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Interviewer: It's a very common medical complaint that doctors get, dizziness. What does it mean and what can you do about it? We'll talk about that next on The Scope.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists" with Dr. Tom Miller is on The Scope.

Interviewer: We're with Dr. Tom Miller, and we're going to talk about when a patient comes to him with a complaint of dizziness. What does that mean, and what can you do about it? So I come to you, I'm saying, you know, I've been feeling dizzy lately. What do you do at that point?

Dr. Miller: That's a really good question. And dizziness is one of the most common complaints that we get in primary care clinics. And basically, you have to break it down, because dizziness is just a non-specific term that means anything from fuzziness in the head to spinning to lightheadedness when you stand up.

Interviewer: All right. I'm assuming since you have to break it down, there'd be different ways that you'd handle the specific symptoms.

Dr. Miller: Right. So as soon as the patient says, "I feel dizzy," then you start to ask questions that are modifiers to how you're going to approach this problem. So, basically, one of the questions I ask, I ask them to describe dizziness. And so they'll say, "I feel lightheaded when I stand up, or I feel lightheaded when I'm getting up out of bed. I get a fuzzy feeling. I start to lose vision, or I feel like I might pass out." That's one type. The other type is, "Do you have the sensation of spinning?" which is vertigo. And that's a very specific type of dizziness, spinning. The room is spinning. You're spinning. You're moving in space. That's very different than a lightheaded feeling or sensation.

Interviewer: So if it's a lightheaded feeling and sensation, what does that mean for the patient?

Dr. Miller: Well, sometimes, it just . . . You know, this can happen in well-trained athletes. So imagine that you go out on a hot day and you run about four miles. You come back, and you're a little bit dehydrated. Your blood vessels are dilated. You sit down on the couch, you begin to watch your favorite sports show on TV, the phone rings and you jump up to get the phone, and whoa, you get wobbly. You start to lose vision. Basically, what happens there is your blood pressure dips, and you're not getting enough blood to the brain, and you start to pass out. That's a type of dizziness that causes lightheadedness.

Interviewer: Okay, that's sounds scary.

Dr. Miller: Basically, that's due to low blood pressure. It's not really scary. I mean, basically, with a couple of . . . First of all, you need to hydrate when you get home, right? Now, sometimes, it can be in people who do have problems like heart disease, or they're on antihypertensives or blood pressure medication that lower their blood pressures to a point that when they stand up and move around, they become they too light. They become to the point where they don't think they're going to stay awake. They're going to fall down. They start to lose vision. Their vision dims. Maybe they're hearing starts to disappear. And it's just this sense that they're going to go down. And so, basically, in that situation, you want to crouch down, and it pushes all that blood back up into your head. So you get down, you crouch down, and then the blood returns, and you're going to be okay.

Interviewer: Like put your head between your legs, crouch down sort of a posture?

Dr. Miller: Yeah, exactly.

Interviewer: What does that look like exactly?

Dr. Miller: Well, actually, probably the best way, if you can handle it, is to squat down. Squatting pushes blood back up into your cardiovascular system and drives blood into your brain, so that . . .

Interviewer: Staying in an upright position when you squat down? Okay.

Dr. Miller: You just squat down. Or if you really feel like you're going to pass out, you lie down.

Interviewer: Okay.

Dr. Miller: All right. And then some people get into a hot tub. They might have a half a glass of wine. They get out of the hot tub, they're relaxed. Boom, they have that sensation. That's pretty common. Basically, as soon as you sense that, and some people for reasons we don't quite understand, are just sensitive to those types of environments where, you know, they're . . . after exercise, or they're coming out of a hot tub, they might get very lightheaded when they stand up. So squatting down immediately is a way to remedy that or lying down will get the blood back to the head and resolve that problem.

Now, in the future, you have to prevent it. And to prevent it, you have to stay well hydrated. You have to be aware of the situations that create this sort of lightheadedness. So that is, again, you know, if you're exercising on a hot day and you relax, you have to realize that you need to hydrate. Also for people who are taking blood pressure medications, they need to be very aware of the situations in which they can become lightheaded, because you don't want to get to the point where you actually pass out or hurt yourself and that happens. That does happen.

Interviewer: Yeah, sure. Because that . . . It's not actually the lightheadedness that's causing the problems, it's what happens after you pass out. Right. Yeah.

Dr. Miller: Yeah, you hit your head and you really have a problem. So, you know, also think about people who are getting up in the middle of the night to go to the bathroom and they get lightheaded. It's dark. They trip, fall, and hurt themselves.

Interviewer: But otherwise, it sounds like the lightheaded type of dizziness is not, in of itself, something scary. You just need to be aware of what's causing it, try to do things to prevent it. If you feel that way, crouch down, try to get that blood back to the brain, and you're good.

Dr. Miller: In a majority of situations. Now, if you're on blood pressure medications, you may be on too high of a dose. You may need to go back to your physician and have your doses adjusted or your reason for taking those medications re-evaluated. Certainly, if you have heart failure, that is a whole 'nother issue. That's sort of beyond the scope of this discussion.

Interviewer: Gotcha. But as a general rule, that lightheaded type of dizziness, in of itself . . .

Dr. Miller: If you're aware of it and you know what you need to do immediately is get down to ground. Squat down or lie down and get your feet up.

Interviewer: Gotcha. What about the spinning kind now?

Dr. Miller: That's vertigo. Vertigo is a sensation of spinning or turning in space. It's that sensation we get when we spin around on a chair, or we turn around and around and around as little kids, you know.

Interviewer: It's been a long time since I've done that because I don't like that feeling.

Dr. Miller: Well, you could be on a fun ride at an arcade somewhere and you have that same sensation. So, basically, that is a sensation that occurs because of changes in the inner ear. So the semicircular canals, which direct sensation and position in space, have this abnormal input. And when that happens, you get the sensation of spinning. You might actually be spinning. And when you stop, you still have the sensation that you're spinning, or it may occur for other reasons.

Now, the most common reason or one of the most common reasons that people get vertigo without actually spinning around in a circle is something called benign paroxysmal positional vertigo. And this occurs as . . . in many people as, not many, in some people as we get older, where you have these little tiny particles break loose and rattle around in the semicircular canals. And what those little particles do is they bang on the hair cells that sense your position in space, and they send this very aberrant signal. And all of a sudden, you have this very strong sensation that you're spinning and turning when you're actually standing still.

Usually, this common cause of vertigo, benign positional vertigo, occurs when you roll over in bed, or you bend over to pick up a shoe, or you look up at a cabinet and try to take a cup out of the cabinet, and all of a sudden, you'll just have this incredible intense spinning sensation that lasts maybe 10 to 15 seconds. And it's reproducible usually by doing that same maneuver. Now, people when they come in and complain of this, they think they're dying, or they're having a stroke. And so it's our job to sort out whether it is temporary as it is in this benign positional vertigo. And if it is, it's likely due to this little particle that's banging around in the inner ear. And there's treatment for that. It's actually physical therapy.

Interviewer: Okay.

Dr. Miller: You could do a maneuver, and usually the maneuver will help put those little particles back where they belong . . .

Interviewer: Really?

Dr. Miller: . . . and then, you're okay. You're on your way. In some cases, if it's worse, we send them to an ear, nose, and throat specialist, and they do their special work, and that takes care of it.

Interviewer: Just want to make sure that I understand. So the lightheaded type of dizziness, unless you're on some sort of medications, sounds like it's not necessarily something you need to mention to your doctor?

Dr. Miller: You can if it's recurrent. I mean, obviously, if you're having situations where it's occurring more frequently and it didn't occur before, that's something you probably should see the physician about.

Interviewer: And the spinning type?

Dr. Miller: The spinning type is something that most people will seek attention for because it's so intense. And you know, if it's bad enough, it'll cause you to throw up. And it's so abnormal and unusual that people seek care for that.

Interviewer: Gotcha.

Dr. Miller: And there is treatment. There's treatment. There are less common causes of vertigo, viral causes where you just all of a sudden have intense spinning sensation and you're sick for three or four days and you're bedridden and sometimes hospitalized because you can't keep any food or fluids down. And that eventually resolves.

Interviewer: Gotcha. So in both of these . . .

Dr. Miller: Sometimes, even more rarely, it would be a stroke.

Interviewer: In both of these instances, perhaps talk to your primary care physician if it's becoming something that happens a lot?

Dr. Miller: Right.

Interviewer: And you know, not only for your quality of life but your peace of mind. But as a general rule, neither one of these two things sounds too threatening?

Dr. Miller: Not too threatening, but can be pretty scary if you haven't had them occur before. And I would think that most people from time to time have experienced the lightheaded kind of dizziness, and they usually will figure out what causes that. It's usually getting up too quickly.

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