Keeping your balance can sometimes be a challenge. ThePassionatePharmacist puts a personal spin on maintaining your equilibrium.
by Joe Goldstein, R.Ph.
We often talk of balance in our personal and professional worlds. Employers claim to care about our work-life balance (while they issue us laptops and iPads to make us more productive at home). We see the scales of justice depicted as in balance (equipoise). Pharmacists of yore used a balance to weigh out powders, creams, and even herbs. Some compounding pharmacists still do that today. The concept of balance is not uncommon, or difficult.
We take for granted our own ability as humans to keep our balance on just two legs. That’s one trait that distinguishes us from other animals. When our ability to maintain that balance is compromised, it can be a temporary self-inflicted state, or it can be a sign of a more sinister pathology. Getting to the doctor, and receiving a proper diagnosis, is essential to finding the best treatment.
Raise your right hand if you have ever had too much alcohol to drink. Raise both hands if you have ever had the room spin around when you lay down and closed your eyes after too much alcohol. Often called “the spins”, or vertigo, this happens when alcohol in your blood stream disrupts the normal fluid properties in a part of your inner ear called the semicircular canals.
The fluid stimulates tiny hairs that line the inside of these canals, and minor changes to the fluid, as with alcohol intake, cause your brain to think you are not in a stable position, but you really are. Keeping your eyes open may help a bit, as you then have point of reference around you. You can sometimes prevent this and other unpleasant effects of alcohol intoxication by drinking a lot of water with the alcohol, as well as after. Or just don’t overindulge! The parts of your inner ear and your brain that control your balance and your eye movements are known as the vestibular system. This delicate system can be disrupted by disease, inflammation, and trauma to the ear, eye(s) or brain, and can lead to vertigo, dizziness, nausea, and loss of hearing and balance.
Vertigo can be a part of a more complex process called dizziness. Dizziness may have multiple facets. It is a condition of being light-headed, and losing your equilibrium, or balance. You may feel disoriented. You may or may not have vertigo. Rapidly spinning around, or moving your head from side to side, can cause vertigo and dizziness. Both may be accompanied by nausea. Dizziness can also afflict people with low blood pressure (hypotension), low blood sugar (hypoglycemia), low levels of thyroid hormones (hypothyroidism), and other medical issues such as inner ear infection or inflammation (labyrinthitis). The inner ear is called the labyrinth, because its shape and structure is very complex. The semicircular canals are part of the labyrinth.
Some drugs can cause dizziness. They include drugs to treat high blood pressure (hypertension), depression or insomnia. Muscle relaxers can cause both dizziness and drowsiness, as can some drugs used to treat seizures, anxiety, and some heart disorders. Some drugs can cause damage to your ear and to your balance if taken at high doses, or for prolonged periods of time (ototoxic).
Standing up quickly when you first wake up can make you very dizzy, because your blood pressure, already low from sleeping and from lying down, drops further when you stand up. Sit at the side of your bed for a minute or two when you first awaken, and then slowly stand. You’ll be less likely to get dizzy and fall, joining the more than 30 million Americans who do so each year, according to the U.S. Centers for Disease Control and Prevention (CDC). Balance issues can be the result of anatomical problems with your feet, and also visual disturbances. Other possible causes of dizziness include not eating enough food, or not drinking enough water. Heights also make some people dizzy.
How do you treat dizziness and vertigo? The several different types of treatments include head and neck exercises, breathing exercises, and treating any underlying pathologies. Drugs treatments that are used are most often types of antihistamines. Meclizine is the most common. Sold as the common brand names Antivert and Bonine, these drugs are thought to reduce the signals the brain receives from the inner ear. Antihistamines may also act as mild anesthetics, or may be useful for their ability to depress the central nervous system. Promethazine is another antihistamine used for this purpose, although it is more commonly used as a cough suppressant. If meclizine is prescribed for you, you may purchase it over the counter (OTC) in either of its common strengths (12.5 mg tablets and 25 mg tablets). You will likely have to ask for it at the pharmacy counter, and it may need to be ordered. Here’s my financial tip of the day: Buying meclizine OTC can save you substantial money. Buy it in bottles of 100 tablets for the best price. The last time I purchased meclizine (in 2017) I paid lass than $5.00 for a bottle.
Nausea often accompanies dizziness and vertigo, and any number of anti-nausea medications may be used, including bismuth subsalicylate (Pepto Bismol). Don’t take Pepto Bismol if you are allergic to aspirin, or are taking an oral anticoagulant. Emetrol, a solution of dextrose and fructose (two sugars) in combination with phosphoric acid, has been an OTC remedy for nausea for nearly 70 years, and is claimed to treat as well as prevent nausea. Always check with your doctor or pharmacist before starting any new medication, including those sold OTC. If these don’t help, your doctor may prescribe promethazine or ondansetron. Sometimes ginger, or saltine crackers, are helpful.
My own experience with dizziness and vertigo has been educational, and frightening (see the previous posts “The Sound of a Dropping Pin” and “Pet Sounds” in this blog). I arose one morning, stood up from bed, and found myself on my butt in the opposite corner of the room. The room didn’t spin—I did. I tried to get up again, and was able to do so only by grabbing onto a chair, hauling myself up, and sitting down until the spinning stopped. I knew I was having minor balance and hearing problems, having been recently diagnosed with a large benign cyst in my right ear canal. What I didn’t know at that time was that the cyst (tumor) had destroyed two of the three bones in my middle ear, all of my inner ear, and was advancing into my brain cavity. I was also learning to balance myself after having three partial toe amputations on my left foot. And I was still getting used to having only partial sight in my left eye, the result of multiple strokes I had suffered the year before. Balance was eluding me on multiple levels.
I got an appointment with the otolaryngologist (ear, nose & throat specialist—ENT) who had originally seen my MRI films the year before, and had diagnosed the cyst, called a cholesteoma. He prescribed meclizine, which I found very helpful, especially at higher doses. Now, nearly a year after surgery to remove the cyst, I have no hearing in the right ear, and continuous severe tinnitus, or “ringing’ in the ear. I no longer have vertigo, but occasional dizziness and disorientation. Sometimes I get more disoriented on bright, sunny days. I have a constant noise in my right ear, which also causes some balance issues. Sometimes the noise is mild, like it is right now. Sometimes it’s a loud roar, like a freight train going by, or a jet airliner on take-off. This has all made me more appreciative of the concept of balance. Balance in my gait; balance in my diet; balance in my hearing; balance in our lives. That balance keeps us grounded while we see the world spinning ’round.