Contrary to popular belief, vertigo is not a fear of heights. It's the sensation that your surroundings are rapidly spinning while you remain still. The condition is not uncommon but is rarely serious. Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by sudden episodes of dizziness brought on by movement.
Here's what you need to know about BPPV.
1. BPPV is caused by a confusion of signals to the brain. The vestibular apparatus, a series of canals located inside the ear, includes a structure that contains tiny crystals of calcium carbonate. These crystals help the body detect gravity, tilting and speed changes in linear motions like stopping and starting at a traffic light. BPPV occurs when some of the crystals escape from their normal chamber and get into one or more of the canals. "When you move your head, the fluid in the canals moves as usual, but when you stop, if the escaped crystals are still moving in one ear, they will continue to stimulate the canal, creating a clash of signals to the brain," explains Kathleen Shortt, a physiotherapist who specializes in vertigo at LifeMark Physiotherapy in Toronto.
2. BPPV often develops very suddenly. BPPV typically occurs without provocation, seemingly out of nowhere. According to one report in the Canadian Medical Association Journal, 50 to 70 per cent of BPPV cases are idiopathic, meaning without substantiated cause. This sudden onset is the way people usually discover that they have vertigo. Their first experience of the condition is often when they roll over in bed, says Shortt.
3. BPPV can be mistaken for a stroke. Some common symptoms of BPPV – nausea, dizziness, light-headedness and loss of balance – are also signs of stroke. However, "there is no physiological connection between the two," says Shortt. "BPPV tends to come and go, and symptoms last only about 30 seconds, whereas stroke symptoms are continuous."
Page 1 of 24. BPPV can be diagnosed and successfully treated. To determine which side of the brain is responsible, a physiotherapist has the person wear special goggles that simulate darkness and track eye movement. The direction in which his or her eyes move indicates which ear canal is involved.
Once the affected side has been identified, a physiotherapist who specializes in BPPV can successfully treat the condition. The most common treatment, called the Epley Manoeuvre, involves rotating the patient's head and body through four specific movements at differing speeds, each held for about 30 seconds. The patient's head and body are manipulated so that the dislodged crystals are moved along the canal and drop back into the correct chamber of the inner ear. Near the end of the Epley Manoeuvre, some patients feel a falling sensation. The vertigo symptoms can resolve quite quickly after this, but the feeling of being a bit "off" may persist for a while after, says Shortt. The treatment is 98.4 per cent effective after three treatments, if required, says Shortt.
5. People with severe BPPV are at risk of injury. To minimize the risk of falling, Shortt suggests the following measures. • Get rid of area rugs. • Clear stairs and pathways of anything that may cause you to slip. • Install grab bars and shower seats in the bathroom area.
Coping with Vertigo Here are some ways to cope with BPPV-induced dizziness. • Sleep with extra pillows. This will help prevent your head from resting on an angle that further aggravates your condition. • Get in and out of bed very slowly. • Walk as if you have a book on your head. This minimizes head movement and helps avoid moving the crystals. • Avoid rapid movements such as tilting your head forward, upward or sideways. • Your doctor can prescribe Serc, which is a betahistine and an anti-vertigo medication that works to reduce the pressure of the fluid in the inner ear. It may help to minimize the initial symptoms of BPPV, although it will not correct the condition.
Dainty and flavourful, everyone loves to indulge in tiny bites of traditional tea sandwiches. Though they appear finicky to make, these tea sandwiches are easy to assemble and entirely make-ahead.
Pinwheel Sandwiches Trim crusts from 5 slices white or whole wheat sandwich loaf, cut Pullman-style. (Ask bakery to cut sandwich loaf horizontally, or Pullman style.) Using rolling pin, flatten slices slightly. Spread with 1/3 cup (75 mL) butter, softened; spread with filling.
Place 1 asparagus spear (or 2 baby gherkins) along 1 short end of each. Starting at asparagus, roll up tightly without squeezing. Wrap each roll tightly in plastic wrap. Refrigerate for 1 hour. With serrated knife, trim ends; cut each roll into 6 slices.
Makes 30 pieces. Pinwheel Sandwich recipe: Curried Egg Salad Triangle Sandwiches Spread 16 thin slices whole wheat or white sandwich bread with 1/3 cup (75 mL) butter, softened; spread filling evenly over 8 of the slices. Top with remaining slices, pressing lightly. Place on rimmed baking sheet and cover with damp tea towel; cover tightly with plastic wrap and refrigerate until firm, about 1 hour. Trim off crusts. Cut each sandwich into 4 pieces.
Makes 32 pieces. Triangle Sandwich recipe: Ham Pickle Spread Square Sandwiches Make sandwiches as in Triangle Sandwiches above except use 8 thin slices white and 8 thin slices whole wheat sandwich bread. Cut each sandwich into quarters.
Makes 32 pieces.Square Sandwich recipe: Pimiento Cheese Spread Finger Sandwiches Make sandwiches as in Triangle Sandwiches above. Cut each sandwich lengthwise into 4 fingers.
Makes 32 pieces. Finger Sandwich recipe: Tuna Olive Salad
Choose the best-quality bread. Never serve end slices. Freezing bread before cutting and then spreading makes for easier handling.
Bread should be lightly buttered no matter what the filling. Butter should be at room temperature before spreading. Sandwiches will not become limp and soggy as readily if you spread butter right to edge of bread.
Cut crusts off bread with long, sharp knife after (not before) assembling sandwiches. This keeps everything neater.
Since tea sandwiches should be delicate, cut each sandwich into thirds or quarters or in half diagonally. Or use cookie cutters to cut into decorative shapes.
Our experts answer reader questions about dropping the last 10 pounds—or more.
Question: I've heard that lifting weights helps the body burn calories even when you're not active. True or false? — Reiko
Answer: That's true. A lot of women prioritize cardio because they want to lose fat, but that burns calories only while you're exercising; as soon as you stop, you're no longer burning as much. Instead, lifting weights revs up your metabolism, so you'll continue burning calories for a few hours after your workout. And don't worry about bulking up; women don't have enough testosterone for that. But you will get leaner!
— Trudie German, certified personal trainer and owner of bodyenvy.ca, Toronto
Question: Is it possible I'm meant to be this big? I've been about the same size all my adult life, give or take a dress size. My mom and my sister are both size 14, and so were my grandmas. Maybe it's genetics? — Anne
Answer: Your genes do play a role, but it's more important to remember that size isn't really a good measure of health. If you're active, feeling good and sleeping and eating well, you probably don't have to worry. According to the World Health Organization, obesity is defined as "abnormal or excessive fat accumulation that may impair health." Of course, as you get heavier, there's a greater likelihood your health could be negatively impacted. But it's impossible for me to tell just by having you step on a scale; I have to do all sorts of tests to see if your weight really is affecting your health.
Question: I'm injured and I can't work out. Is it still possible to lose weight? (Even if I'm eating my feelings about not being able to exercise?) — Katie
Answer: It's certainly possible! In fact, what you eat has more of an impact on your weight than exercise. You won't be able to work off extra calories, so be particularly mindful of other factors that influence weight, too, by getting enough sleep, finding ways to manage stress and choosing healthy whole foods in appropriate portions. And try these tricks: Serve vegetables family-style so they're within easy reach, but keep richer foods on the stovetop; use a smaller plate; and focus on your food—you're more likely to overindulge if you're distracted, so try not to eat in front of the TV, in the car or at your desk at work. Lastly, don't deny your hunger; eventually, it will backfire and you'll find yourself overeating or grabbing a convenient but unhealthy snack. People often think they have to cut back on food if they're going to lose weight, but I counsel my clients to eat more during the day. The idea isn't to willpower your way to weight loss; it's to make sustainable changes.
Heart disease and stroke are one of the leading causes of death for Canadian women—and risk factors, symptoms and even treatment might vary by age. Here's what you need to know.
It was Dec. 13, 2014. I was getting ready to go out for dinner when suddenly everything went wrong. I lost coordination, almost like I was drunk. I went numb, as if the local anesthetic that dentists use had been applied to half of my body. My arm went limp, I could barely walk and, out of the blue, I got a raging migraine. At 31 years old, I was in the midst of a transient ischemic attack, often called a ministroke, but I had no idea.
It wasn't until the next day, when I was feeling only slightly better, that I realized something was really wrong. I didn't want to wait for an appointment with my family doctor, so I called Telehealth Ontario, the provincial service that connects callers to a registered nurse via telephone. In the very back of my mind, I wondered if I'd had a stroke—but I was too young, or so I thought. But when I described my symptoms, it became clear that I wasn't too young. In fact, the nurse who took my call was worried enough to send paramedics to my house. Soon, I was in the back of an ambulance, rushing through Toronto's busy streets on the way to the hospital.
The statistics Luckily, my stroke was mild, and, in July 2015, I underwent surgery to have a patent foramen ovale closure device inserted to close the hole in my heart. But, to this day, I'm still shocked at how little I knew about the risks associated with stroke and heart disease, or just how common they are. As I soon learned, about 1.6 million Canadians—557,000 of them women over the age of 24—report having cardiovascular disease. And, according to a study looking at factors and behaviours affecting cardiovascular health published in 2013 in the Canadian Medical Association Journal, fewer than one in 10 adult Canadians were in ideal cardiovascular health from 2003 to 2011, which means 90 percent of us are making choices that are increasing our risk for a cardiovascular event. In fact, heart disease and stroke is one of the leading causes of death for Canadian women, and most of us have at least one risk factor.
It's a club that I didn't particularly want to be a part of, but having joined, I began wondering what other women's experiences had been like.
Unlike me, when Victoria resident Carolyn Thomas started having a range of symptoms— crushing chest pain, nausea, weakness, sweating and a persistent ache down her left arm—on her 58th birthday, she immediately thought it could be a heart attack and went straight to the ER. But when she got there and told the doctor on duty about her symptoms, he said it was just acid reflux. "I remember exactly what he said," she recalls. " 'You're in the right demographic for acid reflux. Go home and call your family doctor for a prescription for antacids.' " Embarrassed and apologetic, she did just that. But her symptoms persisted for two more weeks. She eventually went back to the hospital, and this time, she was told she was suffering from what was actually one of the most serious types of heart attacks—a complete blockage of her left anterior descending artery, which is often referred to as the widow-maker.
Since then, she has recovered, but it's far from full—she had to retire early and continues to see a specialist at her regional pain clinic.
Irmine MacKenzie also went to the hospital immediately. It's been 35 years since the New Waterford, N.S., resident lost the use of her left arm and leg after suffering a stroke caused by carotid artery stenosis, narrowing of the arteries that carry blood from the heart to the brain. She was 61 years old and, having just finished eating breakfast with her husband, John, she headed to the kitchen to tackle the dishes. Suddenly, plates started dropping from her hands, shattering as they hit the floor.
After a six-week hospital stay and a three-month stint in a rehabilitation program in Halifax, she eventually learned to walk again. Her ability to manage quite well over the past three decades is clearly a testament to her grit— and maybe some kind words from a stranger. "I won't ever forget the ambulance driver who took me to the rehabilitation centre," she says. "He told me, 'We're taking you by stretcher now, but you'll be walking out of there with a cane.' " Sure enough, that's exactly what she did.
A better understanding It has now been two years since I suffered my transient ischemic attack, and I feel like I'm still learning about heart health. I now understand the importance of cardiac rehabilitation, for one thing. When I had my stroke, I didn't know this kind of program existed—my cardiologist didn't refer me to one, but having access to dedicated professionals in a safe, encouraging environment could have helped me navigate the health-care system and guided me toward healthier choices.
One thing I found myself, Carolyn and Irmine echoing is how, as women, we must advocate for ourselves in the health-care system, ensuring that our voices are heard and our health is looked after. We need to put ourselves first, without shame or guilt. As Dr. Paula Harvey, director of the cardiovascular research program at Women's College Hospital in Toronto, says, "It comes back to education and partnership with your health provider. Don't be afraid to ask questions and be informed."
Heart health by the decade Nearly two-thirds of all heart attacks and strokes occur in Canadians 65 or older, but younger Canadians are increasingly at risk. Here's what you need to know at every age.
In your 20s and 30s: Young people with heart-health issues are part of a growing minority. A study published in 2012 out of the University of Cincinnati College of Medicine found that, over a period of 12 years, strokes among people aged 20 to 54 made up an increasingly greater proportion of strokes across all age groups, growing from about 13 percent in 1993–94 to 19 percent in 2005.
Closer to home, the Heart and Stroke Foundation says several studies predict that the rate of strokes among younger adults will double in the next 15 years. The main reason? According to Dr. Tara Sedlak, a cardiologist at Vancouver General Hospital and clinical assistant professor at The University of British Columbia, it comes down to lifestyle—high stress levels, poor eating habits, lack of exercise and smoking. Research bears this out: The University of Cincinnati study suggested that a rise in lifestyle-related risk factors (such as diabetes, obesity and high cholesterol) may contribute to a higher incidence of stroke.
But there is a way to turn the tide: As with other age groups, simple changes such as exercising regularly, quitting smoking and eating healthily could see the rates of cardiovascular disease—and, more specifically, stroke—decrease, says Dr. Paula Harvey, director of the cardiovascular research program at Women's College Hospital in Toronto.
In your 40s and 50s: Cardiovascular disease is less common among younger women, in part because of their higher estrogen levels; the hormone offers some protection to the arteries. But as women approach menopause and their estrogen levels drop, the incidence of stroke and heart attack increases.
Unfortunately, broad knowledge of their increased risk may not protect perimenopausal women from misdiagnosis. According to research by the Canadian Medical Protective Association, which provides advice, legal assistance and risk-management education to 95,000 Canadian physicians, doctors are missing the signs of stroke in patients nearly 10 percent of the time, largely because symptoms are often nonspecific—patients often complained of headache, dizziness, nausea and vomiting.
And women, who have historically been less inclined to advocate for themselves, are particularly at risk. Research out of the University of Leeds in England showed that, between April 2004 and March 2013, 198,534 heart attack patients at National Health Service hospitals in England and Wales were initially misdiagnosed—and most of them were women. During that time, women suffering a heart attack were 50 percent more likely to be misdiagnosed compared to men.
It might be difficult to challenge doctors who tell you nothing's wrong, but Dr. Sedlak encourages women to listen to their bodies and to be firm with health-care providers about what they're experiencing. "If you feel there is a real problem, be persistent," she says.
In your 60s and beyond: Women over 65 have the most strokes of all age groups, but they still have fewer strokes than men the same age. However, a Danish study published in the Journal of the American Heart Association in 2015 found that, after 60, women tend to have more serious strokes than men—and they're more likely to survive, which can have serious repercussions on quality of life.
John Sawdon, the public education and special projects director of the Cardiac Health Foundation of Canada, explains that cardiac rehabilitation programs, which are free with a referral from your doctor, are the perfect next step for recovering cardiac patients of all ages, but they're particularly important for older Canadians, who tend to live more sedentary lives. These programs are supervised by a cardiologist and, after an assessment, are tailored by your cardiac rehab team, which usually includes nurses, physical therapists, kinesiologists and social workers. They can provide exercise training, education on heart-healthy living and stress counselling—all of which can contribute to the health and well-being of people who have heart problems. And they're effective, too: "Research has shown that those completing cardiac rehab live seven years longer than control groups," says Sawdon. It also "reduces incidence of another heart attack by 50 percent."
What's your risk? Ninety percent of adult Canadians have at least one risk factor for cardiovascular disease. But while factors such as obesity, hypertension, alcohol abuse, family history and ethnicity increase everyone's risk, regardless of gender, the following three are particularly relevant to women.
Smoking: While we all know that smoking is seriously unhealthy, it can be especially damaging to women's cardiovascular health. Smoking when taking the oral contraceptive pill can drastically increase the risk of heart attack and stroke. But quitting can cut your risk within a year.
Diabetes: According to the Canadian Diabetes Association, people with diabetes are at a very high risk of developing cardiovascular disease. In fact, "they may develop heart disease 10 to 15 years earlier than individuals without diabetes."
Mental illness and stress: "Women have a higher frequency of stress-induced heart disease, and women's hearts are affected by stress and depression more than men's," says Dr. David Fitchett, a cardiologist at St. Michael's Hospital in Toronto and associate professor of medicine at the University of Toronto.
Heart health dictionary
Atherosclerosis: When arteries narrow and harden due to plaque buildup.
Cardiomyopathhy: Diseases of the heart muscle, which cause it to become enlarged, thick or rigid.
Cardiovascular disease: A broad term for problems with the heart and blood vessels, often due to atherosclerosis. These conditions can lead to heart attack, angina or stroke.
Heart attack: Also known as a myocardial infarction, these attacks happen when the flow of blood to a section of the heart is blocked, preventing the muscle from getting oxygen.
High blood pressure: Also called hypertension, this is when the long-term force of blood against artery walls is elevated, requiring the heart to work harder, which may eventually lead to heart disease.
Microvascular angina: A disease of the small coronary artery blood vessels. Many angiograms do not view the small blood vessels, so this can be difficult to diagnose.
Spontaneous coronary artery dissection: A tear in the coronary artery wall. Physical or emotional stress appears to play a role. Most cases (around 70 percent) occur in women under 50—and a third of those are pregnant or postpartum women.
Stroke: When the blood supply to a portion of the brain is interrupted. This can happen when a blood vessel carrying oxygen and nutrients to the brain either bursts or is blocked.
Try this simple way to beat stress and help relieve symptoms of anxiety and depression.
If you're into yoga, there's a practice you might already be doing that's been shown to benefit people who suffer from mental illness.
A recent study from the University of Pennsylvania found yogic breathing, a practice known as Sudarshan Kriya, helped "alleviate severe depression in people who did not fully respond to antidepressant treatments," and lessened symptoms, such as stress, associated with the mental illness.
Karusia Wroblewski, who teaches yogic breathing in her yoga classes at Toronto's Yogaspace, says the technique has significantly improved the lives of both herself and her students. "They have more energy and their outlook on life improves," she says. "One student reported being able to cut back on anxiety medications. I just received a thank-you letter from a student who had suffered from deep depression, panic, anxiety attacks and insomnia."
Yogic breathing is more than just slowed inhalation and exhalation—it requires a conscious effort in recognizing and regulating our breathing patterns by adjusting the speed, rhythm and volume of each breath. According to Wroblewski, we often neglect the importance of breathing because it's a natural process. She says injuries, stress and even strong emotions can affect "healthy breathing."
Thankfully, for those who can't make it out to yoga class, you can practise yogic breathing at home. It's entirely safe for beginners. Wroblewski suggests finding an experienced instructor if you want to try intermediate or advanced techniques. Here's how to do it.
When: Try practising when you wake up in the morning, or at night right before you go to bed. It's not ideal to do this type of breathing on a full stomach.
Proper position: Start by lying on your back with a pillow under your knees and interlace your fingers, resting them on your abdomen. Close your eyes. Let the tension in your body melt away.
The basics: Inhale gently through your nose—imagine a balloon inside your body slowly inflating. Exhale through your mouth while the air escapes the balloon. Control your breathing; your breaths in and out should be smooth. While you're breathing, try not to dwell on your thoughts—just let them come and go, as if they were on a cloud floating by. Repeat the breaths three to four times, then close your mouth while continuing to breathe through your nose.