing cells extend into the gel from below. As the head moves, gravity and inertia cause the crystals to bend the hairs, which are in contact with nerves. Information on the position and motion of the head is thus relayed to the brain. If the hairs or the crystals in the otolith organs are damaged, feelings of dizziness may result.

In each ear, there are also three semicircular canals that lie on planes that are perpendicular to each other. The canals are connected together by a main chamber called a vestibule. The canals and the vestibule are filled with endolymph fluid. Near its connection to the vestibule, one end of each of the canals widens into a region called the ampulla. One side of the ampulla is lined with specialized sensory cells. These cells have hairlike structures that extend into a gelatinous structure called a cupula. As the head moves in a given plane, the endolymph inside the semicircular canal in that plane remains stationary due to inertia. The cupula, however, moves because it is attached to the head. This puts pressure on the cupula, which in turn moves the hairlike structures. The bending of the hairlike structures stimulates nerves, alerting the brain that the head is moving in a particular plane. By integrating information from all three planes in which the semicircular canals lie, the brain reconstructs the three-dimensional movement of the head. If information from one of the semicircular canals does not agree with that of another, or if the information generated by semicircular canals in one ear does not agree with the information produced by the other ear, feelings of dizziness may result.

All of the signals from the peripheral vestibular system travel to the brain along the eighth cranial nerve, also called the vestibular nerve. Damage to this nerve, either through head trauma or the growth of tumors, can also cause feelings of dizziness. Neurological information from the semicircular canals seems be more important to the brain than information from the otolith structures. If the eighth cranial nerve on one side of the head is damaged, but the other side remains intact, the brain learns to compensate over time; however, the mechanics involved in this process are not well understood.
Demographics

Dizziness is an extremely common symptom occurring in people of all ages, ethnicities, and socioeconomic backgrounds. Balance disorders increase with age, and by age 75, dizziness is one of the most common reasons for visiting a doctor. In the general population, dizziness is the third most common reason that patients visit doctors. According to the National Institutes of Health (NIH), about 42% of the population of the United States will complain of dizziness at some point in their lives. In the United States, the cost of medical care for patients with symptoms of imbalance is estimated to be more than $1 billion per year.
Diseases associated with dizziness

Because it involves so many different parts of the body, the balance system may exhibit signs of dysfunction for a variety of reasons. Dizziness may be caused by problems with the central nervous system , the vestibular system, the sensory organs, including the eyes, muscles and joints, or more systemic disorders such as cardiovascular disease, bacterial and viral diseases, arthritis, blood disorders, medications, or psychological illnesses.
Central nervous system dysfunction

Any problem that affects the nerves leading to the brain from vestibular or sensory organs, the spinal cord, the cerebellum, the cerebral cortex, or the brainstem may result in dizziness. In particular, tumors that affect any of these organs are of concern. In addition, disorders that affect blood supply to the central nervous system, such as transient ischemic attacks, stroke , migraines, epilepsy , or multiple sclerosis, may result in feelings of dizziness.

BRAINTUMORS Although rare, acoustic neuroma is a benign tumor growing on the vestibulo-cochlear nerves, which reach from the inner ear to the brain. It may press as well on blood vessels that flow between the peripheral vestibular system and the brain. Symptoms included ringing in one ear, imbalance, and hearing loss. Distortion of words often becomes increased as the tumor grows and disturbs the nerve. Treatment requires surgical removal of the tumor, which nearly always returns the sense of balance to normal, although some residual hearing loss may occur.

Other brain tumors may also cause feelings of dizziness. These include tumors that originate in the brain tissue, such as meningiomas (benign tumors) and gliomas (malignant tumors). Sometimes tumors from other parts of the body may metastasize in the brain and cause problems with balance.

CEREBRAL ATROPHY Age causes atrophy (deterioration) of brain cells that may result in slight feelings of imbalance. More severe forms of dizziness may result from other neurological disorders.

BLOOD SUPPLY DISORDERS If the blood flow and oxygenation to the cerebellum, cerebral cortex, or brain-stem is not adequate, feelings of dizziness can result. Such symptoms can result from several types of disorders, including anemia, transient ischemic attacks (TIAs), and stroke.

TIAs are temporary loss of blood supply to the brain, often caused by arteriosclerosis (hardening of the arteries). In addition to a brief period of dizziness or vertigo, symptoms include a transient episode of numbness on one side of the body, and slurred speech and/or lack of coordination. If the loss of blood supply to the brain is due to a blockage in one of the arteries in the neck, surgery may correct the problem.

Strokes, or cerebrovascular accidents (CVA), occur in three major ways. A thrombotic stroke occurs when a fatty deposit forms a clot in an artery, blocking blood supply to the brain. An embolic stroke occurs when part of a clot from another part of the body breaks off and obstructs an artery leading to the brain. A hemorrhagic stroke occurs when blood vessels in the brain hemorrhage, leaving a blood clot in the brain.

PERIPHERAL VESTIBULAR SYSTEM DYSFUNCTION When balance problems are brief or intermittent, the peripheral vestibular system is usually the cause. Many different problems may be at the root of vestibular disorder.

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) Benign paroxysmal positional vertigo occurs following an abrupt change in position of the head. Often, onset of vertigo occurs when patients roll from their back onto the side, and it usually subsides in less than a minute. BPPV can result from head trauma, degeneration of the peripheral vestibular system with age, infection of the respiratory tract, high blood pressure, or other cardiovascular diseases. Those who suffer from an infection of their vestibular system, causing severe vertigo that lasts up to several days, can develop BPPV any time within the next eight years. BPPV is also associated with migraine headaches .

Two theories on the cause of BPPV currently exist. One suggests that BPPV will occur when the calcium carbonate crystals in the otolith organs (the saccule and the utiricle) are displaced and become lodged in the cupula of the semicircular canals due to head trauma, infection, or degeneration of the inner ear canals. This displacement will stimulate the nerves from the semicircular canals when the head rotates in a particular position, indicating to the brain that the person is spinning. However, the rest of the sensory organs in the body report that the body is stationary. This conflicting information produces vertigo. The calcium carbonate crystals dissolve after a brief time, and the symptom is rectified. The second theory suggests that cellular debris accumulates into a mass that moves around the semicircular canals, exerting pressure on the cupula and causing vertigo. When the mass dissolves, the symptoms subside.

INNER EAR INFECTIONS Inner ear infection, or vestibular neuronitis, occurs some time after a person has suffered from a viral infection. Onset includes a violent attack of vertigo, including nausea, vomiting, and the inability to stand or walk. Symptoms subside in several days, although feelings of unsteadiness may continue for a week or more. A swelling of the vestibular nerve following a viral infection causes vestibular neuronitis.

Sometimes the inflammation can recur over several years. A viral infection affecting the inner ear, but not the vestibular nerve, is called viral labyrinthitis. Labyrinthitis can cause hearing loss, but all other symptoms are similar to vestibular neuronitis.

Severe bacterial infections can also cause inflammation of the inner ear. These cases include risk of deafness, inflammation of the brain, and meningitis (inflammation of the membranes surrounding the brain and spinal cord). Otitis occurs when fluid accumulates in the middle ear, causing feelings of imbalance, mild turning, or vertigo. When the infection reaches the inner ear, the disease is called acute suppurative labyrinthitis. Treatment for any bacterial infection in the ear is critical to prevent long-term damage to hearing and balance organs.

PERILYMPH FISTULA Perilymph fistulas are openings that occur between the middle ear and the inner ear. This allows a hole through which perilymph can flow, changing the pressure of perilymph flowing into the brain and causing dizziness. Fistulas often form as a result of head trauma or abrupt changes in pressure. Symptoms may also include hearing loss, ringing in the ears, coordination problems, nystagmus, and headaches. Most fistulas heal with time; however, in severe cases, surgical procedures are used to close the hole, using a tissue graft.

MÈNIÉRE’S DISEASE In 1861, French physician Prosper Mèniére described Mèniére’s disease as having four particular symptoms: vertigo lasting for an hour or more, but less than 24 hours; ringing or buzzing sounds in the ear; feeling of pressure or fullness in the ear; and some hearing loss. Some people are affected in both ears; others just one ear. Onset of Mèniére’s may be related to stress, although not in all cases. Nystagmus is usually associated with the attacks.

Mèniére’s disease is thought to be caused by an accumulation of endolymph within the canals of the inner ear, a condition called endolymphatic hydrops. This causes produces a swelling in the canals containing endolymph, which puts pressure on the parts of the canals containing perilymph. The result affects both hearing and balance. In severe cases, it is feared that the endolymphatic compartments may burst, disrupting both the chemical and pressure balances between the two fluids.

The cause of the accumulation of endolymph is unknown, although it can be related to trauma to the head, infection, degeneration of the inner ear, or some other regulatory mechanism. Syphilis is often associated with Mèniére’s disease, as are allergies and leukemia. Some suggest that Mèniére’s disease is an autoimmune dysfunction. There may be a genetic predisposition to Mèniére’s disease.

Mèniére’s disease is usually treated with meclizine (Antivert), antihistamines, and sedatives. Diuretics can be used to rid the body of excess endolymph. Salt-free diets can also help to prevent the accumulation of fluid in the ears.
Systemic disorders

Dizziness may be a symptom of a disorder that affects the whole body, or systems within the body. Dizziness may also be the result of systemic toxicity to substances such as medications and drugs.

POSTURAL HYPOTENSION The major symptom of postural hypotension, also called orthostasis, is low blood pressure. When a person stands up from a prone position, blood vessels in the legs and feet must constrict to force blood to the brain. When blood pressure is low, the blood vessels do not constrict quickly or with enough pressure and the result is a lag before blood reaches the brain, causing dizziness. Postural hypotension can be treated with an increase in fluid intake or with blood pressure medication.

HEART CONDITIONS A variety of heart conditions can cause feelings of dizziness. In particular, arrhythmia, a dysfunction of the heart characterized by an irregular heartbeat, decreases blood supply to the brain in such a way as to cause balance problems. In most cases, symptoms of dizziness associated with arrhythmia result from problems with heart valves, such as narrowing of the aorta and mitral valve prolapse.

INFECTIOUS DISEASES Influenza and flu-like diseases can cause dizziness, especially if accompanied by fever. The virus herpes zoster oticus causes painful blisters and shingles . If the virus attacks the facial nerve, it may result in vertigo. Several bacterial diseases can result in dizziness, including tuberculosis, syphilis, meningitis, or encephalitis. One of the major symptoms of Lyme disease , which is caused by infection of a microorganism resulting from a deer tick bite, is dizziness.

BLOOD DISORDERS A variety of diseases of the blood result in feelings of dizziness. These diseases include anemia, or a depletion of iron in the blood, sickle-cell anemia, leukemia, and polycythemia.

DRUGS AND OTHER SUBSTANCES A variety of substances ingested systemically to prevent disorders of diseases can result in feelings of dizziness. In particular, overdose of aspirin and other anti-inflammatory drugs can cause problems with balance. Antibiotics taken for extended periods of time are also known to cause dizziness. Streptomycin is known to damage the vestibular system, if taken in large doses. Medicines that are used to treat high blood pressure can lower blood pressure so much as to cause feelings of light-headedness. Quinine, which is taken to treat malaria, can cause dizziness, as can antihistamines used to prevent allergy attacks. Chemotherapy drugs are well known to have various side effects, including dizziness. Alcohol, caffeine, and nicotine are also known to cause dizziness, when taken in large doses.
Diagnosis

Because maintaining posture integrates so many different parts of the body, diagnosing the actual problem responsible for dizziness often requires a battery of tests. The cardiovascular system, the neurological system, and the vestibular system are all examined.

Blood pressure is one of the most important cardiovascular measurements made to determine the cause of imbalance. Usually the physician will measure blood pressure and heart rate with the patient lying down, and then again after the patient stands up. If blood pressure drops significantly and the heart rate increases more than five beats per minute, this signals the existence of postural hypotension. Dizziness in people suffering from diabetes or on blood pressure medicine may be caused by postural hypotension.
Neurological tests

Because the central nervous system is integral to maintaining balance, neurological tests are often performed on patients with symptoms of dizziness. A test of mental status is often performed to ascertain that mental function is healthy. Physicians may test tendon reflexes to determine the status of peripheral and motor nerves, as well as spinal cord function. Nerves in different parts of the body may also be evaluated. In addition, physicians may test muscle strength and tone, coordination, and gait.

Neurologists may also perform a variety of computerized scans that determine if tumors or acoustic neuromas are present. These tests include magnetic resonance imaging (MRI) , computerized tomography (CT ), and electroencephalogram (EEG).
Tests of the vestibular system

Most often performed by a otolaryngologist, the battery of tests performed to determine the health of the vestibular system include the Dix-Halpike test, electrostagmography, hearing tests, rotation tests, and posturography.

DIX-HALPIKE TEST The Dix-Halpike test, also called the Halpike test, is performed to determine if a patient suffers from benign paroxysmal positional vertigo (BPPV). The patient is seated and positioned so that his or her head hangs off the edge of the table when lying down. The patient’s head is moved 45 degrees in one direction. The patient is then asked to lie down, without moving his or her head. The same procedure will be repeated on the other side. If feelings of vertigo result from this movement, BPPV is usually diagnosed.

ELECTRONYSTAGMOGRAPHY (ENG) Considered one of the most telling diagnostic tests to determine the cause of dizziness, electronystagmography consists of a series of evaluations that test the interactions between the vestibular organs and the eyes, also called the vestibulo-ocular reflex. Results from this test can inform the physician whether problems are caused by the vestibular system or by the central nervous system.

The most common diagnostic feature observed during ENG is nystagmus, an involuntary movement of the pupils that allows a person to maintain balance. In healthy persons, nystagmus consists of a slow movement in one direction in response to a change in the visual field and quick corrective movement in the other direction. In persons with disorders of the vestibular organs, nystagmus will produce quick movements in the horizontal direction. People with neurologic disorders will show signs of nystagmus in the vertical direction or even in a circular pattern.

In most of the ENG tests, electrodes taped to the patient’s head record nystagmus as the patient is exposed to a variety of moving lights or patterns of stripes that stimulate the vestibular system. The patient may be asked to stand and lie in various positions for the tests. Also, included in the ENG is a caloric test in which warm water and cool water are circulated through the outer ear. This causes a slight expansion or contraction of the endolymph in the inner ear and simulates movement cues to the brain.

HEARING TESTS Because the cochlea and the vestibular organs are adjacent to one another, hearing dysfunction can often be related to problems with dizziness. Audiograms include tests for both hearing and interpreting sounds, and can determine whether or not problems exist in the middle ear, the inner ear, or the auditory nerve.

ROTATION TESTS Rotation tests evaluate the vestibulo-ocular reflex and provide important information when the dysfunction is common to both ears. Electrodes are usually taped to the face to monitor eye movement, and the patient is placed in a chair. The chair rotates at different speeds through different arcs of a circle. The audiologist may also ask the patient to focus on different objects as the chair is rotated.

POSTUROGRAPHY During posturography tests, a patient stands on a platform that measures how weight is distributed. During the test, the patient will close and open his or her eyes or look into a box with different visual stimuli. The platform is computer controlled so that it can gently tip forward or backward or from side to side. Posturography measures how much the patient sways or moves in response to the stimuli. This provides information on the function of the proprioceptive system, as well as the vestibular system.
Treatment

If symptoms of dizziness are found to be associated with systemic diseases such as diabetes, hypotension, or other infectious diseases, or with neurological disorders, treatment for the dizziness is usually successful.

In many patients, dizziness caused by vestibular dysfunction tends to dissipate with time and with little treatment. However, available and common treatments for vestibular problems include physical therapies, medications, and surgeries. In addition, low-salt diets, relaxation techniques, and psychological counseling may be used as treatment.
Exercises and therapy

The physical therapies to decrease dizziness fall into two major groups. Compensation therapies help train the patient’s brain to rely on the sensory information it receives to maintain balance, and to ignore information from damaged organs. Exercises in a compensation program are designed to focus on the movements that cause dizziness so that the brain can adapt to these behaviors. In addition, exercises that teach the patient how to keep the eye movements separate from head movements and to practice balancing in various positions are used.

Specific exercises aimed at relieving benign paroxysmal positional vertigo (BPPV), called canalith repositioning procedures, have recently been developed. By turning the head to one side and moving from a sitting to lying position in a certain sequence, BPPV can be quickly relieved. The movements in the canalith repositioning procedures are intended to move calcium carbonate crystals from the semicircular canals back to the utricle. The success rate with these exercises can be up to 90%.
Medications

A variety of medications are used to treat vertigo. These include vestibular suppressants, which seem to work by decreasing the rate of firing of nerve cells. Common vestibular suppressants are meclizine (Antivert, Bonine, and Vetrol). Also prescribed are anti-nausea medications such as promethazane (Phenergan) and anti-histamines (Benadryl, Dramamine). For dizziness brought on by anxiety attacks, anti-anxiety drugs such as diazepam (Valium) and lorazepam (Ativan) may be used. These drugs all have side effects and are seldom prescribed for long periods of time.
Surgery

Surgery is usually the last step in the treatment of dizziness, only used after therapy and medications have failed. One of the more common surgical procedures for treating vestibular disorders is patching perilymph fistulas, or tears, at the tops of the semicircular canals. Surgery may also be used to drain excess fluid from the endolymphatic canals to relieve endolymphatic hydrops. Cutting the vestibular nerve just before it joins with the auditory nerve to form the eighth cranial nerve can also be performed to alleviate severe problems with dizziness. Finally, the entire labyrinth can be destroyed in a procedure called a labyrinthectomy, although this is usually only performed when hearing has been completely lost as well.
Resources
BOOKS

Blakely, Brian W., and Mary-Ellen Siegel. Feeling Dizzy: Understanding and Treating Dizziness, Vertigo, and Other Balance Disorders. New York: Macmillan USA, 1997.

Olsen, Wayne, ed. Mayo Clinic on Hearing: Strategies for Managing Hearing Loss, Dizziness, and Other Ear Problems. Rochester, MN: Mayo Clinic Health Information, 2003.
OTHER

“Vestibular Disorders: An Overview.” The Vestibular Disorders Association. November 3, 2003. (April 4, 2004). .

“Equilibrium Pathologies.” Archives for Sensology and Neurootology in Science and Practice. January 2004 (April 4, 2004). .

“Dizziness.” The Mayo Clinic. October 10, 2002 (April 4, 2004). .

“Dizziness and Motion Sickness.” The American Academy of Otolaryngology and Head and Neck Surgery. January 30, 2004 (April 4, 2004). .

“Balance, Dizziness and You.” National Institute on Deafness and other Communication Disorders. November 20, 2003 (April 4, 2004). .
ORGANIZATIONS

Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208. (503) 229-7705 or (800) 837-8428. .

Juli M. Berwald, PhD

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Energy efficient light bulbs are so toxic!

do not use these light bulbs they make you sick
Home Health These Light Bulbs Cause Anxiety, Migraines, And Even Cancer. If You Have…
These Light Bulbs Cause Anxiety, Migraines, And Even Cancer. If You Have Them, Do THIS Immediately !
January 14, 2016
Many of us in the effort to save energy and money, replaced our old standard light bulbs with environmentally-friendly with the new generation energy saving light bulbs. However, the new generation of energy efficient light bulbs are so toxic that the U.S. Environmental Protection Agency created an emergency protocol you need to follow in the event of a bulb breakage, due to the poison gas that is released. If broken indoors, these light bulbs release 20 times the maximum acceptable mercury concentration into the air, according to a study conducted by researchers from the Fraunhofer Wilhelm Klauditz Institute for German’s Federal Environment Agency.
do not use these light bulbs they make you sick
Energy Efficient Light Bulbs Can Cause:

Dizziness

Cluster headaches

Migraines

Seizures

Fatigue

Inability to concentrate

Anxiety
Energy Efficient Bulbs Cause Anxiety, Migraines, and Even Cancer. Reasons to Go Back To Incandescent Bulbs
1. Energy saving bulbs contain mercury. Murcury ia a potent neurotoxin that is especially dangerous to children and pregnant women. It is especially toxic to the brain, the nervous system, the liver and the kidneys. It can also damage the cardiovascular, immune and reproductive systems. It can lead lead to tremors, anxiety, insomnia, memory loss, headaches, cancer and Alzheimer’s .
2. Energy saving bulbs can cause cancer.
A new study performed by by Peter Braun at Berlin Germany’s Alab Laboratory found these light bulbs contain poisonous carcinogens that could cause cancer:
Phenol, a mildly acidic toxic white crystalline solid, obtained from coal tar and used in chemical manufacture (http://en.wikipedia.org/wiki/Phenol).
Naphthalene, a volatile white crystalline compound, produced by the distillation of coal tar, used in mothballs and as a raw material for chemical manufacture (http://en.wikipedia.org/wiki/Naphthalene).
Styrene, an unsaturated liquid hydrocarbon, obtained as a petroleum byproduct(http://en.wikipedia.org/wiki/Styrene).
3. Energy saving light bulbs emit a lot of UV rays.
Energy saving lamps emit UV-B and traces of UV-C radiation. It is generally recognised that UV-radiation is harmful for the skin (can lead to skin cancer) and the eyes. The radiation from these bulbs directly attacks the immune system, and furthermore damages the skin tissues enough to prevent the proper formation of vitamin D-3.
GE Lighting 48415 60-Watt 825-Lumen General Purpose A19 Incandescent Light Bulb, Soft White, 48-Pack
In conclusion, these bulbs are so toxic that we are not supposed to put them in the regular garbage. They are household hazardous waste. If you break one in a house, you are supposed to open all of your windows and doors, and evacuate the house for at least 15 minutes to minimize your exposure to the poisonous gas. Unfortunately, soon consumers won’t have the option to buy incandescent lights because they won’t be available. The Energy Independence and Security Act of 2007 (EISA) mandates the phase-out of incandescent light bulbs, and favors energy-efficient compact fluorescent light (CFL) bulbs.

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