Tuesday, April 29, 2008

Non-Drug Treatments for Meniere's Disease

The following are treatments or activities that I have tried, some whole-heartedly, some part-heartedly, to help relieve the symptoms of Meniere's Disease. In some cases I had read somewhere that the treatment helped patients, some were doctor-recommended, and some were just things that seemed to make sense at the time. Some have been a waste of time and money, some have helped greatly.

Chiropractic

I had never tried chiropractic before contracting Meniere's Disease, and don't know much about it beyond the notion that it believes that if the vertebrae are in alignment, the nerves function properly and therefore the body is adequately supplied with blood. My father is a huge proponent of chiropractic, believing that the "treatments" cure just about everything and restore him to good health. Early in my disease I remember reading on a discussion forum several accounts of dramatic improvements in Meniere's symptoms after chiropractic adjustments. So I did some reasearch and found several articles describing the exact adjustment necessary to relieve symptoms. With this article in hand I made an appointment with a local chiropractor. He told me that he had never treated Meniere's patients, but was excited by the article and tried to follow its advice. I saw him 3 or 4 times. I saw no improvements in my symptoms, so I discontinued treatment.

Shortly thereafter I had an appointment with my ENT and mentioned to him that I had seen a chiropractor. He recommended a different chiropractor who had another approach and some experience treating Meniere's patients. The approach is called the Atlas Orthogonal technique, and supposedly targets the first couple of vertebrae. It does not involve twisting or "back-cracking" manipulations, but rather some kind of device that supposedly aligns these vertebrae. I ended up spending quite a bit of money at this clinic and although after each individual treatment I did feel a slight decrease in my dizziness, in the long run I did not detect any permanent benefit and therefore discontinued treatments.

Bottom line: chiropractic did not help me.

Accupuncture

The chiropractor that I mentioned above who practices "Advanced Chropractic" also performed several accupuncture procedures on me. In all cases he consulted a manual to relieve symptoms of dizziness and/or tinnitus. These treaments were quite uncomfortable and provided no change in my symptoms whatosever. It's possible that someone schooled in the art and science of accupuncture, preferrably not an American chiropractor, could do more. But based on my experience, I do not recommend accupuncture for the treatment of Meniere's Disease.

Physical Therapy

My doctor recommended a physical therapist who specializes in balance disorders. I wasn't sure what such a person might do for me, but I tried it anyway. At my first and only visit, she took an extensive oral history and then gave me several balance tests such as closing my eyes and walking a straight line, standing on an unstable surface, etc. At the end of the testing she told me that my performance was at a level that she tries to reach by the end of physical therapy and therefore I did not need it. She told me that she believes that this is due to the extent to which I exercise daily. I will have much more to say about this later. The bottom line for me was that I did not need physical therapy but it likely would have been helpful had I needed it.


Limiting Caffeine Intake

I am a three-cup-a-day coffee drinker and have been for at least 24 years. Good coffee is one of my true pleasures. I had read quite a few times on Meniere's forums and medical pages that some doctors recommend or even require that caffeine intake be eliminated. This was painful to read, but I tried it anyway. If you are used to consuming caffeine and want to stop, you should do so gradually, as you will have bad withdrawal symptoms with a cold turkey approach. Mainly bad headaches that do not respond to pain killers. I tried going down to two cups a day and then one and then none. I am not sure how long I stayed off caffeine but I doubt it was more than a month. I did not notice a difference in my Meniere's symptoms. I am back up to my regular intake of coffee. I should also point out that I do not notice a difference in my symptoms before and after a morning cup. Limiting caffeine did not help me.


Limiting Alcohol Intake

Wherever I found warnings to stop caffeine intake I also found warnings to stop alcohol intake. I am a 2 to 3 drink a day drinker, mainly beer or Irish whiskey. I stopped all alcohol intake for two months. I did not experience a change in my Meniere's symptoms. If anything, they may have been slightly worse. I mentioned this to my doctor, who said that because alcohol is a CNS depressant, it tends to temporarily improve dizziness. I should also point out that my doctor's advice regarding caffeine and alcohol was not to worry about them because they are both diuretics and therefore not detrimental to my main treatment.

Meniett's Device

A Meniett's Device is a machine that delivers small, systematic air pulses to the ear. I had read about it on a few sites, several of which indicated that it can greatly improve one's Meniere's symptoms. It must be prescribed by your doctor and administered by an audiologist. Your insurance may or may not cover it. As far as I could tell, it is not necessarily known why air pulses improve Meniere's symptoms. I scheduled an appointment with the Dizziness and Balance Center for a Meniett's Device fitting, but we were unable to use it because the air pulses made me very dizzy. So I do not have any experience with a Meniett's Device but mention it here because it is a treatment that has supposedly helped some people.


Neuromonic Therapy

Neuromonic therapy is designed to decrease tinnitus, or ringing in the ears. A device is calibrated by a hearing specialist to deliver tones through headphones to the affected ear(s) that have a canceling effect on the perception of tinnitus. These tones are then embedded in music, and the patient wears the device and listens to the music for several hours each day for several months. I have not tried a Neuromonic device yet, but have been on a "waiting list" to receive one for several months. The consensus is that they greatly help to improve the tinnitus, so I am very excited to begin the therapy. I spoke to my ENT about it yesterday, and he said that specific training is required before the device can be dispensed, and the clinic that I use is still waiting to receive the training. Hopefully I will have much more to say about this later.

Tympanostomy Tube

This is a small tube inserted in the eardrum to relieve pressure in the middle ear. It is commonly used to prevent fluid buildup and frequent middle ear infections. It is sometimes used in Meniere's patients with the notion that lowering pressure in the middle ear will help to lower pressure on the inner ear and perhaps relieve symptoms. For adults, the procedure is done by the ENT in the clinic under local anesthesia. It takes about ten minutes and is not painful. First a numbing medicine is place on the eardrum. Then a small hole is created and if necessary, any fluid in the middle ear is removed. Then the tube is placed in the hole. It is about 1.5 mm in size (smaller than a match head). The tube stays in place for several months to several years, depending on the type used, and falls out naturally. The hearing is not affected. I had this procedure done and it did not help me.

Exercise

(!!!***!!!***!!!) I have saved the best for last. And I hesitate to call it "exercise" because that sounds like a prescription for something that you don't want to do. Perhaps "activity" would be a better word. Regardless, my doctor and I believe that my adaptation to Meniere's Disease has been very good, and that my exercise level is likely the reason. Why? The speculation is that the cause of Meniere's Disease, whatever gives us the dizziness, tinnitus, and hearing loss, does not go away. Rather, improvement is experienced because the body adapts to the symptoms over time. And the body is best at adapting to the dizziness part, which is why this symptom consistently shows the most improvement over time. And whatever we can do to help with this adaptation will produce greater, faster improvement.

Exercise has many benefits, but one is that, provided that you are moving your body, it provides constant vestibular stimulation and therefore forces your body to constantly keep itself upright and stable. This is not always easy. Consider the figure skater who learns to spin very quickly in a tight circle for 40 or 50 revolutions and then is able to skate away without falling down. This takes practice. At the beginning of Meniere's Disease, getting up off the couch and walking to the bathroom is very difficult. It takes practice.

I have always been very active, from sports as a child, to weightlifting and running, to my current exercise of choice which is bicycling. Currently I ride to work and back each day, which is about 25 miles total. It takes me about 45 mintues to an hour each way, so I am on the bike for 1.5 to 2 hours a day. I do this year round, consistently. Just about the only thing stopping me from riding is ice, which in the DC area is thankfully infrequent. I have been riding to work for 3 years now. At the beginning it was very difficult and I had to work my way up. Now it is no problem and I'm getting a lot faster. I love it. It's one of the highlights of my day. I should also mention that since I started I have lost 35 pounds and three inches from my waist. I can fix a flat tire in about 10 minutes, and I save my family at least $5000 a year in gas, car maintenance and parking costs. And there's also the environmental friendliness, improvements in mental and physical health, avoidance of traffic and parking headaches, and much more. By the way, if I were to drive to work, it would only take me about 10 minutes less time each way due to traffic and parking. So clearly biking is much more to me than just exercise, and it's not something that I started doing because of Meniere's Disease. In fact, it's more like something that I subbornly continued doing despite Meniere's Disease.

Ok, so why does bicycling help me adapt to Meniere's Disease? I believe it is because I am constantly receiving stimulation as I ride, and am moving my head, and am forced to keep my bike upright and moving forward in a straight line. At the beginning, looking behind me while maintaining a straight line (challenging for anyone) was almost impossible. I even fell a couple of times while doing this. But now it's not a problem. My head is always moving while I'm riding, and I'm always receiving stimulation that is needed in order for me to navigate my bike correctly and safely.

So it stands to reason that any exercise that requires you to move your body through space and keep yourself upright and/or stable would be beneficial. That means walking, running, aerobics, dancing, roller blading, skiing, swimming, tennis, hiking, climbing, soccer, basketball, frisbee, etc. etc. etc. All the fun ones!

What forms of exercise would be less beneficial? In my opinion, those that do not require us to navigate our bodies would be less useful for Meniere's Disease. These would inlcude most of the things that we do at a gym involving equipment, such as weightlifting, treadmill, elliptical, stairmaster, rowing, etc. All the unpleasant ones!

At the risk of sounding too much like an exercise evangilist, I'll stop this discussion here. Except to say that, if anything, get out there and move around!!!!! Oh, and also I'd like to say that bicycling to work doesn't solve ALL the major problems in the world, just the IMPORTANT ones: obesity, pollution, high gas prices, heart disease, depression, traffic congestion, road rage, peak oil and dependence on foreign oil, greenhouse gas emissions, parking.... (I'm only sort of kidding here.)

4 comments:

Anonymous said...

So I am not crazy in thinking & feeling that my symptoms improve when I keep moving!!
Thank you
Sharon

Anonymous said...

Thanks for the advice. Have you tried John of Ohio's supplemental regimen as well?

carl sheppard said...
This comment has been removed by the author.
carl sheppard said...

I've had meniere's since 2004, the one thing that has helped me through it. Cycling, I love my road and mountain biking and for some reason I never worry about falling off due to my meniere's. It's not just been the physical effects that cycling has had but the physiological side. I used to do a lot of weight training but I've now turned to resistance training at home. Exercise has helped me dramatically and would recommend cycling to other meniere's suffers. In fact a work / mtb buddy has been diagnosed and the consultant told him that the cycling will help. I'm 41 now and I'm still getting quicker on the roads. I seem to feel more steady on the bike than I do walking sometimes.