A real diary of dizziness from the dizziness doctor-is the end of the world really here?

Author: Sun Li This article is published by Yimaitong authorized by the author, please do not reprint without authorization.

Note: The pictures and videos used in this article have been exclusively authorized by Mr.
Sun Li.

Saturday, April 17, 2021, from sunny to cloudy, is another rare weekend.
After staying up late last night to sort out the materials for the study, I was a bit sleepy this morning.
Maybe I was a bit tired recently.

After a simple breakfast, I changed the materials from last night and it was noon in a blink of an eye.

I think of today's appointment-to spend the weekend with my son.

Before I went out, I happened to see the unedited student papers on the table, "Oh, this time is really not enough.

Forget it, come back to read it at night.

" After a pleasant dinner, I went to the mall, but I was in the car.
At that moment, I suddenly felt a tremor in front of me, and the people and things in front of me became blurred.
My professional habit made me quickly pick up my mobile phone, fixed my eyes on the camera and recorded a video of about 10 seconds.
Fortunately, there was no nystagmus.
, But his eyes are a little blurred, and the symptoms are relieved in about a minute.

Okay, you can continue to enjoy the happy time.
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After walking in the mall for about half an hour, the previous symptoms struck again.
I leaned on my son and prepared to make temporary adjustments.
This time there was no relief for 10 minutes.
"Hurry up and call the nurse aunt," Bringing promethazine hydrochloride intramuscular injection to help me quickly alleviate my symptoms.
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" The symptoms are getting worse.
This wave is what experts call "the end of the world".
The violent tornado-like rotating counterclockwise, I can’t open my eyes.
Being helped by my son to sit on a chair, frequent nausea, vomiting, stomach contents, palpitation, profuse sweating, palsy limbs, and occasional defecation.
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I tried my best to calm myself and barely squeeze out my strength.
Simply let yourself do a rotation movement, move your legs, fortunately, unlike a stroke, the tongue is flexible in the mouth, and the sound in both ears is clear; think about the otoliths and vestibular migraines experienced before.
Feeling dizzy. The feeling "long time" has passed, the nurse aunt has not yet arrived, and the expected relief has never appeared.

At this time, I was already limp and unable to withstand a little touch from the outside world.
A doctor with 30 years of medical experience and more than 10 years of experience in diagnosing and treating vertigo could not help but feel fear in my heart.
I closed my eyes and leaned close to my son.
While saying "Don't worry about my son," he said "Quickly dial 120 and go back to mother's hospital.
"
Tips: During an acute attack of vertigo, when it is impossible to determine whether the patient is central or peripheral vertigo, the patient should first be instructed to rest supine as much as possible, and to maintain emotional stability as much as possible.
If the patient has vomiting, he should take a semi-recumbent or side-lying To avoid coughing when vomiting, if the condition is serious, call 120 immediately and send to the hospital for treatment.

Under the guidance and guidance of the staff of the mall, 10 minutes later, I was half-lying on the stretcher of the emergency car.
The dizziness continued; during the transportation, whenever there was a bump in the car, or the body felt a little movement and vibration , Even if someone touches my hair, it will induce a new wave of nausea, vomiting and sweating.
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accompanied by a strong sense of weightlessness, like being stuffed into a glass bottle and thrown into the sea, and then surging with the waves of the sea.

When I usually receive a doctor, I am used to asking the patient how often? How to dizzy? How long does it last? …I think of it pale and weak, and the pain caused by the sympathetic symptoms at this time is no less than the so-called "primary symptom.
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I was lost in the vortex, closed my eyes, squeezed the plastic bag that held the vomit on my face, and tried my best to control my incontinence.
The end of the world has really come.
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The ambulance arrived at our hospital and emergency room in about 10 minutes.
The doctor from the vertigo center ran out to pick me up, "Dr.
Sun, Director Sun, what's wrong with you?" "Doing CT\MRI?", I am afraid of light, sound, smell, vibration, and tried my best to say, "Hey I inject 25mg of promethazine hydrochloride injection and 2ml of bromina and procaine".
Although I am still dizzy, vomiting, and sweating profusely, I feel that I have grasped the life-saving straw in my heart.
I hope I can escape the bitter sea sooner.
After an hour, everything is still the same.
The doctors are discussing to send me to the CT room for further examination.
I tried my last best, "Don't move me, and push another diazepam.
" I was dizzy.
With "stability" subdued, I gradually fell asleep. A night’s dream, on a boat, a boat swaying in the stormy sea.
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If you give your vertigo a VAS score, then the vertigo is 10 points.
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Tips for patients with severe dizziness, nausea, vomiting and other symptoms and When it continues to be unable to relieve, malignant dizziness should be ruled out as soon as possible, and symptomatic treatment should be given to relieve the pain of the patient.

Vestibular function, audiology and related examinations are recommended to be suspended.

According to the patient's blood pressure and other conditions, vestibular inhibitors and antiemetics can be given as appropriate.

Commonly used clinical vestibular inhibitors such as promethazine, diazepam and chlorpromazine, but such drugs will delay the establishment of central compensation, so long-term use (less than 72 hours) is not recommended.

It was fine on Sunday, April 18, 2021.
When I woke up again, it was already the next morning.
When I woke up, I still felt a violent shaking.

The doctor on duty came to the ward in the morning, and he asked me to try to open my eyes to observe my nystagmus.

I opened my eyes slowly, and at that instant, everything in the ward seemed to be dumping to the left, and I was wandering in mid-air, like riding a roller coaster.

In just a few seconds, I closed my eyes tightly again.

"I can clearly see the third degree left spontaneous nystagmus" (Video 1).
I have "vestibular neuritis" in my brain.
I am worried about my nerve type.
Will I get PPPD? I opened my eyes again to let the students really see my live textbook.

In order to facilitate the care, my colleagues decided to transport me back to the ward of the department.

Everyone carefully moved me from the hospital bed to the wheelchair, and then from the wheelchair to the hospital bed.
I closed my eyes tightly throughout the process.

It doesn't usually take 10 minutes to carry it, but it feels so long at this time.

In the new ward, I asked them to help me close the curtains and put a blindfold on me.

At this time, any sound and light are torturing me.

The silent darkness is my "life-saving" environment.

With the help of others, I can barely turn over and change my posture, but every change of posture and head position will be accompanied by a strong sense of weightlessness.
The left side position can make me feel more comfortable, and I will be injected with vestibular inhibitors again.
rest.

Tips For most peripheral vertigo diseases such as vestibular neuritis and other acute attacks, the patient likes to lie on the side, and let the patient take a comfortable position as much as possible, while maintaining indoor air circulation, quietness, and avoiding the stimulation of strong light.

In the afternoon, the examination technicians of the department came with Frenzel mirrors and head-shaking testers, and tried their best to complete the spontaneous nystagmus and head-shaking tests.

The towering red saccadic waves are like rays, so dazzling, typical left-facing peripheral spontaneous nystagmus, with a nystagmus intensity of 8.
6°/sec.

The diagnosis of "vestibular neuritis" can basically be determined! The diagnosis is clear, and the treatment plan should be adjusted immediately.

According to the diagnosis and treatment plan of vestibular neuritis in the department, the doctor adjusted the medicine to 80 mg methylprednisolone sodium succinate, 20 mg betahistine hydrochloride, and 0.
6 g gastrodin injection, once a day, intravenously.

In this way, under the action of the medicine, I passed this difficult day in a drowsy state.

 Tips: Short-term low-dose glucocorticoid therapy is recommended in the acute phase of vestibular neuritis.
Hormonal therapy is not recommended for convalescent patients, and antiviral therapy is not recommended; at the same time, drugs that enhance vestibular compensation such as betahistine or ginkgo are recommended Leaf extract, the course of treatment should run through the acute phase and the recovery phase to match the vestibular compensation time.

For patients with severe vomiting, symptomatic treatment is required.

 On Monday, April 19, 2021, it was cloudy and clear for 2 consecutive days of hormones and symptomatic treatment.
The effect is still obvious.
Today, I can remove the blindfold, and the whole world is back in my eyes.
Except for sleeping, today You can raise your head slightly, but there will still be obvious instability when sitting up.

With the support of others, I performed a simple freshening up.

Then he lay back on the bed and ate something slowly.

During the whole process, whenever my head position changes, such as turning my head left and right, lowering my head and raising my head, it will make me dizzy.
When I close my eyes and wash my face, my instability will increase significantly, but I no longer feel nauseated.
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In the morning, the hospital leaders, middle-level cadres and colleagues from various departments came to visit the ward upon hearing the news, and sent a room of flower baskets and fruit baskets.
The fragrance that filled the room made me feel so warm.

In the afternoon, with the help of doctors and students in the department, I went to the vestibular function and hearing examination room of the outpatient clinic to complete the cold and heat test, hearing and VEMP examination together.

The result is not surprising, the right horizontal semicircular canal paresis in the cold and heat test, the VEMP balloon function is normal, and the bilateral utricle function is not induced, maybe only the hearing test can relieve me, which is completely normal.

 Figure 1 Head shake test: Compensatory scans can be seen in the right horizontal and right front semicircular canals.
2 Cold and hot test: The right horizontal semicircular canal responds poorly.
Figure 3 c-VEMP binaural amplitude symmetry ratio is 0.
57%.
Figure 4 o-VEMP: binaural I didn't see the P1N1 waveform differentiation check.
It was already dusk.
Looking at the sunset outside the window, my spirit recovered a lot.

At this time, I realized in a daze that I had changed from the role of a doctor in the past to a patient who truly felt the dizziness, pain, and mental journey.

 Tips According to the tolerance of patients with vestibular neuritis, the corresponding vestibular function test can be selected as soon as possible for individualized and accurate diagnosis, formulation of vestibular rehabilitation programs, and prognostic evaluation.

In addition to the vestibular function tests such as hot and cold tests, vHIT and VEMP, audiology tests should be routinely performed, and OTR and swivel chair tests can be performed at the same time.

Routine cranial MRI examination is mainly to exclude central structural lesions.
When conditions permit, multi-modal brain functional imaging examinations can be performed to help assess central compensation and provide a basis for prognostic evaluation. Tuesday, April 20, 2021, Xiaoyu today is the third day of the illness.
The symptoms of dizziness get better day by day.
I can sit up on the mat for a long time, but I still dare not turn my head and stay still.
It’s like drinking half a catty of liquor, even though I haven’t drunk that much.
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I told the doctor in charge that I can stop the hormone today and increase the rehabilitation training.

Although everyone keeps reminding me to take a good rest, I know that vestibular neuritis must be rehabilitated as soon as possible.
Rehabilitation means getting up soon! I have an appointment with a rehabilitator in the department, let's make a simple assessment first.

Be good! The Vertigo Handicap Inventory (DHI) scored 78 points, the Berg Balance Scale scored 22 points, and the Dynamic Gait Index (DGI) scored 9 points.

Nothing to say, let's practice! Tips Vestibular rehabilitation therapy can promote the compensatory function of the central nervous system, improve the patient's ability to coordinate and control the balance of vestibular sense, vision and proprioception, accelerate the recovery of the body's vestibular function, and eliminate symptoms.

Timely vestibular rehabilitation can help patients recover as soon as possible in balance function.

Before performing rehabilitation training, the assessment of postural balance function is necessary.
It can not only grasp the severity of the patient's disease, but also provide a basis for the formulation of an individualized vestibular rehabilitation program.

Figure 5 Performing a balance function assessment.
With the assistance of a rehabilitation therapist, I started to do simple movements in daily life (video 2) such as lowering my head and raising my head, turning left and right, bending over and getting up (Video 2), but there was still strong instability in the process In addition, due to prolonged bed rest and frequent control of head activities, the neck muscles are very tense, and severe pain appears with the neck activities.

In this case, comprehensive treatments such as EEG, massage, needle embedding and Gua Sha treatment were added.

Tips A personalized vestibular rehabilitation training program that combines the patient's main complaint, clinical manifestations and vestibular examination results will achieve better results.
Specific training measures mainly include improving VOR eye movement training and VSR balance training.

Because patients with vertigo stay in a forced posture for a long time, most patients may have symptoms such as neck and waist soreness, weakness of the limbs, etc.
You can choose traditional Chinese medicine treatments according to the specific situation, which has good results. Figure 6 Rehabilitation training under the guidance of a rehabilitation teacher.
Wednesday, April 21, 2021.
It was sunny and rainy all night.
When the warm sunlight shined on me through the windows of the ward, it was so warm! The sense of weightlessness and dizziness have been reduced a lot today.
The VAS score is 5 points, but the back occipital and neck muscles are still sore and cannot be turned.
The director of orthopedics considered it as greater occipital neuralgia after reading it.
In order to relieve the pain, After further rehabilitation training, I asked them to do closed treatments at Fengchi and Jianjing points (lidocaine injection 100mg, dexamethasone sodium phosphate injection 5ml).

Today’s rehabilitation is gradually increasing on the basis of yesterday’s difficulty.
I began to try to move forward independently, turning my head left and right, raising my head up and down when going forward, practicing adjusting the pace, turning around by myself, constantly stimulating my poor The semicircular canals.
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10 times, 20 times, 30 times.
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I believe it will get better, it will definitely be, come on! Tips The number of vestibular rehabilitation options, the number of treatments and the time are related to the patient's clinical manifestations, lesion location and nature of the disease.

Rehabilitation training follows the principle of simple first, then complicated, first slow and fast.
At the beginning, the program should be adjusted every 1-2 weeks, and the interval between adjustments can be gradually extended after 1-2 months.

 Thursday, April 22, 2020.
Today, I can walk independently, and my speed will be faster.
When I lower my head and turn my head around, I still feel instability and feel dizzy.
Complex movements need help from others.
Next to complete.

Although I need retreat, many urgent tasks in the center are still waiting for me to solve, which makes me a little anxious.

It is also for faster and better recovery, but also for self-denial, and the idea of ​​establishing a more complete rehabilitation program has gradually emerged in my mind.

In this case, I must try my best to carry out every rehabilitation training and record my experience and feelings about it.

In today's Tai Chi time, under the protection of a rehabilitation teacher, I tried to finish a complete set of Tai Chi (Video 3).

This greatly deepened my understanding of rehabilitation training, and also allowed me to realize the real needs of dizziness patients.

When I was recovering at night, I felt a dull swelling and pain in my left lower limb gastrocnemius muscle.
Is it because of vomiting? Electrolyte disorder? Have you experienced hypocalcemia convulsions? Or is it too active? This thought flashed past, maybe it will be all right tomorrow.

Slowly hit a set of 24->
On Friday, April 23, 2021, the symptoms have improved by half, and the VAS score is 4 points.
Although there is no feeling of spinning around the world, there is still a sense of instability when walking fast.

Someone asked me if I was dizzy.
I joked, "Sit up is equivalent to drinking 1 tael (white wine), standing up to drink 2 taels, and drinking half a catty when I turn around.
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" During my rehabilitation today, the pain in my left gastrocnemius muscle increased.
, Affect walking.

A shadow struck, "Venous thrombosis of the lower extremities?" I immediately checked the venous ultrasound, D-dimer, coagulation function, etc.
of the lower extremities.
The results suggested that the left lower extremity intermuscular vein thrombosis, which made me a little frustrated! If you have come, you will be safe.
According to the condition, take orally rivaroxaban 10mg anticoagulant treatment, reduce activity, raise the affected limb, wear elastic stockings.
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Tips Although the venous thrombosis of stroke, hemiplegia and other bedridden patients is our neurologist Long ringing alarm bell.

However, in our previous diagnosis and treatment, we have never paid attention to the fact that bed rest in the acute stage of vestibular neuritis may also cause venous thrombosis.

It seems that in the face of patients with vestibular neuritis, we must also be alert to the occurrence of such complications.

I need to be on duty during the "May 1st" holiday.
At this moment, I am looking forward to returning to work as soon as possible, even though the long-term overload of work has made me feel very tired.

I want to come to the kind of fulfilling life full of work arrangements.
Although it sometimes makes me breathless, it always makes me feel happy, fulfilled and present at work.

"Let me rank it first.

" Although I don't know how long my intermuscular venous thrombosis will take to recover, I know that vestibular neuritis can make me better understand the disease and understand the pain and anxiety of the patient.
"Workaholics" can go online again, "talent is transformed from pain"! Saturday, April 24, 2021 Sunny Today is a rest day.
The hospital is much quieter than usual.
Quietness can make me calm down and think seriously. After going through this ordeal, I also felt that the vertigo is actually a sword hanging above the head.
It might fall when it happens, or it might fall on someone's head.

As a doctor, I will try my best to experience the pain of patients and understand their demands, but this is always not enough.

"Vestibular neuritis" taught me a vivid "class" of skin-cutting.
Although it is not good to get sick, it is also quite rewarding.

At the same time, thousands of thoughts also flooded my mind: Should we establish an emergency department for vertigo? How to better carry out individualized vestibular rehabilitation training for different patients and different periods? How is the vestibular system examination performed in patients with acute vertigo? An unexpected identity swap made my vertigo doctor dizzy.
From the non-professional perspective of vertigo patients, I truly experienced their pain and saw the hope of saving them from the end of the world.

Tomorrow is the day to review the vestibular and balance functions.
What kind of result will it be.
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April 25, 2021.
Sunny Sunday.
Due to the "May Day" holiday, I went to work today and I got up early.
, After freshening up, waiting for the students to bring early morning greetings.

After the shift, doctors and nurses came to the ward one after another and asked about my physical condition.
I told them with a smile that they could wash and move by themselves when they got better.

After eating at noon, the technician opened the door of my room with the instrument and the scale, and came to me for a review.

The first is the balance function assessment.
Although there is no scale score, I know that it must be better, but I still want to know how much the score has changed.
They excitedly told me the Dizziness Disability Inventory (DHI) 40 points (78 points for the first time), 56 points for the Berg Balance Scale (22 points for the first time), and 22 points for the Dynamic Gait Index (DGI) (9 points for the first time).
I just smiled knowingly, because I Also look forward to the situation of head shaking and hot and cold tests.

When I came out of the ward, I chose to take the stairs to the examination room.
First, I wanted to see if I felt the fear when I went downstairs, and I also wanted to see if I would aggravate the symptoms of dizziness when there were too many people.
.  Tips VN patients in the later stage due to persistent dizziness symptoms and poor quality of daily life and other factors, often combined with anxiety, depression and other mental and psychological problems, which gradually evolve from acute vestibular syndrome to chronic vestibular syndrome.

The doctor should explain to the patient the benign outcome of the disease at the time of diagnosis, and provide psychological counseling to the patient to relieve tension and anxiety, so as to help speedy recovery.

The results of the vestibular function test came out soon, although not as good as expected, but it is considered satisfactory.

They told me that spontaneous nystagmus still occurs, but the intensity of the nystagmus has been much weaker than before.
The head-shaking test can still see obvious compensatory saccades, but the gain value is better, and the asymmetry ratio of the cold-hot test is not as before.
That's so high.

In a word, the treatment effect is pretty good! Going back to the ward, opening the diary, and dictating today's feelings and experiences to the students, this has become what I must do these days, and I want to record my personal feelings.

"Always cure, always help, and always comfort.
" I want to record these bit by bit, so that I can recover as soon as possible, so that more people and friends can overcome the pain as soon as possible, and also for the clinical diagnosis and treatment of vertigo.
It's getting better and better! Expert profile Professor Sun Li, chief physician of the First Clinical Hospital of Jilin Academy of Chinese Medicine Sciences, doctoral tutor; head of key diseases of vertigo in the national clinical research base, national outstanding clinical talents in traditional Chinese medicine, heir of academic experience of national old traditional Chinese medicine experts, Jilin Province Professional and technical talents with outstanding contributions, top-notch innovative talents in Jilin Province Chairman of the Vertigo Professional Committee of the Jilin Province Integrative Medicine Association Member of the Vertigo Professional Committee of the Neurology Branch of the Chinese Medical Doctor Association Member of the Stroke and Vertigo Branch of the Chinese Stroke Society Standing Committee Member of the Vertigo Branch of the Chinese Society of Integrative Medicine Vice Chairman of the Geriatrics Professional Committee of Jilin Provincial Society of Traditional Chinese Medicine Vice Chairman of the Neurology Specialty Committee of Jilin Provincial Society of Integrated Traditional Chinese and Western Medicine, Standing Committee Member of the Vertigo Professional Committee of China Medical Education Association