MORGAN: Vestibular Specialist Holly Talks Vertigo, the Causes, Prevention, & Living With It

Summary

Podcast Summary: The Bobby Bones Show Episode: MORGAN: Vestibular Specialist Holly Talks Vertigo, the Causes, Prevention, & Living With It
Release Date: April 13, 2025
Host: Morgan Huelsman
Guest: Holly Cawthon, Vestibular Specialist at Vanderbilt

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Introduction

In this enlightening episode of The Bobby Bones Show, host Morgan Huelsman delves deep into the perplexing world of vertigo, specifically focusing on Benign Paroxysmal Positional Vertigo (BPPV). Joined by Holly Cawthon, a renowned vestibular specialist from Vanderbilt, Morgan shares his personal battle with vertigo and explores the intricate details of its causes, diagnosis, treatment, and living with this debilitating condition.

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Understanding Vertigo and BPPV

Morgan's Personal Journey
Morgan opens up about his own experience with vertigo, mentioning, “I was part of the 1 in 10” who suffer from vertigo globally ([00:58]). After his first BPPV episode in February 2024, Morgan sought Holly’s expertise, leading to significant improvements in his condition.

Defining Vestibular Disorders
Holly clarifies the scope of her specialty: “It’s the inner ear. It’s really that easy. All things balance, all things dizziness, and then concussions fit in with that” ([04:02]). She emphasizes that while she doesn't handle orthopedic issues, she specializes in balance and dizziness-related conditions.

BPPV Explained
Morgan and Holly discuss BPPV in detail. Holly explains, “BPPV is room spinning vertigo that happens with position, like positional changes. So laying down, rolling over in bed, sitting up, all those things make your world go round” ([06:16]). This occurs when tiny calcium carbonate crystals, or otoconia, dislodge from the utricle and migrate into the semicircular canals, sending false signals to the brain.

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Causes and Triggers

Common Causes of BPPV
Holly highlights that BPPV typically affects individuals aged 50 to 70, though Morgan, being younger, represents a rarer case. Causes include high-intensity aerobic activities, head trauma, concussions, whiplash from car accidents, and other inner ear issues. Morgan recounts his vertigo onset following a high-intensity fitness class, illustrating a direct link between vigorous physical activity and BPPV ([13:20]).

Idiopathic Nature
Most BPPV cases are idiopathic, meaning their exact cause remains unknown. However, underlying conditions like migraines or pre-existing inner ear problems can increase susceptibility.

Preventive Measures
Holly admits, “There is no way to prevent it” ([13:20]), aside from potentially maintaining adequate vitamin D levels. High-intensity activities and certain medical procedures can trigger recurrences, but no definitive preventive strategies exist.

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Diagnosis and Treatment

Diagnostic Process
Using advanced technology, Holly demonstrates how she diagnoses BPPV. She states, “I put you in different testing positions, and I watch your eyes when the crystals move within those semicircular canals” ([09:10]). Eye movements indicate the location of the dislodged crystals, guiding the choice of treatment maneuvers.

Treatment Maneuvers
While the Epley maneuver is commonly known, Holly emphasizes that it's not a one-size-fits-all solution. “Most people have heard of something called the modified Epley… that probably works 93-95% of the time,” but recognizes when alternative maneuvers are necessary ([09:53]). Morgan shares his experience, where multiple maneuvers were required to address his multi-canal BPPV ([10:20]).

Specialized Care
Holly underscores the importance of seeking a vestibular specialist rather than a general physical therapist, as specialized equipment like video goggles are essential for accurate diagnosis and effective treatment ([43:37]).

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Living with Vertigo

Emotional Impact
Morgan discusses the psychological toll of vertigo, expressing fear of recurring episodes and the uncertainty they bring: “I was having this huge panic… feeling overwhelmed” ([12:33]). Holly acknowledges the debilitating nature of BPPV, reinforcing that it is indeed challenging ([12:34]).

Managing Recurrences
Once treated, BPPV episodes can disappear until triggered again. Morgan notes that after treatment, he felt “100% again” but remains vigilant for future episodes ([18:37]). Holly shares that patients often experience varying recurrence patterns, with some going years without symptoms and others facing frequent episodes ([25:03]).

Physical Therapy and Rehabilitation
Post-treatment, retraining the body is crucial. Morgan describes exercises like head shakes and wearing therapeutic glasses to manage lingering symptoms: “I have to stare at an X on the wall and just shake my head back and forth while staring at it” ([29:39]). Holly emphasizes encouraging movement to prevent fear-based avoidance behaviors ([26:17]).

Coping Strategies
Tools like rubbing alcohol pads and ice packs help manage nausea during episodes. “We have the little rubbing alcohol pads… it decreases the nausea” ([48:27]). Norman, the facility dog, also provides comfort during intense treatments ([48:07]).

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Prevention and Lifestyle

Avoiding Triggers
While complete prevention isn't feasible, Holly advises avoiding high-intensity aerobic activities that can dislodge otoconia. Morgan humorously concludes, “Don't work out” ([39:55]), though recognizing the challenge given his fitness routine.

Vitamin D Levels
Maintaining adequate vitamin D may reduce the risk of BPPV recurrence by ensuring bone health and calcium metabolism ([15:35]).

Lifestyle Modifications
Although no specific diet or lifestyle changes can prevent BPPV, managing stress is crucial, especially since it can trigger vestibular migraines, a condition often confused with BPPV ([37:24]).

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Audience Questions

Meniere’s Disease and Vestibular Migraines
A listener inquires about managing vertigo in Meniere’s disease. Holly recommends dietary adjustments like reducing salt intake and seeking specialized vestibular therapy, noting that vestibular migraines share similar symptoms but often lack the headache component ([34:35]).

Dizziness vs. Vertigo
Clarifying terminology, Holly explains, “Dizziness is an umbrella term… vertigo typically fits underneath that” ([21:02]). Vertigo specifically refers to the sensation of spinning, whereas dizziness encompasses a range of disorienting feelings.

Vestibular System Sensitivity
Morgan shares his heightened sensitivity to motion-related nausea, questioning if there's a connection to his BPPV. Holly responds that while motion sickness and BPPV are distinct, overall vestibular health can influence susceptibility to various imbalance-related conditions ([21:38]).

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Conclusion and Takeaways

Hope and Treatment Accessibility
Both Morgan and Holly emphasize that vertigo, particularly BPPV, is treatable. “There is hope, there is an answer, there is treatment” ([51:03]). Holly urges listeners to seek specialized care, highlighting resources like the American Physical Therapy Association’s vestibular provider map ([52:49]).

Empowerment Through Knowledge
Morgan concludes by encouraging those suffering from vertigo to seek expert treatment and not feel isolated in their struggles. Understanding the condition and having access to the right treatment maneuvers can significantly improve quality of life.

Final Words from Holly
Holly reinforces the message that patients are not alone and that effective treatments are available: “You don't have to be scared… there’s treatment” ([51:26]).

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Notable Quotes

• Morgan Huelsman ([00:58]): “Morgan is part of the 1 in 10 who suffer from vertigo globally.”
• Holly Cawthon ([04:02]): “It’s the inner ear. It’s really that easy. All things balance, all things dizziness, and then concussions fit in with that.”
• Holly Cawthon ([09:10]): “I put you in different testing positions, and I watch your eyes when the crystals move within those semicircular canals.”
• Morgan Huelsman ([12:33]): “I was having this huge panic… feeling overwhelmed.”
• Holly Cawthon ([21:02]): “Dizziness is an umbrella term… vertigo typically fits underneath that.”
• Holly Cawthon ([51:03]): “There is hope, there is an answer, there is treatment.”

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Resources Mentioned

• American Physical Therapy Association (APTA) Vestibular Provider Map: A comprehensive tool to find vestibular specialists across the United States. Visit apta.org and search for vestibular providers.

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Closing Remarks

This episode serves as a crucial resource for anyone grappling with vertigo or BPPV, offering both personal insights and professional expertise. Morgan and Holly’s candid conversation sheds light on the complexities of vestibular disorders and underscores the importance of specialized treatment and support systems in managing and overcoming vertigo.

Transcript

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[Morgan Huelsman]

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[Holly Cawthon]

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[Morgan Huelsman]

2025 vertigo affects about 1 in 10 people worldwide, with women being more prone to it than men. Additionally, 15 to 20% of adults experience dizziness annually. That's why we're doing an episode all about Vertigo. I am unfortunately part of the 1 in 10. I was diagnosed with BPPV last year after my first positional Vertigo episode in February of 2024. It was my first time ever knowing or experiencing Vertigo. But after posting several moments of my BPPV diagnosis and journey, several people online have come forward with similar ailments and issues. So I wanted to dedicate an episode to all of the Vertigo sufferers. Holly Cawthon joins me this episode. She's a friend and a vestibular specialist at Vanderbilt and the reason that I'm operating at 100% again after both of my BPPV episodes. So you'll hear some of my experiences, but through the lens of Holly, the actual expert on this particular topic, I am bringing on not only one of my good friends, but also a good friend by way of Vertigo. Her name is Holly. Holly is a vestibular specialist in the physical therapy world and she's basically saved my life on multiple occasions. Now hey, Holly, thanks for joining.

[Holly Cawthon]

Hey, Morgan, thanks for having me.

[Morgan Huelsman]

How are you feeling right now, in this moment?

[Holly Cawthon]

I'm good.

[Morgan Huelsman]

Good. Ready to talk all about all things vertigo?

[Holly Cawthon]

Yes.

[Morgan Huelsman]

Okay. I want to know how you got into this line of work, because it's so specific, and you yourself don't have vertigo.

[Holly Cawthon]

No, that's true. I don't. One of my clinicals actually canceled on me in physical therapy school, so I ended up going to a clinic that was about an hour away from Mobile, Alabama, which is where I went to PT school, and my clinical instructor happened to be a vestibular specialist. And so it just fell in my lap. I was good at it, and I loved it, and it's all I've ever done. For 13 years, I've never done a single day of ortho. So I can't help you with your shoulder. I can't help you with your knees or ankles, but I can do anything. Balance and dizziness.

[Morgan Huelsman]

Okay. And vestibular. Give us the breakdown of what all that encompasses when I say you're a vestibular specialist.

[Holly Cawthon]

Yeah. So it's the inner ear. It's really that easy. All things balance, all things dizziness and then also concussions fit in with that.

[Morgan Huelsman]

Vestibular migraines and, like, tinnitus Meniere, Are those some of the things that you work with?

[Holly Cawthon]

So tinnitus is the one thing we can't touch, really, in the vestibular world, there's nothing we can do about that. But Meniere's and other things, like labyrinthitis, weaknesses of the inner ear that I can help with.

[Morgan Huelsman]

Okay. And obviously vertigo, which, for me, what I dealt with and stumbled on to you was bppv, which is benign positional parasylma.

[Holly Cawthon]

I can never say the second benign paroxysmal positional vertigo.

[Morgan Huelsman]

Thank you.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

I just always end up saying positional vertigo.

[Holly Cawthon]

Yeah. No, and that's a good way to. To put it. So it's the number one vestibular diagnosis, and it's actually my specialty and the easiest to treat. Okay.

[Morgan Huelsman]

You say easiest to treat, and I remember my treatments. I was like, this is not easy. But it's so funny. Holly and I, as a patient, doctor situation, if you will. It was always funny because Holly would always reference things. She'd be like, this is so robust. Oh, my gosh, Morgan, this is beautiful. Or, like, just like, this moment. And I'm like, holly, no, it's not true. It was. But you were experiencing, like, okay, this is like, something I can work with and something I can Treat where I was sitting here and I was like, I don't want something to be beautiful in my eyes and in my ear.

[Holly Cawthon]

As I'm staring like closely into your eyes.

[Morgan Huelsman]

Yes. Okay. Bppv, Vertigo. This situation, how does it happen for people? Like, I stumbled into your office because there was a listener of the Bobby Bones show who reached out to me on Instagram. What was her name?

[Holly Cawthon]

Katrina. Karina, Colleague.

[Morgan Huelsman]

And she was like, I have a friend who can work wonders on you. I was like, oh my gosh, do anything to help me right now. I got set up with you had no idea somebody like you even existed, which is why I brought you on here.

[Holly Cawthon]

The best kept secret you are, but.

[Morgan Huelsman]

You shouldn't be a secret. Like, you are helping people who have a debilitating illness all the time. So how does somebody end up one with vertigo or bppv? What are the kind of different variations that would make somebody land in your office with this?

[Holly Cawthon]

So let's start kind of with what is bppv? It is room spinning vertigo that happens with position, like positional changes. So laying down, rolling over in bed, sitting up, all of those things make your world go round, round. And you can't figure out which way is up. So that's the definition of it in.

[Morgan Huelsman]

The little crystals in your ears. And they move from the rocky wall. I will always remember you telling me that.

[Holly Cawthon]

Yeah, so they're called oticonia, little calcium carbonate. They are super small little rocks that come out of your utricle. So that's your balance organ. And they go into one of your six semicircular canals and they send false signals to your brain that you're like going upside down. And again, it makes the world go.

[Morgan Huelsman]

Round and round, which is I describe in two ways. Like when I experienced vertigo, it was. I was either on a tilt, a whirl, or I was like had a blackout drunk moment and the world would not stop spinning. Those were like the two similarities I could relate it to. It's a crazy experience. And then. But why does it happen for some people, why does it not happen for others? And like, how can it happen? Can it happen to anybody? Give me the breakdown.

[Holly Cawthon]

Okay, the breakdown. So it usually happens to people from ages 50 to 70 years old. You are rare. I rarely see it in someone in our early 30s. So that's different.

[Morgan Huelsman]

Welcome to my life.

[Holly Cawthon]

Yeah, exactly. You're special.

[Morgan Huelsman]

Always been special in the doctor's office.

[Holly Cawthon]

It's usually idiopathic. We actually don't really know why it happens to some People and not others. Now, it can be attached to things like migraines and things like if you have an inner ear problem already, it's going to attach onto that and you're going to be at a higher risk for bppv. But for majority of people, it just happens one day when you wake up, and it's terrifying. It's actually really scary. So most people think they're having a stroke or even a heart attack, and they run to the emergency room.

[Morgan Huelsman]

And from what I've learned, running to the emergency room is only going to get you some medicine. So send you on your way and say you have here's some nausea medicine that'll help you not feel like that side effect. But it doesn't actually treat the symptom.

[Holly Cawthon]

Which is vertigo, the medicine that they give you. So it's usually something called Meclizin or Anivert. It really. It's like a Dramamine on steroids. It really doesn't do anything to help the underlying cause. So it's a bit of a band aid. It might take the edge off a little bit, but it's not going to stop the world from spinning around you.

[Morgan Huelsman]

And what does actually stop the world from spinning around you is maneuvers.

[Holly Cawthon]

Yes. Me.

[Morgan Huelsman]

Yes. That's how people get to Holly, by way of typically ear, nose, and throat doctors who then recommend to her. So the maneuvers. But tell people how you diagnose. Because every time I show these crazy videos of you putting the goggles on me and my eyes going crazy, everybody's. I didn't even know. This is wild technology. Tell people what happens when somebody comes in and you're treating them for vertigo.

[Holly Cawthon]

So I put you in different testing positions, and I watch your eyes when the crystals move within those semicircular canals, there's little hairs in there. And again, the signals are sent to the brain, and they actually make your eyes move in certain directions. And so I watch the eyes, and that tells me where the crystals are located, and that helps me choose a maneuver to treat you.

[Morgan Huelsman]

How many maneuvers are actually out there? Because this is a very controversial thing. Because I remember you're like, I told you I did the Epley maneuver. And you're like, oh, dear, gosh, no. Not because the Epley is bad, but because it's not a Vertigo is not a one size fits all. And people use Epley in that capacity.

[Holly Cawthon]

Correct. So most people have heard of something called the modified Epley and that treats the posterior and anterior canals. Now, greater than 93, 95% of the time. That's probably going to work. But I see PPV all day, every day. And so of course it's. It doesn't fix everyone's. So we. Gosh, I don't even. I don't even know how many maneuvers there are, but there are a lot.

[Morgan Huelsman]

There are. And even when we were going through my treatment, I remember you pulling out the book and you're like, I think we need to do a different maneuver that I don't typically have to do.

[Holly Cawthon]

I think I had to do three on you.

[Morgan Huelsman]

And I remember telling people that you did the barbecue roll on me. I'm like, you know, like. Like you were road to him. Like, yeah, I was a literal skewer on a barbecue is what basically she did to me.

[Holly Cawthon]

You were a special case, though, because you started out in one canal and then you switched to another canal, and so it got a little bit muddy. So that's why we had to use so many maneuvers. But.

[Morgan Huelsman]

And how often do you see, like, that happen where you're a. You called me a multi canal bppv.

[Holly Cawthon]

I see it quite frequently.

[Morgan Huelsman]

See, okay, so I'm special, but I'm not, like, so special that I have to become a case study.

[Holly Cawthon]

Right, right. Cool.

[Morgan Huelsman]

I appreciate that.

[Holly Cawthon]

Yeah. Okay. Studies.

[Morgan Huelsman]

Really glad. But the thing that was so hard for me when I was going through this and I cried in your office, and you're like, oh, gosh, Morgan, it'll be okay. We got this. But what was so terrifying for me was not the treatment, not the maneuvers you were doing, nothing like that. It was, I'm gonna have to deal with this for the rest of my life. Because once you've had it, you're likely to get it again. When I first walked into your office for the very first time ever, February of 2024, we were like, okay, this potentially came from a balance fitness class, and this may never happen again. Hopefully this is it. This is one time in ten years from now, maybe we're hoping it was a one off. And fast forward to this year, 2025, and it happens again. And I was like, no, this means it's going to happen more. And I do not want this in my life. And so I was having this huge panic, which I think anybody who deals one with a chronic illness, one with a invisible illness, three with a debilitating illness that people don't understand on any of those levels, you feel just overwhelmed with what your life is going to be like indefinitely. And so when I was sitting in there and I was crying, you're like, oh, no. Like, we're gonna treat this. I was like, no, no, no. This is not you. This is like me realizing that my body's kind of betrayed me and I now have to do this all the time to get better. And it's so debilitating.

[Holly Cawthon]

It is, yeah.

[Morgan Huelsman]

Do you see a lot of your patients come in and they have this kind of same experience where it's like, is this for real? This is what I'm gonna have to keep dealing with.

[Holly Cawthon]

One of. One of the number one questions that I hear is, how do I prevent it from happening again? And there's a really bad joke in the vestibular world that we say that's job security for us. There is no way to prevent it. Things like high intensity aerobic activity, which is probably why it happened to you in the first place. You were at the bounce class, so a lot of impact on the floor probably made those crystals come loose. But other things, like going into surgery and then being sedentary for a while, going to the dentist, going back and getting your hair done, things like that can also make BPPV reoccurring.

[Morgan Huelsman]

And can they also be the reason it starts, like, all of the things you just mentioned?

[Holly Cawthon]

Absolutely. Yep. So usually it's idiopathic, but also a large majority of BPPV patients come in post concussion or a hit to the head or even, like, a whiplash injury post car accident. So usually, like, my younger patients are going to have some sort of blow.

[Morgan Huelsman]

To the head, but when I came in, you're like, oh, he did a fitness class. What is happening?

[Holly Cawthon]

Yours was a high intensity aerobic fitness class. That likely made it happen.

[Morgan Huelsman]

Oh, my gosh. And see, that's what's so crazy about it. And when I talk to people and they're like, you're good now? I'm like, I'm good until it chooses to happen again. And that's what's so scary, because it can happen again, and it can happen. You have no warning, you have no way of preventing it. Just like you said, it's just. And then you're knocked out. Like, when it first happens to me, I am stuck in my bed for three days waiting until whatever. The moment of the episode started subsides to then start trying to heal. And that's what's so scary about BPPV and vertigo itself. But, like, that experience that I had where it was like, again, we're not sitting there, and I was like, oh, my gosh, I could be driving. I could be on a road Trip. I could be miles away from Holly. I could be getting married, and I literally could have this Vertigo episode happen. And that experience was just. Everything came washing over me in that moment where I was like, this is now my life. And now I'm like, on this mission to be like, how can I get the healthiest I've ever been in the potential that it somehow impacts. This is the goal. Right. Like, I just hope that I inadvertently do something to help it.

[Holly Cawthon]

Yeah. And there's really, truly nothing out there that is proven to help prevent it except potentially vitamin D levels. So we do have our patients get their vitamin D levels checked because if you're on the lower side, it can lead to recurrence. But other than that, there's no special diet. There's no we don't tell you to give up coffee or alcohol. There's nothing from that's food related that will help prevent it from happening or from occurring in the first place.

[Morgan Huelsman]

And that's what I see a lot. Because the Internet is a dangerous place.

[Holly Cawthon]

It is.

[Morgan Huelsman]

And you see a lot of things of, okay, I went gluten free and my vertigo stopped. Or you see someone who goes, I went to a chiropractor. I've never had issues again, these kind of gambit of things. But like, truly medical sense, is any of that proven or is it just like potentially happenstance that those connected?

[Holly Cawthon]

I think we need to realize that vertigo is not just bppv. Vertigo can come from a multitude of vestibular diagnoses that actually create the same room spinning symptoms. It's not always super, super easy to treat which BPPV is, but other things like vestibular migraines or a vestibular neuritis, which is a weakness of the inner ear, they actually create the same symptoms that positional vertigo does.

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[Morgan Huelsman]

Okay, so when people are having these experiences of things helping them, it's likely that something else is going on that those help them. But BPPV itself, if you just have like me potentially, we're still working through my understanding of what the heck is going on in my anatomy. But say I just end up having bppv, there is nothing besides the potential of vitamin D levels that I could do that would prevent it from happening, right?

[Holly Cawthon]

That's correct. And you're so young, it's likely going to happen again.

[Morgan Huelsman]

And I do, I've heard of a lot of people who get this, this is the craziest part to me because when this first happened and I found out about you and you were treating me and I was slowly getting better, there were so many people that reached out and they were like, I live with this every day for months on end and they get a little bit better because that's the process of vertigo, which also you taught me that vertigo itself is just the symptom and then you have the diagnosis. So just like you're mentioning, vertigo can be caused by multitude of different things. But, but what I'm aligning here with is the bppv, which is my diagnosis.

[Holly Cawthon]

That's correct. You are, you're special. And I say that in a way that your system is actually really sensitive to the bppv. So not everyone that comes to me has to be in bed for three days. There are people that actually still are able to get up and go to work and function no problem at all. But that is because they, their BPPV is not as what I call robust as yours. So it's likely that the crystals are either really small, so they range from 3 microns to 30 microns. Okay, wow, that's really tiny.

[Morgan Huelsman]

And which you also told me you can't Even see them on. Yeah, you can't pull them out and see them under a microscope.

[Holly Cawthon]

They're so small. So if you, let's say you have a cluster of three size three micron otoconia that are going through your canals, your eye movements and your symptoms are not going to be as intense as if the otoconia are size 30 microns and they're moving fast through the canal. So that's going to create a much more intense situation. So it's not always going to make people vomit and make them sick to their stomach or make them miss work. But in your case, you're just one of the lucky ones. And you've had really good bouts.

[Morgan Huelsman]

Yeah. Really, really lovely bouts. I'm so lucky.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

So when we talk about this though, and people hear like they'll have a dizziness spell, is that potentially vertigo or is it like dizziness and vertigo are separated? Because I was having this conversation with somebody online and she was like, if you get motion sickness and then you have dizziness, it can be connected to vertigo. Is that all intertwined or are they kind of separate entities?

[Holly Cawthon]

Dizziness is an umbrella term. So dizziness is usually used to describe swimmy headed, light headed feelings, whereas vertigo is actually the room spinning. But also you can have vertigo where people say they're spinning within their own head. And so that can happen as well. Okay, but note dizziness is the umbrella term and then vertigo usually fits underneath that.

[Morgan Huelsman]

Okay, but specifically if somebody's having a vertigo episode, typically the world is spinning, typically versus like you're just like a little bit nauseous, queasy, lightheaded, as kind of the dizziness experience. Is motion sickness, vertigo connected at all? Is there some? Because that's an Internet thing where it's like if you get motion sickness in the car or you get motion sickness on rides, which I've had my entire life and I never had vertigo until now. Are those connected at all? Is there something to that?

[Holly Cawthon]

Motion sickness is not connected to bppv.

[Morgan Huelsman]

Okay.

[Holly Cawthon]

In particular.

[Morgan Huelsman]

Okay.

[Holly Cawthon]

I know that there's no connection.

[Morgan Huelsman]

I know it's a crazy thing. But like I'm. When I was going through this experience and I'm going online searching for all kinds of answers, I'm just trying to find anything to understand what's happening to me. Because when it does happen to you, you're terrified and you're like, all I know is the world just went spinning and I can't move my body upright. And you're like, what does that mean? And you Google and you have vertigo. And then I'm like, what the heck is vertigo? And you just go down this rabbit hole of trying to understand what's happening to your body. Because in my day to day life, my entire life, there's only one person, a good friend of mine, who actually has some hearing loss and she has vertigo. She's the only person I've ever known in my life that has had it. Or at least that's talked about having it. But of course, now that I talk about it, everyone has it.

[Holly Cawthon]

Yeah. Usually if you mention it to one person, they're like, oh, my mom had it, my sister had it, my aunt had it. And it may or may not have been bppv, but still they're describing as vertigo.

[Morgan Huelsman]

So people who do have potentially like this room spinning vertigo, bppv, do they have to live with it? Like, you see so many often that people are like, I live with this for my entire life and I'll have an episode and then it gets a little bit better and then it'll happen again. Because to my understanding, you've gotten me to 100% again twice. And ever since, like, only when I'm having those episodes am I living with it. Once the episode has cleared, as you call it, it's over. It's supposed to be over. You're not supposed to have any. No underlying, it's like it's gone. Am I right in that?

[Holly Cawthon]

Yes. Okay, let's say that you would have never found me. Chances are high that in a couple weeks it probably would have resolved on its own. Probably. So we don't know if the crystals reabsorbed by the body or if they're put back in the utricle where they belong. We don't know. But it generally does resolve on its own after a period of time. I will say, though, last week I saw a patient and she was in a car accident eight years ago. She has never seen a physician for her room spinning vertigo. And she just now got to me, eight years. And I put her through all the testing positions and sure enough, it was straightforward posterior canal, what we call cannolithiasis. So those oticonia, those little crystals, were just hanging out in the canal. And I cleared her in one session.

[Morgan Huelsman]

And now she doesn't have any episodes of this, at least until it happens again.

[Holly Cawthon]

Wow.

[Morgan Huelsman]

But she dealt with it for eight.

[Holly Cawthon]

Years and we cleared it in one session.

[Morgan Huelsman]

See, it's so crazy because I. I hear this of so many people who write me and they're like, yeah, I deal with this, and I'm just like, you're not supposed to. You're really not. Like, you're supposed to be able to do these maneuvers and get the treatment, and then your life is supposed to go back until, of course, another episode.

[Holly Cawthon]

Happens, and it may not happen. So it could happen again tomorrow. It could clear and happen in two weeks. I had a patient today that it cleared for 25 years, and then it just came back. And it came back.

[Morgan Huelsman]

It always comes back with a vengeance, too. It just is. Hey, honey, I'm home.

[Holly Cawthon]

Yeah. Yeah.

[Morgan Huelsman]

Wow.

[Holly Cawthon]

I'm back.

[Morgan Huelsman]

That's what's so wild, too, about vertigo. Bppv. There's just. You guys are the specialists in it, but there's still so much unknown about how it exists.

[Holly Cawthon]

It's true.

[Morgan Huelsman]

What's that experience like for you where, like, you're just in this field that's constantly evolving because you don't have every single detail, truly to understand what's happening?

[Holly Cawthon]

I feel so honored to be a part of it. We do a lot of research at Vanderbilt, and we're trying to add to the literature and help figure out all of these answers. But you're right. There's just so much that is unknown. I will say there. There are some. Some studies going on. I believe, overseas that they're working on a medication. It's in very early stages, but we're trying to find answers. And some. We're trying to find the magic pill. Right? That's what everyone who comes to physical therapy wants. They want that magic pill. They don't want me to put them through the maneuvers that make them sick and vomit, and they just want that magic pill. And hopefully one day we'll have that. But until then, it's just. I'm kind of your best.

[Morgan Huelsman]

It is. And it is crazy you say that about the maneuvers, because every time I did have a treatment with you, I would get better. But I don't know. Also that people understand that when you do the maneuvers, even if you're doing, like, the Epley at home, you're inducing the vertigo, you're moving the crystals around, right? So it's. You're literally what you are trying to avoid happening. You're doing. You're moving you in the positions to try and get them to move back to where they're supposed to be. And every time I would get done with one of our sessions, I'm like, I'm out for the count. I'll see you guys tomorrow. I'll get better. That was just so crazy. To people. Because it's. You went to an appointment, you're supposed to be better. I'm like, no, I will. But it's just a little bit different of how that works.

[Holly Cawthon]

Yeah. And do you remember one of the number one things I told you? So we encourage movement. We don't want you to avoid any positions except for right after the repositioning. Then we want you to stay pretty still for a short period of time. But we don't want you to be fearful. We don't want you to not roll on your right side. We don't. We don't want you to be scared to get up out of bed. So we encourage movement. It's. And it's important for the inner ear.

[Morgan Huelsman]

Yeah. And what's funny is there was a moment because, again, when I was going through all these moments, like, I had you, but I still had the Internet, and I was still trying to figure out what was happening, and I was like, I'm going to get a neck brace. You're like, do not get a neck brace.

[Holly Cawthon]

Yeah. We used to give neck braces out, like, 20 years ago, but it's no longer practiced because, again, like, that's encouraging the fearful, avoidant behavior that we discourage.

[Morgan Huelsman]

And there is also this side of this, like, that I also didn't realize when it first happened, because it was all first experience. Everything was new to me, but going through it a second time. My body has PTSD from this experience where I'm, like, doing a movement. I'm like, okay, we're going to go spinning. Be prepared. And it doesn't. But my body's anticipating almost like it's like placebo is happening where my body thinks it's spinning, but it's not really. That's another side to this, too. Okay. You heal the episode, but your body is still storing. Everything that happened to you all goes back to the body keeps its score. But your body is, like, still in the movement. And you've had to help me on that side of things, too. And that gets into more of the physical therapy. So can you share your little expertise on that side, too?

[Holly Cawthon]

Yeah. So when you have. Okay, let's say I can't remember what your exact symptoms were, but let's say every time you roll on your right side, the room goes crazy. So then your brain actually gets so used to it that after we clear out the mechanical reason for the vertigo. So the crystals. When you roll on your right side, the brain actually thinks that you're gonna spin. But again, there's no mechanical Reason. And so you don't truly spin, but that's that kind of PTSD that you're talking about.

[Morgan Huelsman]

And maybe that's not the right word, but it feels that way in my body.

[Holly Cawthon]

Like, that's a good description.

[Morgan Huelsman]

It's like a lingering or. Okay. My body's still dealing with the trauma of whatever happens. Like, here we go. And we had to retrain my body this last time to literally roll over on its side, because every time I rolled over, I was like, I think I'm having an episode. You're like, you're not. You're cleared, but okay. We have to retrain your body to understand that you're okay and you're safe, like, in your own body again.

[Holly Cawthon]

So I would have you do it 10 times.

[Morgan Huelsman]

And the head shake. I have to stare at an X on the wall and just shake my head back and forth while staring at it. I'm like, I would do them at work. And everybody's like, what are you doing? I'm like, don't worry about it. Don't worry about it. I'm trying to get better.

[Holly Cawthon]

And you also. You also had light sensitivity too, so you would have to wear therap glasses.

[Morgan Huelsman]

Yes. Which also saved my life. Turned into a partnership with them too.

[Holly Cawthon]

They're amazing.

[Morgan Huelsman]

Yeah. Like, shout out code, Morgan. You can use it. You can get 15 off. But they were so helpful because when I was having my episodes and they were so intense and I had to go to work because I can't take a month and a half off work every time this happens. The Therapex allowed me to be in very lit rooms, much like this podcast room where we have lights. And so those therapeutics. And I was wearing them on the podcast too, because it dimmed everything around me.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

What is that technology of, like, why you guys use those when people have the light sensitivity? Because people are asking, and I don't know. I just know they helped.

[Holly Cawthon]

I know just enough about this to tell you, you actually have the rose color lenses, and they block out 25 times more of whatever it is they block out than blue light.

[Morgan Huelsman]

Okay.

[Holly Cawthon]

So I can't tell you that. And now I can tell you that again, shout out there. Spec. Like, they have all different color lenses that, you know, if you've got sensitivity to sunlight, you may need this color lens. Or if you have sensitivity to fluorescent lights, you need this color lens. They can be really helpful.

[Morgan Huelsman]

And this is also something that I newly learned was how connected my eyes were to my balance and inner ears, which was why I was light sensitive, because I wasn't before, but because I was going through this. Like, all of that connects in there, right? Am I making that up in my head?

[Holly Cawthon]

So I have to be able to see your eyes in order to tell where the crystals are in the canals. So again, if, let's say they beat, there's like an upbeat. That means posterior canal, downbeat, anterior canal. So things like that. So, yeah, they're a window to the inner ear.

[Morgan Huelsman]

So crazy.

[Holly Cawthon]

It.

[Morgan Huelsman]

It reminds you how connected everything is no different. How like your skin is your biggest organ.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

You put stuff on that, it's absorbed in your body. It's all of that. And you're. I'm learning all of this. And I'm just like, oh, it really is all connected. And holy crap, this sucks. But here we are.

[Holly Cawthon]

And gosh, when you have an episode, it really is horrendous. But what I tell my patients is that when you've had it once, you now know what it is and it's going to be less scary the next time around because you know that there is a quick fix.

[Morgan Huelsman]

Yes. And that was exactly what happened the second time. I knew exactly what to do. I knew to call you right away. Literally.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

I was like, holly, I need help. This happened again. But I also knew. So the second time it happened, I was like, okay, this is vertigo. I knew that I was about to have this experience. It didn't make it any less easy. Like, I was still, like, couldn't get out of bed. I still was, like, literally laying naked on the bathroom floor. Oh, my God, I'm sweating. This is painful, and not in the way that you think, but painful. Like, my body is just, like, going through it. But I knew that I needed you to do these maneuvers and to understand what was happening. So it was a at least easier process than me having zero information. Which is why the podcast was so important, because there's so many people out here that are dealing with this.

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[Morgan Huelsman]

So, and speaking of all these people, there were some people that put in some questions and we've talked about some of them. But we'll have you reiterate because they asked the question she had. One lady says she has a patient with Meniere's who has tried everything, any suggestions to potentially help her. And that's the only context I have. So I have no idea what all they tried, but I don't know if this is anything you can help with.

[Holly Cawthon]

So Meniere's can also present with vertigo. It can present with dizziness, balance impairment, all, all of the vestibular symptoms. But the repositioning maneuvers that take it away immediately aren't going to work. So we always start with diet and lifestyle modifications for Meniere's. So you really want to decrease the salt intake and decrease the fluid behind the ear. That's where we start. And then you need a good vestibular therapist that actually knows what Meniere's is. And also a lot of times patients are misdiagnosed as well. A lot of times patients come in with a diagnosis of Meniere's and it's actually vestibular migraines.

[Morgan Huelsman]

Interesting. So what is the similarities there? Tell me what each one is to you in your, like, expert opinion.

[Holly Cawthon]

They just share a lot of the same symptoms is the problem.

[Morgan Huelsman]

So I'm thinking vestibular migraines are like very intense headaches, like very painful, and maybe you have some lightheadedness dizziness with it. Meniere's, if I remember my research correctly, is like, you have like something's happening within your ear anatomy that's causing the vertigo to happen. Is that correct? Am I?

[Holly Cawthon]

Yes, Very close, yes. So many years. There's a lot of fluid going on behind the ears. One day the person can walk down the hallway just fine, and the following day they can have an attack and literally be falling into the walls. It's a wild presentation. Vestibular migraine is very different in the fact that you actually. I believe it's greater than 60% don't actually have the headache component.

[Morgan Huelsman]

Interesting.

[Holly Cawthon]

You just have the vestibular symptoms. You can have the visual auras and all of that, but there's actually no pain. So that's why it goes misdiagnosed a lot.

[Morgan Huelsman]

Wow. Okay. That's super interesting because I associate migraine with headache pain because migraine is just like an amplified headache to my understanding. Yeah, so when you said that, I was like, oh, yeah, that's what's. No, that's crazy. Okay, so hopefully that's some helpful things. Maybe you guys have it. But again, I don't have any other context like what all I've tried and what else they've done.

[Holly Cawthon]

I would say in that case, just find your nearest vestibular pt.

[Morgan Huelsman]

Okay. Yeah, that's good information. Yeah. Can stress cause vertigo to flare up?

[Holly Cawthon]

Not from a crystal standpoint. Okay, so it can. It is one of the triggers for say, vestibular migraine. So a lot of times patients will have to be medically managed with medications, things like that, because they can't avoid the stress of a really hard job or their in laws just moved into their home. So things like that. It can trigger symptoms of dizziness. Absolutely. But it will. It's not connected to bppv.

[Morgan Huelsman]

Okay. See, and this is crazy about just all these different areas is like there can be so much happening in there and you really need someone like a Holly to understand the anatomy and what's going on in there because it can go so misdiagnosed on multiple levels. To your point, like not just Meniere's, but all of them. At least this is how it's sounding to me. Why does vertigo benign happen out of nowhere during perimenopause for some people? Do you know any connection to that?

[Holly Cawthon]

Great question. We are still looking into that. So we know that hormones are. They have an effect on the vestibular system, but we just. We don't know enough.

[Morgan Huelsman]

See, that's so crazy. Yeah, but it is connected. There is something that's happening with.

[Holly Cawthon]

We think so.

[Morgan Huelsman]

Okay.

[Holly Cawthon]

I can't completely be sure yet.

[Morgan Huelsman]

Yeah, it's.

[Holly Cawthon]

And also you got to think though, the average person. The initial onset of BPPV is from.

[Morgan Huelsman]

Age 50 to 70 and perimenopause is happening around there.

[Holly Cawthon]

So is it just coincidence or is there actually a connection?

[Morgan Huelsman]

Wow. Okay. And that's also hard if you're experiencing both at the same time.

[Holly Cawthon]

I know, my sweet ladies. I know that hurts.

[Morgan Huelsman]

Do some exercises which we touched on this, but do some exercises such as burpees or handstands bring on vertigo.

[Holly Cawthon]

So they can. They absolutely can. High intensity aerobic workouts, kind of like a similar, like blow to the head can make the crystals come loose. Now, again, Maureen, you are a bit of, of a special one. I. We just generally don't see it in someone as young as you. But that we made that direct connection. You went to that class, you woke up the next morning. It was hard to not be able to connect those two.

[Morgan Huelsman]

Yeah. And because I then did that and knocked it loose, I was more likely for it to happen again.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

That was that connection.

[Holly Cawthon]

Correct.

[Morgan Huelsman]

Stupid trampoline class.

[Holly Cawthon]

Yeah. Don't work out.

[Morgan Huelsman]

That's what I've learned in all this. Don't work out.

[Holly Cawthon]

No cardio.

[Morgan Huelsman]

Don't do it. Meanwhile, I'm over here, I'm doing like hit workouts and stuff. Welcome to my life. But what you have also always told me is you can't be fearful and you can't live your life in fear of it happening. Because this is something so important to say. And I want you to say in your own words, but, like, it's going to happen no matter what.

[Holly Cawthon]

Yeah. So whether you are sitting on the couch or you are out having fun with your friends and living your life, if those crystals come loose, they come loose. It's going to happen whether you like it or not.

[Morgan Huelsman]

Yeah. And that was an important thing for you to tell me because that made me not fearful because it didn't matter what I was doing. Yes. Things like hit workouts could potentially aggravate and make it happen quicker. But you telling me that was like, okay, this happening regardless, I can go out and have my life and it'll be fine. It's going to happen regardless. So I might as well enjoy what I can do in the moment.

[Holly Cawthon]

Yeah. And we don't know who it's going to happen to. So just because your mom had it or your aunt had it, it doesn't mean that you're going to have it.

[Morgan Huelsman]

It's not genetic either.

[Holly Cawthon]

Not.

[Morgan Huelsman]

Which was an important detail. You also told me because nobody in my family ever had it. And you were like, yeah, it's not. You're just. You get picked out of the litter.

[Holly Cawthon]

You're just one of the lucky ones. Yeah, we were meant to be friends. That's why we were.

[Morgan Huelsman]

That's exactly why it was supposed to happen. Okay. And some of these other ones came in here, but they're funny. I'll make you laugh. Yes. Why? Like, why does this happen?

[Holly Cawthon]

We don't know.

[Morgan Huelsman]

We're learning about our systems and everything. Then another one was, why does my vestibular system hate me? Girl with men ears.

[Holly Cawthon]

Oh.

[Morgan Huelsman]

So maybe you can give her some words of wisdom or some. Something to make her feel better. Because you made me feel better in a lot of hard moments for me.

[Holly Cawthon]

So with any vestibular diagnosis, life gets better. You just have to have the right treatment. And it's so for me, as a vestibular specialist, it's so frustrating when patients come in like this week. Girl, I can help you. My colleagues, we can help you. There's treatment. We can make you live a normal life. We can make you have fun again and not be fearful. Yeah, there is treatment. There's not a magic pill. It's a little bit of work. BPPV is a quick fix. We love bppv. One quick maneuver.

[Morgan Huelsman]

You say we. I don't.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

And also it was not quick for me, so don't look at me.

[Holly Cawthon]

So as a vestibular therapist, we love bppv. It's super straightforward. It's again, you come in with these positional changes, we do a quick maneuver and you're done. Other diagnoses, like vestibular hypo functions, weaknesses, mirrors, vestibular migrants, they require a little bit of work, a lot of homework, actually.

[Morgan Huelsman]

Yeah. And it sounds like some of them come with lifestyle changes, which is some of the hardest illnesses to deal with.

[Holly Cawthon]

And migraine or, I'm sorry, diet and.

[Morgan Huelsman]

Things like that, changing things in your entire life. Whereas mine, I just have to come in and you have to keep working me through treatment, and then one day it'll be over and until the next time kind of thing. I do understand that. That side of it too. And this is another one. We had already answered, but he had asked, how do I get rid of reoccurring bppv? Although mild, sometimes I'm just tired of it. I understand.

[Holly Cawthon]

How do you get rid of it? You come see me, you get treatment.

[Morgan Huelsman]

Because isn't it also possible too? Because this was something I had to learn, like just going to a regular physical therapist. Although incredibly helpful in so many scenarios, I had gone to one. And the only maneuver he knew was Epley. And for me, specifically, Epley was not gonna help me.

[Holly Cawthon]

Yeah, sometimes the modified epilepsy just doesn't work. In your case, it. It just isn't the magic ticket. So I think we think we tried the Lee maneuver on you. The smart. There are a couple of different things, but again, it's not always posterior anterior. So if you go to a general orthopedic physical therapist and they put you in the testing positions, they may not have the equipment that I have. Specifically, I have these video goggles. They help me see your eyes without letting your brain fixate. So if your eyes can fixate on something, your brain can shut down the nystagmus or the eye movement that I'm looking for. And that helps us with diagnosis. And if you go to an orthopedic pt, they may not have that specialty equipment, and then they may not be able to see what they need to see, and they won't be able to treat you, which.

[Morgan Huelsman]

That was so helpful for you in understanding which maneuvers you had to do on me and not just having the one repertoire of Epley you needed multiple, which was so important. And again, that was a part of my learning journey because I had somebody do an Epley maneuver on me, and I was like, I'm not better. Okay, you guys are all lying on the Internet. I feel like crap.

[Holly Cawthon]

And your canal's converted, too. So you were again, like, one canal, and then it converted to another, and so we had to switch it up.

[Morgan Huelsman]

And how often, like, I know you say I'm special, but that's not just me. There's a lot of people out there that have those experiences, and they could be seeing the things online that were like, you can do this, and this will work. When in reality, like, it always helps to have an expert like a Holly. If you're not in Nashville or around Nashville, find a vestibular specialist. That is the key to looking for.

[Holly Cawthon]

Right.

[Morgan Huelsman]

Like, it's true to finding a you somewhere else.

[Holly Cawthon]

Yeah. You can give it a shot at home by yourself. So you can look up the modified epley online and 50, 50, guess the correct side and try to treat yourself. The problem with treating yourself is that you can actually make it a little.

[Morgan Huelsman]

Bit wor, which is what I did.

[Holly Cawthon]

So if you make it worse, it can actually convert to a more difficult canal, like the horizontal canal. And even worse than that, the crystals can actually go from the canal to the cupula, which is a jelly like material where the crystals get stuck and Then what do you have to do when something is stuck? You have to knock it loose. So then we've got to knock out the crystals and then clear them from the canal, which I also had experience with as well.

[Morgan Huelsman]

And you called the cupula jelly, like substance. So I really use a lot of normal people terms like rocky wall and jelly, like substance and crystals.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

And those are not the medical terms.

[Holly Cawthon]

Yeah, no, but that's what we use. That's how I describe it. Like in the utricle, in that balance organ where the otoconia sit, it is just this really rocky wall. And that's where they come off. They just fall right off.

[Morgan Huelsman]

But honestly, when you were using all of those, it gave me the best understanding of what was happening to me because.

[Holly Cawthon]

Oh, wooshes. Wish is my favorite word.

[Morgan Huelsman]

Yeah, you do love to use wishes. And I had a lot of those. So I'd be like, holly, I'm having a wish. You're like, that's not normal. Okay, let's figure this out. And that was an easy way to also describe it. But it did, because it. And it was funny when we talked about it on the show. Everybody's talking about crystals. This is so like, woo stuff. I'm like, no, you all have them. I'm just the only one that's actually dealing with them.

[Holly Cawthon]

That's true. So everyone has them. They are. So you've got two. Two balance organs on each side. So you have a utricle and a saccule on both the right and the left side. And so you've got your three semicircular canals. Let's say we're talking about the right side. And the utricle sits like this. The saccule sits like this. So you've got crystals in here and in here, but the utricle blocks the saccule. So the crystals are only going to come out from here into the canals.

[Morgan Huelsman]

Which is where the maneuvers come into play. And that's why I get rotated like I'm a skewer on a grill barbecue.

[Holly Cawthon]

Rol.

[Morgan Huelsman]

Because you're literally moving those crystals through these canals in the ways that they can be moved.

[Holly Cawthon]

That's correct.

[Morgan Huelsman]

Because if you do it the wrong way, they're not going to move.

[Holly Cawthon]

They're going to go into that jelly like.

[Morgan Huelsman]

Yeah, substance, which was not fun, let me tell you. That was probably the worst experience. I literally looked at Holly like, I'm going to vomit. I think I did. Yeah.

[Holly Cawthon]

There was one day which happens from time to time. Usually I can catch it, but it does Happen.

[Morgan Huelsman]

Yeah. And to Holly's credit, and in Vanderbilt is so awesome. They not only had a. A. What is Norman called?

[Holly Cawthon]

Oh, our facility dog. Norman.

[Morgan Huelsman]

Yeah. He's a service dog.

[Holly Cawthon]

Right? We love Norman.

[Morgan Huelsman]

Yeah. So I had a service dog with me in so many of these treatments, but then on top of that, like, when I'd get super sweaty being induced with the vertigo, they'd come in and they just, like, weigh me down with all these packs of height.

[Holly Cawthon]

It's true. Yeah. Because it helps with nausea. Oh. It's a magic trick.

[Morgan Huelsman]

Okay. Talk about, though, the magic trick. That is the rubbing alcohol by the nose.

[Holly Cawthon]

Okay. Yeah, same. It's like the same as an ice pack. So it has an effect on you and it decreases the nausea.

[Morgan Huelsman]

So you just.

[Holly Cawthon]

Amazing.

[Morgan Huelsman]

Get a little, like, piece of paper and you put rubbing alcohol. Is that what it is?

[Holly Cawthon]

We have the little rubbing alcohol pads.

[Morgan Huelsman]

Okay.

[Holly Cawthon]

And you just pull out a pad. I just. And I just held it up against.

[Morgan Huelsman]

Your nose, and it stops the nausea from coming. Can that happen with all kinds of nausea or is it specifically related to this?

[Holly Cawthon]

Yeah, absolutely.

[Morgan Huelsman]

That's so crazy. I learned about that too. See all the things that I learned in this experience.

[Holly Cawthon]

And ice packs. So ice packs are my go to. And then I use.

[Morgan Huelsman]

Okay.

[Holly Cawthon]

The rubbing alcohol.

[Morgan Huelsman]

Yeah. Because the ice packs do feel really good. Because your body is, like, heating up. It's like you're kind of like a core and it's gonna.

[Holly Cawthon]

Yeah, it gets clammy and sweaty. And again, people do get sick, which is.

[Morgan Huelsman]

Yeah, you guys sent me home with one of those. Throw up.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

I'm pretty sure it's still in my car. I'm like, somebody ever sees this, they're gonna be like, what is wrong with this woman? Yeah, it's fine. Just in case.

[Holly Cawthon]

It's so interesting to me, though. Some patients come in with a lot of nausea and they're super, super sensitive to the maneuvers like you. And then other patients that come in, they just have zero nausea. 0, 0 complaints while I'm doing it. And then they just run on their way. It's fascinating to me that everyone's system is so different.

[Morgan Huelsman]

I do wonder too, if there's a connection for me in that because I have, like, growing up, I've always gotten. This is why I hate roller coasters. They make me so ill. So ill. But also I hate the drop that you get in your belly. But more than that, like, I get literally violently ill. And I get car sickness. I get sick on boats. I've had. Always had A this dizziness. And like whenever I've gotten sick, just a freaking common cold, I have nausea or I have lightheadedness. Also I think about in the course and if I ever were to have a child and I'm gonna be freaking sick all the time.

[Holly Cawthon]

Yeah.

[Morgan Huelsman]

So I think about those things. This is my symptom of anything is, oh, you're gonna be vomiting, you, you got a little stuffy nose. Vomit. That's just my life. And so I do wonder if you have sensitivity in your life. Then like, something like this happens and all it does is, yeah, maybe it has to. Because not everybody feels that way in all of those experiences. Right, right.

[Holly Cawthon]

No, it's true.

[Morgan Huelsman]

So then you get two different people with vertigo, one like me and one that doesn't. And they're like, no, it's fine where my body's like, yeah, no, we hate this. We're good. Systems are so weird. Which is also why I wanted to bring you on and just talk about just the craziness of all of this. So many people deal with it. You don't have to be alone in dealing with it. You can also get treatment. Like, you don't have to live with this.

[Holly Cawthon]

And I think that's the take home of today. And that's what you and I wanted to get across to everyone is like, there is hope, there is an answer, there is treatment, and there's in BPPV alone, specifically, there's quick treatment. You just have to go to the right therapist. Not all physical therapists are created equal. Just like I said earlier, you're not going to come to me to. For me to fix your shoulder.

[Morgan Huelsman]

Yeah. You are a very specific thing. So the thing that we always do I leave on this podcast is like, whether it be a piece of advice and motivation, and that might have just been it. We might have just had our closure. But is there anything that we haven't talked about that you wanted to make sure you shared in this whole kind of experience of our friendship and vertigo treatment?

[Holly Cawthon]

I think it's important to me as a vestibular specialist that all my patients know that they don't have to be scared. And like you said, they're not alone. So many people suffer from vestibular diagnoses and illnesses, but there's treatment and you have to find the right therapist. So I just kind of want to give like a little shout out. If you are watching this podcast and you don't know where to go, there is a website called Apta. And if you type in Apta vestibular map of providers. Then it's going to pop up all the states and all the vestibular providers that are part of the apta. So American Physical Therapy Association. So that's a really easy way to find a therapist that specializes in vertigo. Or you can come to Vanderbilt and see me and my colleagues. We are at PI Beta Phi rehab and we love what we do.

[Morgan Huelsman]

Which you should absolutely see Holly and her colleagues if you are in the area, but if you're not. Dang, that tool is awesome. I didn't know that existed.

[Holly Cawthon]

It's the best resource and so I just really want everyone to know that you don't have to come eight hours to see us. There are vestibular specialists all over the country.

[Morgan Huelsman]

Yeah. Oh, Holly, you did so good. I know you were nervous about doing this, but you did so great. And I appreciate you coming on and like sharing all of your wisdom and expertise because as much as you probably don't want to admit it, you are an expert in what you're doing and you're. You're doing like the work that matters and you're changing people's lives.

[Holly Cawthon]

That's really sweet. I love what I do.

[Morgan Huelsman]

I.

[Holly Cawthon]

It makes me happy every day.

[Morgan Huelsman]

Yay. Thank you for coming on. I appreciate it.

[Holly Cawthon]

Thanks.

[Morgan Huelsman]

So many takeaways during this episode. Our health is such a huge part of our lives and BPPV is debilitating and something I would not wish on anyone. So if you're a fellow sufferer or anything impacted by vertigo, I hope this episode helps you find some very deserved relief. Thank you all for being here and as always, I love you. I'll talk to you next week.

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