Author Topic: A word to the wise regarding vestibular rehab  (Read 3322 times)

wendysig

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A word to the wise regarding vestibular rehab
« on: October 03, 2008, 06:18:09 am »
Hi all,
I only have three sessions left for vestibular rehab (my insurance company only allowed 12 sessions as a lifetime benefit for this problem) and although I am happy on a whole with my progress and the two PTs I've been working with, every now and then they say something that makes me think I am their very first AN patient.   Yesterday my PT said my vestibular function being weaker on my right (AN) side.  This really floored me and I told him the vestibular nerve has been removed during surgery and never grows back.  It has always been my understanding that the vestibular nerve in your good ear takes over all balance function after surgery.  I know vision plays a part in balance functiuon  too, but it makes me wonder again if these guys really know what they doing with regard to treating AN patients.  Although I did make the mistake of not asking how many AN patients they had treated before I began physical therapy, I did ask if they provided vestibular rehab.  I recently asked one of them if they had treated many AN patients and he said "Not many"  I have a feeling the real answer was "Not any."  I do know that halfway through my 12 sessions this same PT told me he had just finished a course in vestibular rehab and that I was his guinea pig.  I have a feeling I was everyone's guinea pig.  If you are planning to start vestibular rehab make sure you ask how many AN patients have been treated at each facility you check out.

Wendy
1.3 cm at time of diagnosis -  April 9, 2008
2 cm at time of surgery
SSD right side translabyrinthine July 25, 2008
Mt. Sinai Hospital, New York, NY
Extremely grateful for the wonderful Dr. Choe & Dr. Chen
BAHA surgery 1/5/09
Doing great!

Dog Lover

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Re: A word to the wise regarding vestibular rehab
« Reply #1 on: October 03, 2008, 09:13:55 am »
Oh my gosh. Doesn't it just make you so frustrated when you are either paying LOTS of money or burning what insurance benefits you have and the provider isn't as qualified as you were led to believe?

I"m so sorry. But you said you have 3 sessions left.. maybe looking for another VPT would benefit you. Even if you could only see an experienced AN VPT for 3 sessions it might make a big difference in your progress.

Good luck,
Cathy
Cathy
9mm x 3mm Left Side AN
Mid Fossa Aug. 21, 2008
Dr. Gantz / Dr. Woodson
Univ. of Iowa Hospitals and Clinics
No facial issues, hearing saved, I keep active and feel back to normal.

Omaschwannoma

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Re: A word to the wise regarding vestibular rehab
« Reply #2 on: October 03, 2008, 12:20:32 pm »
I will agree one hundred percent with you that all AN patients going into rehab make sure the facility has treated AN patients before as this re-training is so very important to getting the brain to adjust properly. 

Don't worry here as maybe in the end all will turn out okay with your PT.  Do continue your therapy when you get home adding to it by putting yourself in situations that challenge your balance--mall walking, outdoor walking, walking at night, etc.  If this fails though go back to your treating surgeon and tell him about this and he will be able to determine if your brain has compensated.  If it hasn't compensated then leave this up to him to get you into another facility and let him deal with insurance problems! 

Sorry you feel like a guinea pig and hope you progress to better balance soon. 
1/05 Retrosigmoid 1.5cm AN left ear, SSD
2/08 Labyrinthectomy left ear 
Dr. Patrick Antonelli Shands at University of Florida, Gainesville, FL
12/09 diagnosis of semicircular canal dehiscence right ear

4cm in Pacific Northwest

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Re: A word to the wise regarding vestibular rehab
« Reply #3 on: October 03, 2008, 12:36:21 pm »
You have brought up a very good point.  :)

I am finding that my own created exercises are helping the most at home. I seem to have a feel for where I am weak- and just work on it. I went to 2 sessions- to discover that the therapist did not do “hands onâ€? therapy (after the fact  :-\ >:( ) when the referral I has was for vestibular and neck therapy combined... leaving me having to find a separate therapist for the tight neck issues... so I have not gone back to that therapist.

I had a feeling that insurance would put a limit to how many sessions they will provide- so it has me thinking I need to pursue more interviews to find someone else who does PT (re the neck) and vestibular therapy. This time I will ask more specific questions before I commit to the PT.

Similar to what we have here on what to ask a surgeon- before choosing one
E.g.
http://www.anausa.org/questions_for_physicians.html

…I think we should have something for questions to ask before choosing a vestibular and/or physical therapist.

What do you think of that idea?

DHM
4cm Left, 08/22/07 R/S 11+ hr surgery Stanford U, Dr. Robert Jackler, Dr. Griffith Harsh, Canadian fellow Assist. Dr. Sumit Agrawal. SSD, 3/6 on HB facial scale, stick-on-eyeweight worked, 95% eye function@ 6 months. In neuromuscular facial retraining. Balance regained! Recent MRI -tumor receded!

wendysig

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Re: A word to the wise regarding vestibular rehab
« Reply #4 on: October 03, 2008, 11:08:25 pm »
Cathy,
I feel llike an idiot for not asking how many AN patients were treated at this facility.  I certainly asked every doctor I had a consultation how many AN patients they had treated.   I guess I now understand why eveyrone I worked  (three different PTs) with seemed so very interested in me too.  Another example of how rare ANs are.   .  I am more annoyed at myself than the facility.  It was ultimately my fault for not asking the most important question.   I guess when I asked about vestibular rehab, at the time I thought that covered the subject.  I am also very annoyed at burning my insurance benefits as well as the amount of money I've spent -- each session cost me an additional $20 out of pocket.  I can't help wondering how much my insurance paid for each session too.  On the flip side of things, the PTs at this facility have helped me regain much of my balance even if not as much as I had hoped.  The one who took the vestibular course in particular has worked very hard to help me.  I'm not sure if it would pay to try to go somewhere else for the last three sessions.  No other facility on Staten Island that accepts my insurance even offers vestibular rehab and I don't think I mentioned this, but I also only have until October 10.  My insurance only covers sessions that take place within 60 consecutive days as well as limiting the number of sessions.  It really seems to make sense to make the most of the three sessions I have left where I am now going.

Karen,
I practice all the exercises I learned in PT at home at least twice a day.  Besides that I walk, usually rain for shine every day at least one mile.   My neighborhood is quite hilly and I deliberately choose a route that has two small hills, one medium sized hill and many inclines.  I have been walking on grass as welll as the sidewalk and visit the mall at least once a week.  I've found getting on escalators that are going down something of a challenge too -- I have a little trouble deciding when to step on as the stairs seem to move more quickly than before -- just my perception I know.  I don't like the mall as much as I used to either or crowds in general -- too much visual stiimulation from all the activity I think.  I don't really get very dizzy but do feel sort of disoriented and slightly nauseous.  When it gets to be too much to stand I look at one spot on the floor because it makes me feel better.  When I reach that point, I've  usually had enough and  leave.  If things don't get better I may ask my doctor to see if he can convince the insurance company I need more physical therapy but I am not hopeful that even his intervention would help.  They seem to have policies set in stone.

DHM,
You are lucky that you are able to assess your own weakness and figure out how to work on them.  I understand your desire for formal help from a PT as it has proven helpful to me even if it hasn't delivered everything I hoped for.  I think having a list of questions to ask when interviewing/consulting a potential PT would be very helpful.  I see my mistakes now -- hindsight is 20/20. I have a question for you --  regarding your tight neck muscles have you ever seen a chiropractor?  I had a lot of upper back pain after my surgery probably from both my neck muscles being moved during surgery and the horrible hospital beds.  My doc let me see a chiropractor with the proviso that I didn't let her manipulate my neck -- he said it was too soon for that since I started seeing her three weeks after my surgery.  I think she helped me quite a bit even with that restriction.  My back feels a lot better and my neck, thankfully, is almost back to normal.

My thanks to each of your for your input and suggestions.  I hope this post will help others along the way.

Wendy

1.3 cm at time of diagnosis -  April 9, 2008
2 cm at time of surgery
SSD right side translabyrinthine July 25, 2008
Mt. Sinai Hospital, New York, NY
Extremely grateful for the wonderful Dr. Choe & Dr. Chen
BAHA surgery 1/5/09
Doing great!

Dog Lover

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Re: A word to the wise regarding vestibular rehab
« Reply #5 on: October 04, 2008, 04:25:41 pm »
Wendy,

Well, don't feel like too much of an idiot, because I never thought to ask either. I just went with what my surgeon recommended. I think I got lucky is all.

You never know what will happen with insurance companies. If you have your insurance through your employer, have your employer go to bat for you. Ultimately it comes down to them, I think.

Cathy
Cathy
9mm x 3mm Left Side AN
Mid Fossa Aug. 21, 2008
Dr. Gantz / Dr. Woodson
Univ. of Iowa Hospitals and Clinics
No facial issues, hearing saved, I keep active and feel back to normal.

wendysig

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Re: A word to the wise regarding vestibular rehab
« Reply #6 on: October 05, 2008, 02:52:35 pm »
Cathy,

Thanks for your suggestions -- my insurance is actually through my husband's job, but maybe I will call and try to twist theyr arm.  I asked the office manager at PT and she said it is a waste of time -- I've got lots of time and I don't mind being a pest if I have to.

Wendy
1.3 cm at time of diagnosis -  April 9, 2008
2 cm at time of surgery
SSD right side translabyrinthine July 25, 2008
Mt. Sinai Hospital, New York, NY
Extremely grateful for the wonderful Dr. Choe & Dr. Chen
BAHA surgery 1/5/09
Doing great!

Dog Lover

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Re: A word to the wise regarding vestibular rehab
« Reply #7 on: October 05, 2008, 07:38:05 pm »
I would. A friend I work for got 6 more PT sessions for her husband, through work. (her insurance). It's worth a shot! :)
Cathy
9mm x 3mm Left Side AN
Mid Fossa Aug. 21, 2008
Dr. Gantz / Dr. Woodson
Univ. of Iowa Hospitals and Clinics
No facial issues, hearing saved, I keep active and feel back to normal.

Omaschwannoma

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Re: A word to the wise regarding vestibular rehab
« Reply #8 on: October 06, 2008, 04:36:39 am »
Wendy,

Go back to the mall as often as you can stand it.  This seems to be your "weak" zone and the more you do this the less you will feel nausea and unsteadiness.  The other thing to try is some of the more intense eye focuse exercises that have been posted  under balance issues (I beleive) and the head shaking ones work very well for me. 
1/05 Retrosigmoid 1.5cm AN left ear, SSD
2/08 Labyrinthectomy left ear 
Dr. Patrick Antonelli Shands at University of Florida, Gainesville, FL
12/09 diagnosis of semicircular canal dehiscence right ear

wendysig

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Re: A word to the wise regarding vestibular rehab
« Reply #9 on: October 07, 2008, 08:04:55 pm »
Hi Karen,
Thanks for the advice.  Amazingly, now that I ony have two more PT sessions, the PT is stepping things up and has given me even more exercises to do.  I decided to ask him today if he had ever had an AN patient before and he said he had but I am still doubful. :-\  I'm sure the exercises will help, but it would have been nice if they'd been introduced earlier.  I don't know if I can make it to the mall more often but I am going into Manhattan on Saturday (I hope anyway) and I will certainly be dealing with crowds there.  Hopefully the worst will be over before long.  Since I won't have PT appointmetns after this week (the insurance company turned me down), I'll have to push myself  a littleharder.  I ordered a Dyna-disc (suggested by Eve aka Jerseygirl) and hope this will help.  This is also one the latest the PT had me working on.  It is hard to use but if it wasn't I wouldn't need to do it, would I?

Wendy
1.3 cm at time of diagnosis -  April 9, 2008
2 cm at time of surgery
SSD right side translabyrinthine July 25, 2008
Mt. Sinai Hospital, New York, NY
Extremely grateful for the wonderful Dr. Choe & Dr. Chen
BAHA surgery 1/5/09
Doing great!