When the brain processes all this information, the body is able to maintain its balance and move without falling. The whole process occurs automatically and continually, which is the only reason activities like ballroom dancing, ice skating and ballet are feasible.

Dizziness is a feeling of lightheadedness, fainting or spinning, and vertigo is one of the most common types of dizziness. It is the sensation of motion where there is none, or an exaggerated sense of motion when moving.

Nausea, vomiting, pallor and perspiration can accompany vertigo, and vertigo can be acute, chronic or recurrent. About 1.5 million Canadians have a diagnosis of vertigo, while about a third of the population report they have experienced dizziness.

Unfortunately, these numbers are only guesses because many people do not seek medical attention and in other cases, the symptoms may clear before the patient seeks medical attention.

The vestibular system in the inner ear is responsible for balance when moving. It is filled with fluid and lined with hair cells, and it looks like three concentric circles each with a different orientation.

When movement occurs, the fluid in the vestibular system also moves, and these movements stimulate the hair cells. Think of how the waves from behind a motorboat hit the shore. The hair cells are linked to the nervous system which uses this information to interpret balance.

Benign paroxysmal positional vertigo accounts for 20 to 40 per cent of all vertigo cases and is thought to be the result of infection, surgery, trauma or even inflammation of the inner ear.

Debris or small crystals are found in the semicircular canals of the inner ear. With this condition, bouts of vertigo occur, especially with head movement. However, the vertigo can clear on its own or alternatively become chronic. Physical manipulation by a trained professional can reposition the fluid as well as the debris or particles, thereby resolving the problem. This non-drug approach is usually more successful than medication.

Meniere’s disease is probably the most familiar type of vertigo, although it is actually only the second-most common type. It is thought to be the result of circulation problems, viral infections, an allergy, an immune system problem, migraine headaches or even a genetic trait.

There can be an aura or warning that the dizziness will occur, and common symptoms include fluctuating hearing loss, tinnitus or ringing in the ears, and a feeling of fullness. The onset is usually abrupt with episodes lasting for about 30 minutes. Current thinking is that increased pressure in the inner ear is the cause, so treatment is aimed at reducing pressure, for example with a low salt diet, avoiding caffeine, smoking cessation, diuretics or water pills.

Betahistine is the most commonly used drug for vertigo, and it is believed to help stabilize the vestibular system. It has mixed results and can cause drowsiness and gastrointestinal side effects. Taking it with food can reduce these symptoms.

Historically, benzodiazepines and flunarizine were used to reduce vestibular excitability, but today these drugs are not considered effective. For the nausea that can accompany vertigo, anti-nausea drugs like dimenhydrinate tablets and scopolamine patches are usually recommended.

Ideally, any underlying causes for vertigo should be investigated and corrected, but some cannot be, for example older age, family history, previous head trauma.

Other contributing factors can be addressed and treated, for example high blood pressure, heart disease, diabetes, smoking, diminished eyesight or hearing, and alcohol consumption.

The key take-home is this: Vertigo is definitely a condition that should not be dismissed because it can lead to falls and broken bones! Don’t ignore it.

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Vertigo is a more technical term. It refers to a feeling of motion when there is none, or an exaggerated sensation of motion in response to movement.

Nausea and vomiting can accompany both dizziness and vertigo.

About 1.5 million Canadians have been affected by dizziness or vertigo, but the sensation is difficult to diagnose in that it is very subjective.

To understand dizziness and vertigo, you need to know how your body senses its balance. The vestibular system is found in the inner ear and contains otoliths. These are like grains of sand.

When you move, the otoliths move too, and it is this movement that sends messages from the vestibular system to your brain about your orientation in space and motion.

Along with your vestibular system, your eyes, muscles, and even touch sensation provide input for your brain, which interprets the information in these signals.

As you can imagine, if even one set of these signals is compromised, you may experience dizziness and/or vertigo.

If you suffer dizziness, you obviously want to rule out any conditions that may be causing it. Problems with the vestibular system or the nerves that transmit information to your brain may be implicated. Some medical conditions like heart beat irregularities, anemia, diabetes, migraine, or even a head injury can cause dizziness, so treating such underlying conditions may help the dizziness.

Many drugs have dizziness as a side effect because they affect the nervous system. These include, for example, alcohol, antidepressants, antipsychotics, narcotic pain relievers and anti-seizure medications.

Also, if a drug affects the cardiovascular system, dizziness may result, for example beta blockers, calcium channel blockers, diuretics or water pills. Changing to another drug or a different dose may reduce the adverse effects.

Benign paroxysmal positioning vertigo accounts for about 20 per cent of vertigo cases. A physical manipulation of the head known as the Epley manoeuvre is able to move the otolith particles back where they belong and alleviate symptoms.

Meniere’s disease is the second most common type of vertigo. It is not well understood but dietary salt restriction and diuretics or water pills sometimes help. Betahistine is commonly used to “stabilize” the inner ear, but its benefit varies greatly from person to person.

The dizziness you experience when in a car or plane is the result of contradictory messages from your vestibular system and the rest of your body. If you are bothered by motion sickness, prevention is preferred. Sit where there is the least movement in the car: the front seat. When flying, sit over the plane’s wings. Look at a fixed point in the distance, not at something closer to you which may move, and don’t try to read.

Dimenhydrinate suppresses the vestibular system and this will reduce symptoms, but remember to take it prior to getting into the car or on a plane and watch for drowsiness.

Regardless of whether its dizziness or vertigo that you experience, don’t undertake any tasks that require alertness and precision because you may not be able to perform the task, especially if it is driving a car, or taking care of a child.

And, don’t just ignore ongoing dizziness or vertigo. Get it checked.

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Your body contains about 3.5 grams of iron, of which 2.5 grams are in the red blood cells. A blood test will determine your iron levels and help diagnose iron-deficient anemia.

Incidentally, there are other types of anemia depending upon what is causing your drop in red blood cell numbers. Causes range from excessive bleeding (from trauma, heavy periods, or even a bleeding ulcer) to low levels of vitamin B12 or kidney disease.

Anywhere from nine to 13 per cent of Canadians have iron-deficient anemia, with women being the most commonly affected. Anemia usually develops slowly. Paleness and tiredness are the most commonly noticed symptoms, although you may mis-attribute these symptoms to overwork, stress, not eating well, lack of sleep or the like.

Weakness, dizziness, increased heart rate, and decreased capacity for any physical activity are signs of more severe anemia. People often overlook the symptoms of anemia, but if they do happen to you, don’t ignore them. Get them checked out.

Iron is the treatment choice, but there are several formulations. Ferrous sulphate which comes in red tablets is 20 per cent elemental iron; ferrous fumarate, which is a dark-red tablet, is 33 per cent; and the green tablets of ferrous gluconate are 11 per cent.

Ideally, you want to take the formulation that gives you the most elemental iron, but ferrous sulphate and ferrous fumarate can cause more stomach irritation than ferrous gluconate. Taking the iron with food or a meal will reduce this adverse effect. Because iron is better absorbed in an acidic environment, drinking a glass of orange juice along with the iron will increase both the acidity of your stomach and the iron’s absorption.

Antacids, calcium, and even some drugs such as the tetracylcine antibiotics can impair the absorption of iron, and it can be advisable to avoid taking your iron within three hours before or two hours after taking these drugs to avoid the problem. (Some multi-vitamin and mineral-combination products include both calcium and iron in their formulations, which means neither mineral is being absorbed. Choose a multiple vitamin product with either calcium or iron, not both, then take the other mineral as a single-ingredient tablet separately from the multiple vitamin.)

If you do not want to take iron tablets, then dietary sources of iron may be an option along with treating any underlying cause, for example a bleeding ulcer. Meat is high in iron content and it contains a type of iron known as heme-iron which is well absorbed by the body. Non-heme-iron is iron found in plant sources such as beans, green leafy vegetables, and dried fruits such as raisins. Unfortunately, non-heme-iron is less compatible with your body and you need two to three times as much. As well, many cereals and foods are fortified with iron.

If you do take an iron supplement, remember to store it safely out of reach of any children because iron is among the top 10 medications involved in accidental childhood poisonings. The tablets themselves are brightly coloured and a child may think they are candy.

When children are given iron, their dose needs to be calculated based on their weight. Both drops and liquid iron preparations are available, but the two do not have the same concentration of elemental iron. Before you give a child any iron supplement, it is essential that the child needs the iron, that you have accurately calculated the dose based on your child’s weight, and that you have the correct concentration.

If you are not sure, ask your pharmacist to check your numbers. You certainly do not want to add to the accidental poisoning statistics!

Marie Berry is a lawyer/pharmacist interested in health and education.

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Today, benzodiazepines are taken on a chronic basis by about four per cent of Canadians, but when used for anxiety or insomnia, these drugs are actually intended for short-term use only and at the lowest possible doses. For example, for sleeping problems, the actual recommendation is no longer than seven to 10 days, and if usage continues for two to three consecutive weeks, a complete re-evaluation is recommended.

As you may realize, however, many people take these drugs on an ongoing basis for sleeping.

Ideally, if you experience anxiety or sleeplessness, identifying the cause and remedying it is more effective than taking benzodiazepines. Keeping a diary of symptoms and your daily activities might point to some activity or situation that may be problematic. Non-drug approaches can also be tried, such as relaxation techniques, counselling, sleep hygiene and even exercise.

An increased risk for falls and broken bones is a possible complication of benzodiazepine use. You may think that it is only the elderly or even people in nursing homes who may have this increased risk, but anyone can be affected. It also seems that you are at the greatest risk within the first couple of weeks of beginning a new prescription or new dose of a benzodiazepine.

Benzodiazepines inhibit a neurochemical in the nervous system known as gamma aminobutyric acid, which in turn reduces anxiety and induces sleep. It is the side-effects of these drugs that increase the risk for falls. They are able to increase the swaying of your body from side to side, which can reduce your ability to balance. Drowsiness, unsteadiness, and an increase in postural hypotension (i.e. lightheadedness) when you get up from a lying or sitting position also contribute. As well, headache, dizziness, weakness, confusion, blurred vision, vertigo, and a hangover effect are also possible, which certainly make keeping your balance more difficult.

Other drugs with similar potential side-effects can enhance these benzodiazepine side-effects, thereby increasing your risk for falls. If you have a condition like Meniere’s disease, low blood pressure, low iron, or chronic fatigue problems, that already makes you dizzy and unsteady on your feet, and keeping your balance with benzodiazepines can be difficult. Drinking alcohol increases the potential and severity of all the side-effects of these drugs.

About one in three people aged 65 and over fall each year, but many more younger people fall annually. No one keeps track of the younger people because they do not break bones as readily, requiring hospitalization or nursing-home admission. But remember, benzodiazepine use can contribute to falls in all age groups, so even if you are younger you may not break a bone, but you will be bruised and injured.

With age the risk for broken bones increases because the incidence of osteoporosis increases. For people over 50 years, 80 per cent of all fractures are the result of osteoporosis. Obviously, avoiding falls is key. Clean up clutter that you might trip over. Also tack down slippery mats, ensure your lighting is good, remove ice and snow, wear good footwear, use a cane or walker if they help, and make sure your prescription eye glasses are up to date. Also take benzodiazepines only for the shortest period of time possible.

Marie Berry is a lawyer/pharmacist interested in health and education.

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