benign paroxysmal positional vertigo (bppv)

One more complication of getting older came to my attention this week. My husband had difficulty maintaining his balance when sitting and standing, so I (with a lot of help) whisked him off  to the emergency room to find out what was wrong. After an X-ray, EKG, CT Scan, lots of blood tests, and an MRI, the diagnosis was BPPV, Benign Paroxysmal Positional Vertigo. I was very pleased with the first word in that diagnosis – benign.  From my own experience with Paroxysmal Supraventricular Tachycardia, I already knew that paroxysmal just means it happens now and then, without being predictable. Vertigo I already understood. Positional refers to the fact that the vertigo was brought on by a change in the position of the head, in this case when my husband sat up quickly in bed. When he did that, crystals in his inner ear shifted position, bringing on the vertigo.

What are these crystals and how do they shift positions? Here is my high-school-biology-based explanation.

The inner ear contains three loop-shaped canals that contain fluid and sensors that monitor the rotation of the head. There are also other structures that monitor the up and down, right and left, and back and forth motion of the head related to gravity. These latter structures have crystals that make you sensitive to gravity. The crystals sometimes get knocked out of position which results in your inner ear being unable to determine your position relative to gravity, making you feel dizzy or light-headed or out-of-balance.

The treatment was a little unusual. We are so used to some drug being prescribed for any physical problem, but the attending physician explained that drugs have no place in treating a structural or mechanical problem. The shifting of crystals in my husband’s inner ear was probably the result of the deterioration of the inner ear structures. That is the usual cause in an older person. The same diagnosis in a younger person may be the result of damage as a result of a blow to the head. The treatment involved controlled (from the therapist’s viewpoint, but not so much from my husband’s viewpoint) rapid head movements intended to dislodge the crystals from the problematic position into a less problematic location. This was followed by keeping the head in as stationary a position as possible for several hours to minimize the risk of the crystals moving again. Since the crystals are more likely to move while lying down, my husband had to remain in bed with his head raised at least 45% above his body. Since it is possible the condition may reoccur, he will have a few more vestibular treatments to ensure the crystals are not roaming around his ear canals.

The symptoms of BPPV can be disturbing, even though the condition is not considered serious:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • Lightheadedness
  • Unsteadiness
  • A loss of balance
  • Blurred vision associated with the sensation of vertigo
  • Nausea
  • Vomiting

Those latter two symptoms can bring on dehydration which has its own set of complications, some of which can be serious. Should you or someone you care about report these symptoms, do not wait. Go to the nearest urgent care facility before the symptoms become more serious.

References:

From the Mayo Clinic

Dizziness-and-Balance.com

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it really may be too late

Retirement Plan by aag_photos, on Flickr
Creative Commons Creative Commons Attribution-Share Alike 2.0 Generic License   by  aag_photos 

As my husband approached Social Security eligibility, our mailbox filled with offers for “free” lunches from financial advisors and planners. The invitations all included some version of the statement that it is still not too late to plan for retirement. Except for the first one, he declined the invitations. The first one confirmed our suspicions and what we already knew – there is no such thing as a free lunch.

Now that I am approaching that same age, the invitations have started arriving again. A recent arrival made its pitch this way:

Learn how to:

  • Determine the amount of money you need to retire
  • Create your own goals for a “successful retirement”
  • Eliminate debt and improve cash flow
  • etc., etc., etc.

No matter what the invitations say, at this point it is too late for those lessons. We don’t need them. We have already done the saving and goal setting. We have no debt. And since I have never heard of the people offering these lessons, I have a hard time taking them seriously. It feels like an offer that will result in the loss of my time and money. So I have ignored them.

But I have to admit that some of the etc., etc., etc. points are relevant, such as:

  • Select the retirement plan distribution choice that is right for you
  • Plan your retirement income (emphasis is mine) to preserve a comfortable standard of living
  • Transfer the risk of potential financial losses before or during retirement
  • Reduce or eliminate taxes, expenses, delays and legal challenges with estate planning

Of course, I didn’t recognize the relevant ones because of my skepticism at the outset about why they were pushing the first set. I had already followed all the advice from financial advisors to ensure I have funds put away for my retirement years. I was focusing on the savings phase of retirement planning. And the financial advisors we had been doing business with weren’t getting in touch with us to consider the future.

Well, most of those financial advisors weren’t getting in touch with us. Thankfully, one did – Greg Roemer of Thrivent. If it hadn’t been for Greg, someone we came to know and rely on very late during the retirement savings phase, I am not sure I would have realized the importance of the retirement income phase. We would have stumbled along allowing events to cause actions and that might have worked out OK. Thankfully, our persistent advisor didn’t give up on us. Greg invited us to review our financial situation to see if adjustments are advisable. When we couldn’t connect because of family emergencies – he is on the east coast and we are on the west – he still didn’t give up. He continued to recommend that we meet and arranged with another Thrivent advisor on the west coast, Don Neff, for us to meet in Don’s office where we were able to connect via video conference. Here is some of the information he provided to help us – in our situation, not yours – consider options.

  • Waiting until I am 70 to begin collecting Social Security is a way to ensure an 8% per year increase. And that makes sense even if I stop working before I reach 70. It would have applied in my husband’s case, too, but we were so eager to begin collecting those Social Security benefits we didn’t stop to ask anyone about it. Sometimes it really is too late.
  • I understand the difference between a qualified and a non-qualified financial instrument. I have both, and I knew how each affected me during the retirement savings phase, but not the retirement income phase. Just the name – qualified – made those plans sound advantageous and therefore better somehow. But now that I know the difference, I am glad not all our retirement savings went into qualified plans with their required minimum distributions once we reach the age 70 1/2.
  • That age – 70 1/2 – is nipping at my husband’s heels, so we need to find a ways to minimize the tax consequences of those distributions. We plan to begin making contributions to a 529 plan for our grandchildren. Unfortunately, since we live in California, we get neither tax deductions nor tax credits for these contributions (so says About Money), but not every good action pays off immediately. The payoff will be the future education of our grandchildren. And there are other ways to get those deductions and credits.
  • We also now have a plan to consolidate our many different retirement accounts. Each one made sense at the time we opened them. But there was no overall plan involved. Serendipity brought us to this one for that reason and that one for another reason. We have pockets of our savings here and there, some very small, some more significant. I considered it diversification. Keeping track of just two or three in the same place instead of the nine or ten we have with many different institutions is the kind of simplification we need in the future.

Had our financial advisor not been so persistent, we would likely have made decisions that could significantly complicate the income distribution phase of our retirement planning. We already made one other decision – in addition to my husband beginning to collect Social Security at the earliest possible time – that we might have avoided had we consulted with an advisor sooner. My husband is a both a U.S. and a British citizen and has worked in both England and the U.S., making contributions into both social security systems. But since he has been following me around the world for the past 20 years, he hadn’t fully contributed to the U.K. system. Thinking it was a prudent step, he made the catch-up contributions so that he would qualify for both pensions. Once he did that, his Social Security was reduced by a percentage of his U.K. pension. He paid for the benefit and because he did, he gets less of the other.

Sometimes it really is too late.

 

is he kidding?

All my problems with paroxysmal supraventricular tachycardia have been addressed, or at least I think so. I will know more in a couple of weeks. Here is why I think the problems are now gone: I wore a heart monitor for a month, during which time I spent three days in the hospital while the cardiologists and electrophysiologists explored possible reasons for an extended ventricular tachycardia, or V-tach, event the monitor detected that I didn’t even feel. Following that, I wore another type of monitor, a Zio Patch, for two weeks, after which I had an electrophysiology study that concluded with a catheter ablation to kill the cells that have been sending the extra signals that have caused my heart to beat so rapidly.So I was a little surprised to get a phone call from the company that provided the one of the monitors. My husband took the message and told me it was important that I return the call because the guy had some information for me. I was in the middle of a work phone call but that didn’t prevent me from speculating on what that news might be. I didn’t know which of the two companies the call came from. The first one sent signals from the monitor for the month I wore it which is how my doctor knew there was an extended V-tach. The Zio Patch recorded my heart activity, but the results weren’t transmitted. I had to send the device back so the results could be downloaded and interpreted. I assumed the call was from the second company.

It wasn’t. It was from the first. And it had nothing to do monitoring my heart, or at least not directly. The man from the company wanted to let me know that they also provide monitors for individuals, the kind that can be worn around the neck so that if I fall I can press a button and say, “Help, I’ve fallen and I can’t get up.” He suggested that getting such a monitor would help me continue to live independently.

Was he kidding me? I politely told him I was about 20 years away from expecting to have to address whether I can continue living independently, based on my parents’ genes.

Maybe I just don’t get it because I haven’t felt ill or diminished in any way during this process. And then I suspect I am getting all this attention solely because I have passed the age for qualifying for Medicare.  It seems to be a badge that indicates I am falling apart.

We’ll see.