A farmer, a nun and a prisoner walk into an emergency room…

There is no funny punchline to this joke, but the good news? I didn’t break the farmer…in fact, I fixed him!

He came in with a complaint of dizziness and nausea that he experienced every time he looked to the right or looked up. As a farmer, it was difficult for him to feed the pigs and do work in the barn looking to his left all the time, so he came in with his wife. He said it started the night before when he got up to go to the bathroom, and he got dizzy. No, he corrected himself, it started when he rolled over in bed, right before he got up. The room spun round and round and round.

If you’re a doctor, nurse, or medical studnet, you may be jumping up and down right now with your hand in the air screaming, “Ooh, ooh, I know what it is, pick me, pick me!”

He had a textbook case of BPPV or Benign Paroxysmal Positional Vertigo. There are two classic eponyms associated with BPPV, one is the Dix-Hallpike maneuver, and the other is Epply’s maneuver…any 3rd or 4th year medical student will quickly associate BPPV with Dix-Hallpike, but few have ever performed the maneuver, let alone the Epply’s! In fact, most of my colleagues looked at me like I was nuts when I told them what I was doing. Some of you are wondering what I am talking about…both are maneuvers that reproduce the symptoms which include nausea and vomiting. Fun! The Epply’s maneuver continues the diagnostic portion of the Dix-Hallpike by rolling the patient on his back, on his side, and twisting and turning the head as you go…and eventually, correcting the underlying problem causing the vertigo!

I don’t have the patience to explain it all right here, but I can’t tell you how ecstatic I was to returned to the patients room, and saw him looking up, down, right left and all around without feeling any dizziness whatsoever. He had a smile on his face that would not fade. I fixed him! Did you hear that? I FIXED him!!! No breaking this patient, I fixed him!

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