Could you take phosphorous to help break down those calcium crystals?

We think though this goes back to as you’re saying, BPPV is attributable to the calcium crystals, and to be honest, a lot of the times, I have patients who have it just so rarely that I don’t know if there’s truly a root cause or if this is just sort of a one-off or something like that. It is thought that it can be related to prior head trauma, so that could be a predisposing factor. Some cases we think might be related possibly to Meniere’s disease or maybe like vestibular neuronitis or some other causes of sort inflammation that we think about within the central nervous system. I think you’re on the right path Chi in terms of looking at inflammatory markers.

Another thing that I do keep in the back of my mind, again, it’s not the first thing that comes to my mind, but with recurrence of BPPV, there is a higher frequency of BPP in giant cell arteritis, so that’s something just way back in my head. If the patient’s also complaining of headache, fatigue, if they’re having fevers, vision loss, I do think about temporal arteritis, also called giant cell arteritis. Pretty rare. That is going to occur only in your adult patients probably over 50 years of age, but put that one in the back of your mind. You didn’t mention any of those other symptoms, so probably not an issue. We also have seen some higher rates of migraine, hypertension, dyslipidemia, and stroke with BPPV. You did mention that this patient had some strokes, so you do need to think about vascular mechanisms. If this patient has hypertension, think about addressing their vascular health. You already suggested doing things in terms of looking at the gut and looking at inflammation. I think those are really important and make sure you check this patient’s blood pressure. Does he have hypertension? Does he have dyslipidemia? Those might be two things that you really need to think about. Then, if he has either the hypertension or hyperlipidemia, start going down those pathways of treatment and maybe thinking about supplements that would be appropriate for the hypertension and/or the dyslipidemia. Again, because of the stroke, I already have sort of a higher probability that I would be going down one of those pathways. Just based on the history that you’ve told me, I would think most about looking at the cardiovascular etiologies, but I think there’s still a lot we don’t know about BPPV. Again, it depends how recurrent these episodes are, but again, for the majority of my patients, BPPV is pretty pretty rare, more often one-off but because this is an 80-year-old patient do make sure this is not in the setting of giant cell arteritis, just asking about the other symptoms. It sounds like you need to treat the gut. That’s going to be the first piece. After treating the gut, think about hypertension and dyslipidemia and depending on what that looks like the supplements you need to use to go down those pathways. Great question.