Podcast: The Vestibular Patient Experience During Audiological Testing


Vestibular Patient Experience During Audiological Testing


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Audiological testing can be an important step in helping doctors determine whether the inner ear is the source of a patient’s dizziness. However, if you’ve ever talked with someone who has been through the gamut of tests – it’s not exactly a picnic in the park. Many patients – already ill from symptoms and fearful of tests that can exacerbate them –  are anxious about their first audiologist appointment.

This episode of the ICU – “I See You” podcast covers the topic of audiological testing and the experience of vestibular patients who undergo these tests. Guests Jesus Gomez, audiologist and PhD student, joins the discussion to listen to the experiences of vestibular patient Karen Mizrach. Listen now to this thoughtful and vulnerable discussion about addressing challenges and anxieties that a vestibular patient faces going into, during, and after audiological testing.

About the guests:

In December of 2017, Karen woke up in the middle of the night with vertigo. After many doctor visits, tests, and treatments, the dizziness and off-balance sensations continued and it has become a chronic condition. Finally, she saw a neurologist who recognized her symptoms as Vestibular Migraine and Cervicogenic Dizziness, and this year PPPD was added to her list of conditions. The most challenging part of these disorders has been the isolation. Karen is divorced with grown children who don’t live close by. Living alone and having to quit her job teaching made this challenge all the more difficult. Finding VeDA was a game-changer! She now feels connected to people who understand and are supportive. Karen has become a VeDA volunteer to give back to the community that has made a difference in her life.

Jesus Gomez is an audiologist and first-year Ph.D. student in the vestibular sciences lab at James Madison University. He received his B.S in Communication Sciences and Disorders from the University of Virginia and Doctorate of Audiology from the University of Tennessee, where his interest in vestibular science began under the direction of Dr. Steven Doettl and strengthened during his 4th-year externship at the Cleveland Clinic with Dr. Julie Honaker. His interests are in electrophysiology and vestibular sciences, where he is currently under the mentorship of Drs. Erin Piker and Chris Clinard. His overarching goal is to become a bilingual clinician scientist serving both Spanish and English speaking populations.


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.


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


Cynthia Ryan – VeDA  00:03

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  00:14

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.


Cynthia Ryan – VeDA  00:29

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


Kimberly Warner – Unfixed Media  00:43

audiological testing can be an important step and helping doctors determine whether the inner ear is the source of patients dizziness. However, if you’ve ever talked with someone who has been through the gamut of tests, it’s not exactly a picnic in the park. Many patients already ill from symptoms and fearful of tests that can exacerbate them are anxious about their first audiological appointment. In this episode, they discuss these challenges. How audiologists can help mitigate patient anxiety and nurture an easier and more vestibular friendly experience. I’m excited to introduce our first guest today Karen ms rock in 2017. Karen woke up in the middle of the night with vertigo. After many doctor visits, tests and treatments, the dizziness and off balance sensations continued. Finally she saw a neurologist who recognized her symptoms as the singular migraine and cervicogenic dizziness. And this year pppd was added to that list. The most challenging part of her has been the isolation, living alone and having to quit her job made this challenge all the more difficult. Finding VeDA and becoming a volunteer was a game changer because she now feels connected to people who understand and are supportive. Welcome to the show, Karen.


Karen Mizrach  02:09

Hi. Thank you very much.


Cynthia Ryan – VeDA  02:12

Thanks, Kimberly. And I’m excited to introduce our next guest. He’s just Gomez, who is an audiologist and a first year PhD student in the vestibular science lab at James Madison University. He received his doctorate in audiology from the University of Tennessee. And his interests include electrophysiology, which sounds amazing and crazy to me. And vestibular science. His overarching goal is to become a bilingual clinician scientist serving both the Spanish and English speaking populations, which I think is also amazing. And if others have not checked it out, VeDA, just launched a another video series for Spanish speaking patients on this tubular topic. So we’ll we’ll put that in the comments. Welcome. Jesus and Karen.


Jesus Gomez  03:08

Thank you. Thank you for having me as well.


Kimberly Warner – Unfixed Media  03:11

So this is a really exciting, interesting, provocative, difficult topic. Let’s start carrying with you because I want to sort of lay the foundation for what vestibular testing actually is. So let’s begin with how did you feel about going into vestibular testing before your appointment? Like did your doctor prepare you for the experience? And if so, what did he or she say?


Karen Mizrach  03:45

Well, it was a really difficult time for me. I was not functioning very well, I was having trouble moving around my house. Nevermind going to the doctor and trying to deal with all that. So I would say I was actually very enthusiastic about the testing the concept of it because I really wanted some answers. And so I dug deep and got to the doctor. And the doc the I first went to a balance clinic that was an en t office. And he did not really explain to me about the testing other than to say I needed to schedule it. There were several tests and I should plan to be there about two hours. I would have to say I was not nervous about the test. because I really didn’t know what they were, I was really anxious about getting there. And waiting in the waiting room. I mean, really, things that I had never even thought about before became very difficult just to walk down the hallway following somebody to the testing room is, you know, it’s still a challenge now, but in the beginning, I really almost couldn’t make it. So that was, that was the hardest part for me in the beginning, was just navigating my way to appointments and through the offices.


Kimberly Warner – Unfixed Media  05:46

Wow, I’m nodding my head, because I remember the navigation is so hard. So I really appreciate you bringing that up. It’s so


Cynthia Ryan – VeDA  05:58

yeah, it’s so interesting to me that this starts even before the testing, you know,


Karen Mizrach  06:04

the testing was a relief, I always and to this day, when I go to the doctor, once I’m in the room, and um, with the nurse or the doctor or an audiologist, I feel fun. I feel safe. Like if something happens, I’m okay. It’s Yes. It’s really just sort of the logistics of getting my body to get there and work correctly.


Cynthia Ryan – VeDA  06:36

Yeah, interesting. So, Jesus. I know that we taught we from this in the vestibular community, we talk a lot about vestibular testing. And the anxiety that often goes along with it from a patient’s point of view. are or were you aware that people experience high levels of anxiety prior to vestibular testing? Is that something that they talk to you about when you are in school?


Jesus Gomez  07:13

Yeah, so one of the, I’d say, a lot of times when we take care of patients, something that we always are, that was really stressed in my program at the University of Tennessee, was really how much we need to put emphasis on patient counseling. A lot of times what happens is caring, I’m not really sure how long it actually took you to get vestibular testing. But a lot of times the wait for getting vestibular testing is very long. Do you mind me asking how long it was for you?


Karen Mizrach  07:46

Initially, at the E N, T, end of things, I would say it took about a month to get the appointment for those first tests, but that was really just the beginning. Because they came up with normal, you know, there was nothing there. So I had to do further testing and further appointments. And some of them I didn’t get in for a year.


Jesus Gomez  08:16

Exactly, yeah, it’s there’s, there’s such a need for vestibular testing. You know, a lot of times, I’ve heard statistics, that usually takes about almost three, three to four months to get scheduled for have a severe test batteries that we’d like to consider. And that is a very long time, especially when you have those initial episodes that can be so severe and so debilitating. So, I kind of have that thought in the back of my head, just knowing you know, this patient has traveled a long ways to see me. And they have really just, you know, been suffering with this situation for a very long time. So something that’s always really been stressing me is, you know, when we go and get patients that the appointment starts as soon as I get the patient. So it’s not necessarily like when I am, you know, taking their case history or something like that in the in the room. But I like to get to know them from the very beginning and just saying, you know, how’s your day been going? Did you find us, okay? I really feel like this really helps us to kind of get on the patient’s level and establish a good rapport with them, which I think is so crucial. Because a lot of times there’s so much anxiety going into this, there’s so many unknowns, we they don’t know what’s going on with their bodies. And, you know, what can happen is, is that these patients, you know, I’m just one stop and all the different kinds of tests that they have to do. They they’re going to see either cardiology and neurology EMT and when they come to see me, you know, it’s it can be a long wait. So that’s kind of how I usually like to start my appointments with that kind of mindset. Oh,


Kimberly Warner – Unfixed Media  10:02

that’s amazing.


Cynthia Ryan – VeDA  10:04

Yeah, I actually, I was in a, I had a medical procedure not too long ago. And I remember that specifically that the doctor, you know, could have been a stressful situation for me and the doctor was talking to me and distracting me and asking me, you know, we got into talking about hiking and other things, you know, and and that was helpful for me to focus on something else.


Jesus Gomez  10:29

Yeah, absolutely. You know, you know, dizziness has something really hard to explain. There are so many ways to describe dizziness. And sometimes in order for a patient to really give me a good description of what they’re saying, they have to feel comfortable. And in order for them to feel comfortable, I really want them to know that this is a team effort, that, you know, I’m here to help them. And what they tell me is going to help me help them as well. So we’re going to be working together so that we’re able to find, you know, if this is the cibula related, or inner ear related, that we will find some answers for her, you know, and sometimes it’s it’s not inner ear related. It’s not dissimilar. But we know kind of the steps that we need to take


Cynthia Ryan – VeDA  11:17

in order to continue.


Karen Mizrach  11:19

I appreciate that you say, it’s hard to describe dizziness and the symptoms, because it really is, you know, I’m familiar with how it feels. But trying to communicate that to somebody else is really difficult. And it’s wonderful that you are aware of that and that maybe you could even offer, you know, different words to use and descriptions. And that’s very helpful.


Jesus Gomez  11:51

Yeah, when we talk about dizziness, like you’re saying, it’s so hard to describe, so I’ll say, you know, is the room spinning? You know, do you feel like, you know, your Do you feel like that the world is moving? Do you feel like you’re veering to one side versus the other. There’s just so many adjectives that we can use. And then a lot of times when patients are so stressed, it’s hard for them to just say, you know, I’m dizzy, or I don’t feel good. So that’s why it’s so crucial for us to really understand the anxiety and the stressors that are that they’re facing when these years.


Kimberly Warner – Unfixed Media  12:22

Karen, you mentioned that, you know, a lot of the anxiety for you is, you know, navigating to the appointment. Tell me a little bit about your experience, when you actually began the vestibular testing. And it sounds like you had a couple different rounds of that. So yeah, let me know, let us know what that was like for you. And then also, what


Karen Mizrach  12:45

are the results? Well, the first round of testing, like I said, was done at an E N T clinic, a balanced clinic. And they did a hearing testing. And they did a V and G test, which is very uncomfortable, you know, where they’re putting warm water in your ears and sort of tracking your eye movements and different things. And that was, it was interesting. It I did okay with it, I the symptoms that it provoked did go away pretty quickly. And the results were normal. So my hearing, they said for your age is normal. And the vn g did not show any funny eye movements or anything. I had a brain stem potential test, which I think is an audiology test. Also, I did not understand that at all. But they told me the name of it, and I just went with it. So all those tests came back normal. And one thing I will say is, I found it very disconcerting, that went when being told the results. They always said, good news. Everything’s great. And to me, it was not good news. I felt like what that’s not great. I want to know what’s wrong. You know, I wanted it to show something. So but those tests were normal. And then I also did testing with a physical therapist and vestibular therapist who did a lot of different I did a posturography test in a booth and they can make the walls move and the floor moves and it you know really just throws your system sort of into chaos to see how you respond to different things. And that was interesting. That did show vestibular dysfunction, so that that was a little bit more helpful. But then I also ended up in a neurology office, and they did MRIs. So it seems like every, every different kind of provider, I would go to had a whole set of testing. And the MRIs came back normal. So yeah, it’s, it was an ongoing process, probably for two years of and I ended up the audiology testing. I’ve done a couple of times. The vn g, and the hearing test,


Kimberly Warner – Unfixed Media  15:57

was there a period of recovery for you afterwards, it doesn’t sound as you’re describing, it just doesn’t sound to me that you had a lot of anxiety in those tests,


Karen Mizrach  16:06

or in the physical therapy testing. It did take me a while to recover. I it really throat through my system into some symptoms that didn’t resolve quickly. But I was able to go home, you know, I sat there a while and rested and I was able to get myself home. So yeah,


Cynthia Ryan – VeDA  16:40

I’m sure it’s very hazy, as you can probably tell us about this with your experience, it’s different for everyone. And some people have more dramatic reaction, either because their physical, their physical problems are more dramatic, or, you know, they might simply be more prone to feeling anxiety. And I know, my mother has manures disease, and and there have been times when she has been in the office and couldn’t couldn’t leave for hours because she you know, she was just, there was something that was done that that caused her to spin. I’m curious, I’m curious, Karen was talking about how you had some tests and audiologists office, I’m in an EN Ts, some of the physical therapists, some of the neurologists, obviously, you know, I always think of vestibular testing being done by an audiologist. But it seems like every as with every part of vestibular care, it’s a multidisciplinary team act. He’s loose, can you talk about how you work with the other health care providers in the on the patient’s team to to collect the information from the tests and to interpret the results and share that with the patient? How does that? How does that communication work?


Jesus Gomez  18:08

Yeah, so typically, what will happen is, in order for a similar patient to be seen, we get a referral from someone, typically as their primary care physician. So they are the main point of contact. So what will happen is, we will complete our testing that we do, we will let the patient know or impressions, kind of what we have found today, if we didn’t find anything, and then we relay the information back to the primary care physician, or other providers that are or about to be like coming up next on their journey. So if they’re going to see neurology, perhaps we’ll make the the note visible to them. And that way, everyone kind of stays in the loop as to kind of what has to happen.


Cynthia Ryan – VeDA  18:56

So Can Can I ask who’s, I don’t want to use the term responsibility, but whose role is it to to help the patient understand the the test results and what that means for their care?


Jesus Gomez  19:11

Yeah, well, for me, like when it comes to the simulator testing, like I feel like it’s my job for them to help help them understand kind of what we did today. So the way that I like to set up my appointments is like, you know, initially I’ll ask them, you know, do you know the purpose of today’s test? And kind of what is what is our main goal today? I usually always, almost always tell them, you know, today we’re going to either rule in or rule out if your if your symptoms of dizziness are due to an inner ear problem, you know, so that way they kind of have that expectation kind of set up. Okay, you know, maybe I am not going to get full answers as to why my dizziness has happened. But I will know by the end of the day, if it’s inner ear related or vestibular related so As we progress through the testing, I like to always, you know, we’re in there for a really long time, two to three hours is, is a very long appointment. And a lot of doctor’s visits, you know, aren’t that long, you usually you’re in and you’re out. So I think it’s, it’s really important to really, you know, nurture that relationship with your patient, and really get to know them during this time. And kind of this is where I’m kind of gauging kind of how much the patient really wants to know about what is going on, you know, some patients are very comfortable with us saying, you know, the results today indicated that, you know, it’s not a vestibular problem, or it is, but so I’m really wanting to know, into the pathophysiology of it, like, you know, what is going on inside. So that’s kind of ways that I like to gauge them. And as we go through the testing, I’ll explain my test. And then at the very end, I’ll kind of circle back around and say, you know, the goal of today’s appointment was to, you know, rule in or rule out or inner ear. And this is kind of what we found today. And from that point, you know, I let them know that these are my recommendations, and I’m going to be sending them off to the primary care physician or whoever referred them to me, and that they can always contact me if you have any questions. So


Kimberly Warner – Unfixed Media  21:19

okay, since your your approach is so much better than good news, you don’t have to stipulate. Karen, go ahead. Yeah, I


Karen Mizrach  21:31

was just gonna say, tying in with that I, I love how you talk about maybe ruling out things, rather than saying everything’s normal. It’s, I think that would have been so helpful for me, if I had understood that. We’re not just looking for the problem, we may just be able to rule out a few problems. And I did not really understand that going in, I thought, you know, we were going to find the answer. So I like that you said, you’re going to talk to them about rolling out things to that. That is important.


Kimberly Warner – Unfixed Media  22:16

Karen, I had the same thing happen. I had the same I went through two different days of audiological testing. And I got the good news, everything. Right, you passed all the tests with flying colors. Yeah, it’s very disheartening after you’ve been struggling for so long. Yeah.


Cynthia Ryan – VeDA  22:38

I think it is a big role for all healthcare providers to set expectations for, for their patients, because we see health care providers as this, you know, this paragon of knowledge, and they’re supposed to, we go to them, and they give us the answers. And sometimes they don’t have all the answers, and it is so specialized, you know, Jesus does one thing. So he’s not going to be able to give you all the answers, he’s going to be able to give you certain answers. And then, but setting those expectations and educating like you do, hey, Soos, you know, I’m going to do this, and then I’m going to pass you on to this other, you know, then you’re going to go back to your primary care, and they’re going to do this. And I had one other thought. And Karen, maybe you can share your experience with this, you know, in the especially in the acute phases of the stapler problems. Oftentimes, patients experience some, some cognitive slowness, some cognitive difficulty problems, thinking and concentrating. And I have to imagine that that affects your ability to even hear and interpret what a healthcare professional is telling you. Did you did you have that experience? Karen?


Karen Mizrach  23:52

Yes, I would assume that I did. I felt like I was trying to concentrate and focus, you know, and listen, but you’re right, there’s so much going on. And like I said, I was worried about how I was gonna walk to my car. So yes, I think there is that feeling that I can’t really take all this and it is hard to keep track. And when you end up having so many tests done and so many health care providers, you do there is some trouble I would say keeping track of who said what and what it meant. And I would end up coming home and researching a lot. You know, just based on the few words I took away from the appointment I would come home and and look at it and that I mean when I am on my own and I went to most of these appointments on my own, but I think that if patients do have an opportunity to Bring somebody that might be helpful to take notes or just be a second set of ears and eyes to interpret.


Cynthia Ryan – VeDA  25:11

Yes, I’ve heard that as well is used is that? Do you have that happen often during the whole audiological testing process? Do you have family members coming with the patient?


Jesus Gomez  25:22

Yeah, a lot of times, that is the case. And there is some fogginess to kind of you know what their symptoms were because it has been a while or, you know, maybe the r&b at acute phase and they are experiencing those symptoms. So that could be a factor. And we have those thoughts in the back of our head. There’s specific test results as we go on, we’re also analyzing. And I think it’s also, you know, Karen, what you said about, you know, we gave you so much information, but then you had to go and do some research at home. And I think that can happen so many times, because, you know, we’re talking about some really complex things, and then we just give you all that information back. So something that I learned, when I was at the Cleveland Clinic, where I completed my externship, I was under the direction of Dr. Julie Honaker. And what she really stressed to me was that, you know, we need to give something for the patients to take home. So she would give them these, you know, her recommendations, and kind of, you know, what were the next steps. And I just found that to be so valuable, because you know, it’s true, we give you so much information, by the time you get home. You know, there’s it’s hard to remember everything, and it’s good to, for you to have, you know, something in writing, you know, this is kind of what we found today or interpretations. This is the next step where you need to go


Karen Mizrach  26:47

yes, yes, that’s, that’s a huge help. And I love that idea of writing something down to take home. So that, you know, once you’ve sort of recovered and can think about it, you’ve got that information. That’s great.


Cynthia Ryan – VeDA  27:04

And I think that’s one of the roles that VeDA plays in the in this process is, with our educational resources, helping patients understand, hopefully, before they go in for testing, but if not, you know, like I many of our professional members, handout vetoes articles to their patients and say that they’re a big part of it is that they’re patient, they’re there. They’re easy to understand, you know, it’s not a lot of medical jargon. And just just that understanding what just went, just what happened can really reduce your anxiety a lot. And, and, Karen, I think it is also really important to point out how different it is, if you have a support network, both to go to your appointments with you and to to evaluate the information when you get back. You know, I might my brother just was in an auto accident and has a vestibular concussion. And we are all the whole family is on an email, you know, check it he’s checking in with me because of the vestibular part, my sister because she’s a physical therapist, and we’re all helping him understand the results of his his tests, because the information he’s been given is really complicated.


Kimberly Warner – Unfixed Media  28:27

Karen, you’ve had a long journey since 2017. So I’m kind of looking at the whole trajectory of your journey here. And the you know, we’re focusing on vestibular testing today. How, in your opinion, valuable, was that testing for you, personally? Because I know it sounds like a lot of them didn’t really offer any results for you. But I’m curious, in your opinion, what what that felt like for you, and what do you feel the value of


Karen Mizrach  29:04

those were? That’s a good question. I think at the time, I did not see the value. I felt very frustrated that I was spending so much time and energy and effort getting to these appointments, and I really wasn’t getting any answers. But at this point, I’m glad that I did them. Because I one thing I would say to patients is you really don’t need to keep repeating these tests. And so now that I have done those, I’m done with that. And I am glad that I did that. And I ruled out some of those things so that I could focus on the neurologic It aspects of what’s going on with me. So I didn’t feel it was valuable at the time because there were no concrete answers. But now that I’ve learned more about it, I feel that it is important to get some of those tests initially, the physical therapy tests, I did think were helpful. But I think that maybe had more to do with the fact that the physical therapist was very supportive. And that was when I first got clued in that there were a lot of people that had problems like this, I thought I was the only one. And I had never heard of this. And the physical therapist was the first person that really talked to me about how this does happen often, and there are things that can be done. And I felt that the testing did give me a little bit of information on how to proceed. So. And really, also, I would add that it’s important, and I did not learn this right away. But it’s important to get your test results. On paper, I think, take them home, keep track of what tests you’ve had, when you had it what the results were. Because with these conditions, you may end up going to several different providers. And if you can show them you’ve had some of these tests, you don’t have to repeat them again. And so I do have a folder that if I’m going to a new doctor, I will take with it. So I don’t need to repeat all these all the time.


Kimberly Warner – Unfixed Media  32:07

See, Cynthia, I think you’re muted.


Cynthia Ryan – VeDA  32:11

Yes, indeed, I my mouse moving background, I’m trying to keep you guys from having to listen to my cat. So I was I was just saying they’re not fun the first time. So why Doom again? Jesus, can you think of can you share with us maybe the story of a patient that was having a particularly difficult time when they came to you and maybe had one of the the longer batteries of test? And what you were, you know, how did you help them through that process? And what do you think the outcome? What was the outcome?


Jesus Gomez  32:51

Yeah. So something that really comes to my mind is, I had a patient who just had a lot of anxiety coming in, they had, they had a lot of other things going on with them, but in particular, that their dizziness was so debilitating for them, they actually wanted to come and see me on a wheelchair. So that’s kind of how we started their appointment. And they expressed to me how, you know, she’s heard about that water tests that, that you were talking about carrying of that water going in your ear. And she was like, I, I’m really nervous about that. I want to do it, because I want to have an answer today. But in order, like, but, you know, just just walk me through it. So one of the end up happening was, you know, I explained to her kind of first what our test was going to do, like, you know what, what the point of this was, and then just went through the, you know, where this this test is called the caloric you know, we’re going to be putting warm and cold water in and really just, you know, kind of helping her to kind of know what is to come. I don’t like to use words, like, you know, for example, this is going to make you really dizzy, I don’t like saying that. But I will tell them, you know, this test might give you a sensation of motion or something like that might make you feel like you’re floating. And with that in mind, the patient is kind of able to prepare kind of what is to come. But then at the end, I always tell them or before we start the caloric I will say, you know, I want you to know that, you know, this test is important and that we do need to get these results. However you are in control of this that you know, if you choose to we can stop this test and we don’t have to do it. But you know, it will give us some information that maybe another test wouldn’t. So as we began kind of, you know, you know, closed up those goggles, I you know, gave her a little countdown and you know, you know put the water in and you were carrying you probably remember that water was really warm at first probably right yeah. So she was, you know, she’s like, Oh my gosh, it’s so warm, so hot. I was like, Do you want to stop? And she was like, no, let’s keep going. And, you know, throughout the testing of something that we have to do is just keep the patient’s mind active. So what we do for our testing is, we’ll ask them a series of questions. And at the beginning of the test, you know, I kind of was gauging kind of what she was interested in, and like what her situation was. So I remember asking about her dog, she had this 17 year old, I think it was like a, like a Snazaroo, or something like that. And it made her so happy that she really just wanted to talk about her dog. So that’s kind of what we chose, as she was waiting. She told me so many tricks that her dog would do. And then, you know, carrying, you probably remember, there’s a point where you know, is a peak where you feeling like the most like, you know, they’re floating sensation, and then essentially, eventually come back down, and you kind of stabilize. So as she was telling me, we were able to get some good results. And, you know, she was still very happy about being able to talk about her dog. And she was like, you know, other than, like, that initial warm feeling of the water, like, you know, that was okay. And that’s kind of how he went on when we did the other year. Just because, you know, I think it’s really important to really get to know your patient. And that will help really calm them down. And, you know, what we were able to find was, you know, there was a vestibular event that happened that, you know, really, she needs to go move on for physical therapy. And I was able to get some really good results with that test that I did. And then then I explained that to her. So


Karen Mizrach  36:38

wonderful. Yeah, that’s great.


Cynthia Ryan – VeDA  36:41

Jesus, you were saying in your in the beginning that your goal is to be a multilingual clinician, do you have many Spanish speaking patients?


Jesus Gomez  36:53

Yeah. So while I was, when I was in Cleveland, I was able to see a lot of patients who spoke Spanish, and it was it was just so it was very nice to be able to speak in my in my native tongue. Because I Spanish is my first language. And all the times what happens is, when we use translators, there’s a lot that can get, you know, missed. So I really like to do that. And I feel like, you know, not only is it stressful to be dizzy, but then you’re waiting a long time. And then on top of that, you add the language barrier, I feel like it’s that can be caused a lot of extra anxiety. So I really, really just want to be able to do that to help my patients out. And I think a lot of them do appreciate that I’m able to speak Spanish to them and kind of gives them a little bit more of a sense that, you know, I understand where they’re coming from and what they’re saying.


Karen Mizrach  37:50



Cynthia Ryan – VeDA  37:51

I think that’s wonderful. It’s one of the things that Rita recently added to our vestibular health care provider directory is language, so that clinicians can, can indicate which languages they speak, because I think that it does matter make a big difference to a lot of patients to see a clinician who they can speak to even if they do speak English as a secondary language, it’s still helpful to, to have a provider that they can speak to in their


Karen Mizrach  38:21

native language.


Kimberly Warner – Unfixed Media  38:23

He says what a compassionate, thorough, knowledgeable physician you are, I just want to applaud what you’re doing. And I feel like you’ve thought through every step of the process. Thank you, from the bottom of my heart. Thank you, Karen, is there anything that in addition to what haces has already provided, and what he offers to his patients? Is there anything else that you wish healthcare providers knew? Or wish that they did to help make this testing process a little bit easier?


Karen Mizrach  39:01

Um, I guess that the best thing really like hey Soos is saying is just to show that compassion for how difficult this process is, and what we go through to find some answers. So you know, I, I always appreciate it when even if the person that I’m seeing doesn’t have anything to offer me or didn’t find anything in the testing if they understand that it’s been frustrating and discouraging, you know, just to express that and also to give direction, where to go next and what to do not just to throw your hands up and say I don’t know what to do. I’m sorry, good luck. You know, I’ve had people say that good luck, and maybe even just something small, just a suggestion of what to do next really feels hopeful. And it feels like, you know, you have some power.


Cynthia Ryan – VeDA  40:20

Necessary? Yeah, definitely empowering. So here’s your site. I’m curious, do you know if there is any, you know, advances in vestibular testing technology that is geared toward making the experience more patient friendly, or technology or otherwise processes?


Jesus Gomez  40:45

Yeah, well, there’s a wide range of advances that are currently occurring in the field. But we also, you know, just have to know that, you know, biosimilar science in itself is a very young field, there are so so many things that we are learning about the system, you know, something like that we can do is, you know, we are able to, you know, direct patients who were there, you can see some YouTube videos, for example, that will help them with their physical therapy, I’m aware of a lot of more things in terms of the rehabilitative side, that, you know, there’s virtual reality that’s being taking into account that to help the patient’s work through getting back into establishing a sense of normalcy from the comfort of their own home. Because as Karen was saying, you know, it’s, it’s a journey to getting up there, you know, a lot of these vestibular centers are kind of spread out. You’re lucky a lot of times if there’s one, like within an hour of you, when I was in Cleveland, and people travel five, six hours just to see me. So just innovations like that, and there’s still so much that the field is still growing.


Cynthia Ryan – VeDA  41:55

You’re absolutely right there is there’s still so much to do with with vestibular research. And a lot that is going on I thank you for that is there is what would you say is your biggest takeaway from today?


Jesus Gomez  42:13

I just I really appreciate, Karen, just your your side your perspective of things. Because I really think it’s so needed for other providers to really hear kind of how the patient is feeling. You know, that, you know, it’s, it’s really not okay to say everything’s normal, because the patient knows that, you know, maybe my results were normal today. But I don’t feel normal. And what we’re trying to do is we’re trying to help you regain some normalcy to your life. And I would just really appreciate that so much. And I think this will help educate other providers that you know, that we have to take into account the patient as a whole kind of what is going on, in their, in their daily life that they’re, they’re missing out on, that they want to regain. And I think it’s really, really important that we’re aware of that.


Cynthia Ryan – VeDA  43:07

That is a perfect way to wrap this up that it’s, you know, we’re looking at this. We were looking at this from a holistic perspective, you know, each patient is a person first and what’s going on in their life and how they are being impacted by this is going to differ when,


Karen Mizrach  43:30



Cynthia Ryan – VeDA  43:31

when clinician Bridget Wallace likes to say when you’ve seen one vestibular patient, you’ve seen one vestibular


Kimberly Warner – Unfixed Media  43:37

patient Oh, I love that. That’s that is. Yeah. Karen aces. Thank you so much for sharing your your passion, your stories, your pain. With us today I am you know, my take home from this is just the the absolute importance of laying down clear communication for these tests from the very beginning, what are the expectations and letting that patient know? Every step of the way, you haces hold their hand every step of the way. And I think that’s essential. So thank you and Karen, thank you for sharing, baring your soul with us a little bit and telling us how hard this experience can be.


Cynthia Ryan – VeDA  44:24

Yes, thank you both. Hey, Soos we’re gonna see if we can call on you.


Karen Mizrach  44:32

Thank you for inviting me, I really appreciate it.


Jesus Gomez  44:39

Thank you. It was great. Being able to speak with you all and thank you for sharing your experience. Karen. I really enjoyed it. And thanks


Cynthia Ryan – VeDA  44:47

to the whole vestibular community for for being there to to listen and and support us and for additional questions. Please visit vestibular.org To find out more about vestibular testing and find a vestibular healthcare provider near you. Alright. Thanks for tuning in to ICU this month.


Kimberly Warner – Unfixed Media  45:17

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