Cullen Lane, DPT, talks us through an inner ear or “vestibular” issue. What exactly does vestibular mean? In short, it’s how the position of the fluid within your inner ear changes with movement. On this latest episode of the podcast Head to Total, vestibular expert Cullen Lane and host Colleen Young discuss symptoms, causes, and when to see a professional for inner ear fluid imbalance.
#podcast #healthcast #doctor #synergy #podcasting #podcaster #ear #Earproblems #earhealth #synergy #innerear #vestibular #medical #Medicine #doctor #professional #DPT #fluid #movement #balance #vertigo
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Cullen Lane, DPT, talks us through an inner ear or “vestibular” issue. What exactly does vestibular mean? In short, it’s how the position of the fluid within your inner ear changes with movement. On this latest episode of the podcast Head to Total, vestibular expert Cullen Lane and host Colleen Young discuss symptoms, causes, and when to see a professional for inner ear fluid imbalance.
#podcast #healthcast #doctor #synergy #podcasting #podcaster #ear #Earproblems #earhealth #synergy #innerear #vestibular #medical #Medicine #doctor #professional #DPT #fluid #movement #balance #vertigo
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Colleen Young: Hey friends, welcome to another episode of Head to Total, our podcast that pulls back the curtain on all things medical. Special guest today, Cullen Lane, and Cullen is with Synergy Health Partners Physical Therapy. Cullen, welcome to Head to Total.
Cullen Lane: Thanks for having me.
Colleen Young: Hey, it's gonna be a good time. I was looking forward to talking to you. Interesting topic today, as always, we've got something called a vestibular program that we wanna talk to Cullen about. Cullen, most people myself included, we don't even know what vestibular means. Can you set us on course here before we talk a little bit about you? What is vestibular?
Cullen Lane: Yeah, it's a bit of a tricky one, even to just explain, but the simple way of saying it, it's kind of your inner ear system that helps you with whether it's balance or vision and kind of combining those things together, if that makes any more sense.
Colleen Young: It absolutely does. And I'm sure our friends will put up a nice little graphic about the inner ear, as we go through this, but I'm getting way ahead of myself. I wanna talk a little bit about you and how you get started in physical therapy. Where are you from? Give us the whole story on Cullen Lane.
Cullen Lane: All right, that's a long one. So I'm originally from Fife Lake which is a little town southeast of Traverse City in Michigan. And I grew up there, I went to high school in Fife Lake. I did community college in Traverse City where I got my associate’s before I transferred to Central Michigan in Mount Pleasant. And then I got my bachelor's degree there and exercise science, which is kind of the stepping stone towards getting into physical therapy. So then I got into physical therapy through CMU. And instead of being back in Mount Pleasant for that, they have a cool program where they split up part of their class and 12 students of each class go to Houghton, Michigan, which is way up in the UP, only about nine and a half hours from where I live now. I'm still in Michigan and I did my doctorate there and then towards the end of that, I had clinicals where I was in Grand Rapids for a while. Also during grad school, I got married to my wife Hannah and then graduated, passports. And I work in Livonia now at Synergy Health Partners.
Colleen Young: Did you keep getting kicked out of all these cities, or what happened? You kept going from city to city to city. A whole tour of Michigan there.
Cullen Lane: Exactly. So now whenever somebody mentions some portion of Michigan, I can relate to it. I kind of know, like I've been a little bit of everywhere.
Colleen Young: You know, for the listeners that aren't from Michigan, we gotta say Traverse City is just a beautiful city to spend time. They can spend some time in Traverse City, Michigan. It really is breathtaking.
Cullen Lane: It's nice to still have family there.
Colleen Young: Oh, mooch off them, Cullen, that’s what I would do.
Cullen Lane: Yeah, exactly. I've already been up there four or five times this summer.
Colleen Young: Yeah, that's the way to go. That's why you should always strategically place family in good resort locations so that you can just go in. You're visiting the family.
Cullen Lane: I know that's exactly when I was moving away, my dad was telling me I had to move to somewhere he wanted to visit.
Colleen Young: That's exactly right. How about when you were in northern Michigan, did you encounter a lot of Green Bay Packers fans?
Cullen Lane: When I lived in the UP, yes. Oh yeah, definitely more than Lions.
Colleen Young: It's all so close. Yeah, people wearing cheese on their heads and everything crazy like that. All right, so now that we know a little bit about you, what was the passion that drove you to physical therapy? Because there was a lot of education. And you're a doctor, I mean, you have your doctorate degree, the training and the education so what pulled you to physical therapy?
Cullen Lane: A big part of it was kind of the classic, I got injured in high school and went to physical therapy to get treated and thought it was pretty cool. I was there and I went to a nice clinic and I thought they had a ton of fun when they were there, and it barely seemed like work with what they were doing. They kind of just got to hang out with patients and their coworkers and that was the job it seemed like, from the outside. And then once you get in, it's a little more in-depth. And I wanted something where I could stay active and still be able to use my brain to kind of max me out each day and push me a little more than sort of something more monotonous.
Colleen Young: And when you came to Synergy Health Partners, did they have all three physical therapy locations, or did they add on as you were here or what happened there?
Cullen Lane: Yeah, so when I joined we had the Warren location, which was fairly new at the time in Livonia, which is the one I'm at, and we didn't have the Greg Grant facility yet, so that's a new one. And so far, I haven't been over there yet, but excited to see it soon.
Colleen Young: Yeah, you guys are gaining a lot of momentum in the marketplace, so that's why I wanted to see when you joined the practice, you know, where we were at the growth stage. So you're primarily in Livonia, and I know that's a very busy clinic and it just seems like you guys are constantly adding new programs. Could you talk to us about your new vestibular program and your role in it and what has happened?
Cullen Lane: Yeah, so definitely a brand new program. Vestibular therapy is something that most physical therapists will learn about in school, and though you learn about it, most of the time you're not treating many patients. So once you're out of school, after a little bit, a lot of that kind of goes away. Most therapists can probably do your basic, oh, let me check for BPPV, but past that, unless you've had more training, it's stuck with you. So for our program, that's why I had to take a course through the Shirley Ryan Ability Lab and learn a bit more in this fairly in-depth course about vestibular systems, and all the neuroanatomy that goes with it. And so with our program, after taking that course, I had an idea of how we wanted to build it. And it's nice to be able to start there and come into a company and say from scratch and select, all right, this is the equipment we'll need and all those different things to make a top end program, which is great. And as of right now, we've gathered all this equipment and I'm still looking to take more courses to keep up on it and be the premier person in the area that people can go to.
Colleen Young: What types of patients do you treat? Is it athletes? Is it your average everyday person like myself? What's the range of patients that you treat?
Cullen Lane: Yeah, it's all over the place, so whether it's athletes, whether it's post-concussion or even sometimes it's not a concussion, maybe it's a focus issue or with any hand-eye coordination. Sports, sometimes if you're having vestibular issues, your eyes may not be following the ball like you'd like them to. So things like that that you don't necessarily think of. And then it goes all the way to the elderly who maybe they're having balanced deficits or they're just having some dizziness, which it turns out a lot of older people as a age, they think that's just a part of aging, which is not true. And that's something that we can look at with the vestibular and then everybody else in between and as you can see with them.
Colleen Young: That's a great point because I did think that a lot of balance issues happen. No, no, a lot of balance issues happen as you age, but there really is no connection between age and balance issues.
Cullen Lane: Yeah, exactly.
Colleen Young: I didn't realize that. I thought it was just as I get older and I do, I'm getting dizzy spells and I just thought that was a part of the normal aging process.
Cullen Lane: Yeah, not quite. There's definitely things that will happen.
Colleen Young: Yeah, I'm gonna take from that I'm really not aging. So yeah, you gave a really good description of the patients, let's start to go into the equipment. So Cullen, I understand now you're patient-base, can you talk to me about some of the equipment that I would see if I came into your practice and asked you about the vestibular and you ran me through my paces?
Cullen Lane: Yeah, so you may see very little equipment or you may see a whole plethora of things. It just depends on what I'm finding with you. First of all, I'll start by looking at your vision first off with eye charts, the classic light pen, looking at your pupils, things like that. And just looking for issues with any vision that may be causing some dizziness or balance deficits that you're having. From there we have infrared video oculography goggles that I'll put on your head, and that helps me see your eyes while you're in the dark. And I can watch from my computer to see what your eyes do as they put you in different positions. And I'm looking for different movements with your eyes to try and diagnose what may be going on with you, or hopefully we see nothing and it looks fine. So that’s a pretty neat tool to be able to use and I'm not sure that many people in the area actually have them. And so that's kind of fun because you'll be able to see a recording of what I'm watching. And so once we do that test, you can actually look on my computer and I can show you kinda what you looked like or your eyes look like as I put you in these different positions to try to get you to be a little dizzy or reproduce any symptoms you might have so we can narrow in on it.
Colleen Young: Okay, that's just cool, it's like a video game. That is really cool.
Cullen Lane: Yeah, it kinda looks like a VR headset too. And then there's a lot of different treatment tools we use. It's as simple as a string with a few different colored beads on it, all the way up to a laser I put on your head that you have to follow on a maze that's on a wall.
Colleen Young: So essentially you're using cat toys to diagnose me with some kind of vestibular issue.
Cullen Lane: Exactly, yeah, so if anything smells like cat or anything.
Colleen Young: Yeah, nice. That'll make everybody at Synergy real happy that I just compared all this high-end equipment that they have to cat toys. That'll be good. My podcasting days are gonna be over soon. So now I understand that I come to you because I'm feeling dizzy or I've been concussed or something just isn't right. I'm running into things. I work with somebody who frequently runs into the doorframe and although, let's be honest, it's funny because he's a younger guy, it might be a serious issue with his vestibular and his inner ear; it might be, we don’t know. It's good humor around the office, but it could be something serious within his inner ear. Once you put me through the paces and you put me through the cat toys, the high-end equipment, what are my next steps with you Cullen?
Cullen Lane: Yeah, so that varies based on what I do find. If it's a serious enough issue, I refer you to a neurologist or ophthalmologist for a second opinion on certain things depending on what I find. Or if it's something I can treat in-house, so a lot of times if you have a vestibular hypofunction, so one side of your inner ear isn't working properly, there's different exercises I can give you to do for home. And you just check in once a week or so and we kind of see how things are going. Some patients I can treat you that day and hopefully your symptoms are relieved then and there and you may just come back in a week to check up and see if things have remained fixed or if we need to do another adjustment, but yeah, it varies greatly.
Colleen Young: Is there or are there, especially within Michigan, do people feel symptoms of vestibular issues at certain times of the year? Is it a season change or that doesn't happen at all?
Cullen Lane: Not typically. And again, vestibular is so widespread that your typical dizziness; not necessarily. Every once in a while if you get into something like flu season, there's been incidences of higher rates of that vestibular hypofunction I talked about due to sometimes if you get the flu sometimes it can mess with that inner ear. There's still not a hundred percent sure why. And it may just be whether it's that virus that sort of interferes or can change the consistency of the fluid in your ear at that time. Certain medications may be used to help treat the flu, but that's definitely something that you may see a slight peak in. But most everything else, if you're looking at things like post-concussive symptoms, you get more in the summer months because people are outdoors versus in the winter.
Colleen Young: Okay. So Cullen, talk to me about how many appointments it takes to come in and see you, I say I'm having these problems, we go through the equipment and then you make your recommendations. Is it two appointments, three appointments? What's that like?
Cullen Lane: Yeah, it depends on, like I said, it could sometimes be as simple as BPPV where I just need to reposition those little crystals in your ear and have them go back to where they should be. I can fix it right then and there and then we follow up in a week and so maybe it's just two visits. If it's something a little more complex such as that hypofunction, it may be I see you once or twice a week for maybe a month. It depends on each patient, how quickly they tend to recover or how quickly they adapt to these symptoms, so yeah, it varies a lot. And then if you get into the balance portion, that can take a bit longer because you can get into more having to train muscles, which takes more time, but yeah, it varies pretty widely.
Colleen Young: You mentioned crystals in the ear, how is that different and what is the difference? Because again, you're talking to somebody that doesn't know medical like you know medical and our listeners are in my boat, right? They don't know medical like you know medical. You said crystals in the ear, what's the difference between the liquid in your ear in eustachian tubes? See how I threw out that big word I was trying to impress you. The eustachian tubes, is there a difference there or how does that work? What's the difference between the fluid and the crystals?
Cullen Lane: Yeah, so in a way the crystals are typically something that give you a sensitivity based on how they're tipping in the inner ear which tells you directionally. And so in a way, almost if you think of it, they're sitting on some sort of sensor that is telling your brain hey, we're moving this way. And what's pushing them is when you have these little mycelia, the little hairs in your ear in or in those canals and that fluid that you're talking about, that endolymph is what moves and it's pushing and activating or inhibiting different motions. That's how your brain can differentiate. So if one side's being activated, the other's inhibiting and it gives you a sense of direction. And that's why if you get something like vertigo, you'll feel like things are moving even though you may be stationary. That's because in your ear that fluid is possibly moving or those sensory areas, those mycelia are being moved a certain way, which could be from those, otoliths, the little crystals in your ear, which are moving through that fluid and causing the fluid to move a little bit. Which gives you that sensation that you are moving even, but it's just delayed. So if you think a drop in a rock and water huddle, kind of float slowly, but it's still moving that fluid, which then your brain senses as movement, even though you're stationary.
Colleen Young: It sounds like such a delicate balance. If one little thing is off, it really does throw you off. It's amazing that as many adult beverages as I've drank and taken a fall here and there, that I don't have this issue because it sounds like a delicate complex, right in your little inner ear.
Cullen Lane: Well when you do have your adult beverage that's when you have the room spinning, if you have one too many. That's partially because the alcohol that goes into your system, it sort of dilutes that fluid in your ear, which gives you movement and it's off. So it's not typical, your body's adjusted to its typical consistency of that fluid. When you drink too much, it gives you that, oh, it's a little lighter fluid so maybe you're feeling spinny.
Colleen Young: Cullen, you've just explained my whole collegiate career, that explains so much of what happened here. So essentially in southeast Michigan, your practice is one of the few practices that have a vestibular specialist like yourself and the equipment that goes along with it. Is that correct?
Cullen Lane: Yeah and that's a big one. There are a lot of clinics that will say vestibular therapist or therapy, but a lot of them again are that typical, oh, I learned this in school and they know a few positionings maybe. They can check those basic lines. But to really get the full picture, there's things like that video oculography, the infrared one where I can see your eyes in the dark. There's certain things with the vestibular that after about five days your body will adapt and you won't be able to see that in normal lighting. So if you go to someplace that doesn't have these goggles, they may think oh, you're fine, I'm not noticing anything with your eyes, they're not moving or shaking. And that's because your body's already adapted after those five days. But if I can take you and I put you in the dark with those goggles, then that's when your body will show those signs again.
Colleen Young: Okay, fascinating topic today on vestibular from Cullen Lane. I took away from our discussion a couple things. I now know why I get dizzy when I drink too much. I'm amazed and I'll seeing Mitch Missy at that orthopedic Urgent Care after I have a few adult beverages in my vestibular. I've learned that this is a very serious thing in all honesty, that people do have problems with the inner ear and things get off balance and it is a dangerous situation. You can take a hard fall and experience vertigo. So I gotta come to someone like yourself who's got the training, and who's got the equipment. And the other thing I learned today was that Traverse City is a great place to visit and we should all do that.
Cullen Lane: Yeah, definitely. If there's one takeaway, it's that dizziness is definitely not a sign of oh, it's just how I age and that's something that's gonna happen. It doesn't have to and I think there's a lot of people out there that just think that's something that happens. And I see patients most days who when they lay down, they get up and, “Oh, I'm dizzy,” and I have to discuss with them that that's not a typical normal thing that you have to deal with in your daily life. It can be addressed.
Colleen Young: So Cullen, a lot of great takeaways from our discussion today, the first being, I now know why I get dizzy when I drink too much. I now know that dizziness is not a part of me getting older and I know that Traverse City is a great place to visit. But I think the most important takeaway that we gotta give everybody is how to get an appointment with you. And correct me if I'm wrong, go online to Synergy health.org/physical therapy. They see your profile and learn all about Cullen because he does more than just vestibular. He's a wonderful physical therapist that has a doctorate, very knowledgeable about a lot of subjects. Click the make an appointment button and schedule some time with you.
Cullen Lane: Yeah, it's pretty simple.
Colleen Young: Well Cullen, I can't thank you enough for the time today, it has been a very interesting discussion. And we hope you'll come back to Head to Total and talk to us more about some of the other cool things you have at Synergy Health Partners Physical Therapy.
Cullen Lane: Yeah thanks Colleen, hoping to be back pretty soon.