hearing what we choose…

A few months ago, I posted an entry about “Polly”, a 22 year old patient who has a high amount of myopia to go along with her post surgical (for high exotropia) vertical imbalance.  You can read the original post here.

In the weeks and months since my original post, Polly’s symptoms of dizziness and nausea have worsened, but she did not report them to me as she attributed these symptoms to her home VT. Upon reviewing her home activities three weeks ago, Polly informed me of her increased symptoms.   She admitted that her dizziness and nausea don’t occur for 2 to 3 hours after she completes her home VT, but leave her with no option but to lay down for “a few hours” until her symptoms subside.  Since the 2 to 3 hours piece did not fit with concerns we normally hear, I paused our session and immediately had my doctor to join us, and asked Polly to repeat her symptoms to the doctor.  Assuming the VT activities were causing things to happen after that much time had passed seemed dangerous… and you know what happens when we assume.

As an aside, pulling the doctor out of an exam to assist is probably frowned upon, but in this case I recognized that we could be facing greater health issues, so my feeling was it was necessary.

After hearing Polly’s first hand account of her increased symptoms, my doctor concurred that out of an abundance of caution, testing beyond vision was necessary.  A visit with an ENT was recommended, and possibly having an MRI on her head was also discussed.  The next day, Polly’s mother called the office very upset.  She was yelling, in fact.  Her opinion was that we promised her “VT would be completed within 6 months, and we are now approaching the 8 month mark and saying we are not the answer”.  She was incensed that we suggest she now needs to spend money elsewhere, and felt we should have made this recommendation in the beginning.  After the call, we looked back at the report initially provided to the patient at the consultation and it reads “18 to 24 months of Vision Therapy with the possibility of discernible improvements after 6 months”.  Not quite a 6 month promise to cure.  Nonetheless, this family heard and understood a 6 month plan, and are disappointed we could not provide a miracle.

After a second consultation today with our doctor where mom and dad were told that Polly’s vertical was gone and she was achieving intermittent SILO, Polly’s parents have decided that VT does not work, and have discontinued.  They shared, for the first time, that there is a genetic component for Vertigo in their family as well as a degenerative disease process (I don’t remember the name) whose primary symptoms are dizziness and nausea.  Although we asked Polly repeatedly if her dizziness could be caused by other pathology, she adamantly said she was not aware of any. It came out today that in fact, there is a family history of two possible causes. To add insult to injury, before leaving, these parents  even ridiculed our doctor for the MRI and ENT suggestions.

It’s a challenge not to take this to heart.  We are in the business of helping people, and when something goes haywire, it’s like a black cloud overhead.  I don’t see this as a failure per se, but it’s not a success by any stretch.

When we worked together, my friend Linda Sanet used to remind me to try to turn every failure into a learning experience.  It’s challenging today, but I am trying.

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Posted on July 24, 2013, in From My Perspective.... Bookmark the permalink. 4 Comments.

  1. la madre tigre

    Ouch. Was one of the conditions Meniere’s disease, perhaps? It’s hereditary, and could have been responsible for some of the vertigo.

    The expectation of a six-month cure reminds me of a couple of VT parents I’ve run across who have their children going through aggressive treatment during the summer, and are expecting fabulous results (and cessation of treatment) in August, when school starts again. While I wish them well, I’m afraid if results are less than stellar the parents are going to call VT quackery.

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    • Robert Nurisio COVT

      Thanks, J. As a former patient, I’m sure you can appreciate their frustration, as I do. The difference being you understood the ebbs and flows to be part of the process. I’m sad for my patient, as VT really could have made a difference, but if they are not willing to continue we have to accept it. In the interest of patient privacy, I’d rather not divulge further information. I will say that her condition was not Meniere’s, but a condition associated with many auto-immune disorders. When I Google’d the condition, the first three symptoms to appear were fatigue, dizziness and nausea.

      Say hello to your kids for me!! Hope they are well 🙂

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  2. sharon callaghan

    Hi Robert
    Thank you for sharing this. As I mentioned, three children in vision care have apparently died here because they were not referred.
    You did the right thing, and a family history of the two conditions causing vertigo and nausea does not rule out other possible pathology as the cause of the symptoms.
    Hopefully, when the family have had time to consider, they will recognise you have their interests firmly at heart. And the VT has not been wasted – the test results were great news. I have had similar disappointments when clients’ concern gets the better of their thinking, and they sting. Keep up the good work.

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