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

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.

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.

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.

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]).

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]).

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]).

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]).

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]).

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.”

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.

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.