Vol. 10, No. 3, Summer 1993


CHARLIE DASCHBACH:

LIFE WITH MENIERE'S
IS A BALANCING ACT
FOR PHYSICIAN

Editor's Note: The following story first
appeared in the December issue of Barrow
magazine, a publication of Barrow
Neurological Institute of St. Joseph's
Hospital and Medical Center (SJHMC) in
Phoenix, Ariz. The story is reprinted here by 
permission of Barrow.)
 
In spite of a dizzying schedule, Charlie
Daschbach, M.D., has his feet planted
firmly on the ground. At the moment, with
characteristic splashes of wit and
enlightened instruction, he's steering an
eager brood of interns through patient
rounds.

Charlie's self-assured movements are
hardly those reminiscent of a person who
once found his environment spinning out
of control. Six years ago, the symmetry in
his life was severely tested by Meniere's
disease, a condition that causes repeated
attacks of dizziness due to increased
pressure of the inner ear fluids.

Charlie's first attack occurred in early
1987 during the middle of the night. "The
bedroom was spinning and it felt as
though someone had hit me over the head
with a hammer. I fell out of bed, crawled
to the bathroom and started vomiting,"
explains Charlie.

"The next day, I went to see neurologist
Joseph White, M.D., who was my boss and
mentor at the time. He did a physical
examination and suspected my problems
were due to Meniere's. He prescribed a
diuretic to reduce body fluids and salt, and
Antivert to reduce the dizzy sensation. For
the next three days, I was extremely dizzy,
couldn't move my head and continued to
vomit."

Two weeks later, a series of hearing tests
and an MRI, which was necessary to rule
out an acoustic neuroma, confirmed
Meniere's in Charlie's right ear. While
dizziness is the primary symptom of
Meniere's, hearing loss, tinnitus (ringing in
the ear), fullness in the involved ear and
rotary vertigo (spinning) accompany the
condition.

After the diagnosis was made, Charlie,
who continued with medical therapy,
experienced monthly attacks. He would
suddenly fall down at work or home and
was unable to stand or keep his balance.
The episodes would last anywhere from
two to six hours.

"Meniere's causes a general feeling of
disorder. It's a terrible feeling of panic
and fear, and it's accompanied by a deep
sense inside that everything is wrong," says
Charlie.

Initially, the effects of the disease were
manageable. "In the beginning, the
Meniere's didn't interfere with my work
because my manager, boss, the residents
and interns, and other St. Joseph's
physicians arranged their schedules to help
me during an attack," says Charlie, who is
an internal medicine physician, and as the
director of medical education at SJHMC,
oversees all intern and resident programs.

During this period, Charlie looked to
other factors to help decrease the
symptoms of the disease. "I started
searching for easy answers, such as
examining my sleep habits, diet and other
lifestyle issues. Unfortunately, the
correlation didn't make a difference."

Charlie immersed himself in literature
about Meniere's, reading copious amounts
of research until, as he humorously recalls,
"I became dizzy from reading."

It was also during this time that Charlie
became increasingly aware of others'
perceptions of him. "I wish this disease
gave you green spots on your face and had
significant outward signs. I was really
afraid of others' opinions when I'd lose my
balance and fall down. I was very
concerned that people thought I had a
drinking problem," he reflects. "I now have
a greater appreciation for others with
neurological complications and the
challenges they face from public
perception."

The magnitude of the symptoms and the
impact of Meniere's on Charlie's life took
its toll during Pope John Paul's visit to
SJHMC during September 1987. "Since I
was familiar with many of the cardinals
involved with the pope's visit, I was asked
to be Channel 12's color commentator for
the event. I was scheduled to be at the
television station at 4 a.m. Around 1 a.m.
I woke up very sick and was retching. I
made it to the station in time but had to
call a friend to drive me there. I made it
through the broadcast, but I was mildly
dysphoric."

It was this episode that caused Charlie to
see neurologist Phillip Daspit, M.D., about
surgery alternatives.

"The decision to perform surgery on those
with Meniere's is strictly based on a
person's incapacitation and lifestyle," says
Daspit. "In Charlie's case, the effects were
impairing his personal and professional
life."

Less than a month after the papal visit,
Charlie underwent an endolymphatic sac
procedure on his right ear, performed by
Daspit. "During this procedure, the
surgeon makes an incision in the
endolymphatic sac and places a piece of
silastic material in the center of the sac to
aid in fluid absorption of the inner ear,"
explains Daspit.

The procedure was done on an outpatient
basis, and Charlie felt ecstatic with the
results. "I was on cloud nine following the
surgery. I felt cured. The vertigo
disappeared."

Of the 100 patients Daspit has performed
the surgery on, approximately 70 to 80
percent find the dizziness is alleviated and
that the hearing loss is stabilized in the
affected ear. "Candidates for this
procedure include those with serviceable
hearing, such as those who can be helped
with a hearing aid, and those people
whose hearing fluctuates," he says.
"Balance is the primary concern of people
with Meniere's, and the hearing loss is
secondary. They just want the dizziness to
stop." But he is quick to point out that not
everyone who experiences dizziness has
Meniere's. "In fact, many people come
into my office incorrectly diagnosed with
Meniere's. There could be several reasons
for a person's dizziness; Meniere's only
affects a small part of the population."

For one year, Charlie remained free of
symptoms, but then the attacks resumed,
occurring every 10 days or so. "I went back
to see Dr. Daspit, who did another series
of hearing tests. My hearing was stable in
the right ear, which meant the hearing loss
diagnosed a year before hadn't changed,
and the hearing in my left ear was normal.
However, it was obvious the shunt was not
alleviating the vertigo, so I agreed to a
second surgery."

Charlie's recovery from the second
surgery, a selective sectioning of the right
vestibular nerve, was much more difficult
than the first. "I had severe vertigo, was
vomiting and couldn't stand or walk
without assistance. I didn't quite
comprehend the degree of difficulty the
surgery would cause me," he says. "I don't
remember much about my hospitalization
except that the neurosurgery residents and
BNI nurses were a godsend to me."

"During this procedure, the surgeon
performs a craniotomy and cuts the
balance nerve, sparing the cochlear nerve.
This sectioning stops the vertigo Meniere's
patients experience. However, the
procedure temporarily causes a person's
balance to become worse because it takes
awhile for the central nervous system to
compensate for the loss of one of the two
balance systems. Once the opposite ear
stabilizes, the vertigo is eliminated,"
explains Daspit.

A combination of the Meniere's and
surgery has caused total hearing loss in
Charlie's right ear. Unfortunately, in
August 1991, Daspit confirmed bilateral
Meniere's because of fluctuation in
Charlie's left ear. However, Charlie has
not had an attack like those prior to the
second surgery.

It's a guessing game if and when Charlie
will become deaf in the left ear. The
prospect of a non-hearing world is evident
in lifestyle adjustments he has already
made. "I've ordered a special stethoscope
that amplifies sound for my left ear, and
when I walk with people they must be on
my left side. I also sit with my 'good' ear
facing a crowd. My wife has begun to
learn basic sign language too."

The experience with Meniere's has caused
Charlie to appreciate his mortality and,
except for the disease, his health. It's also
changed his manner as a physician.

"I'm a much better doctor because of the
Meniere's and subsequently because of
being a patient. I now realize the value of
a 10 to 20 minute patient visit. We
physicians tend to be focused on the office
visit and not on the impact of disease on
the patient's whole life. I now think in
terms of a patient's activities of daily
living, such as cooking and shopping. I
also impart this to the interns, asking them
to take the time to determine how disease
is affecting their patients' lives in general."

Obviously, total hearing loss will be a
significant factor in Charlie's ability to
communicate with patients and students as
a physician and educator, but that has not
tempered his hope for others. "My
secretary's son is deaf and he wants to be
a physician. I realize the obstacles he will
face, but I always encourage him because
I believe it's possible to be deaf and still
be a good physician."

    _________________________


NEW MATERIALS

We've recently added a document, S-4:
Dining Out, by Katherine Warren, Ed.S.,
NCC. It's full of tips for getting out
without getting dizzy. Dining Out is free to
members. Please send a stamped, self-
addressed #10 (long) envelope with your
request.

    _________________________


POEMS AVAILABLE

Priscilla Staples, a VEDA member, has
written 45 poems that she is making
available (at cost) to VEDA members.
Ms. Staples has vestibular hypofunction,
secondary to gentamicin ototoxicity, and
the poems are about experiences common
to many VEDA members. To ask for her
poems, write to her at 121 West Main St.,
Fort Kent, Maine 04743. 
LIBRARY PACKETS

Members often write to VEDA to say
they've had no luck in their home towns
finding information about vestibular
disorders. Typically, local libraries have
nothing in the card catalog under
"dizziness" or "vertigo."

To help solve this problem, VEDA is
offering library packets to members to
place in local libraries. The packets
include Balancing Act and several
brochures and flyers on vestibular
disorders.

VEDA can't afford to send these packets
free to all the libraries in the U.S.
However, individual members who want to
help others are invited to buy packets
from VEDA for $10 each to donate to
libraries. To get a library packet, send a
check to VEDA for $10. Include a note
requesting a library packet.
 
When you give your packet to your
librarian, be sure to tell her or him that
it's a donation, worth $10, meant for the
vertical file or pamphlet file. Or possibly
Balancing Act could be shelved as a book. 
Ask the librarian to catalog the vertical
file material under "dizziness" so other
people with symptoms but no diagnosis
will be able to find it.

Ask your librarian for a receipt if you
want one for your tax records.

After you've successfully placed the packet
in your library, please let VEDA know the
library's name and address. We will create
and maintain a list of such libraries to try
to avoid duplication of effort.
NEWS AND
REVIEWS

By Susan L. Engel-Arieli, M.D.

Below are summaries of articles that
appeared in recent medical and
professional journals:

1. Regeneration of Inner Ear Cells --
Recent research indicates there may be
hope for eventually curing leading forms
of deafness. Inner ear cells have been
restored in mammals using a chemical
made from Vitamin A. Before this,
deafness resulting from a loss of hair cells
was assumed to be permanent.
Researchers predict that the information
gleaned from experiments in rats could be
tried on human beings within a decade. 

The death or malfunction of auditory hair
cells is thought to be the cause in the
majority of the 18 million cases of
deafness in the U.S. The cells can be
damaged by loud noises, chemicals,
diseases, or age. If the new research holds
up, it may be possible to repair the inner
ear in humans and treat deafness and
other inner ear problems. See Lefebzre,
P., et al., "Retinoic Acid Stimulates
Regeneration . . .," Science, Vol. 260, April
30, 1993, pages 692-695. 

2. Vertigo in the Beauty Parlor -- The
author of a recent article suggests that a
head or neck hyperextended during
shampooing at a beauty parlor may be an
important risk factor for strokes in elderly
women. The extent and possibility of this
happening depends on the duration and
force of movement, circulation, and
degree of atherosclerosis and arthritis of
the neck.

Concern was raised when stroke symptoms
occurred in seven elderly women after
shampoo treatment. Symptoms included
vertigo, slurred speech, dizziness, nausea,
vomiting, numbness, and weakness. Some
of the women returned to normal; others
improved but had deficits, and others
remained impaired.

The hazard of neck hyperextension and
rotation was not previously suspected in
the elderly, who are at a higher risk for
strokes.

The author suggests that elderly people
should avoid hyperextending the neck
during shampooing and that beauty shops
should substitute a safer, flexed posture.
See Weintraub, Michael, "Beauty Parlor
Stroke Syndrome. . .," JAMA, Vol. 269,
No. 16, April 28, 1993, pages 2085-2086.

3. Vertigo Before Strokes -- Doctors recently
reported on two patients who developed
vertigo for several months before suffering
strokes. Both had risk factors for strokes,
and both had transient episodes of other
neurologic symptoms not associated with
the vertigo. Also, both developed
recurrent vertigo, which lasted for several
minutes up to several times a week.

The doctors assume that the episodes of
vertigo resulted from transient blood loss
to the inner ear or vestibulo-cochlear
nerve. See Oas, J., et al., "Vertigo and the
AICA Syndrome," Neurology, Vol. 42,
1993, page 2274.


4. Toxins and Dizziness -- 
Chinese researchers recently studied the
incidence of abnormal health symptoms in
paint workers exposed to xylenes and
toluene. Symptoms included chronic
dizziness, fatigue, palpitations, acute
headaches, and chest tightness. Workers in
the high exposure group were 3.3 times
more likely to develop three or more
chronic symptoms than the low exposure
group. See Wang, J.D., et al., "Acute and
Chronic Neurological Symptoms,"
Environmental Research, 61(1), April 1993,
pages 107-16.

5. BPPN After Vestibular Neuronitis -- A
recent article discussed nine cases of
BPPN that developed after bouts of
vestibular neuronitis. The interval between
neuronitis and the BPPN onset ranged
from two weeks to 20 years. The extent
and degree of the lesions varied, which
could explain the time difference in the
BPPN onset, the authors said. See Harada,
K., et al., "A Clinical Observation of
BPPN. . .," Acta Oto-Laryngolica,
Supplement (Stockholm), 503, 1993, pages
61-63.

6. Tidbits on Vestibular Neuronitis (VN) -- 

Steroids and VN: Neurotologic test results
improved significantly when steroid
therapy was used recently in 34 patients
with vestibular neuronitis as compared to
77 patients who were not given steroids.
See Ohbayashi, S., et al., "Recovery of
Vestibular. . .," Acta Oto-Laryngolica,
Supplement (Stockholm), 503, 1993, pages
31-34.

Follow-up in VN Patients: Complete relief
from VN was seen in 57 percent of 60
patients recently studied. One month after
onset, 90 percent had abnormal tests, 80
percent after six months, 50 percent after
five to 10 years. Because of this 50
percent, the prognosis for VN is not
always wonderful despite subjective
symptom relief. See Okinaka, Y., et al.,
"Progress of Caloric Response. . .," Acta
Oto-Laryngolica, Supplement (Stockholm),
503, 1993, pages 18-22.

Epidemiology of VN: A survey of VN in
Japan recently showed no sexual
difference in its incidence. The peak of
age distribution was between 40 and 50
years; 30 percent of all cases had common
colds prior to the disease. See Sekitani, T.,
et al., "Vestibular Neuronitis. . .," Acta
Oto-Laryngolica, Supplement (Stockholm),
503, 1993, pages 9-12.

Viruses and VN: Studies have shown that
the following viruses can infect and
damage the vestibular nerve and labyrinth:
rubeola, herpes simplex, reovirus,
cytomegalovirus, influenza A, and mumps.
See Davis, L.E., "Viruses and VN. . .,"
Acta Oto-Laryngolica, Supplement
(Stockholm), 503, 1993, pages 70-73.

Bilateral VN: Bilateral VN with a different
onset for each side was reported in a
recent study of two patients. In one case,
problems appeared in one ear three weeks
before involvement of the second ear. In
the second case, the time differential was
five years. See Ogata, Y., "Bilateral VN,"
Acta Oto-Laryngolica, Supplement
(Stockholm), 503, 1993, pages 57-60.

VN in Elderly People: Japanese studies of
74 elderly people with VN showed no
sexual difference in incidence, no bilateral
VN, 10 recurrent cases, preceding flu or
cold in 10 percent, 35 cases with
complications of which hypertension was
the most common. See Hara, H., et al.,
"VN in Aged Patients," Acta Oto-
Laryngolica, Supplement (Stockholm), 503,
1993, pages 53-56.

VN in Children: Seventeen cases of VN in
children were analyzed. There were 11
males and six females ranging in age from
3 to 15 years. Bilateral and recurrent cases
were not encountered. Fifty three percent
of the children had a preceding cold or
flu. The prognosis in children was found
to be better in children than adults. The
central (brain) and peripheral (ear)
compensation and recovery was much
more effective in children as well. See
Tahara, T., et al., "VN in Children," Acta
Oto-Laryngolica, Supplement (Stockholm),
503, 1993, pages 49-52.

7. BPPV Treatments -- Sixty patients at
Johns Hopkins Hospital received either a
single treatment (Semont maneuver)
based on the hypothesis that vertigo of
BPPV is caused by debris adhering to the
cupula of the posterior semicircular canal
(cupulolithiasis) or a single treatment
(modified Epley maneuver) based on the
hypothesis that the debris is floating free
in the posterior canal (canalithiasis).
Treatment for cupulolithiasis resulted in
remission of vertigo in 70 percent of the
patients and improvement in another 20
percent. Treatment for canalithiasis
resulted in remission of vertigo in 57
percent and improvement in another 33
percent. There was no statistically
significant difference between treatments.
Further studies are needed to look at the
long-term effectiveness of the treatments,
the authors said. See Herdman, S.J., Tusa,
R., Zee, D., et al., "Single Treatment
Approaches. . .," Archives of Otolaryngology
-- Head and Neck Surgery, 119 (4), April
1993, pages 450-454.

Below are summaries of articles appearing
in consumer publications:

1. Healthy Lawn, Sick People? -- Pretty
green grass can be a hazard to your
health. If you use bugs and weed killers,
you may be taking in the poison by
inhaling the air, walking barefoot, or by
tracking chemicals into the house. Low
doses of pesticides can cause dizziness,
headaches, and muscle twitching. Larger
amounts can lead to damage of the
nervous system, kidney, liver, or to cancer.
To help prevent illness, follow directions;
wash chemicals into the lawn with the
sprinkler; don't walk barefoot on the
chemicals; try natural pesticides to kill
insects, and ask neighbors to tell you
before they spray. This information comes
from the National Coalition Against the
Misuse of Pesticides and the
Environmental Protection Agency,
Washington, D.C.

2. More Dangerous Chemicals -- According
to the Environmental Protection Agency
(E.P.A.), the average household contains
between three and 10 gallons of hazardous
chemicals. The article lists some of the 11
most risky chemicals you can buy. If any of
these ingredients are listed on the
container, avoid buying it, or use extreme
caution. Some of the 11, which the article
says can produce dizziness or vertigo, are
as follows:

a) perchlorethylene, used in dry cleaning,
adhesives, aerosols, paints and coatings.
Common side effects include dizziness,
headaches, nausea, fatigue, loss of
balance, and irritation.
b) benzene, used in waxes, resins, oils,
varnish, lacquer, and gasoline. It is very
irritating and can cause brain, nerve, and
blood damage.

c) naphthalene, used in solvents,
fungicides, toilet bowel deodorizers, and
moth repellents. It can damage the
nervous system, eyes, liver, kidneys, skin,
and blood.

d) paradichlorobenzene, used in moth
repellents, insecticides, germicides,
deodorants, and fumigants. It may produce
dizziness, weakness, irritation, loss of
weight, and liver damage.

Please note that the above chemicals may
have other side effects and that there are
other chemicals that can produce
dizziness. See Winter, Ruth, "Too Many
Dangerous Chemicals. . .," Health
Confidential, Vol. 7, No. 6, June 1993,
page 4. 
 
3. Coping with Motion Sickness -- Ship
humor for people who suffer from motion
sickness includes the joke, "At first you're
afraid you're going to die. After a while,
you're afraid you won't." Dr. K. Dardick of
the Connecticut Travel Medicine Clinic in
Storrs, recommends one of the following
to get over the worst: a) a transdermal
scopolamine patch, an antihistamine called
buclizine, or promethazine (an anti-
nauseant), all of which are prescription
drugs; (b) non-medicinal products
including pressure bands worn on the
wrists, and ginger root (or ginger cookies
if the root is unavailable). Other advice
from experts includes the following: focus
on the horizon; breathe fresh air; avoid
alcohol; turn your thoughts to something
else; recline and support your head with a
pillow; if traveling by car, stop and get out
occasionally to let your body recover. See
Hellmich, Nanci., "Halting Motion
Sickness," U.S.A. Today, Section 6D, May
6, 1993.

4. Poetry in Motion -- Research indicates
there may be a genetic predisposition to
motion sickness, according to a recent
article. Children between the ages of 2
and 12 are particularly susceptible to
motion sickness, but it can strike anyone.
Even astronauts are vulnerable to this
malady.

Prescription drugs may make some people
woozy, drowsy, and/or disoriented and
should not be used in pregnant or nursing
women.

Inexpensive, non-drug therapies include
the following: (a) ginger. No one is sure
why it works, but it is thought that it may
interfere with the brain's release of
queasiness-causing stress hormones to the
stomach. Herbalists recommend an adult
dose of 1,000 to 1,500 milligrams of ginger
30 minutes before departure. Children
may benefit from ginger candy or Reed's
Ginger Brew (a ginger-ale brand with a
high concentration of ginger); (b)
accupressure wristbands, sold in many
pharmacies. According to one
gastroenterologist, the bands work best if
you periodically press on the button
throughout the trip; (c) aromatherapy
using inhalers containing essential oils of
various plants. Certain scents such as
peppermint oil appear to be particularly
soothing; (d) plum balls, which are
lozenges made of Japanese plums and rice
flour. See "Putting the Poetry Back in
Motion," Vegetarian Times, May 1993,
pages 95-96. 
Author's Note: Please note that neither Dr.
Engel-Arieli or VEDA can recommend or
be responsible for an individual's reaction
to a particular treatment. These reviews
are not intended as a substitute for
professional health care by your own
physician. Please do not begin any
treatment without first checking with your
physician.

    _________________________

SUPPORT
GROUP
NEWS

The Southern New Hampshire group
takes pride in its illustrated monthly
newsletter, which recently included
articles on hearing tests, hearing aids,
and regional and local meetings.

The leader of the 35-member Vero
Beach, Fla., group says, "The most
important thing my group has
experienced is the knowledge that they
are not alone. . . . We need to acquaint
all family physicians and ear specialists
about vertigo and Meniere's. . . ."

Australia has eight states, including the
island state of Tasmania, home of
Meniere's Australia. Two other states,
Victoria and Queensland, also have
vestibular support groups. Meniere's
Australia is helping to set up a support
group in a fourth state, Western
Australia.

The Fanwood, N.J., support group
alternates between guest speakers and
rap sessions for its monthly meetings.
Recent speakers discussed living wills,
chronic illness and the family, allergies,
audiology and balance, and medical
news. The group also devotes the June
meeting to spouses and holds a holiday
party in December. This year, members
had a table at a local health fair and
spoke to church groups about vestibular
disorders. "Sometimes we laugh, and
sometimes we cry, but we're all there for
each other and try to lift each other's
spirits when needed," said group leader
Kathleen Lang.

Members of the Corpus Christi, Tex.,
support group are working on a brochure
to be given to family practice doctors for
their waiting rooms.

The Philadelphia, Pa., group meets
quarterly. Meetings usually include a
speaker but allow time for personal
sharing of experiences and suggestions.
Last summer, the group held a "small
but spirited" picnic.

Otologists, psychologists, pharmacists,
dentists, nutritionists, and physical
therapists have spoken to the support
group in Royal Oak, Mich. The group
leader is seeking a homeopathy specialist
for a meeting in the fall. 

(Space limitations prevent us from using
all the support group information
received. More will appear in the next
issue.)




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