Thursday, 5 September 2019

Physiotherapy for Dizziness and Balance Problems

Over the past few months, I've been having physiotherapy for the dizziness I experience daily, and the balance problems I've had for years.

My first session consisted of a long assessment of my problems, and going over the forms that I had filled in prior to the appointment. I was asked all sorts of questions, including about any other symptoms I have, how severe, how often etc. I mentioned about headaches that come with the dizziness sometimes, as well as the flashing lights/"floaters" I get in my line of vision most days. I also have had a few falls; where my knees or ankles have just given way. I've bruised like a peach and sprained ankles because of those!

After all of the questions had been answered (and I was pretty exhausted), my physio decided to do a few tests; starting with blood pressure testing when lying down for 10 minutes, sitting up, and then standing. At the time, I was being investigated for symptoms of Postural Orthostatic Tachycardia Syndrome with a 48 hour portable ECG (the results turned out to be insignificant, so I never got round to having the tilt table test). The blood pressure results were relatively normal, so the physio said that excluded a few things (he didn't specify what).

Just before the session ended, my physio gave me a few simple exercises to do (If I remember correctly, they involved turning my head to each side, tilting my head each side, and turning my head upwards and downwards slowly) My next session would involve some balance tests.

Subsequent sessions mainly involved asking how I'd got on in previous weeks, how I'd found I'd managed with the exercises, then introducing me to more balance tests and exercises to try at home. Although my balance didn't seem to improve, despite the exercises (which I did do regularly, like a good patient!), I did find my physiotherapist very helpful with advice, and his findings. After speaking about some of my symptoms, he asked if I had been told (by doctors) that I may be suffering from a type of migraine that doesn't always present with the classic headache. I guess I hadn't really thought about migraines, although an optician did mention it to me due to the flashing lights I get in my vision. I'm due another eye test anyway (it's on the To Do list) so they'll probably want to investigate that more. As the flashing lights have been getting worse, and the dizziness hasn't improved, I decided to speak to my GP about it. He gave me Stemetil for the dizziness, but decided not to prescribe the usual migraine medication, as I don't often get the headaches. Sod's law, I'm getting them more now!

As well as this, at my penultimate physio appointment we spoke about my balance, and I mentioned how I believed a lot of it was down to my hypermobility. My ankles are very hypermobile and often give way. I used to get teased at school for falling down suddenly in the playground. I've been embarrassed by falling while in the middle of a town centre as well. Thankfully it's not resulted in serious problems (the worst has been a sprained ankle) but it's not pleasant anyway. I told my physio that I was thinking about asking my doctor to refer me to a rheumatologist to see if my Hypermobility Syndrome was actually Hypermobile Ehlers Danlos Syndrome . They used to be interchangeable diagnoses, but the criteria for HEDS is stricter now and they are believed to be different points of the Hypermobility Spectrum Disorders

I expected the physio to roll his eyes at me and dismiss my concerns, like various healthcare professionals have, but he actually took me seriously! He told me to definitely talk to the doctor and get a referral, so I can be properly assessed.

My last session was earlier today and when I told him the doctor had referred me to a Rheumatologist (Finally!) he was pleased, and wanted me to make sure the one I see either has a specialism in Ehlers Danlos Syndrome, or can refer me on to a Rheumatologist who specifically deals with EDS patients.

He was also pleased that I'd seen the doctor about my migraines. It looks like I've now been diagnosed with Vestibular Migraines . If the Stemetil doesn't help the dizziness or other symptoms, he will refer me on to a neurologist.

Lastly, we spoke about my balance problems. The physio decided there was no more he could do for me, so he has referred me on to a specialist rehab centre for balance problems. I'm not sure how long the waiting list is, but apparently the sessions are longer and the exercises a lot more intense. This should help my balance and give me better quality of life though.

Overall, I've been very pleased with these physio sessions. I may not have noticed improvements as such, but I've gained so much knowledge and advice, as well as support and advocacy from this physio, and I think these are invaluable. I feel that, with my physical health at least, I am starting to be taken seriously and actually getting the referrals and treatment I need.

I will of course blog about my referrals, when they finally come through, but in the meantime, I will try to keep you up to date with my physical and mental health progress. My next appointment is with the ENT specialist, so hopefully I will get more tests and/or treatment for the migraines!

Resources

1. Postural Tachycardia Syndrome: https://www.nhs.uk/conditions/postural-tachycardia-syndrome/ 

2. Tilt Test: https://www.bhf.org.uk/informationsupport/tests/tilt-test

3. Joint Hypermobility Syndrome: https://www.nhs.uk/conditions/joint-hypermobility-syndrome/

4. Ehlers Danlos Syndromes: https://www.nhs.uk/conditions/ehlers-danlos-syndromes/ 

5. Hypermobile EDS and Hypermobility Spectrum Disorders: https://www.ehlers-danlos.org/what-is-eds/information-on-eds/hypermobile-eds-and-hypermobility-spectrum-disorders/

6. Vestibular Migraines:  https://www.webmd.com/migraines-headaches/vestibular-migraines#1

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