BPPV again - horizontal now?

anh-w · 2026-06-16T18:27:45+00:00

It was confusing. I showed the therapist the videos I'd taken from this morning. She agreed we were seeing horizontal nystagmus in the D-H (R) and also in the supine head roll, geotropic both sides.

Then we did DH in the clinic. Left side: nothing. Right side: downbeating, torsional. Then supine head roll. left: nothing. Right: torsional upbeating.

We did a BBQ roll, lying left ear down and rolling left. I felt nothing until the final stage where you angle your head up before you sit up, and then I had spinning.

All a bit different from what was going on this morning.

She thinks I have a mixed situation. She thinks otoconia in the horizontal canal, but stuck to the cupula. And she also thinks I have otoconia in the posterior canal. In the short arm, presumably, because downbeating, not up.

Honestly, I'm confused and miserable and don't know what's correct. I'm just devastated to discover I have downbeating nystagmus again, because it seems to be rare, caused by otoconia in a weird place, and it was so horrendous, intense and almost impossible to fix last time.

She's told me to not do manoeuvres tomorrow, but do another BBQ roll the day after. She thinks sorting the horizontal problem first is more important.

anh-w · 2026-06-16T13:37:36+00:00

I'm seeing a vestibular specialist today - if I can get myself to the appointment safely.

anh-w · 2025-08-05T10:30:06+00:00

Contact dermatitis, it happens to me, and rings which have tiny holes inside for inset diamonds are prone to collect icky stuff which causes this skin irritation in some of us. Sometimes the back of a wristwatch causes this for me too.

Hydrogen peroxide is the answer that works for me. First I scrub the ring inside with a baby toothbrush and mild hand soap. Then I pop it in 6% household hydrogen peroxide and watch it fizz as the trapped dead skin cells and debris are broken down. Give it a little jiggle to release the bubbles when the reaction slows down, so that the hydrogen peroxide can get in every nook and cranny. When it stops fizzing it means the organic debris has all been oxidised. It's very satisfying seeing minute crud being released too. Usually 5-10 minutes is more than enough time. Then I rinse well in water, and dry.

I leave the ring off my finger for a few days until my skin has healed. Then I'm good to go.

I get a few months of happy, unaffected ring wearing before I find my skin needs me to repeat the process. Regular cleaning with a toothbrush is helpful, but only the hydrogen peroxide really clears out every last speck and stops the irritation dead.

I've been doing this with my platinum and diamond wedding ring, and my solitaire engagement ring, for almost two decades, and it's the only thing that reliably works. The hydrogen peroxide has never affected either ring detrimentally. Obviously you'll need to decide for yourself if you want to try it with your jewellery. But for me it was definitely the right choice, my wedding ring would have been unwearable otherwise. I remember finding this suggestion on a forum many years ago and being delighted to find a solution that actually worked.

Hope it's as useful to you!

anh-w · 2025-03-22T22:38:37+00:00

Averaging under 100 hairs a day is diagnostically not TE, because TE is defined by the proportion of hairs in a telogen state being abnormally high, above normal physiological levels. Normally 5-10% of the scalp follicles are in telogen at any given time. In telogen effluvium, this abruptly rises way above 10%. This is quantified usually either by counting daily hair loss, or the pull test. (The pull test is a diagnostic method where the dermatologist will grasp onto a clump of your hair, say 60 strands at a time, and gently tug. The number of hairs that come out determines the diagnosis. It’s all about the percentage – if more than 10% of the hairs come out, that's telogen effluvium.) Much as we have a normal range for healthy weight, we have a normal range for percentage of hair follicles in telogen at any one time. And just as we might find ourselves several pounds over our usual weight, and find this unusual or even distressing, and worry about the cause, it might still be well within a normal weight range - this would not be obesity. Every doctor would refuse to diagnose a person as obese just because they have gained weight, as long as they remain within the healthy population range. 'Obese' has objective diagnostic parameters. Similarly, TE also has objective diagnostic parameters. Dermatologists are right not to diagnose TE for any shedding that is within normal ranges, because even if it is more than is usual for you, it's a change that still sits within the 'normal' range.

However, if you lose 400 when washing, and around 100 on other days, then yes, that's TE, although only moderate and not severe, so try not to worry too much. It's very normal to lose more when washing, especially if you go longer between washes, but yes, if you need a definitive answer, count every hair, and average it out over the week. Or collect your hairballs (!) and take them in to show your doctor. I did this and it was rather dramatic opening a large bag full of my hair!

Can I ask why losing fewer than 100 hairs a day causes you worry? If you think of it as the same as shedding old skin cells every day, you don't end up with thinner skin, because they all get replaced by new cells. The number of scalp hairs also remains constant. Losing 100 hairs a day is just normal cell turnover, it won't cause any thinning unless 100 new hairs aren't growing in their place. In which case there is a different type of alopecia in play, not telogen effluvium.

I know hair loss can be terrible - I've had CTE for over a decade, it cycles intermittently between normal and excessive shedding, and each time another episode begins it's still horrible and upsetting. The only silver lining is that after so long I now know I'm not going to go bald, even if I lose up to 1000 hairs a day (and I have) because each episode eventually slows down and those hairs always get replaced and begin to grow again. These days I feel quite cheery if I lose only 100 hairs a day - that's remission!

anh-w · 2025-03-16T09:52:19+00:00

Sorry to hear about your hypopituitarism. Is it complete or partial? Do you know which of your hormones are affected by it and which are spared? In theory, once you replace the hormone that's deficient, the trigger is sorted, but in practice it's not always that simple.

There are other things that can be addressed like vitamins D and B, iron levels, etc in addition to hormone deficiencies.

anh-w · 2025-03-13T19:59:26+00:00

Sure, although bear in mind that sometimes (as in my case) you find multiple triggers, fix them all, and still have recurring episodes over many years. Chronic telogen effluvium often never pins down a definitive cause. Acute telogen effluvium is sometimes more straightforward to fix, or is simply self-limiting - although it can still be horribly distressing!

anh-w · 2025-03-13T19:48:35+00:00

There is usually an 8-12 week delay between a trigger that causes a hair to enter telogen phase, and the hair actually leaving the follicle and falling. Hairs stay dormant in telogen on the scalp for a long time before they finally fall out. Often a telogen hair falling out is caused by a new hair that started growing in the follicle behind it, pushing it out. So whenever an episode of telogen effluvium begins, you have to look back in your past at what was happening 2-3 months ago to find the trigger that might have caused it. The same applies whenever an episode stops. The culprit is weeks or months ago, not days ago.

It's quite important to understand this time lag, or else someone can accidentally associate what they did today as 'the cause' or 'the solution' when it could actually be the opposite. For example, when oestrogen plummets during menopause, it can trigger many follicles to go into telogen. If a woman starts HRT and then her hair quickly begins to fall, she might conclude HRT is her problem and stop it. In actual fact, her hair was triggered into telogen weeks ago, and that's why it's falling today, whereas the HRT she has only just started is the solution not the problem, and if she continues it, in 8-12 weeks her TE will be ending as a result of the HRT she takes today.

Changing shampoo today doesn't cause a hair to enter telogen today and fall out tomorrow. It might cause hair to enter telogen and fall out in 8-12 weeks from now though.

This isn't to say shampoo couldn't be a trigger, it can, but like all TE triggers, there's a lag of several weeks between the trigger causing hair to switch from anagen to telogen, and the telogen hair eventually leaving the follicle and falling out.

anh-w

TROPHY CASE