A Brain Injury is damage to the brain that results in a loss of function such as mobility or feeling.  Brain injury can also cause cognitive dysfunction.

Traumatic Brain Injuries can result from a closed head injury or a penetrating head injury.

There are two broad types of head injuries: Penetrating and non-penetrating.

1. Penetrating Injury: A penetrating injury occurs when an object pierces the skull and enters brain tissue. As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized injury to brain tissue. Skull fractures can cause cerebral contusion. Brain trauma occurs when a person has an injury to the brain, and can be mild or severe. When a person sustains trauma or injury to the brain, he or she may lose motor functions along with cognitive and physical abilities. Physicians use the Glasgow Coma Scale to determine the extent of brain trauma. This is a neurological scale that measures the level of a person’s consciousness.  A mild injury may cause temporary symptoms, like a concussion; while a severe injury could require years of rehabilitation, like a stoke or tumor.
2. Closed Injury:  A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. It is caused by an external force strong enough to move the brain within the skull. Causes include falls, motor vehicle crashes, sports injuries, blast injury, or being struck by an object.

There are two most common types of brain trauma, which are:

1. traumatic brain injuries  2. acquired brain injuries.

1-Traumatic brain injury

This occurs from external force on the head or neck. These injuries can occur from blows to the head or aggressive twisting of the neck. Some ways this could happen include falls, motor vehicle accidents, sports, and vigorous shaking. In infants, Shaken Baby Syndrome is a type of traumatic brain injury.

2-Acquired brain injury

This means simply you got this injury after you were born and it was caused by a condition or illness after birth. This type of injury can result from several different causes like strokes, toxic poisoning or brain tumors. Degenerative diseases and lack of oxygen may also cause this type of brain trauma. Here are some examples of acquired brain injuries:

-Bleeding in the brain which can lead to brain injury. Blood Vessels in the brain can rupture resulting in an intra-cerebral hemmorage (one of the causes of a stroke). Symptoms may include headaches, loss of vision, weakness to one side of the body and eye pain to even garbled speech.

-Anoxia is another insult to the brain that can cause injury to it. Anoxia is a condition in which there is an absence of oxygen supply to an organ’s tissues, even if there is adequate blood flow to the tissue.  Common causes of anoxia are near drowning, choking, suffocation, strangulation, heart attacks, lung damage, or very low blood pressure.

–Hypoxia refers to a decrease in oxygen supply rather than a complete absence of oxygen, and ischemia is inadequate blood supply, as is seen in cases in which the brain swells. In any of these cases, without adequate oxygen, a biochemical cascade called the ischemic cascade is unleashed, and the cells of the brain can die within several minutes. This type of injury is often seen in near-drowning victims, in heart attack patients, or in people who suffer significant blood loss from other injuries that decrease blood flow to the brain decreasing oxygen supply to the tissue.

-Toxemia, which is poisoning from chemical or biological factors that can damage the brain. Toxemia can be caused by drugs, chemicals of several types, gases or even toxic foods.

-Viruses or types of bacteria. An infection of the brain can be very damaging; here are some examples:

*Meningitis is a inflammation of the lining around the brain or spinal cord, usually due to infection; Neck stiffness, headache, fever, and confusion are common symptoms.

*Encephalitis (en-sef-uh-LIE-tis) is inflammation of the brain. Viral infections are the most common cause of the condition. Encephalitis can cause flu-like symptoms, such as a fever or severe headache. It can also cause confused thinking, seizures, or problems with senses or movement.

**HIV can lead to brain injury. HIV, can affect the brain in different ways. HIV-meningoencephalitis is infection of the brain and the lining of the brain by the HIV virus. It occurs shortly after the person is first infected with HIV and may cause headache, neck stiffness, drowsiness, confusion and/or seizures. HIV-encephalopathy (HIV-associated dementia) is the result of damage to the brain by longstanding HIV infection.  It is a form of dementia and occurs in advanced HIV infection. Mild Neurocognitive Disorder is problems with thinking and memory in HIV, however is not as severe as HIV-encephalopathy. Unlike HIV-encephalopathy it can occur early in HIV infection and is not a feature of Aquired Immune Deficiency Syndrome – AIDS.

*Lastly Herpes. There are two types of herpes simplex virus (HSV). Either type can cause encephalitis. HSV type 1 (HSV-1) is usually responsible for cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) commonly causes genital herpes. Encephalitis caused by HSV-1 is rare, but it has the potential to cause significant brain damage or death.

*Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.*Viral infections due to blood sucking insects like mosquitoes and ticks to animals with rabies a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the U.S.

When a person is diagnosed with a brain trauma, doctors will decide if rehabilitation is needed. Rehabilitation programs may vary depending on the type of brain injury and estimated recovery time. Treatment usually consists of physical therapy and daily activities. In extreme cases, patients may need to learn how to read and write again.

Therapy for brain trauma typically takes place on an outpatient basis or through an assisted living facility. Therapy may last several weeks, months or even years, and sometimes the patient is not able to make a full recovery.

It may not always be obvious when a person has sustained a brain injury. The patient may have hit his or her head and not have symptoms until a few hours later. Some signs of a possible brain injury are headaches, confusion and loss of memory. If brain trauma is not treated, it could cause permanent damage or death.

Brain injuries can affect the patient and the patient’s family, with emotional and financial hardship. When problems arise with treatment or financial issues, a specialist or brain injury lawyer may need to intervene.

“Over the last 30 years, the risk of dying from cancer has steadily declined, sparing some 4 million lives in the United States. This downward trend can partially be explained by big wins in smoking cessation, early cancer detection, and treatment advancements.

The risk of developing 6 of the cancers on the rise is associated with excess body weight. Listed in order of strength of the association, those 6 cancers are endometrial, liver, kidney, pancreas, colorectal, and breast.”

The American Cancer Society (https://www.cancer.org/research/acs-research-news/facts-and-figures-2024.html)

Cancercenter.org states the following:

”One of the most common risk factors for cancer is something we can’t do anything about—age. Our cancer risk increases as we get older, with the average age at diagnosis hovering around 68.

But a new study in Nature Reviews Clinical Oncology says that over the last few decades, doctors have been seeing dramatic increases in cancer in adults younger than 50. The disturbing trend has scientists searching for:

• Reasons behind the sharp increase in early-onset cancer
• How best to screen for or detect cancers in young adults
• Whether the cancers are different types of common cancers in older adults
• Which treatments show promise for younger people

Cancers in the under-50 age group may foreshadow an “emerging pandemic,” says the study’s researchers at Brigham and Women’s Hospital in Boston. Cancer patients under 50 are at a different point in their lives than the typical, older patient: They may be students, parents of young children, family breadwinners or caregivers to aging parents. Their cancer treatments may mean a different financial burden, one that hits during their prime income-earning years. They may also face higher risks of other health issues, including infertility, heart disease and secondary cancers.

“Young adults often have a more challenging landscape than older adults diagnosed with cancer,” says Toufic Kachaamy, MD, Interventional Program Specialist and Chief of Medicine at Cancer Treatment Centers of America® (CTCA), Phoenix (he was not involved in the study). “When you’re 40 and get cancer, there’s a good chance that you’ve never been sick before. One day, you’re out to dinner or a party, the next thing you know, you’re on chemotherapy.”

Which cancer types were studied?

Researchers looked at 14 cancers being diagnosed with increased frequency in adults who haven’t turned 50 yet:

• Breast cancer
• Colorectal cancer
• Endometrial cancer
• Esophageal cancer
• Extrahepatic bile duct cancer
• Gallbladder cancer
• Head and neck cancer
• Kidney cancer
• Liver cancer
• Multiple myeloma
• Pancreatic cancer
• Prostate cancer
• Stomach cancer
• Thyroid cancer

Colorectal cancer

Some of the highest increases in early-onset cancer are being seen in patients with colon cancer and rectal cancer. While colorectal incidence rates have dropped by almost 40 percent since 2000 among adults 50 and older, the rate is rising in those under 50. The latter trend may be linked to obesity levels that have exploded in the 18-25 age group, from 6.2 percent in 1976-80 to 32.7 percent in 2017-18.

Some researchers have thought that a higher body mass index (BMI)—or how much someone weighs compared to how tall he or she is—was a more significant risk factor for colon cancer than for rectal cancer. But that theory may not hold for early-onset cases, since researchers say rectal cancer is increasing in the United States at a faster rate than colon cancer.

Stomach cancer and esophageal cancer

Stomach cancer and esophageal cancer, like colorectal cancers, are diseases of the gastrointestinal tract. Eight of the 14 early-onset cancers studied are cancers of the digestive system.

The findings suggest someone’s microbiome—the microorganisms floating around in the digestive tract—impacts cancer risk, either because of changes caused by poor nutrition, lifestyle factors such as smoking and drinking, or a significant increase in the use of antibiotics in recent decades.

Some risk factors for early-onset esophageal cancer include smoking, obesity and gastroesophageal reflux disease. Heavy alcohol consumption is considered a risk factor for all stomach cancers, including early-onset cases.

Breast cancer

The study, instead of using the under-50 and over-50 groupings typical for breast cancer analyses, looked at premenopausal and postmenopausal women. Breast cancer is rising in both groups, but at a faster rate among younger, premenopausal adults.

Some studies have shown that a large number of female breast cancer patients under 50 were not considered at high risk for the disease. Now, the American College of Radiology and the Society of Breast Imaging recommend women begin regular mammograms at age 40 instead of 50.

Some research on premenopausal breast cancer points to reproductive risk factors, obesity, physical inactivity, alcohol consumption and the prevalence of Western-style diets—ones high in red meats and processed foods—as contributors to early-onset breast cancer.

Lung cancer

Lung cancer was not included in the study because it’s been decreasing in both the under-50 and over-50 age groups. But the proportion of lung cancer cases among nonsmokers in the under-50 age group is rising.

Women also are making up an increasing proportion of lung cancers diagnosed in patients under 50, with men contributing to a steeper decline in those cases than women.

What caused cancer rates to rise in people under 50?

While increased screening may partially explain the rising number of early-onset diagnoses, researchers say that doesn’t tell the whole story.

“Evidence suggests that the earliest phase of carcinogenesis might start in early life or young adulthood, followed by intervals of up to several decades between initial cellular damage and clinical cancer detection,” the study’s authors wrote.

Since the mid-20th century, many unhealthy changes have affected diet, lifestyle, obesity, the environment and our microbiomes. Those changes may now be occurring earlier in life and may be making humans more susceptible to cancer at a younger age. Studies also suggest the increase in early-onset cancers may be part of the growing trend in chronic diseases affecting younger adults.

If you’re a parent or thinking about becoming one, your concern about early-onset cancer should extend to your children. The study says that a woman’s smoking, diet, alcohol consumption and obesity during pregnancy may play roles in her child’s future cancer risk. Providing your children with healthy meals, limiting processed and sugary foods in their diets, encouraging them to exercise, watching their weight and avoiding their exposure to second-hand smoke may help reduce their future cancer risk at a time when they’re too young to make good choices for themselves.

“We found that this risk is increasing with each generation,” says Shuji Ogino, MD, PhD, a professor and physician-scientist in the Department of Pathology at Brigham who was involved with the study. “For instance, people born in 1960 experienced higher cancer risk before they turn 50 than people born in 1950, and we predict that this risk level will continue to climb in successive generations.”

Which cancer risk factors affect young adults?

Some of the causes behind the increased cancer rates for adults under age 50 are thought to include:

• Drinking alcohol in excess
• Smoking tobacco
• Eating a Western diet
• Being obese or overweight
• Having type 2 diabetes
• Getting too little sleep, having abnormal sleep patterns and/or getting too little sleep during childhood
• Bearing children at a late age
• Having the first menstrual period at a young age
• Lower breast-feeding rates and increased formula consumption
• Using oral contraceptive
• Being exposed to environmental toxins

https://www.cancercenter.com/community/blog/2023/01/why-are-cancer-rates-rising-in-adults-under-50

Through Harvard.ed they state the following:

“In an extensive review, the team found that the early life “exposome,” which encompasses an individual’s diet, lifestyle, weight, environmental exposures, and microbiome, has changed substantially in the last several decades. They hypothesize that factors like the Western diet and lifestyle may be contributing to the rise in early onset cancer. The team acknowledged that this increased incidence of certain cancer types is, in part, due to early detection through cancer screening programs. They couldn’t precisely measure what proportion of this growing prevalence could solely be attributed to screening and early detection. However, they noted that increased incidence of many of the 14 cancer types is unlikely due to enhanced screening alone.

Possible risk factors for early onset cancer included alcohol consumption, sleep deprivation, smoking, obesity, and eating highly processed foods. Surprisingly, researchers found that while adult sleep duration hasn’t drastically changed over the several decades, children are getting far less sleep today than they were decades ago. Risk factors such as highly processed foods, sugary beverages, obesity, Type 2 diabetes, sedentary lifestyle, and alcohol consumption have all significantly increased since the 1950s.

“Among the 14 cancer types on the rise that we studied, eight were related to the digestive system. The food we eat feeds the microorganisms in our gut,” said Ugai. “Diet directly affects microbiome composition and eventually these changes can influence disease risk and outcomes.”

“https://news.harvard.edu/gazette/story/2022/09/researchers-report-dramatic-rise-in-early-onset-cancers/

Some of the causes behind the increased cancer rates for adults under age 50 are thought to include:

• Drinking alcohol in excess
• Smoking tobacco
• Eating a Western diet
• Being obese or overweight
• Having type 2 diabetes
• Getting too little sleep, having abnormal sleep patterns and/or getting too little sleep during childhood
• Bearing children at a late age
• Having the first menstrual period at a young age
• Lower breast-feeding rates and increased formula consumption
• Using oral contraceptive
• Being exposed to environmental toxins

“All living things depend on millions of chemical reactions that happen constantly. Chemical reactions that keep you alive happen fast! When you eat food, breathe, play, and grow, all of these are chemical reactions, and they must take place quickly.

3X7340

What are enzymes?

Enzymes are vital for processes to take place in our body without them they couldn’t take place.  We have many enzymes  in our body from our saliva to our pancreas.  Enzymes are specialized proteins that are produced by living cells to catalyze reactions in the body=breakdown.

A catalyst in action brakes down something, any chemical substance affected with the speed of reaction without being permanently altered by the reaction.  For a chemical or biochemical reaction to occur, a certain amount of energy is required=the activation energy.  Energy can be transformed from one state to another.  The role of an enzyme is to decrease the amount of energy needed to start the reaction.  Exactly how enzymes lower activation energies is not completely and fully understood but it is known that an enzyme attaches itself to one of the reacting molecules, this is called a substrate complex.  Thousands of enzymes exist but each kind can attach ONLY to one kind of substrate.  The enzyme molecule must fit exactly with the substrate molecule (just like how pieces in a jigsaw puzzle have to fit in their specific space of the picture).  Well, if the substrate and enzyme don’t perfectly match or fit properly no reaction takes place.  When they do fit perfectly the substrate molecule can react with other molecules in a synthesis reaction and when completed the enzyme is free to move on elsewhere to connect with another substrate molecule.  This whole process takes place quickly.  Clearly, enzymes are essential to the body’s overall homeostasis. (In order to lead a healthy life, we need to bring a balance in the way we lead our lifestyle.  Homeostasis is nothing but a mechanism which helps the human body maintain a balance between the internal and external environment).  Enzymes quickly perform catalyze chemical reactions and they also govern the reactions that occur.   Enzymes are named by adding the suffix “ase” to the name of their substrates.  Here are some examples below.

Protein in the form of an enzyme acts as a catalyst.

The breaking down of proteins=Trypsin Proteins are large biological molecules consisting of one or more chains of amino acids.  Proteins perform a vast array of functions within living organisms, including catalyzing metabolic reactions, replicating DNA, responding to stimuli, and transporting molecules from one location to another.  Trypsin is a enzyme catalyst, which allows the catalysis of chemical reactions.   The ending product of the break down is amino acids not sugar.  Know high on a protein diet continuously for years can hurt the body also.

The breaking down of starches = the enzyme that does this function is amylase

Know this about amylase, it is present in human saliva where it begins the chemical process of digestion; that starts in our mouth. Foods that contain much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns some of their starch into sugar in the mouth. The pancreas also makes amylase (alpha amylase) to hydrolyse dietary starch into disaccharides and trisaccharides which are converted by other enzymes to glucose to supply the body with energy.  There is even b and y amylases. Ending product on enzymes breaking down starches or carbohydrates gives us one thing only sugar.)

The breaking down of sugars, like sucrose = the enzyme is sucrase.  The ending product of the enzyme is it breaks down complex sugars to more simple sugars in the body.

The breaking down of fats (lipids) = the enzyme is lipase. 

Lipase perform essential roles in the digestion, transport and processing of dietary lipids in most if not all living organisms (example (triglycerides, fats, oils).Most lipases act at a specific position on glycerol backbone of lipid substrate (A1,A2 or A3 in the small intestines).  For example, human pancreatic lipase (HPL) is the main enzyme that breaks down dietary fats in the digestive system, converts triglyceride substrates found in ingested oils to monoglycerides and two fatty acids.  Know that glycerol is a simple sugar compound.  Enzymes deal with breaking down our foods because they take a major role in what we call the process digestion in the human body but notice what the ending result is of mostly every ingredient out of 3 of our food groups, which is SUGAR.  It’s because of the food already having some sugar in it but more importantly also the chemical reaction with the enzyme to allow the food to break down into smaller compounds to be utilized in the body=simpler sugar compounds which also plays a part in the entire digestion process.

So know sugar in the body is our fuel for energy with the help of digestion process to breakdown sugars, this is how it work: 

When the body gets a meal within 1 hour digestion starts in the stomach and complete in 6 to 8 hours depending on how large the meal is, especially if 3 large meals a day.  The foods if contain starches, fat, lipids they all break down to simple sugars that transfer to the bloodstream and whatever energy the body needs at that point the tissues with cells utilize it but when enough sugar is used and we have excess in the blood we than have the body store the extra sugar that first converts the glucose (active sugar) to glycogen (inactive sugar) in our liver.  The liver is only so big and when it reaches its optimal level of storage than the sugar gets stored in our fat tissue = WEIGHT GAIN.  This is the problem with people in America not understanding this process.  Plus as most people get older from 30 than to 40 years old and every 10 years after that till heaven we put cellulite on the body for 2 major reasons not eating as healthy due to the bikini and speedo fit not being the priority in life but getting the feet up after a hard day’s work is.  The other reason is we aren’t as active as when we were 20 or 30 years old and the metabolism naturally slows down unless you’re a Jack la Lanne or body trainer.

How do we deal with this to prevent obesity?  Do what I did go on a 4-6 small meal/health snack diet.  Eat a meal every 3 hours with keeping fat, calories/sugar, carbohydrates in proper proportions to prevent excess sugar in the meals to not allow fat storage=weight gain.  Of course some exercise or activity daily or every other day helps tone the muscle and not let it flab due to cellulite.  Live healthier habits of living not just a month, 3 months or 6 months but make it your daily routine with treating yourself to foods you don’t eat daily to maintain a good weight and increase your health status to allow you to live a happier, longer and more exciting life.

Enzymes deal with breaking down our foods because they take a major role in what we call the process digestion in the human body.  but notice what the ending result is of mostly every ingredient in our 4 food groups is; SUGAR.  It because of the food has some sugar in it but also the chemical reaction with the enzyme to allow the food to break down into smaller compounds to be utilized in the body with send through the entire digestion process.

There are risks with eating just high protein diets for long periods of time.  You put yourself at risk for:  Osteoporosis:  Research shows that women who eat high protein diets based on meat have a higher rate of bone density loss than those who don’t. Women who eat meat lose an average of 35% of their bone density by age 65, while women who don’t eat meat lose an average of 18%. In the long run, bone density loss leads to osteoporosis.

Kidneys:  A high protein diet puts strain on the kidneys.  It is well known that patients with kidney problems suffer from eating a high protein diet which is due to the high amino acids levels.  A high-protein diet may worsen kidney function in people with kidney disease because your body may have trouble eliminating all the waste products of protein metabolism.

However, the risks of using a high-protein diet with carbohydrate restriction for the long term are still being studied. Several health problems may result if a high-protein diet is followed for an extended time:

Some high-protein diets restrict carbohydrate intake so much that they can result in nutritional deficiencies or insufficient fiber, which can cause health problems such as constipation and diverticulitis.

Some high-protein diets promote foods such as red meat and full-fat dairy products, which may increase your risk of heart disease.

If you want to follow a high-protein diet, do so only as a short-term weight-loss aid.  Also, choose your protein wisely. Good choices include fish, skinless chicken, lean beef, pork and low-fat dairy products. Choose carbs that are high in fiber, such as whole grains and nutrient-dense vegetables and fruit.

It’s always a good idea to talk with your doctor before starting a weight-loss diet. And that’s especially important in this case if you have kidney disease, diabetes or other chronic health condition.

So if you want to continue on high protein diets longer than 6 months know how to alkalize the body chemicals to decrease the proteins and there are supplements that can do that via the pharmacy or look up even online.

Before changing your diet always do a diet check with your doctor to make sure its cleared “OK” by the doctor since he knows your entire medical history!

“If the dizziness cannot be relieved with the conservative medical approach, surgery may be recommended to help alleviate the symptoms. There are 3 commonly accepted procedures to accomplish this:

1. Posterior semicircular canal plugging procedure
2. Singular nerve removal
3. Vestibular nerve clipping

Posterior semicircular occlusion has been adapted and utilized at the Michigan Ear Institute with great success. Only a small portion of the people with BPPV are even considered for this surgery, but because the success of this procedure at the Michigan Ear Institute has been excellent, it is an appropriate possibility for those who may require it.”

Michigan Ear Institute (https://michiganear.com/posts/bppv-fact-sheet/)

Surgical Procedures for Vestibular Dysfunction When is surgery necessary? 

When medical treatment isn’t effective in controlling vertigo and other symptoms caused by vestibular system dysfunction, surgery may be considered. The type of surgery performed depends upon each individual’s diagnosis and physical condition. Surgical procedures for peripheral vestibular disorders are either corrective or destructive. The goal of corrective surgery is to repair or stabilize inner ear function. The goal of destructive surgery is to stop the production of sensory information or prevent its transmission from the inner ear to the brain.  The types of surgeries used if non-invasive treatments are not successful are possibly: 

Labyrinthectomy:

A labyrinthectomy is a destructive procedure used for Ménière’s disease. The balance end organs are removed so that the brain no longer receives signals from the parts of the inner ear that sense gravity and motion changes. The hearing organ (cochlea) is also sacrificed with this procedure.

Vestibular nerve section:

A vestibular nerve section is a destructive procedure used for Ménière’s disease. The vestibular branch of the vestibulo-cochlear nerve is cut in one ear to stop the flow of balance information from that ear to the brain. The brain can then compensate for the loss by using only the opposite ear to maintain balance.

Chemical labyrinthectomy:

A chemical labyrinthectomy is also known as transtympanic or intratympanic treatment or gentamicin infusion. This is a destructive procedure used for Ménière’s disease. An antibiotic called gentamicin is introduced into the middle ear and absorbed via the round window. The drug destroys the vestibular hair cells so that they cannot send signals to the brain.

Endolymphatic sac decompression:

Endolymphatic sac decompression is a stabilizing procedure sometimes used for Ménière’s disease or secondary endolymphatic hydrops to relieve endolymphatic pressure in the cochlea and vestibular system. A variety of techniques exist. One method involves allowing the sac to decompress by removing the mastoid bone surrounding it. Other methods involve inserting a shunt (a tube or strip) into the endolymphatic sac so that, theoretically, excess fluid can drain out into the mastoid cavity or other location. The effectiveness of decompression techniques in controlling vertigo remains in doubt.

Oval or round window plugging:

If the exercises described above are ineffective in controlling symptoms, symptoms have persisted for a year or longer,  and the diagnosis is very clear, a surgical procedure called “posterior canal plugging” may be recommended. Canal plugging blocks most of the posterior canal’s function without affecting the functions of the other canals or parts of the ear. This procedure poses a substantial risk to hearing — ranging from 3-20%, but is effective in about 85-90% of individuals who have had no response to any other treatment (Shaia et al, 2006; Ahmed et al, 2012). The risk of the surgery to hearing derives from inadvertent breaking into the endolymphatic compartment while attempting to open the bony labyrinth with a drill. Sensibly, canal plugging for BPPV (note the first letter stands for “benign”) is rarely undertaken these days due to the risk to hearing.

Alternatives to plugging:

Singular nerve section is the main alternative. Dr Gacek (Syracuse, New York) has written extensively about singular nerve section (Gacek et al, 1995). Interestingly, Dr. Gacek is the only surgeon who has published any results with this procedure post 1993 (Leveque et al, 2007). Singular nerve section is very difficult because it can be hard to find the nerve.

Dr. Anthony (Houston, Texas), advocates laser assisted posterior canal plugging.  It seems to us that these procedures, which require unusual amounts of surgical skill, have little advantage over a conventional canal plugging procedure.  Oval or round window plugging is a stabilizing procedure sometimes used for repair of perilymph fistulas. Openings in the oval and/or round windows are patched with tissue taken from the external ear or from behind the ear so that perilymph fluid does not leak through the fistulas.

 Pneumatic equalization (PE) tubes:

Pneumatic equalization (PE) is a stabilizing procedure sometimes used for treating perilymph fistulas. A tube is inserted through the tympanic membrane (eardrum) with one end in the ear canal and the other in the middle ear, to equalize the air pressure on the two sides of the eardrum.

Canal partitioning (canal plugging):

Canal partitioning is a stabilizing procedure sometimes used for treating BPPV or superior semicircular canal dehiscence. The problematic semicircular canal is partitioned or plugged with small bone chips and human fibrinogen glue to stop the movement of endolymph and foreign particles within the canal so that it no longer sends false signals to the brain.

Microvascular decompression:

Microvascular decompression is performed to relieve abnormal pressure of the vascular loop (blood vessel) on the vestibulo-cochlear nerve.

Stapedectomy:

Stapedectomy is a stabilizing procedure sometimes used for otosclerosis. It is accomplished by replacing the stapes bone with a prosthesis.

Acoustic neuroma (vestibular schwannoma): 

This procedure involves the removal of a noncancerous tumor that grows from the tissue of the vestibular branch of the vestibulo-cochlear nerve.

Cholesteatoma removal:

This procedure involves the removal of a skin growth that starts in the middle ear and that can secrete enzymes that destroy bone and surrounding structures.

Ultrasound surgery:

Ultrasound is applied to the ear to destroy the balance end organs so that the brain no longer receives signals from the parts of the ear that sense gravity and motion changes. Cochlear dialysis Cochlear dialysis is a stabilizing procedure sometimes used to promote movement of excess fluid out of the inner ear by filling the scala tympani with a chemical solution.

Thanks to NYU Medical Hospital in Manhattan, NY you can Click here to download the “Surgery for Peripheral Vestibular Disorders” publication. – See more at: http://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-surgery#sthash.GDeNWxjl.dpuf.

If you have this problem and need a great hospital than let us look at the ranking of hospitals:

Of all 180 hospitals in the New York, New York metropolitan area, the 53 listed below are the top-ranking. This metro area, also called NYC, includes Long Island, Westchester County, and northern New Jersey. I know if I had a problem that I could not get rid of immediately with a antibiotic simple cure I would next want to go to the best if my county’s hospital couldn’t remove the problem completely. So here through “US News and World Report” via the internet they show the following information on the best hospitals in NYC and Northern NJ: (Look below or to the next page)

These are their rankings on Columbia Presbyterian and NYU, NATIONALLY, in the following categories:

Starting with the best is Columbia Presbyterian in NY, for those in NY, as your #1 choice:

Adult Specialties

This hospital was among 144 facilities—roughly 3 percent of the 4,743 analyzed for the latest Best Hospitals rankings—to be ranked in even one of the 16 specialties.

COLUMBIA PRESBYTERIAN RATINGS:

NYU HOSPITAL RATINGS:

• #50 in Cancer
• #11 in Cardiology & Heart Surgery
• #22 in Diabetes & Endocrinology
• #21 in Ear, Nose & Throat
• #26 in Gastroenterology & GI Surgery
• #8 in Geriatrics
• #38 in Nephrology

• #8 in Neurology & Neurosurgery************************ Impressive for neuro surgery of the ear.
• #4 in Orthopedics
• #33 in Pulmonology
• #9 in Rehabilitation
• #6 in Rheumatology
• #12 in Urology

Gynecology

For further checking of hospitals go to http://health.usnews.com/best-hospitals/area/ny/new-york-presbyterian-university-hospital-of-columbia-and-cornell-6210024 since hospitals do change yearly in their scores and this is the most recent.

“BPPV with the most common variant (crystals in the posterior SCC) can be treated successfully — with no tests, pills, surgery or special equipment — by using the Epley maneuver.  If some situations pills may be ordered (Ex. antivert)”

John Hopkins Medicine

(https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv)

Reassurance and avoidance of the provocating position. Antivertigo drugs: prochlorperazine (stemetil), Cinnarzine (stugeron) and Betahistine (Serc). Surgical: Posterior semicircular canal denervation.

TREATMENT

In all cases the doctor first has the patient (pt.) in their office and either through them or through physical therapy ordered by the M.D. after evaluating the pt with diagnosing the pt. with BPPV in treating the pt. using exercises which help in high percentages resolving the vertigo but continuing them when the vertigo is gone will do very little help unfortunately including it commonly comes back several weeks to months later and the exercises help more than. These exercises used are:

OFFICE TREATMENT OF BPPV: The Epley and Semont Maneuvers

There are two treatments of BPPV that are usually performed in the doctor’s office. Both treatments are very effective, with roughly an 80% cure rate, ( Herdman et al, 1993; Helminski et al, 2010). If your doctor is unfamiliar with these treatments, you can find a list of clinicians who have indicated that they are familiar with the maneuver from the Vestibular Disorders Association (VEDA) .

The maneuvers, named after their inventors, are both intended to move debris or “ear rocks” out of the sensitive part of the ear (posterior canal) to a less sensitive location. Each maneuver takes about 15 minutes to complete. The Semont maneuver (also called the “liberatory” maneuver) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other (Levrat et al, 2003). It is a brisk maneuver that is not currently favored in the United States, but it is 90% effective after 4 treatment sessions. In our opinion, it is equivalent to the Epley maneuver as the head orientation with respect to gravity is very similar, omitting only ‘C’ from the figure to the right.

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure. It was invented by Dr. John Epley.  It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

When performing the Epley maneuver, caution is advised should neurological symptoms (for example, weakness, numbness, visual changes other than vertigo) occur. Occasionally such symptoms are caused by compression of the vertebral arteries (Sakaguchi et al, 2003), and if one persists for a long time, a stroke could occur. If the exercises are being performed without medical supervision, we advise stopping the exercises and consulting a physician. If the exercises are being supervised, given that the diagnosis of BPPV is well established, in most cases we modify the maneuver so that the positions are attained with body movements rather than head movements.

After either of these maneuvers, you should be prepared to follow the instructions of your doctor or physical therapist who should give you written instructions on them to take home with you, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear. Not always the case.

       What to expect from your doctor on your visit with vertigo

A doctor who sees you for symptoms common to BPPV may ask a number of questions, such as:

• What are your symptoms, and when did you first notice them?
• Do your symptoms come and go? How often?
• How long do your symptoms last?
• Is one or both of your ears affected?
• Does anything in particular seem to trigger your symptoms, such as certain types of movement or activity?
• Do your symptoms include vision problems?
• Do your symptoms include nausea or vomiting?
• Do your symptoms include headache?
• Have you lost any hearing?
• Have you had any weakness, numbness or tingling in your arms or your legs?
• Have you had any difficulty talking or walking?
• Have you had chest pain?
• Are you being treated for any other medical conditions?
• What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?

Need assistance in where to go for help treatment on surgery in the hospitat for benign posterior paroxysmal vertigo?  Than tune in tomorrow to Part IV.

“The signs and symptoms of BPPV can come and go and commonly last less than one minute. Episodes of BPPV can disappear for some time and then recur. Symptoms varying from dizziness, unsteadiness, nausea, vomiting, and a sense of feeling everything around you is spinning. Often, there’s no known cause for BPPV. This is called idiopathic BPPV. Although BPPV is uncomfortable, it rarely causes complications. The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055)