Can Screens Trigger Vertigo and Dizziness?

ICU – “I SEE YOU” PODCAST

Can Screens Trigger Vertigo and Dizziness?

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Devices—can’t live with them, can’t live without them. Televisions, computer screens, even phones send our nervous system reeling so it takes years to return to modern communication. When we are symptomatic, trying to scroll through an article on the phone or watch a movie on a tablet can be torture. Attending a Zoom meeting with multiple people talking and moving can be unbearable. Even texting back and forth can be dizzying. But staying connected is an important part of our recovery, and this often is through virtual mediums, so it is important to use every tool available to improve our ability to function while using a digital device. Even small changes can have a big impact. In this episode of the ICU – “I See You” podcast, we take some time to explore these challenges and discuss a multitude of ways to make our digital companions more user-friendly.

This podcast is a co-production of the Vestibular Disorders Association (VeDA) and Unfixed Media.

ABOUT THE GUESTS

Dr. Cheryl Berger-Israeloff has more than 20 years experience practicing optometry and focuses her practice on a subspecialty called neuro-visual optometry, which deals with the diagnosis and treatment of vision-based problems commonly found in the brain-injured population. Dr. Israeloff is a pioneer in the optometric treatment of conditions that cause blurred vision, motion sickness, and headaches. She graduated from Cornell University and SUNY College of Optometry.

Alexandra Biss has had dizzy symptoms since she was in her teens, but she officially started her vestibular journey during the start of the COVID pandemic in 2020 when she completely lost her balance and was unable to walk without support. She was ultimately diagnosed with chronic vestibular migraines that stripped her independence and stability. After multiple doctor visits she finally met a neurologist who was a vestibular specialist. While her symptoms are still prominent, through medication and vestibular therapy she has begun getting back on track. She currently works as an underwriting analyst at an insurance firm in Canada and has started running, which is now a central passion of hers. On the days she was bed bound, never once did she think she would be able to take part in any sport again. Her newly-found love for running has allowed her to regain stability and confidence. She has completed two half marathons, both raising money for VeDA, and is currently preparing for her first full marathon this coming May.

Hosts:

Cynthia Ryan, Executive Director of the Vestibular Disorders Association (VeDA) https://vestibular.org/

Kimberly Warner, Founder and Director of Unfixed Media https://unfixedmedia.com/

This podcast is a co-production of the Vestibular Disorders Association (VeDA) and Unfixed Media

TRANSCRIPT

VeDA uses otter.ai to create machine-generated transcripts. This transcript may contain errors.

Cynthia Ryan – VeDA 

Welcome to the ICU Podcast where we explore the Vestibular experience through conversations between patients and the health professionals who care for them.

 

Kimberly Warner – Unfixed Media 

During this podcast, we invite patients to share their stories and healthcare professionals to ask questions. So they are equipped to better care for and truly see the invisible challenges faced by their patients. I’m Kimberly Warner. And

 

Cynthia Ryan – VeDA 

I’m Cynthia Ryan. And we are your hosts on this journey of discovery.

 

Kimberly Warner – Unfixed Media 

Oh my gosh, I’m really looking forward to this conversation. Today, we are going to talk about devices while we are staring at screens as I speak, and we can’t live without them. But we sometimes feel like we can’t live with them either, especially if you are neat like me living with a Vestibular disorder. When I was in the first two years of my Vestibular disorder, I remember longing to turn back the clock to the 1800s televisions, computer screens even my smartphone set my nervous system into a tailspin. So it took me years to return to modern communication, I was completely isolated. And because I wasn’t connecting digitally during that time, I had no idea others were experiencing the same problem as me. When we were when we are symptomatic. Trying to scroll through an article on the phone or watch a movie on a tablet can be literal torture. Attending a Zoom meeting with multiple people talking and moving can be unbearable. Even just like texting back and forth with a friend can be dizzy. But we also know that staying connected is an important part of our recovery. And this is often through virtual mediums. So it is important to use every tool available to improve our ability to function while using a digital device. Even small changes that we’ll talk about today can have a big impact. So we’re going to take some time to explore these challenges today and discuss a multitude of ways to make our digital companions more user friendly. Since we can’t turn back the clock

 

Cynthia Ryan – VeDA 

yes, indeed, we really it’s I get these messages sometimes on my phone that my my usage has been up since last week or down since last week. So even our digital devices are reminding us to be careful about how much for how much time we’re spending on them. So I want to start by welcoming Dr. Cheryl Berger Israel off who has more than 20 years experience practicing optometry and focuses her practice on a subspecialty called neuro visual optometry which deals with the diagnosis and treatment of vision problems commonly found in the brain injured population. We’ll talk more about that as we get into this. Dr. Cheryl is a pioneer in the optometric treatment of conditions that caused blurred vision, motion sickness and headaches. I’m sure a lot of you can relate to that. She graduated from Cornell University and SUNY College of Optometry. Welcome Dr. Cheryl.

 

Dr. Cheryl Berger-Israeloff 

Thank you. Nice to be here.

 

Kimberly Warner – Unfixed Media 

Nice. Nice to meet you, Dr. Cheryl. And for our patients guests today. We have Alexandra this and this is this is our first time we’ve had Alexandra with us. So I’m looking forward to hearing more of your story. Alexandra just a little background had has had Dizzy symptoms since she was in her teens, but she officially started her Vestibular journey during the start of the COVID pandemic and 2020 when she completely lost her balance and was unable to walk without support. She was ultimately diagnosed with chronic Vestibular migraine that stripped her of in her independence and stability. And after multiple doctor visits, she finally met a neurologist who was a Vestibular specialist. While her symptoms are still prominent through medication and the singular therapy she has begun getting back on track. So she currently works as an underwriting analyst at an insurance firm in Canada and has started running, which is now a central passion of hers and maybe we’ll find out if that’s even a little bit of a therapy for her. The day she was bed bound never once did she think she’d be able to take part in any sport again, so her newly found love for running has allowed her to regain stability and confidence. She has completed two half marathons both raising money for Vita and is currently preparing for her first full marathon. This coming may welcome Alexandra so nice to have you here.

 

Alexandra Biss 

Thank you for having me.

 

Cynthia Ryan – VeDA 

so impressive. Wow.

 

Kimberly Warner – Unfixed Media 

Yeah. Well, so we just heard a little bit about your background. Sounds like you’ve been living with dizziness for a long time. Can you tell us a little bit in sort of a summarized version of your Vestibular journey?

 

Alexandra Biss 

Of course, ya know, you’ve hit the nail on the head in the overarching journey. But yeah, it was something that I always felt that I had growing up. And it wasn’t a sense of nausea, it was just feeling a little bit unsteady. As I grew up, if I would be taking part in any sport, I come from a very sporty family. And I did just have that inner sense of I don’t, I could fall over, I’m near falling over. And then at the start of the COVID pandemic, you know, when we are we were always open to using screens, even more just to keep up with family and friends. And I’m from the UK, the pandemics that I was here when the pandemic started in Canada, and so I had to travel back. And yeah, it happened pretty much overnight, I woke up, and I was so dizzy, and I felt like I was almost drunk walking home. That was the feeling that I was experiencing. couldn’t feel so dizzy, I was so nauseous, couldn’t keep any food down. So I in turn, lost a ton of weight, I looked incredibly unhealthy. Even though I was starving, I couldn’t keep any food down, because I did just have this Dizzy aura 24/7 There was never a break when I would have these really, really bad episodes. And because it’s not a common thing, especially in people my age, and I was only 20 When I like this really started for me. So there really wasn’t a direction that I saw was clear a path I saw was clear. You know, I went to my general practitioner. She said, Oh, if you’ve got a headache, you know, maybe you just lie down. And I thought no, it’s not a headache. It’s something else. I can’t cope. I don’t know what this is a conflict of my finger on it. And had I not had private healthcare with my dad’s employment, I probably wouldn’t have even been able to connect with this neurologist here. He’s so busy. He’s doing clinical trials all the time at Imperial College in London. And had I not keeping connected with him after multiple visits to, you know, I had tests for my hearing, I had tests for all sorts of things, and they just couldn’t put a nail on the head. And the I met my neurologist, and he diagnosed me with it. And we slowly went up in increments with my medication. And it was overnight again one day I woke up and I’m like, oh, maybe maybe I can, oh, I’m fine. I can walk. You know, I can go downstairs without my mom helping me I can use the bathroom. So yeah, I pretty much overnight, the recovery as well. I still do have the odd episode, every now and then. But I’m very much aware of when they’re coming. And I know what triggers me. And it’s convenient. We’re talking about screens, because again, it’s I couldn’t even escape the horrible cycle I was in just lying down in bed, I couldn’t watch TV, because the screens moving all around. I couldn’t, there was no enjoyment in it. Even listening to music. I just thought I’m not even enjoying this, like any screen. Looking at it. I couldn’t see the day. It’s felt very long. And so now Yeah, I do use a lot of tips and tricks to help me but we can talk about that afterwards. Yeah, that’s the broad, very broad story.

 

Kimberly Warner – Unfixed Media 

I find it really interesting that it was the pandemic that triggered or brought this to a head with all the screens that everybody was using in that scene. I

 

Alexandra Biss 

think it was almost like, I think the world almost fell, at least I did. It was a massive reset. It made everyone come to a halt. No matter what field you’re in, no matter what you were doing. It was no, no, you have to stop. Now you can’t do anything, you can’t leave your house, you have to stop. And I’m very much in a belief that because we had to stop, then my body could finally go, I’m exhausted. This is really what’s going on. And it all just came out. It was like almost a rash kind of it just came out overnight. And I truly do believe it was the fact that we had the pandemic had to stop. And then it all came out. They’re like, Yeah, you know what your body’s exhausted? Because you’ve been feeling like this for a really long time. And this is now what we’re gonna, this is not what we have to do.

 

Cynthia Ryan – VeDA 

Yeah, that happens to me all the time. Push, push, push. And then one. One thing triggers me to have to, oh, let this this is all caught up to me and I’ve got to actually deal with it. And then it comes

 

Alexandra Biss 

once. Yeah, that’s how I felt.

 

Cynthia Ryan – VeDA 

So when we’re interacting with our screens, we’re obviously the interacting with our screens primarily with our eyes or vision. So Dr. Cheryl, can you tell us tell us what neuro visual optometry is so that we can kind of have a background for for what we’re going to talk about.

 

Dr. Cheryl Berger-Israeloff 

So, um, I belong to the neuro visual Medicine Institute, and we are a subset of Optometry. We’re actually working on our fellowship certifications now on the board for that. And what we focus on and how we were trained not just brain injury, we’re really trained to focus on the visual aspects of the Dizzy patient, whether your dizziness is from brain injury or just happened. That’s our primary focus. My practice has kind of evolved from that. But that’s still about 70 75% of what I do the rest I deal with, with stroke patients. And just just double vision patients, so I’ve just kind of got known for you know, if you have double vision go to her. So, but primarily, what we do is we look at very fine tune the visual aspects of the Dizzy patient, and our treatment approach is is different. We use micro prisms to help get the eyes in alignment to help alleviate the system. So I don’t know if you guys are aware, but you’re probably aware that some visions have primary sense and the eyes and the ears are very much connected and balanced and moving through spaces, these three systems, its eyes, its ears, you got that feedback loop, Vestibular ocular reflex, eyes go the opposite way up and down, side by side. And also your proprioception, right. So your input from all your muscles, your joints, how you hold your body. That’s why it’s great, Alexandra, that you’re running. Wow, that is great. Because you’re using those systems, we know that people who get out there and move their body do better. They do they do better. So what we look at is, if you think of that tripod, we look at that visual system very carefully. And there are signals that go back and forth between the Vestibular system and the eye muscles through this Vestibular ocular reflex, especially the vertical eye muscles. And we know that that’s what they measure when they do Oh, that’s right, they measure they put electrodes by your vertical eye muscles. So we know that that’s why when someone gets acute dizziness, and if they get BPPV, you get nystagmus, right? Because it’s it’s the eye muscles reacting to a problem with the Vestibular system, or brain, it can come from brain too. So that’s what we look at. And we have a unique treatment approach.

 

Kimberly Warner – Unfixed Media 

Yeah, I’m curious, maybe we can maybe this will come later. But I just want to ask you the question because I, I didn’t have a diagnosis for years and eventually ended up with the Mal de Debarquement brand diagnosis. And I ended up actually going to neuro optometrist in Chicago and thought it was gonna be the holy grail for me and she did work with prisms. And it didn’t help for me. So I’m assuming that’s that sometimes when there’s the neurological mismatch, it’s not necessarily going to be corrected by?

 

Dr. Cheryl Berger-Israeloff 

Well, it could be but it’s also, I don’t know who you went to. Did you go to a neuro visual specialist or did you go to a neuro just a neuro optometrist? Because you prism just moves an image. That’s all it does. There’s no magic, it’s physics, it moves an image. And a lot of people use prism in different ways than how we use it. So there’s different philosophies. So when you when someone a dizzy patient is looking for someone to really evaluate them, I think it’s important that they look for a neuro visual medicine specialist, someone who was trained by the neuro visual Medicine Institute. It’s a separate training that we go through. So yeah, and I think I think that’s, that’s a key, because you have to understand part of what I trained and learned and I didn’t learn this in school, I learned this in my postgraduate training was how the Vestibular system works. I know now about things that, you know, a new patient comes to me or I’m speaking to another doctor, and they’re like, Who’s that crazy eye doctor that knows about, you know, third window hopeless effects and like, you know, so that’s, I think, a crucial, crucial aspects to be able to evaluate what is wrong with with someone and and sometimes, you know, my worst day is when I say to someone, I can’t help you. That’s the worst they can make that better for you. But a lot of people we can. A lot of thank you for that clarification.

 

Kimberly Warner – Unfixed Media 

That’s, that’s really helpful. So going back to screens, I’m really glad that we touched on that. But I want to come back to you, Alexandra. It sounds like you were in college when your visual Vestibular system and everything just started to go awry. And you were unable to look at screens at all. And that’s probably a primary I’m dating myself, but we weren’t using iPads and stuff when I was in college. But, um, so that must have been really extraordinarily challenging, both academically and socially. So yeah, talk about that a little bit.

 

Alexandra Biss 

Yes, of course, you know, when you’re 21 it, your screens, your is your life, when you’re in school, college university, I was enrolled in the University of Toronto. And because it was the pandemic, I’d flown back to London, thank goodness. So I wasn’t living alone. And I was with my parents. And, honestly, I think I got through it because of the room given to students during the pandemic. And the new faces, we were challenged, we were challenged with being a student online, and I had the time difference also. So my classes one a normal time, you know, I had I tutorials, finishing at one in the morning, John was because of the time difference. So I couldn’t look at a screen, I couldn’t read anything on the screen. And it was very, I would lie on the sofa, my eyes were closed, and My poor mom sitting next to me, you know, on my feet. And she, I had the class going, and I’d be talking to her saying, can you just take these out? That’s how I would do it. And that took a very, we get on very well. But if I didn’t have my mum to do that, for me, it wouldn’t have been a Oh, okay, well, you can have this accommodation, because how could I have even written a polite email to a professor saying, Hey, I’m kind of dizzy. Can you just pass me? It’s not. I didn’t even know what was going on with me. So even asking my professors to give me some leeway. I couldn’t even I couldn’t have done that. So I because my brain was because my thoughts were so intact. It was just all my symptoms that were a nightmare. I still managed to get my work done. And my poor mom again, she was typing for she was like my scribe. But yeah, so through prayer, I managed to do that. And on my phone in my social life. It was not you know, it was non existent not only from the pandemic, but I couldn’t keep up with anything. I missed so many crucial events that I couldn’t attend to. I not that I lost friends that I had friends thinking about, you’re just dizzy. Like, what do you mean, you can’t come? What do you mean, you have to flake? Because I woke up that day. And I said, oh, sorry, I thought I’m having an episode. I can’t, you know, I can’t you’ll watch me walk. And it’s the thing I remember was when I was walking, I you know, as you get older, and you’ll see on the street, someone who’s of old age, and they kind of do walk with a bit of a hunch. I was walking with half my body near the floor, and any when I could walk, and I didn’t know why I was doing it. But now looking back and thinking, Oh, I just was ready to fall. I had to be near the floor because I you know, I knew I was such a fall risk. And so yeah, social life was out the window. I couldn’t, you just couldn’t look, it was so dizzying, seeing the screen flow around you. But one thing that I very much, now learn and I get like talking about like my job, you know, it is my screens my life. I couldn’t not work with screens. But I use the nightlight feature on all of my devices. And it’s on 24/7 I’m labeled the grandma in my office because you’ll come by my desk and the screen is like a warm yellow tone. Everyone else is like bright blue. But that really maybe it’s the placebo effect I don’t know. But because it’s not my making my eyes squint. i It does help. So even on days where I’m feeling like those words and even around because the blue light isn’t like piercing my eye and her thing. I’m the I’m a big believer and everyone should have nightlight on all the time.

 

Cynthia Ryan – VeDA 

So it sounds like when you were in your acute phase, you basically just didn’t use screens, you couldn’t even you know, deal with trying to figure out workarounds. At that time, you had to just not use the screen and and over time you figured out those workarounds. So and I want to get back to I want to put a pin in talking about those tips and tricks because I know that there are more than than that one the the nightlight but I want to start, Cheryl Dr. Cheryl by asking what is it? Why do Vestibular patients have such a hard time with digital devices and screens. What is going on? That that makes their eyes so sensitive? Well, I’m saying their eyes, but I’m guessing it’s more than that.

 

Dr. Cheryl Berger-Israeloff 

Yeah. Okay, so I think the first thing is to understand and realize that the Vestibular patient, again, you think of this tripod of eyes, ears, proprioception, the Vestibular patient is so shaky on that ears. Right, they’re using their eyes more than anyone else. So number one, their visual system is exhausted all the time, because it’s working overdrive, just to help them so they don’t topple over. Right? That’s number one. Number two, sitting on a screen and anything doing all of this close up work is very unnatural. For any human. We have not we have not evolved, we’re still our evolution, visually is still hunter gatherer, it is not sitting and keeping everything converges. So if you have even minor problems, and you’re not a Vestibular patient, you have problems. Okay. So that’s number two. Number three, when you scroll on a screen, the text is moving. When you read on just that paper, the text not moving, you do these eye movements, now you have an extra added eye movement. And then the smaller the screen, the more eye movement you have to do, just to get to the next line. Right. So you have increased II movements, you have a very unnatural setting for a human, you have that we never get a break. Because by the way, when people are not doing their work, they’re looking at one of these, right, so you never get that break. It’s exhausting. And then let’s talk about the filters and the light and the blue. I don’t think it’s placebo effect. blue wavelengths scatter more, right, blue wavelengths scatter more, you get that sensation of that scattering. And that makes you feel sick, too. So these are my computer glasses, I don’t have them on now. Because they’re, they’re not so attractive to type. But this is, um, these are my computer glasses, I have my own now you guys are so much clearer for me. They I have I have the blue tech, which is like embedded in the lenses, the classic, they came up with an ultra two minute old, I have my own major binocular vision problems. So I have actually more than microprism in here I have a lot. And I also have that blue block or anti reflective. So this simulates on the screen exactly what Alexandra said like that warm yellow. And, and I have it set perfectly for this focal point. And I always said, I really hope I don’t get a stimulant disorder because I have major visual problems I haven’t fixed. But if I did it, my eyes would be so exhausted all the time, I would probably it double all the time. So that’s the whole thing. That’s why screens are so challenging for not one reason, for a multitude of reasons, a multitude of reasons.

 

Kimberly Warner – Unfixed Media 

I think you just answered a question for me too, because I so pursuing the AI solution for me in the early stages of my disorder. I also went to AI vision therapy, and after one day, and so let’s just put into context, my eyes were exhausted because I’d already had a year and a half at that point of trying to compensate. One day of visual therapy. I went home and about an hour later I developed my first brain zap. I’m sure you’ve heard people say what those are. And I thought it was having a stroke and we fell to the floor. I proceeded to have six months of probably 12 brain zaps a day. I never went back to vision therapy, but I’m sure again, it was probably like just too much, even if it was trying to, you know, create a solution is do is my understanding. Probably correct there.

 

Dr. Cheryl Berger-Israeloff 

Yeah, yeah, probably Yeah. over the edge. And it really depends on that person’s visual status. But when your system is so exhausted, and like I said you because of the work and the jobs we have to do in the world we live in today. People need a tool to you need a tool to help relieve those symptoms first. If you don’t have that, and you just try to do it. exercises to do that you can totally throw somebody can get totally thrown over the edge. Your because your visual system you’re so exhausted anyway. And a lot of people, they’re still doing a job or they’re still a student, they still have to live their life in

 

 

that during an unusual

 

Dr. Cheryl Berger-Israeloff 

scenario, Kim

 

Cynthia Ryan – VeDA 

during life rebalanced live when we were talking with Dr. Rachel Whelan’s, who’s a neurologic physical therapist, she, in the context of the stimulator rehabilitation therapy, use the term dosing and I imagine it’s similar here, you know, you have to dose the exercises so that you’re not overdoing it. And that is also you know, dose it that could maybe also be applied to, you know, the amount of time we spend on the screen, or, you know, and I think we’ll get into this next all the, you know, the tools we use, you’re showing your, what you called Computer glasses, what are often referred to as, you know, light sensitivity glasses, like the ones or migraine glasses, like the ones that I’m wearing, these are from axon, or also known as Avelox. And there are a couple of companies that produce these glasses that have very specific wavelengths of light. I have

 

Dr. Cheryl Berger-Israeloff 

that too. I don’t have them for me. So that’s a different if you I don’t know if you want an explanation on that now or not?

 

Kimberly Warner – Unfixed Media 

Well, let’s do that. Actually, I want to that will pick that up because I want to hear Alexandra, you, you’re called grandma at your workplace. In fact, my friends call me grandma too, because of my schedule and all that alone. But tell me others adaptations that you’ve done other than the night mode on your computer screen.

 

Alexandra Biss 

There’s the night mode is the big one. And I think, knowing when to step away, and take those little bio breaks that I’ve heard people turn them as, it’s not that you’re not working hard, it’s that if you’ve been staring at a screen for over two hours, you’re you need a break, whether you feel it or you don’t. And we screens. It’s not only just at work, but it’s every single part of our day, I was talking about this with my colleagues, you know, you wake up, fine. You go to the office, and you’re on your phone on the way into work. You look at screens, all day long. You look at your phone on the way home from work, you sit down on the couch, or you put the TV on its coffee, you don’t realize how many screens you’re looking at, and the amount of time we’re looking at them all day long. So I think that’s been a big thing. learning when to just say I need at least 15 minutes, no screen, at least 15 minutes. So yeah, that’s a big component that night, the night mode and knowing when to step away, so I’m not just looking for such a long period of time. And

 

Kimberly Warner – Unfixed Media 

our is your workplace sort of friendly to that need it.

 

Alexandra Biss 

You know what? I think if I said, I have vision problems. At the beginning, when I first started to my job, I think if I said I had vision problem, it might have been there’s not that there is any frosty reception at all. But I feel very nervous to talk about having a balance problem and having a Vestibular disorder because it’s a very, I’ve learned that I’m not like ashamed of it, but plopping that out there. I’m worried well, they think I’m unstable, will they think I can’t, I won’t be able to turn up to work. Because when my episodes were happening when I was in my early 20s, there’s no way there’s no way I could have held down a job. There’s apps I barely got through my degree, there’s no way I would have been able to go to work. And so I’m, I am still caught. I’m getting better, but I am very cautious of dropping the bomb and sharing. Why have because it is people don’t know it’s not a known problem. It’s not a common one, especially being young. I don’t know anyone else in my kind of Angel age who’d has had any balance problems before. So I’m getting better at sharing that. But yeah, it’s they’ve been completely I’ve never once had an issue where if I say I need to step away from my screen, they’re like, No, you need to keep working.

 

Cynthia Ryan – VeDA 

You know, nowadays, they have lots of tools that you can use on your computer that do different things like change the contrast, some of them are overlays that go over, you know a website, or you know, some websites have I contrast you were talking about the light and I think contrast is part of it. A high contrast is difficult to look at. So there are some websites that will and this happened. This is an issue for people with seizures for example, that can trigger a seizure or motion In, you know, some websites have you know, that will just start that will launch into some sort of motion that you can’t, you know, then you have to turn it off by then it’s too late. Have you ever used any of those tools?

 

Alexandra Biss 

I, the one that I use that I’m just talking about contrast, I, whenever I’m on an application, whether that be my email my, like on any like Word, PowerPoint, if I’m using any type of software, I usually always put it on dark mode, I even on my phone on dark mode. And I don’t know whether I think because it doesn’t feel as bright when you do have a bright white screen, you’re trying to find your emails, it’s just a little bit. It’s just too much. Whereas when it is dark, and the brightness isn’t too, too high. I think the dark mode feature has really helped me so every time I get a news app or anything, I’m like what the dark mode

 

Cynthia Ryan – VeDA 

all digital devices are different. Some have like the iPhone has the parallax effect that you can turn on or off, which affects motion, because I know that that is a big thing we have VeDA has people complaining all the time, if we post something on social media that has that starts with motion. So we definitely are very aware of that as well. Dr. Cheryl, you were you were starting to talk about treatments. You know, you mentioned the prism lenses. And then Kimberly was talking about vision therapy. So I’m curious, when someone when a does a person comes to you? What treatments or lifestyle adjustments do you suggest if they’re being negatively impacted by the screen? Right,

 

Dr. Cheryl Berger-Israeloff 

which they all are? They all are. So I think one of the things is crucial is to figure out their visual status. So and it has to be extremely precise. Right? Because, again, they’re using their eyes more than anyone else. And humans do are using their eyes, primarily anyway. So you have to kind of have in that mindset, I tell everybody that I live in the little bit, right? So I live in the little thing, the little bits because the little bits can have huge impacts. So very often with a Vestibular disorder, you’re getting the wrong signals into those eye muscles because you have damaged there. And so you get kind of wacky signals going back and forth. So that’s kind of our first step is to analyze what’s going on with that you get if you’re getting those wacky signals, you get these muscles pulling and kind of spasming. And instead of correcting to where they’re supposed to correct, they overcorrect. And then humans don’t want to see double at all. So then they go like this. And it exacerbates their dizziness because everything’s kind of constantly doing this and shaking and spasming. So we analyze that. And then we move those images together. And so another very common symptom. With a dizzy patient, when they’re on their computer or their screen, they see double way faster than someone else. They don’t have to have much of a problem to right away. system so exhausted, it’s just not correcting properly, they see double. So that is that first thing doing our normal nerve visual medicine exam. Then when I’m correcting that person, I want to know their setup at work. I need to know how many screens? Where are the screens? What’s the difference? Because I need to I need to figure out the physics of that. What is that demand for that person? What is that focusing demand? And what is that demand that convergence demand? And are they good at doing converging? Or do they over converge? And that’s one of the problems sometimes we see with someone who was put right into vision therapy and they’re busy doing convergence work, and they actually over converged. So they’re either constantly doing this, and that person is going to get sick from time to do that. So we analyze all of that in the normal AI world. When people talk about oh, I had that patient, you know, they brought me this diagram and their workstation and now I got him What a pain. I’m like, can you please bring me like, measure out for me I send people back to their offices with like, take a tape measure because I want to know. So that is what’s really crucial. And then the next step visually is the different filters that we use. So I just want to kind of educate you on the difference between what I’m wearing right now, this is blue text. So this is an actual blue wavelength, when any kind of wavelength of light, you can reflect, or you can absorb. This looks yellow, because we’re absorbing blue wavelengths. And you could actually see the blue reflections because I have like the double on here. So it also reflects off the blue wavelengths. What Cynthia is wearing is Avelox. It’s, it’s really, it’s FL 41, which is a tense. So FL 41 doesn’t do anything with the blue wavelengths. Sometimes when I use FL 41, a blue put a blue block or anti glare up on top of it, I’ll get even a little bit more softening because I’m affecting different wavelengths of light. The whole migraine glasses and the Avelox came from two small Canadian Studies a really long time ago to small studies that they studied this about 41 tint. And people with migraines said they reduced their headache, intensity and frequency. So of course, all these you know, companies came up with these, you know, proprietary little mixes of this tent, but it’s basically epa 41. So we use FL 41 and 10. Because we it’s a specialty tent, the blab keeps for us. And we, we use it, I use it a lot with patients. And it’s like that rosy kind of tip and we I use different intensities of it. And I have different samples of that that we try to see. So that’s the difference. So that fo 41 Or you know, the axon Avelox. Unless you put a blue blocker, it’s not really blocking blue wavelengths, which scatter more. Right? So we know that blue wavelengths scatter more. So I combined some of those things. Some of it is a little dependent. I always tell everybody, like with the FL 41. I got like two small Canadian Studies to hang my hat on. So I don’t know, is there anything magical about blocking those wavelengths or people like it, whatever it’s attend, if it makes you if it works, it works. And we try it out in the office, I have people actually sit right here in front of my computer setup. And I have no adjustments on this. Because I really want to know some people work in an environment, they can’t have anything adjusted. So I want to see what they feel like. And some people prefer different things. And then of course, you know, everybody, everybody’s different. And there’s cosmetic things too, right. So maybe they don’t want to wear yellow glasses all the time. I find when someone sensitized it, they have to be working in environment and they’ve got the fluorescence and that can’t be changed. Those scattered. Also they actually flicker and it’s picked up your peripheral retina. This works very well. With another. Yep,

 

Cynthia Ryan – VeDA 

I’ve just with the fluorescence I’ve had people tell me that what they do is they just wear a hat inside. Yeah, you know.

 

Dr. Cheryl Berger-Israeloff 

Exactly. Exactly. Another thing that we use in our treatment a lot and I think that also sets us apart from other optometrist or neuro optometrists, we use noise cancellation a lot. So the ears, like they’re very connected, and you can get these wacky signals into your eyes and make those images seem to shake, remove more, just because your ears are being stimulated. And some of those balance organs respond to sound, even though we don’t really use that for hearing anymore. So we use different noise cancellation devices. And some people you know, find that having that on when they’re doing their work really, really helps. But it’s you have to really analyze for that patient. Exactly that focal point where they have to see when you’re holding a phone, it’s closer. It’s a lot of eye movements. So that’s another thing I tell people, you know, I’ve had people who were doing great doing great, they decided to, I’m going to read a novel on my phone, and then they call me I had the worst day of my life. I said, You did, you know, 100 times more eye movements just because you’re on a little screen, right? That’s extremely challenging, very unnatural, just not a good thing for anyone to do. And so, to Alexandra’s point about taking those breaks it’s it’s super, super, super important. And and a lot of times you know we do we write letters for patients to say they need to take a break. Physically, mentally, visually, it’s not good. It’s not good.

 

Cynthia Ryan – VeDA 

Yeah. That’s, you know, you don’t need all these these fancy tools in these glasses, you can just look away from your screen. There you go. And how about natural light? You know, I would imagine that, you know, is light, just light? Or is natural light different?

 

Dr. Cheryl Berger-Israeloff 

So yeah, so natural light is different, because you have different different wavelengths in those spectrums, right. So it’s different, and natural light is still better. However, some people, you know, just being outside and a super sunny day that really bothers them. And that’s another thing that you have to be careful with, because some people are so sensitized by light, they are wearing super dark sunglasses, even indoors all the time. And that’s not good for your visual system, you’ll dark, adapt yourself, and you’ll never get back into it. So that’s, that’s a process that, you know, people come to us, and we have to slowly take down those tests, because they’ve been wearing, you know, a full on sunglasses inside. But natural light is, is, of course, always better. But I don’t know, I guess I’m a realist. Also, I’m a realist at heart. And I try to understand what that person has to do, and my whole goal and focus and is I’ve got a human in front of me that needs to function. And I’m all about how do I get that person to function up to their best ability for what they have to do in the shortest amount of time? Like, how do I do that for that person. And I tell a lot of people I had a woman the other day, you know, she had bilateral Vestibular hyper hypofunction, bilateral, both ears. She’s had this for a while, I said, I said, I can’t fix that. Right, I can’t fix that. No one can fix that. But I can make this the best as possible. And it makes it makes make a huge difference to someone a huge difference from nonfunctional struggling in their day to day life, to doing their job performing, enjoying their life. And I think that’s huge. And so you really have to think of, I think of every patient that way, every patient,

 

Kimberly Warner – Unfixed Media 

it reminds me of just basic stress management, there’s, it’s not one tool, it’s many tools. And so the same with our eyes, and our ears, each one of those little things, just diminishes the stress level a little bit. And you know, then we pile them all on top of each other. And that might just be enough to prevent an attack.

 

Dr. Cheryl Berger-Israeloff 

Exactly. It’s reducing those triggers, making everything as is easy as possible. And I think one of the problems in our system is everybody looks at they’re in the medical system, everybody looks at their body part, exclusively. But humans don’t work that way. We don’t work that way. It’s, it’s all it’s all together. And the more I learn, the more I’m fascinated that anybody works. Right? So that’s how complicated it so everybody looks at their one part. And then they say to the person what that looks fine to me so especially if you’re a woman go must be anxiety, right? That’s got to be anxiety. There’s nothing more we use, there’s xiety and because they’re not thinking this is a whole person. Right, Alexander What is your

 

Kimberly Warner – Unfixed Media 

so looking at the whole person, like Dr. Cheryl was just talking about, you started running. And of course, we’re talking about screens here, but I feel like this is really important because you developed an activity and imagine it takes quite a bit of time and your days, where you’re suddenly not looking at a screen anymore. Is that was that one of your decisions here? Or did that sort of catalyze your decision to start running? And also I want to know how natural light works with you as well.

 

Alexandra Biss 

Yeah, natural light a guy’s it’s almost I need to wear my sunglasses and I need to have a hat on and also just being ginger I’ve been conditioned that way you don’t go out as if it’s sunny you don’t go out without your boss. I when I was really really ill and my episodes are really bad. I can just remember thinking you know what, I don’t care if I you know being young and self conscious that how I look. I don’t care if I balloon up shrink. I just want to be able to walk I just want to like I can’t do anything anymore. This is going to be my life now I had dreams I wanted to live abroad I wanted to and suddenly it’s oh no no, you can’t do any any of that. You’re a home new might make it to the couch downstairs instead of the instead of your bed. That was my goal for the day. And so I remember thinking like if I so help me God if I ever get better. I want to do something that I never would have thought I would be able to do and running. I you used to not be able to run a minute 10 seconds, I’d be like, Well, I have an undiagnosed asthma, I can’t even move. Like I’m not a runner. I was always a sport supporter, not the sport activists like I could never do it. And I think because when you’re running your head straight, I, if I get to across across roads and traffic light, I don’t even just running it in my life, I don’t, I always go very slowly looking left and right. Because if I swing my head too quick, I feel like I’m suddenly in like a rule. It’s like a vortex almost in my, in my head. And it’ll knock me out for the rest of the day. So I’m very conscious about moving slowly, but also not constricting my movement, because then I get really stiff in my head and my neck. So I’ve learned to be very easy, especially if I’m driving, I’m doing anything. And I need to just take it slowly if I’m looking at the side. But I think the fact that when you’re running, you know, it’s just you and your thoughts and you’re running straight, your head is straight. And I think that’s why it’s been such a manageable thing for me to learn how to do because I’ve tried other things, you know, I still can’t, I tried a golf swing a couple months ago, forget it, I couldn’t, it’s the swinging motion of my head. Tennis again, it’s just anything that has any head tilting or head movement is still a no go for me. And I don’t think I will want to do that. Because I’m so worried about it triggering an episode to me now that’s not worth it. I’d rather do what I know I can do, and keeping my head straight and just running forward. I think that’s why I’ve been able to do obviously, with sunglasses and a hat on if it’s sunny out.

 

Cynthia Ryan – VeDA 

Yeah, and I think for people who I get that just going straight for people who can’t run walking, I think, also first need. And, and, you know, I was just thinking that, for me what my recreation is, my exercise is hiking. And that’s the time when I’m not looking at a screen, you know, for a whole day, I’m not looking at a screen. And I imagined that that must really help my system to reset. You know, I

 

Alexandra Biss 

sometimes don’t even run with I used to run with headphones, and I’d have a podcast with a guy or I’d have music. And that I didn’t realize was really triggering. And I couldn’t work out why it was triggering, because it’s just music. Oh, I’m just you know, I’m distracting myself. I don’t want to run, I’ll get bored. I need some, you know, I need Music To motivate me. But actually now I enjoy running without any headphones. Even early in the morning or late at night when there actually isn’t. There isn’t a sirens or aren’t honking there aren’t any, you know, it’s just as quiet as possible. That’s now my optimal stage.

 

Cynthia Ryan – VeDA 

Right. Now what occurs to me is we’re we’re talking about visual issues and how and Vestibular issues. So we’re not just talking about people who have visual issues. And we’re not just talking about people who have Vestibular issues. We’re talking about people who have both. So Dr. Cheryl, Mike, my question did,

 

Alexandra Biss 

entwined. Yeah.

 

Kimberly Warner – Unfixed Media 

Yeah. Yeah. And

 

Cynthia Ryan – VeDA 

they, one can exacerbate the other. So I’m sure when you have someone who, you know, is experiencing dizziness, how do you work with them to help them find the root cause of their dizziness when that’s not, you know, you’re dealing with the visual issues. How do you get them help them deal with the Vestibular issues? Right. So

 

Dr. Cheryl Berger-Israeloff 

that’s another aspect of how I was trained. I was trained to be a dizzy sorter, right. So the first thing is the history listening to that patient. When we have an initial evaluation, I have a two hour block of time for that person. So another huge amount of that time is for me hearing their story. And I say to them, tell me your Disney story. Almost every single person says it’s a long story. I say, I know. I want to know the day it started what you were doing when it started from that listening to 1000s of stories. You start thinking along a path. Did they have an acute Vestibular neuritis? Did they have BPPV? Was that diagnosed? Were they diagnosed 40 years ago with veneers but maybe it’s not really veneers because everybody had veneers 40 years ago. What was their testing? What’s their sound sensitivity like certain questions? Do they possibly have a third mobile window defect that was missed because that is super super common. From there do they do they have dysautonomia or pop That’s, and that’s the problem. And so we’ll do blood pressures, you know, lying down sitting standing, and they’re dizzy, because that’s the problem. Are they dizzy? I had one patient, he was so lightheaded, dizzy, I saw his list of medications. And he had some psychiatric problems. And he went from one psychiatrists to another to another, nobody, weaning them off anything. They just kept adding, and adding and adding. No wonder nothing is working. Right. So the history or figuring it out is super important. Are they dizzy? Do they have ocelots? Here? Because they have nystagmus? And what is that nystagmus front? Is it a Vestibular disorder? Is it I had one guy once that boo, boo, boo, boo, boo, vertical? And they’re like, they don’t know why they don’t know why he’s so dizzy from it. Of course, they didn’t know why. I said, Did you have an MRI? Yes, I did. They didn’t find anything I say you go back and have another MRI, look at the brainstem, he had a little stroke in his brainstem. So vertical Nystagmus is going to make somebody feel really dizzy nystagmus that abnormal eye movements, right, that shaking up and down. And, and with someone like that, we try to find what’s called the no point. So we can move the images where it slows down a little bit. Also, that’s one of the more challenging things because sometimes I can’t do anything to help that person. But at least I can point someone in the right direction. So I also have resources. And at least in my area, now we get patients from all over the place, even you know, outside of the country. So I don’t always have VITA is that is a huge help when someone comes from somewhere else to find someone who really is a qualified Vestibular therapist. Around here, I know people, there are a couple of really, really, really fine neuro otologist who are really interested in the Dizzy patient in the country. And that will actually do records reviews for people. And so we get that person in touch with them. And sometimes it’s just kind of starting to think about that diagnosis. Because those someone will say, Well, I’ve been tested. I’ve been this, I’ve been that. And I said, No, you haven’t. You haven’t you haven’t had every test. And then I always catch everything to say. Just because nothing showed up on a test doesn’t mean there isn’t a problem. It means we don’t have the test yet to find the problem.

 

Alexandra Biss 

Doesn’t when there’s so many tests that can be overwhelming as well. Yeah, I’m sorry to interrupt having so I yeah, I don’t even know the name of all the names of all the different tests I had. I remember a tilt table test that’s propelling water spun in my test under the sun. Yeah. And that became so depressing and debilitating, just going for another another test and nothing right have the more do I have? Right? And that that is what beginning of my journey, that exam really got me down in the dumps? Yeah, knowing what tests I needed to do. So there are so many person we have made so many steps forward, but it is it’s not a very well researched field. So there aren’t tests that will say you have even why have there isn’t a test to say you have what I have. It’s from talking to my doctor and he realized I have you know,

 

Dr. Cheryl Berger-Israeloff 

that’s exclusion so they have to that’s why they have to do all those tests. They’re excluding and saying this it’s not this it’s not this it’s not this so

 

Kimberly Warner – Unfixed Media 

it can be such a helpless experience and I know what you’re saying and I lived that myself and I think having someone like you Dr. Shara would have been such an just need to sit down and say what is day one look like? Like how did this start and to really have that map inside and understanding I don’t feel like you’re you’re kind of one one in 10 Perhaps practitioners in the country that can do that. And yeah, women in you know, Zander’s case. It sounds like you got lucky eventually you found that that position but it there was a lot of trial and error.

 

Alexandra Biss 

Yeah, yeah. That was a lot of back and forth and I because I no one in my family had ever had anything like this. I remember one day you know, I’m on the couch. I’m just I’m non stop growing up. I don’t even feel nauseous and it’s just it is all day long. And my parents are looking at me thinking oh, my dog does she have brain cancer? Like is this something so so so deadly that we didn’t see coming? Because they had no idea. Once I found my doctor, I found my medication. I learned to live with it, but when the symptoms can be so violent, yeah, it’s like it’s like a rabbit hole of oh my god, oh my God, what did she have? What did she have? So yeah, lots of tests very, very, very disheartening. But there is hope at the end of the day, there is a light at the end of the tunnel. And it’s just I wish I could go back to my 21 year old self now and say like, not only did you manage to move back here alone, you aren’t, you know, you don’t live on the couch anymore. You can you have a job, I just remember thinking, okay, all my life that I’m all my all my goals and dreams gone, like. So, yeah,

 

Dr. Cheryl Berger-Israeloff 

you’re an inspiration. And you should really tell your story. And one of the things I want to applaud you for is is the running, I’m a big exerciser. And that’s another thing I talked to all my patients about. Not only when you find whatever, whatever you like, that you enjoy, that you can tolerate that you really love to do, I think part of the other benefit to it is the natural, happy hormones that get released in your brain because you like doing it. And I think that is so healing for everybody on so many levels. I think what I always tell people, again, one of the ways I think about a dizzy patient, and so many of them are so anxious, right? And I’m saying you don’t feel right, you don’t feel safe in your environment. So your body’s releasing the stress hormone. So the disease, the mystique of this problem is causing your anxiety, anxiety wasn’t causing your problems, it’s the other way around, you’re not you don’t feel safe in your environment. And whatever we can do to work to get someone out of that fight or flight mode is so helpful. And that exercising, when it’s something that that person likes, is just huge. It’s got more benefits than just your cardiovascular health and your it really, really helps. And, you know, you think you’re just looking straight ahead, but believe it or not, you’re running, you are scanning your environment. So you aren’t doing that. So you are using that Vestibular ocular reflex, and you’re really using it because as you go up and down, right, that’s part of that reflex to, right, your head’s going up and down, your eyes go in the opposite direction. So you don’t even know you’re doing it. But you are. And so that’s just kind of more that’s therapy, and learn to get out there and move their potty in that space. do much better. And I think that’s another problem. Because when you’re sitting on the screen, you’re just sitting

 

Alexandra Biss 

again, when you can’t do it. Yeah, when you can’t, when you’re, you know, in the beginning of when I started the Vestibular therapy, I was like, Okay, you’re gonna sit in a chair, then you’re going to stand, then you’re set? Yes. And then you’re stuck. I thought really know what I’m doing. Yeah, I was a healthy woman, I was a healthy, child healthy completely. And then doing that therapy, that physical therapy. I just got to be learning how to sit and stand out that is a therapy and I think go over the big hill, and you learn what works for you and what triggers you. And if you are lucky enough to be able to be physical and news. I think that’s that’s the goal that I think myself and probably a lot of Vestibular patients would want as a goal, even if they still have symptoms and still have bad days. Because the bad days are like depressing that day, there’s you can’t see the light at the end of the tunnel. And you think you will be dizzy forever, you know. So having a physical active goal has been I think the best thing that’s come out of me even though you know, I’d wouldn’t want to change anything. But I’m actually now okay with the fact that I went through all that now that I have this thing that I enjoy,

 

Kimberly Warner – Unfixed Media 

what’s your what’s marathon will you be doing this year so we can all route up route.

 

Alexandra Biss 

I’m actually going to set up the fundraising page today. It’s a Toronto one is on May 5. I’m terrified. I actually did do a 30 kilometer run this morning. That was the furthest I’ve ever ran in my life. I can’t feel my feet. You know, well, I’m not going I don’t need a time in mind. I want to go and enjoy the day and enjoy crossing the finish line. That will be if I can do that. And I will I know I’ve put in a lot of hard work and training and on and especially within Toronto weather when it’s snowing. And you open your door and I’m almost snowed in. It’s like, great. I’ve got 8k to do tonight. Okay

 

Kimberly Warner – Unfixed Media 

awesome. Yeah. 1000 into this tubular patients rooting you rooting you on.

 

Alexandra Biss 

Thank you. I enjoy having them in my bag.

 

Cynthia Ryan – VeDA 

One of the things I love about this podcast is that we get to talk to people when they have been through their journey and can look back on you know the difficult times and appreciate where they were and we can also send that message that it will get better that there is hope. So I hope anyone listening out there who is having a difficult day today can feel the hope and and know that with with good, good care a full good team of Vestibular specialists is not just one, one doctor, you need a whole team, a multidisciplinary team of Vestibular specialists and the support of people like you who are also struggling with this through the Vita community that things will get better. So thank you both for sharing your story. Thank you for sharing your expertise, Dr. Cheryl, and thank you all for for joining us today.

 

Dr. Cheryl Berger-Israeloff 

This was wonderful.

 

Cynthia Ryan – VeDA 

Thanks for tuning in to ICU this month.

 

Kimberly Warner – Unfixed Media 

We hope this conversation sparked a new understanding of the Vestibular journey. And for all of our patients out there leaves you feeling just a little more heard. And a little more seen. I see