Epley’s canalith repositioning maneuver

vertigoThe emergency room doctor used words like “benign” and “idiopathic” to explain Joseph Delahunt’s head-spinning vertigo — the kind of words doctors use when they’re stumped and need to say something.

But the adjective “benign” really fell short. Crippling was more like it. If Delahunt tried to stand or even just turned his head, the world started whirling — the worst drunken-bed-spins kind of whirling. If you looked into his eyes, you’d see his eyeballs jerking rhythmically back and forth as if fixed on a passing train.

Delahunt crawled to get to his car so his wife could drive him to the hospital. He hung his head out the window and puked most of the way. The fifty-something Air Force veteran was healthy and active — selling real estate and practicing yoga — until the attacks started. They didn’t stop.

Delahunt’s family doctor referred him to a neurologist, who referred him to an ear, nose and throat surgeon. They wrote a lot of prescriptions for motion-sickness pills and other drugs that didn’t work.

To avoid attacks, Delahunt took to living in a reclining chair in which he could keep his head from moving too much. For nearly three months, he left the recliner only to go the bathroom. The surgeon talked about a drastic last resort: cutting some nerves in his head to stop them from blasting vertigo-inducing signals to his brain. The tradeoff would be loss of balance and maybe impaired hearing, too.

Internet searches led Delahunt to a solo practitioner named John Epley who claimed to have developed a cure for the most common cause of chronic vertigo. Most doctors dismissed Epley as a crank. Two of his hometown colleagues had accused him of unprofessional conduct.

Epley’s stooped shoulders and gentle eyes made him look like a turtle. No amount of combing could tame the stubborn cowlick in his short hair. And although he had no medical school affiliation or grant support, he had managed to publish some results in the Journal of the American Academy of Otolaryngology. In the 1992 report, he described the 100 percent cure rate of his “canalith repositioning maneuver” in 30 patients with the condition known by the cumbersome name of benign paroxysmal positional vertigo.

At Epley’s office, an assistant helped Delahunt down a long hallway to a gray-walled room with closed blinds in which Epley had built a strange apparatus. Inside a giant steel ring hung a padded chair. Motors, gears and drive-chains were rigged to flip and twirl the chair. It looked like something NASA would have used on chimpanzees.

Delahunt stepped up to a platform and into the chair. An assistant clipped straps across his chest and ankles. She covered his eyes with a mask as big and heavy as a brick. It contained a video camera to track his eyes. She clipped a vibrator behind his ear. It buzzed lightly, about as vigorously as a vibrating cell phone.

“Are you comfortable?” the assistant asked. Delahunt nodded, grateful for the Valium he’d taken.

“We’re going to roll you back,” Epley said. He fingered a joystick controller to tilt the chair back until Delahunt faced the ceiling. The device showed signs of last-minute modifications: a radio transmitter lashed to its frame with nylon straps, a video camera clamped to an adjacent shelf, cables to the added components snaking from an overhead ceiling tile, pushed slightly ajar.

On a black-and-white computer display, Epley gazed at a video stream of his patient’s eyes, looking for the rhythmic twitching triggered by positional vertigo. With a flick of the joystick, Epley spun Delahunt 45 degrees clockwise as if on a giant rotisserie. Epley spun him back in a counterclockwise move that ended with Delahunt face down. Then he swung Delahunt upright and face-forward and repeated the choreographed series of tilts and whirls. And that was it.

The assistant unbuckled the straps. Delahunt climbed out of the chair and stood up. No waves of vertigo struck no matter how much he moved his head. The nausea was gone. He was cured.

[ I wrote a long newspaper feature article about John Epley and his clash with the medical establishment.  This is an excerpt from that piece, re-written using a different writerly voice as an exercise for a narrative non-fiction class.  The original piece (Doctor and invention outlast jeers and threats) was published in The Oregonian in 2006 but is no longer accessible at the newspaper’s website. A lot of people have re-posted bootleg versions, though.]

Photo by Brocken Inaglory (Own work) [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons

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