Sometimes I feel angry when someone looks at me and assumes I am well. I know that may seem weird since I do SO MANY activities on a daily basis to maintain my wellness and live a full, active life. On a conscious level, I absolutely want to project an image of wellness. It’s better for my business to appear to be completely capable and dependable, infallible if you will. As a healthcare provider, I also have a certain responsibility to be a role model of self-care and wellness, which is the motivation for so much of how I spend my time and money these days. So I feel embarrassed and I wish it wasn’t true but often I feel a wave of anger when someone looks at me and assumes that, since I am young and I am smiling, I am pain free and have perfect balance.
When I feel that way, I breathe and try to remember the prayer of St. Francis. Then I return to asking myself the question, how can I be of service? How can I share my experience, strength and hope with others who are still suffering? I find that being of service to others who suffer like I have helps me find meaning in my journey to this place in my life and relieves my feelings of anger.
I have been battling with vestibular migraines since I was a kid. I remember my mom taking me to Fort Meade Hospital in Maryland when I was in elementary school on multiple occasions to get a demerol shot in my buttock to reduce the pain, stop the vomiting, and allow me to fall asleep. I distinctly remember the first migraine I ever had: I was lying in my bed crying for hours. It felt like a big, strong man was sitting next to my bed squeezing my skull as hard as he could. I remember I couldn’t even move or open up my eyes. Then I began vomiting repeatedly and my mom took me to the hospital for emergency care.
I have probably been to the emergency room at least 10 or 15 times in my life due to uncontrolled migraine pain and unceasing vomiting that lasted for hours to days.
Once I got older, the migraines became more frequent and severe. The magic ER cocktail seemed to be narcotic pain medication, anti-nausea medication, a tranquilizer and an IV for hydration, plus of course saltine crackers, apple juice and a blinding fluorescent light in my eyes the whole time until I stopped vomiting and crying because I passed out from the drugs.
Before I learned how to heal myself and care for my migraine episodes as I do now, I was at high risk of becoming a prescription drug addict, as many migraine sufferers are. I was taking triptans orally and by injection 2-5 days per week, which is not recommended because it can cause cardiac side effects at high usage and is generally only for intermittent use. I carried a purse full of prescription muscle relaxers, anti-inflammatories, opioid pain medications, strong non-narcotic pain killers, and anti-nausea suppositories. I spent thousands of dollars on medications and often had rebound headaches from taking so much. But still I forged ahead, putting my career and my job performance before my health and well-being, popping pills, drinking coffee every morning, skipping meals during the day, drinking a glass of wine almost every night and staying up until midnight or 1am checking my work email from home.
One time I even drove home from my office with an extreme migraine, holding a trash bag on my lap and vomiting the whole way. I felt the dizziness, nausea and headache coming on while I was at work and I knew that if I stayed at my office I would get stuck vomiting and lying on the ground in the public restroom in my office building. When my friends later found out I had driven my car while vomiting, they made me promise to call someone for help next time or to call a cab. It had not even occurred to me to call someone to ask for a ride, since I was so independent and enjoying so much professional competence and success at that time. I had to be strong and not let anyone see my weaknesses.
“I’ve got a bluebird in my heart that wants to get out. But I say “Stay in there." I’m not going to let anybody see you.” - Charles Bukowski
I remember one time around 2008, when a particularly severe episode of "vertigo, vomiting, headache, blurry vision, off balance hell" lasted well beyond the first ER trip because I was having the “worst headache of my life” and so I got worked up at the ER for a subdural hematoma, which is a stroke caused by a bleed in the brain. In order to check for the subdural hematoma the ER doctors performed a spinal ta,p or lumbar puncture, to look for blood in the clear fluid around that surrounds the brain and spinal cord, or cerebrospinal fluid (CSF). They didn’t find any blood in my cerebrospinal fluid so they decided that I must not have had a stroke - THANK GOD - and it was simply the “worst headache of my life.” I was thinking, that’s what I told you guys that when I came in here eight hours ago!”
Then I was sent home with the “magic ER cocktail” of medications to treat all of my symptoms and told to “sleep it off.” When I woke up, my headache was even worse and I could hardly stand up or walk to the bathroom. Can you imagine how the “worst headache of your life” could possibly get any worse??? It was so bad that my mother had to get on a plane immediately and fly to California on the same day to come to help me because I was having a vestibular, migraine, anxiety, pain crisis - a total meltdown. I was hysterical and could not get off the couch because my head hurt so bad and my dizziness was so severe. When I returned back to the ER again, with physical assistance to even walk because I was so weak from vomiting for days, the ER physician realized that I was having an adverse reaction to the spinal tap, which is fairly common but I had been unaware of the possibility when I consented to the procedure.
I have since learned that as many as 25% of patients who have a spinal tap develop a headache from the cerebrospinal fluid leaking after the puncture into the nearby tissues. These post-puncture headaches typically last for hours to days after the spinal tap, but can last for a week or more. Like mine, they often co-occur with nausea, vomiting and dizziness.
In order to prevent these severe, debilitating migraines, a neurologist I followed up with wanted to put me on a beta-blocker, even though I was only 30 years old. I refused because I didn’t see an end in sight if I started taking that medication so young. Another neurologist I consulted with prescribed anti-seizure medications, which have such severe side effects that woman are strongly advised against getting pregnant while on them due to the high probability of birth defects. As a woman of child-bearing age, that did not appeal to me either.
I have my Yoga Teacher and Physical Therapist, Rachel Krentzman to thank for my eventual breakthrough. Rachel worked with me in individual yoga therapy sessions for years to teach me a variety of therapeutic yoga poses and sequences to heal myself from anxiety, depression, migraines, neck pain, back pain, SI joint pain, shoulder pain, and to improve my balance. She helped me develop a solid home practice for self-healing. Rachel then invited me to attend her 200-hour Purna Yoga Teacher training to learn more about the theories of yoga therapeutics and to deepen my understanding of how to take care of myself with yoga. I have since continued to study and practice yoga therapy with many very skilled teachers. But it was Rachel who witnessed me going from one neurologist to the next during our years of working together, with discouraging results, and recommended that I consult with Dr. Kulreet Chaudhary, MD. It was not until I found Dr. Kulreet Chaudhary that I learned this principle of Ayurvedic medicine:
“If you eat the foods that are right for you, you won’t need medication. If you don’t eat the food that is right for you, medications won’t help you anyways.” -Principle of Ayurvedic Medicine
Through working with Dr. Kulreet Chaudhary, I realized that my high-pressure, high-salary job was literally killing me. While under the care of Dr. Chaudhary, I was unable to work for almost an entire year due to the severity of my symptoms. I had to resign from my job, go on disability, and still I continued to suffer almost daily migraines, vertigo and dizziness with occasional panic attacks and bouts of depression symptoms. While I was unable to work, I was able to frequently follow up with Dr. Chaudhary for ongoing monitoring, gradually transitioning to an Ayurvedic lifestyle and self-care program and, over time, eliminate all prescription medications.
"I learned the difference between forcing and feeling, and to honor the messages from my body."
From a place of desperation to return to well-being, I discovered healing modalities, tools and remedies to reduce if not completely eliminate all of my symptoms and health conditions that I had not previously been exposed to during my training as a Doctor of Physical Therapy. My self-care program now consists of a combination of principles, practices and techniques from Ayurveda, Chinese Medicine, Qi Gong, homeopathic medicine, Naturopathic medicine, Bach flower essences, essential oils, energy healing, ThetaHealing, sound healing, yoga therapy, magnet therapy, mindfulness, spiritual reading, drumming, devotional singing, walking meditation, laughing meditation and community service. And to tell you the truth, vestibular migraines are just one of the reasons I experience occasional episodes of dizziness and vertigo. I have many other health and medical conditions that I have to manage on a daily basis to reduce if not completely eliminate my episodes of dizziness or vertigo, including a history of multiple BPPV episodes and a vestibular hypo function from chronic ear infections as a child, along with atlas subluxation complex from the orthopedic trauma I have experienced (to name a few…more to come on that later).
But I still breathe and smile. People look at me and see me smiling and laughing, appearing to be well and care free. How am I able to do that?
The First Reason: Because I practice mindfulness taught in the tradition of Thich Nhat Hanh, and I have developed compassion for myself.
I have reduced my living expenses and I live in a studio that is less than 200 square feet so that I can work less, take better care of myself, and enjoy my life more. The more I notice I am suffering with anxiety, migraine, sinus headache, dizziness, vertigo, imbalance and depression as a result, the more I slow down, look deeply into the situation, observe my symptoms, and then take compassionate action to nurture myself, even if that means “not showing up” somewhere that I said I would be. I am so lucky that I have found a community of friends who understand what I am experiencing and forgive me if I have to cancel on them when I am not well. They know when I do show up, it will be with my full presence, whole-heartedly and I will bring a warm smile.
Because I am a practitioner of mindfulness as taught by Thich Nhat Hanh, I am part of his Sangha, which is a worldwide community of people who are determined to live in peace. Through my local Sangha I have found a community of support - a refuge when my suffering becomes more than I can bear alone. I have friends who nurture me who I can count on, and I am part of a global community of mindfulness practitioners who are there for me. I now know I have a community that understands me and a safety net to catch me if I fall, who will compassionately witness my life. As one of my Sangha sisters recently said to me, “I am never alone again."
The Second Reason: Due to sheer desperation, I have sought out the most skilled team of healthcare providers to address all the causes of my dizziness and I continue to follow up with them and do my best to live by their recommendations. I now know and understand so much about dizziness and vertigo, perhaps more than any single provider than I have ever met, that I no longer worry about when I will get the next vertigo attack, migraine or panic attack.
The professional blessing I have received as a result is that is that I now have a highly skilled network of providers that I can refer my patients to when they have multiple causes of dizziness and vertigo. I have realized that I don’t have to know everything myself, but I have to know who to ask. Some of my patients have seen 14, 23 or 57 doctors before they find me and are able to receive a detailed, comprehensive, holistic evaluation of all the possible causes of dizziness and vertigo that are affecting them. When I provide them with a list of possible or likely causes of their symptoms sometimes up to 10 or 15 different causes, they are usually stunned but it validates their experience and explains why they never got complete relief from any other single healthcare provider. I have discovered that the best care for someone with dizziness or vertigo comes from a humble, competent team of individual providers whose skills are complementary, and who are willing to recognize the limits of their knowledge, stay within scope of practice, and make appropriate referrals to other qualified providers.
Fact: Dizziness is usually multifactorial.
The Third Reason: I have trained my boyfriend to be a compassionate witness. I have a wonderful new man in my life, Simon, and I have explained to him the extent of my symptoms of neck pain, anxiety, dizziness, vertigo, migraines, sinus headaches, imbalance, occasional falls, hip pain, vestibular decompensation episodes, and resulting depression symptoms. He listened to my explanation without flinching and said “I am here for you. Let me know what kind of support you need.”
So I took the opportunity to educate him on principles of managing vertigo that I teach in my continuing education courses for physical therapists. I told him about deep belly breathing for reducing anxiety if I have a vertigo-related panic attack which seems to just automatically happen within my nervous system, if I feel like I am going to fall from dizziness or vertigo. I told him that I still want to live an active life and have fun. I want to challenge myself and experience all that life has to offer without fear or avoidance, like I experienced for many years before I was this knowledgeable and skilled at caring for myself. Then I taught Simon the three principle of active rest technique for managing symptoms of vertigo.
I also taught Simon the six mantras that Thich Nhat Hanh uses for relationships, to be together in harmony and awareness. We have now incorporated these mantras into our daily communication and built compassion into our everyday speech, which nurtures and heals us both.
Recently, we went stand up paddle-boarding in the Pacific Ocean, to a kelp bed about 500 yards off the coast of San Diego and the water was extremely choppy due to some wind gusts. Between the paddle-board rocking all around on the waves, my visual field moving with the crests of all the waves, the wind blowing me around and my vestibular impairment, I was terrified that I would fall off my board. I was seeing HUGE fish swimming about three feet below me that looked like sharks and I became terrified. Another friend tried to reassure me that they were “only Barracuda.”
It’s not the same appeal as swimming with the dolphins, let me tell you! So I had to lie down flat on my back on my paddle-board and look up at the sky while relaxing and breathing to recover from that panic attack and visual vertigo experience before I could make it back to the shore.
Another time recently when Simon and I were hiking in Elfin Forest in San Marcos, CA, we came upon a stream about 20 feet wide rushing white water and slippery, wobbly rocks that hikers had to climb across. I started across the stream but then I started having vertigo from the uneven, wobbly, slippery rocks we were stepping on combined with the rushing water which created a complex visual background. I just knew I would fall in the water any second and I started to panic so we had to turn back and were unable to complete the trail. I was so embarrassed but I also respected the limits of my balance. Simon was very supportive, not frustrated with me and didn’t express any disappointment so it made it easier for me to calm down and smile again after I had panicked.
Then on another trail at Mission Trails in San Diego, we were scrambling up the side of mountain last Sunday morning near some rock climbers. I noticed my balance felt a bit off after a Saturday night of enjoying a few adult beverages and the alcohol was still in my system. I am not a heavy alcohol drinker at this point in my life, since alcohol triggers migraines and impairs my balance. We got to a point towards the top of the trail where I started to notice I felt like I was going to fall backwards and tumble down the mountain. We were so high up that there was a lot of exposure of the visual field to a drop off and not many trees or bushes. There were dirt and rocks, some wedged in the ground and some loose rocks. At one point, I looked down, wobbled, lost my balance and started to panic. I almost fell backwards and then I sat down quickly on a large boulder. I had been doing great with the hike so far and clearly my hip was holding up well after a long three year process to rehabilitate it after an extensive surgical repair.
Simon bounded easily up the rest of the trail to the top of the mountain and circled back down to report that the “view was awesome.” He absolutely thought I could make it because “It wasn’t much further to the top.” So I optimistically, dusted myself off and began scrambling up more of the dirt and rocks until we got to a switchback that was close to one of the drop-offs and I looked down. I felt like I couldn’t tell how to stand up straight. I was standing on a slanted trail with no visual vertical references, plus I have vestibular issues and had consumed alcohol the night before. Before I knew what was happening, I experienced a full blown panic attack and lied down on the trail, placing my stomach, arms, legs and face against the dirt and rocks. I couldn’t move or breathe.
Simon was about 10 feet in front of me, almost at the top again when he noticed that he didn’t hear me behind him anymore so he turned around and saw me lying there frozen. He immediately walked back down to where I was and asked kindly, “Are you ok Babe? Did you fall?” To which I replied, “I’M TERRIFIED! I AM GOING TO FALL OFF THIS MOUNTAIN AND TUMBLE TO MY DEATH.”
At that point, I was so grateful that I had previously shared with him how to help me with a panic attack and what I teach to my patients and students about managing episodes of vertigo, because I could not think clearly at all. All I could think about was sliding over the ledge on my left or tumbling backwards down the mountain. All I could picture was a clip I had seen of a hiker tumbling to his death head over feet. Then my mind flashed to the embarrassment I would experience if a helicopter had to come rescue me but I also knew I couldn’t hold on for long enough to wait for a helicopter. It all happened so fast but it felt like an eternity as I clung to the dirt and rocks with every part of my body.
Luckily, Simon came around to my left side and coached me, “Ok Babe, you are ok. Just breathe. Notice your belly rising and falling as you breathe. You are ok. You are safe. I am here for you. Feel the ground under you. You are lying down on the dirt so you cannot possibly fall right now. Feel the stability of the ground. Keep your eyes focused like a microscope on only your next step and do not look around. Keep your head as still as you can to keep your vestibular system quiet. And breathe. OK now roll over and slide down.”
At which point, I was able to roll onto my side then onto my back and begin to slide down the trail on my buttocks until we arrived at a spot where there was scrub along the sides of the trail. Once we arrived back at that level, I was able to stand up and walk without a problem because the trail had leveled out and there was more visual references to orient myself to upright and vertical. By the time we reached the bottom of the trail and the road leveled out, I was walking and balancing just fine but still reeling from all the adrenaline. I was absolutely covered in dirt - my arms, legs, clothes and face like camouflage paint. Later that day, I found a cup of dirt from scooting down the mountain in each pocket of the jacket I had tied around my waist.
One of the other important tools that I have layered into my life to reduce the anxiety that I experience during my experiences of vertigo is laughter. When I laugh, it helps me to relax and enjoy my life more, overriding the feelings of anxiety that often appear during my daily life. Now that I have discovered the importance of laughter in my own life to minimize pain, reduce my symptoms of depression and anxiety, improve my immune function and enjoy my life more, I bring my laugh with me wherever I go. Sarito Sun, who teaches Laughing Meditation at the lovely Chopra Center in Carlsbad, CA, mentored me in leading laughing meditation a few years ago and studying with her, I earned a Certification as a Laughologist! Sarito taught me to laugh in the morning when my alarm goes off before I even open my eyes. I can hear her voice now reminding me, “When your alarm goes off, before you even open your eyes, stretch like a cat and laugh. You will have a beautiful day.”
In 2014, I was a Keynote Speaker at the All America Laugher Yoga Conference. Ever since then, I have been a card-carrying member of the "Ha Ha Sisterhood,” which is a global community of woman who vow to:
- Laugh in front of others every day
- Help someone laugh every day
- Do something good for you everyday
“Sometimes you climb out of bed in the morning and you think, I'm not going to make it, but you laugh inside — remembering all the times you've felt that way.” ― Charles Bukowski
I have practicing physical therapy since 2002, making house calls and caring for older adults since 2004, and specializing in vestibular rehabilitation since 2006. During my professional career I have had to continue to work while experiencing a migraine on many occasions. I have vomited on the front lawn of patients homes and in the kitchen trash can at another patient’s house. I have had to step out of staff meetings at my office to throw up in the outdoor stairwell trashcan so that no one would see me. And, much to my horror, I have even vomited in front of my colleagues in trash cans a few times while having a migraine. During my annual performance reviews, many of my supervisors have reflected to me, “You are the best physical therapist I have ever hired but you also call out sick more than anyone I have ever met."
For the longest time, I was not sharing with others what I was going through, because like many who suffer with dizziness, vertigo, anxiety and headaches, I didn’t understand what was happening or how to manage it and I just kept pushing myself. I have since learned that the “perfectionistic, type A, overachiever, high performer” is a typical personality type that often co-occurs with dizziness, headaches, anxiety and neck pain. In fact, when I attended the Advanced Vestibular course created by the Neurology Section of the APTA that I realized that I was a “classic” vestibular presentation. Michael Schubert, PhD, PT, presented a case of a woman who was in a high-pressure, high-paying job in her 30’s, type A personality, perfectionist, complaining of jaw pain, neck pain, headaches, migraines, anxiety and sinus/allergy issues. It was literally a defining moment in my life - I realized I didn’t want to be a “classic case” anymore. ""
"Our smile affirms our determination to live in peace and joy." - Thich Nhat Hahn
Through this experience of sharing my vulnerability with my Sangha, with my boyfriend and now with you, I have realized that I can be strong and competent sometimes. But it’s ok to need to ask others for help and support sometimes too. That’s where the mantra “That’s partly true” becomes relevant - to recognize all aspects of ourselves and accept all of it as part of this human experience. I am sharing this with you today, not because I want your sympathy or to be dramatic, but because I now I know that I am not alone. I share my truth to reassure all those who are suffering in silence, feeling alone, appearing to others from the outside like “they are fine” while feeling angry, anxious, depressed and misunderstood in the vestibular/ anxiety hell inside their own head.
I hope you can reach out to your loved ones, open your heart, tell them the extent of your suffering, and when you are having a “good day,” teach your loved ones how to coach you:
- How to reduce anxiety during a panic attack
- How to relieve or reduce vertigo symptoms during an attack
- How to communicate with you with compassion to support you through it in a loving way
To my brothers and sisters in the world who have been suffering for years and feel alone and misunderstood, I am breathing with you now. I wish you all the best on your journey to recovery. My wish for you is that you have a comprehensive evaluation so that you can discover the root cause(s) of your symptoms and eliminate them or empower yourself to prevent and manage them. My wish is that you will live again!
“We must learn to cure what need not be endured and how to endure what cannot be cured.” -BKS Iyengar
I have made a big pile of compost with my years and years of suffering and I’m using as fertile soil to grow something beautiful to share with the world - my message of hope, precision in evaluation of dizziness and vertigo, clarity in treatment planning and optimism for a better life for those who suffer like me. I believe that, no matter what our religious, ethnic or cultural background, or political beliefs, we can all agree on providing the best possible experience to our loved ones who are growing old and dying. When I am in my 80’s and 90’s, if some new piece of information emerges that will reduce my suffering and humiliation, I hope another young and smiling advocate emerges to walk with me at the end of my life too. That’s why I have dedicated my career to providing an excellent healthcare consultation service for patients, and teaching and mentoring other healthcare providers to expand my reach. That's why I now publicly advocate for vestibular screening for all older adults, especially those with unexplained repeated falls, and offer world class quality of care for vestibular patients of all ages, especially those who are undiagnosed or improperly diagnosed.
That’s why I have transformed my own experience into a comprehensive, holistic approach to dizziness and vertigo that has now reached thousands of people suffering worldwide, called “The Bell Method.” The professional services that I provide and the continuing education curriculum I have developed are the beautiful lotus flowers that have grown out of the mud to offer to the world from my experiences. And much like the flowers blooming on the bluff that I see in San Diego overlooking the ocean, I am going to be here doing my thing whether anyone notices me or not. I am holding the space for healing to occur in thousands of individuals and insight to arise in the minds of thousands of healthcare providers.
In the last year, I’ve had over 200 licensed physical therapists graduate from my continuing education courses and I continue to develop two additional training manuals for the intermediate and advanced level courses that I am launching in 2017 for the physical therapists who have completed my foundational curriculum and want to master “The Bell Method.” I am offering consultations to patients worldwide in the Bell Method assessment and healing strategies. And I have developed a comprehensive continuing education curriculum, along with creating vestibular study groups, for physical therapists, physical therapy assistants and primary care providers to support the enrichment of their practice and improve the quality of their outcomes. I have launched a YouTube channel to educate the public regarding frequently asked questions about dizziness and vertigo, hosted a national webinar as a VeDA spokesperson in 2015 to raise awareness on “Balance & Aging” as well as published a NewsBrief on the topic of the rise in fall-related deaths older adults, due to undiagnosed vestibular disorders.
I have blazed the trail for sure to save my own life, but I am happy to walk with you along the way as you save yours. But do me a favor, let’s start with a walking meditation so we can just breathe, smile and enjoy being alive on this glorious day. Hear the birds chirping, feel the sun shining on your face and the wind blowing on your skin?
As I recently told one of my new patients who was astounded by my genuine smile when he learned the extent of my intermittent dizziness and vertigo episodes, "I wouldn’t change it for the world.” Now, I can honestly say that I am actually grateful for all my experiences because I have been desperate enough to heal myself that I am now uniquely qualifed to facilitate the healing of others, deeply and completely.
“I wouldn’t take nothing for my journey now.” - Maya Angelou
I will leave you with perhaps the most important advice that Dr. Kulreet Chaudhary ever gave me during my years of working with her to get off my prescription medications: “In order to be healthy, you have to disappoint at least one person every day.” Once I started putting my own well-being ahead of what I thought other people expected of me and who I thought I was supposed to be, I was able to step into my authentic life and discover my life’s purpose. I still keep a single point cane in the trunk of my car in case I have a really bad day, but at least it’s purple with some bling on it!
A poem written by one of Kim's friends after reading her story: