Dr. Ian M. Purcell and a patient demonstrate how the unique pieces of technology available only at Alvarado Hospital, can help patients suffering from vertigo issues.
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Dr Ian M Purcell's Alvarado Hospital Vertigo Special Jody: Hi, I am Jody, and three years ago I came to see Dr. Purcell. I was suffering from migraines and vertigo, and he has been helping me ever since, and he is the most amazing, compassionate doctor that I have ever met. Dr. Ian Purcell: Hi. My name is Dr. Ian Purcell. I am a neurologist at Alvarado Hospital in San Diego, California. I am what they call an otoneurologist, and that is a neurologist that specializes in vertigo and balance disorders and hearing disorders. My job is to see patients when they come into my office and give them an accurate diagnosis as to why they are dizzy and then treatment options that they cannot get anywhere else anywhere in the country. I am going to show you four very, very unique pieces of equipment that we use to not only diagnose why the patient is dizzy but also give them treatment. The device that Jody is on right now is called an Alter-G treadmill. This device allows us to alter the amount of gravity that the patient is experiencing. Right now we have Jody running at approximately 60 percent of her normal weight. This allows a patient with a chronic balance problem to task on a treadmill for extended durations of time. The eyes are locked on the target by the inner ear and the brainstem. That mechanism is like a gyroscope that allows information from where the head is moving in space to get to the brainstem and then to the eyes that allow the eyes to lock on a target. People with chronic balance issues can’t do that. They say, “Hey doc, I can’t move my head around quickly in space, and it makes me feel off or feel like I am on a merry-go-round.” This is what we are doing with Jody. We are practicing aggressively these maneuvers to try and help her get better. Stabilize right there. Continue that. What we are doing right now, this is a machine called a Spine Force. This initially designed to stabilize the spine from all the paraspinous muscles. We utilize it in my clinic for balance complaints. These are the people that have a difficult time integrating information coming from their feet up through their spinal cord, up to the brain to be processed to maintain balance. That’s one of the three things you need for balance–your eyes, your ears, and your feet. So what we are practicing here is the patient utilizing information coming up from their feet with the resistance protocols so they can learn to rely more on information coming up through their spinal cord. This piece of technology is a very, very high performance motion simulator called a Force Dynamics 301. We are utilizing it to take a patient with a vestibular disorder, vestibular injury–that’s an injury to the inner ear--and have them task, keeping their eye focused on a target with the visual surrounds moving by them. This is an important integral part to our vestibular therapy here at Alvarado. This particular device is called the Epley Omniax® Chair. It’s a canalith repositioning maneuver chair. What does that mean? That means patients that have loose crystalline debris in their inner ear that is supposed to be attached to hair cells in there but sometimes it breaks loose and starts shifting around the labyrinth in the inner ear or the balance portion of the inner ear. Those crystals, if they are in a particular portion of the ear they don’t cause dizziness, but if they migrate and shift into these canals which normally sense rotational movement of the head, begin tickling hairs in these canals, the patient will start reporting positional-related vertigo. That’s means, “Hey doc, whenever I pitch my head upwards or downwards or I lay down in bed, roll over to left to right, I get a brief sensation of disequilibrium or spinning or true vertigo with nausea and vomiting.” This can be very debilitating. Jody has had this diagnosis in the past, and this chair not only helps diagnose, but we can also treat the patient on the chair. That’s what we do on this machine is one, diag