Healing Vestibular Issues with Jenni Veneruz

Jenni Veneruz shares how healing vestibular imbalances can make a huge difference when overcoming the effects of concussion and stroke as well as other vision issues like strabismus. She explains how your dizziness or vertigo may originate in your inner ear and there may be a simple fix. Don't miss this episode!

Resources:

Find Jenni: https://choicehealthcentre.com/our-team/vestibular-physiotherapists/jenni-veneruz/

Vestibular Disorders Association (VeDA):   https://vestibular.org/

Find a clinician: https://vestibular.org/healthcare-directory/

Professional Training: https://360neurohealth.com/certificate-of-competency-in-vestibular-rehabilitation-2-0-course

Click the link above to message me directly. It comes to me as FAN MAIL! How great is that? Just click on the place that says, "If you liked this episode CLICK HERE:"

Transcript

Denise Allen: Hello, this is Denise Allen. Today I'm recording this episode from Nanjing, China. I'm going to be here in China until July 2025 teaching English speaking and writing at Nanjing Tech University. So if you see fewer episodes from me, that is the reason I'm navigating also a 12 to 15 hour time difference between me and the United States as well as various other challenges. So thank you for listening today and for your patience and I hope you enjoy this episode. 

Welcome to the Healing Our Sight podcast. I'm your host Denise Allen and today my guest is Jenny Veneruz. Jenny has been a registered physiotherapist since 1995. She discovered her passion for helping people with vestibular disorders about 15 years ago and has since successfully treated treated over 4,000 people with a variety of inner ear conditions. She has taken many advanced postgraduate courses in this area and teaches vestibular courses to other registered health professionals. She's been a guest lecturer at the University of Toronto and traveled to Qatar to assist ents and audiologists there in developing a vestibular rehab program. She owns a physiotherapy clinic in Ontario with a focus on helping vestibular patients and presently works out of Choice Healthcare center in Dartmouth, Nova Scotia where she is building their vestibular rehab program. She sees patients from all over the east coast of Canada as this is such an under serviced area of treatment. Her goal is to increase the awareness of vestibular impairments, how common they are, how under diagnosed they are and that there are simple effective treatments available. I am so thrilled to have you today Jenny.

Jenni Veneruz: Thank you for having me. It's exciting. Yes.

Denise: I think that this is probably an area of treatment that people are pretty unfamiliar with.

Jenni: Yep. And not only the general public, but other healthcare professionals as well. So it's nice to be able to get the word out because as I said, it's a very under diagnosed problem that can really affect people's lives.

Denise: Oh absolutely. Can you tell us a little bit about the process of becoming a registered physiotherapist?

Jenni: Sure. So way back when I went to university, which was a long time ago, you could get right in out of high school. So I did a four year undergraduate degree and graduated in 1995. Presently physiotherapy is a master's program. So people need to get an undergraduate degree first and then they can do two years of physiotherapy in our undergraduate program and even the master's program. Now we really don't touch very much on the vestibular system and that area of physiotherapy. So it's really postgraduate courses and extra training that we do so that we can help people with inner ear disorders. It's. It's not certainly a typical area of physiotherapy.

Denise: Okay. I guess I don't honestly know exactly what a physiotherapist does differently than what you're doing now, either.

Jenni: Well, I think when people think of physiotherapists, they think of, you know, shoulder pain, neck pain, back pain. You know, people will go to a physiotherapist after knee surgeries and, you know, after breaking their wrist. So we do a lot of orthopedic care. But physiotherapists also work a lot with people who have had strokes, you know, brain injuries. We also work in hospitals with people who have cardiorespiratory issues. So, you know, there are different facets to physiotherapy. The vestibular. Vestibular area is just not that well known. Probably less so than even the cardiorespiratory area.

Denise: Yeah, I would say that's true. So what made you decide to get into the vestibular area?

Jenni: So I was working in hospitals, and, you know, I wasn't all that thrilled with my position in there. And then my entire family suffers with a very common vestibular impairment called BPPV, which some of your listeners may have heard about. But it's a really common issue where the crystals in the inner ear come out of a little sac, float into the canal where they're not supposed to be and make people dizzy. So, you know, my. My parents both would have episodes on and off. I've had episodes on and off. And then, you know, we had somebody just come into the hospital and do a short little talk on vestibular impairments. And I thought, wow, that's a really interesting area. And why aren't more people doing this? Because the treatment is so simple and so effective, and when you have this condition, it's really debilitating. So I just decided to do some more training, and I've done most of my training in the US There's a certification course in Atlanta that's pretty intense. And then we do advanced updates along the way, because, like anything, there's more research that comes out, more treatment ideas and assessment techniques. So it's really that lifelong learning. And then over the years, having treated many, many patients, I've got that kind of experience under my belt as well. So it's just been a kind of a game changer for me in terms of enjoying my job and helping people that otherwise wouldn't have been helped.

Denise: Nice. What does BPPV stand for? For those who don't know.

Jenni: Yeah, so it's a really long word for basically, your rocks are loose is what I tell patients. You've knocked your rocks loose. So BPPV stands for benign, meaning it's not, you know, anything cancerous. Paroxysmal, which means it's a condition that comes and goes. Positional, which means you have symptoms with a change in position of your head, and vertigo, which means you have the sense of movement when there isn't any. And vertigo is not always a spinning sensation. Sometimes it's a rocky, lightheaded feeling. Sometimes your world tilts. But like I said, it's just a very long word. So BPPV is basically the condition where the crystals in a sack in the inner ear, which are supposed to be there, become dislodged and float into one of the canals in the inner ear. And because they're sloshing around in there, as we move our head, it stimulates the nerve in our inner ear, which is called the vestibular nerve. And that nerve tells our brain that we're moving when we're not. It also creates eye movements that shouldn't be there, and it affects our balance and our postural muscles inappropriately. So it causes those issues of unsteadiness. And if people go to vestibular.org There is a really good handout with pictures, and it shows you the anatomy. If they look for the handout that says BPPV, it will go into a lot of detail about that.

Denise: Okay, great. So how would people know whether they're actually suffering from a vestibular issue?

Jenni: Yeah. So, you know, a lot of people think of vestibular issues and vertigo. If you've heard people talk about vertigo, that is one of the common symptoms. But a lot of people think that vertigo is just an intense spinning sensation. So a lot of patients will say, I woke up in the morning, sat at the side of my bed, and the room just started to spin. That's a pretty classic symptom of a vestibular impairment. But there's a lot of other small sort of ways people can identify, and one of them is with the vision. So I know your listeners typically are interested in the eyes, and blurry vision is a very common vestibular symptom as well. So the inner ear controls eye movement. So one of the main functions of the vestibular nerve is to stabilize your eyes, especially when your head is moving. So if there's something wrong in the inner ear and the vestibular nerve isn't doing its job, the eyes will actually move slightly and people will have a sense of not being able to see clearly, especially when they're tired. Things are a little bit blurry. The sense of things jumping up and down in front of their eyes, that's very much a vestibular symptom. Imbalance, nausea, motion sensitivity. Sometimes people will just feel off. You know, they don't actually get dizzy. Head pressure, fatigue, all of those are very common symptoms as well. Feeling like you're on a rocky boat all the time when you're not. So it can be a pretty nasty sensation. Sometimes people get it for a couple of days and it goes away. Other people have it for a long, long time.

Denise: Is it something that comes on gradually or all at once, or how would you know that that's what you're experiencing?

Jenni: Either. Either or. So a lot of people, it comes on very suddenly. Some people, it's gradually over, you know, months where they start feeling worse and worse. It depends on what is going on in the inner ear. There's, like I said, BPPV, which is a very common mechanical problem, tends to come on quite suddenly. If people have another common condition called vestibular migraine, where the dizziness is actually an aura that can come on more gradually. Sometimes it's sudden, depending on what the brain is doing to the inner ear. I see a lot of people who have had inner ear viruses that can also come on quite suddenly.

Denise: They wouldn't necessarily know to see you, though, when that happens. Right. They would go to their primary doctor, most likely, who may not tell them about you. Is that true?

Jenni: Yeah. So unfortunately, a lot of times what happens is because there's a lot of things that can make people dizzy. Obviously, you know, if somebody's having a heart attack or a stroke or there's something more sinister going on that can cause dizziness. So most people end up at the Emerge or a walk in clinic. If they have a family doctor, they might, you know, be able to get in in this century. I don't know. But yeah, so they'll end up there. Most often what happens is they check all of the other things. They do their heart tests, they do blood, everything is fine. And then they're diagnosed with vertigo. And vertigo is not a diagnosis. Vertigo is a symptom. So we still have to figure out, well, why are you dizzy? A lot of times people are Prescribed a medication called Cirque, or the generic is betahistine, which is a suppressant. So it's basically like gravel for your dizziness. And it doesn't fix the problem. Very few times does it actually even help the symptoms. So people come out, they're like, okay, well, you know, it's not, I don't have a brain tumor, I'm not having a heart attack, but I still feel horrible. And they don't know where to go. So, you know, that's why it's so important to sort of, you know, have these connections and know that there, there is a, you know, very common reasons for those symptoms and that you don't have to live with them.

Denise: Right. When you say they're very common, is there like a percentage of the population that will experience them or how common are they? Exactly.

Jenni: So the condition where the crystals drop out of the inner ear or not out of the inner ear, there's a sac in the inner ear, the crystals come out of there and into a canal. That's very common. And I believe the statistics in Canada are just around 50% of people over the age of 65. Now that's in the research, but I can tell you that it's far more common than that just because it's so often not even diagnosed. And then not only it's not diagnosed, but then it's not treated. So it's very common. I would say probably most people will have this at least once in their life. Sometimes they can manage it, sometimes they can't.

Denise: 50% you said, though, that's mind boggling to me.

Jenni: Yeah, I think, you know, the stats, you know, if people coming in to emerge for symptoms related to an inner ear disorder are very, very high, most people will see four or five specialists before they ever get diagnosed, which in our world right now means years, years of suffering before maybe they get a diagnosis. So, you know, to have the knowledge that there are people out there that can, you know, assess, diagnose and treat without a doctor's referral is really important. Early management, like anything, is very important.

Denise: Yes. That's amazing. So if we're talking about vision, how, how is that related to the vestibular issues that that we've been discussing?

Jenni: Yeah. So I've since moving to Nova Scotia connected with an amazing neuro-optometrist, Dr. Dobson, and I believe she spoke on your podcast a while ago. So she sees a lot of patients post concussion, so head injury, motor vehicle accident, a lot of people are sent to her because of the sensation of Blurry vision. They'll see their regular optometrist, and the optometrist will say, your prescription is fine. You don't need new glasses. Your static acuity is fine. Perhaps go see Dr. Dobson and see if there's another issue going on. And, you know, after speaking with her and connecting with her, we've realized that a lot of those patients, they have an undiagnosed vestibular impairment that needs to be fixed so that the vision is stable, and then they can continue on with vision therapy. Because these conditions can move the eyes, it is very hard to get better with vision therapy until this especially the mechanical problem is resolved. So with vision therapy, a lot of people post concussion or head injury will go see Dr. Dobson. They'll start to do. To do well with the vision therapy. But we were finding they're hitting a plateau. And usually the reason for that is this unaddressed vestibular component. So we've kind of developed this program where patients will see me first. If they go to Dr. Dobson first, she'll do some of my tests and say, you know what? I think you need to see Jenny first. I stabilize the vestibular system so that the eyes are ready to work with her.

Denise: Okay. What does that look like when you're in therapy with. With you?

Jenni: So when I do my initial assessment, I do look at the eyes, because that's how we diagnose the inner ear. The inner ear is past the eardrums, so doctors can't see it with their little light scope.

We look at the eyes to see very classic eye movements that occur when there's something wrong with the inner ear. So a lot of it is just, you know, just that we do some quick head movements which are very small and do not cause vertigo, because I know people are terrified of bringing that symptom on. So we check the vestibular nerve. We make sure the vestibular nerve is functioning well. We do tests just to screen for other things that can make people dizzy, like central issues. You know, we screen for stroke and Ms. And other things. We can clear that. Then we check for the mechanical problem, which is a simple test which just tips the head in a certain position so that if there are loose crystals in the canal, we can identify it very quickly, and then we can treat that the same day. So usually if I identify it on the assessment, we treat it right away. I bring people back in a week, and usually that piece of things is stable. And I'll teach people how to manage any recurrences of that problem as well. So that throughout their vision therapy, if they have a recurrence, they can manage it quickly and it won't affect their progress.

Denise: So is it movement based then, as you're treating these issues?

Jenni: Yeah, the maneuver. Lots of people have heard of the Epley maneuver. It's actually. It's called a modified Epley maneuver, which is turning the head in certain directions. Nothing is an extreme range of motion, so it's not hard on the neck. So we turn the head in certain directions just to guide those crystals back into the sack where they're supposed to be.

Denise: Wow.

Jenni: Which seems kind of crazy and simple considering that some of these people have been suffering for, you know, six years. I saw somebody this week who has been having vestibular issues for six years after her car accident and couldn't understand why she wasn't getting better again. You know, how many specialists has she seen? You know, she was working with vision therapy. And Dr. Dobson said, like, I think you need to go see Jenny to see if this is why you've hit this plateau. Sure enough, she had this mechanical problem in both ears. We fixed it, and she's already noticing more improvements. The problem with leaving this for six years is the brain actually will start to rewire itself and adapt to this problem to try to help people cope. So when it's left, we have to do a little bit of extra rehab to help the brain readjust and recalibrate to where it should be. And that kind of rehab, after we resolve the mechanical issue, Just involves simple head movements, focusing on a target balance, Retraining. Retraining the brain on how to tolerate certain movements, like bending over and looking up and tolerating extra stimulation. So they're not difficult exercises, but they're very, very effective because our brains are so plastic, thankfully, and we can rewire them just as we would work with somebody post stroke.

Denise: Okay, so stroke that maybe isn't affecting the vision. Or are you working with stroke victims who also are working with Dr. Dobson?

Jenni: So when I'm talking about stroke, when we work with somebody who's had a stroke, we work on the basis of neuroplasticity so that, you know, the basis that the brain will find new pathways and relearn how to do things. And that's actually what we're doing when we do vision therapy and we do vestibular rehab. So not necessarily with a stroke patient, but it's the same philosophy with somebody who's had a concussion or a brain injury.

Denise: Okay. So when someone's had an injury like a car accident, or maybe they've had a stroke. Are they going to go see Dr. Dobson first for the vision therapy and then she refers, or does it go both ways? They can see you first and then you refer to her.

Jenni: Okay, so I can speak sort of. If we had an ideal world and everything worked perfectly in our health care system, what would happen is that if somebody had a minor car accident or a minor head injury, so we're not talking, you know, they're in a merge, and they. They have a whole host of other physical issues. In the perfect world, they would, you know, be sent home, see how they felt over the next couple of days if there's persisting symptoms like nausea, motion sensitivity, visual issues. So a lot of people say their eyes hurt. You know, they can't focus on their screen, they feel dizzy with movement. In a perfect world, they would book in for a vestibular assessment first, because in nine cases out of 10, and there are some people that would disagree with this, but because I've seen so many people, I can tell you that nine people out of 10 after a concussion will have this mechanical problem. So we would fix that mechanical problem first. Oftentimes, if we fix that quickly, all of the other symptoms go away. If the other symptoms don't go away and the mechanical problem is stable, if they still have visual issues, so, you know, they're still getting pain with their eyes, they're still feeling dizzy with eye movement and peripheral stimulation, Those are the people I would send to Dr. Dobson. So the vestibular piece is stable. 

Let's move on to the eyes. The people that usually end up with eye issues after concussion are people that either haven't had this mechanical problem identified and fixed, so everything kind of goes haywire, or the people who had preexisting eye issues. So a lot of patients who had trouble bringing their eyes together even as a child, their brain had the capacity to adapt and cope with that until they have an injury, and now their system just can't handle it anymore. We also find a pattern with people that have a history of motion sensitivity. So if you were that kid who couldn't read in the back seat, you get a concussion, you're probably going to be the person that needs a little bit of extra help. The people that have a history of migraine headaches, especially with visual aura, are also the types of people that usually need some extra help. So once I've kind of identified those issues, stabilize the vestibular system, they would likely move on to Dr. Dobson. She would do her piece and things would resolve a lot quicker than they do. You know, with patients trying to bounce from doctor to doctor, you know, trying to get into a doctor, trying to get over their symptoms by themselves, that quick management would be beautiful.

Denise: We would like to get to the point where we have that ideal world, wouldn't we?

Jenni: Would be nice, yes. Realistically, what happens is, you know, Dr. Dobson's great. She has a lot of family doctors now who know her name, they know what she does, so they'll refer to her right away. And then if she gets that patient now she's aware of the vestibular piece, she'll send them to me first, I stabilize them, send them back. So we're trying.

Denise: Yeah. So you've probably met a few people in other parts of the country, as you've done all of your training. Do you get the sense that this kind of working together happens in other parts of the country or the world?

Jenni: Not as. Not as much as it should. I think that people, health professionals who have a lot of experience working with vestibular clients, or like Dr. Dobson, a lot of experience with neuro-optometry, do realize that you need a team of people to help patients get better. If I see a client after a head injury, a concussion, even a mild concussion that has a history of motion sensitivity and migraine, generally speaking, I am not the only person that that client needs, so I know that I have an important piece of it. But they may need to move on to vision therapy. We found craniosacral treatment is another really good team member to have. A lot of patients have residual head pressure and, you know, ear pressure and eye issues that they can help resolve. So it is. It is nice to have a really good team of people. It's just probably not as prevalent as it should be.

Denise: Right. Yeah. I've. Since we've been talking, I've been thinking about someone I know who had a traumatic car accident where he was burned over a large portion of his body. And so that's the part that got addressed initially, you know, and he still has tinnitus years after. And also of. I don't know if this problem with his eyes not dilating appropriately was ongoing or if that also was connected at some point with the accident. But is that something that you would be able to treat even, like, years later?

Jenni: Yeah, it's certainly. With him, obviously, the physical component was number one. So, you know, oftentimes the inner ear and the eyes is like, okay, we're not even going to dress that until everything else is. Is healed. Somebody who develops tinnitus post head injury, oftentimes it is because of the mechanical issue that happens in the inner ear. And it sounds like it was a pretty big impact. So the odds of him having this mechanical problem if it hasn't been treated is pretty high. And when the brain is trying to cope with this extra issue, it can't always mask the noise in the inner ear. So he is definitely somebody. I would, you know, do a full assessment, see if this mechanical problem is an issue. If it is, fix the mechanical problem and see how much resolves just from fixing that. Sometimes the tinnitus is reduced. Sometimes it goes away. Sometimes we need to do extra vestibular rehab to help. Again, his brain would need to do probably some unwiring. If it's been years, you know, the brain has kind of figured out a way to help him cope. It's not always the right way. And then Dr. Dobson would certainly be the next piece. If his eyes aren't dilating and constricting properly, that can give people a lot of light sensitivity and sensitivity with, like, extra stimulation, like, you know, busy stores and crowds and things like that.

Denise: Right? Yeah, he definitely has that going on, too.

Jenni: Oh, yeah, yeah. And certainly, you know, that would be the next piece. And. And I have seen patients that are years out of their injury that obviously, you know, this mechanical problem can be fixed at any time. It's just sloshing around in there, waiting to be put back. It's just, how much has the brain adapted to that? If it hasn't adapted much, then they'll probably feel a lot better after we just do the one treatment to fix the crystals. If the brain's really, you know, been struggling, then we do extra rehab and see how it goes.

Denise: Wow. Okay. Well, this is exciting news. So how would my listeners find someone like you who's qualified in their area?

Jenni: Yeah, so that's. That's a great question. There's. There's not a lot of us. I usually direct people to a website called vestibular.org. it's V E D A, VeDA. It's the Vestibular Disorder Association in the U.S. Canadians can also put their name in as a qualified health professional. So there's a section on there where you can click find a health professional. You can type your address in and come up with a list of names. Now, in saying that if you pay your fee, any professional can put their name in there. So what you want to do when you find somebody in your area is you Want to call them and ask what their training is. So a key factor is asking for if they've had the Emory E M O R Y. The Emory course by Susan Herdman. That's the certification course that really kinds of puts you that much above somebody else who's just done little courses. You want to know a lot. You know, anybody can really do a maneuver for these loose crystals. You can learn how to do the maneuver on the Internet. So, you know, how many dizzy patients have they seen? How many advanced courses have they done? Because if it's someone like your friend that's been in a major accident, probably has a host of issues, you really want somebody that knows just more, a little bit more than just the maneuver. So that's a good starting point. I'm always, you know, happy. I. I've taught a lot of physiotherapists. It's again, it's just a matter of experience. 

Denise: So you take the course. 

Jenni: Yeah, that's a starting point.

Denise: And you've seen a lot of patients after that.

Jenni: Yeah, it's pretty much all I've done for the last 15 years, and I'm still seeing new things. Everybody is a little bit different. The presentation is a little bit different. I've learned that you don't always see the classic textbook eye movements and symptoms when you get somebody with this mechanical problem. So if somebody's just, you know, a little bit trained and they don't see the classic things in the testing, they won't treat it because they'll say, oh, you know, I. I don't see that. So it's not. It's not this. They don't treat it. It's missed. The other therapy sort of hits a plateau.

Denise: I see.

Jenni: So I think it's just, you know, it's just that extra experience that helps.

Denise: Right. Well, this has been fascinating and hopefully very helpful for everyone that's listening today. Do you have some final words of wisdom for people as they're looking to treat these kinds of issues?

Jenni: Yeah, I guess, you know, as they've probably already done if they have visual issues, is advocating for your treatment, knowing that something's not right, you know, your body. A lot of times people, you know, will go to a specialist and, you know, they'll say, you're fine. If you know in your head that you're not fine. It's that vestibular piece could be it, you know, that really could be the one that is the game changer. And, you know, by doing a full vestibular exam with somebody who knows what they're doing, they'll tell you if it's not vestibular, maybe it's visual. You know, they'll send you to somebody like Dr. Dobson. But yeah, do advocate for your health if you have, you know, lingering head pressure, you know, you feel foggy all the time, you're bumping into things and you're like this. Just. I just don't feel right that, you know, oftentimes is that vestibular portion that's missed.

Denise: Okay, that is great to know. Awesome. Okay. Yeah. Thank you so much for all of your great information today. And I will put the link in the notes for the organization, the website.

Jenni: And there's also on that website, sorry, There's a ton of really good, up to date research on all vestibular conditions. So if somebody is interested in learning more about the crystals that I've talked about, BPPV. There's a very good article on that. Very good article on the vestibular system and concussion, head injury, vestibular migraine. I know. You know, we don't go into a lot of detail on the podcast, but there's a ton of information there and it's free access.

Denise: Wonderful. That's a great resource for people. We'll definitely share that. Yeah. Thank you.

Jenni: Helping your people.

Denise: Yeah, that's. That's why I'm here, is to make sure that we get the word out that there's always something we can do. So great.

Jenni: Thank you so much.

Denise: Thank you for listening to the Healing Our Sight podcast. I'd love to hear from you. Please share and also join our Facebook community at Healing Our Sight to leave suggestions or comments. Have a great day.