Abigail Leksell suffered from vertigo for 10 years, experiencing periods of dizziness that came out of nowhere. They were accompanied by nausea and lasted anywhere from a couple of minutes to a couple of hours.
Mrs. Leksell, now 38, of Butler, also eventually experienced ringing in her right ear with some hearing loss.
Her personal care physician diagnosed Meniere's disease, which is caused by a buildup of fluid in the inner ear.
There were other doctors. Neurotologist Douglas Chen, director of the Hearing and Balance Center at Allegheny General Hospital, is now her fourth.
The treatment was always the same:
"There's not a whole lot they can do," Mrs. Leksell said. She was told to restrict her salt intake and was prescribed a diuretic and Antivert (meclizine, also sold as Bonine and other brands), a drug to take as needed for nausea.
At one point she went into remission and went a couple of years without a dizzy spell "because I was really careful."
But, she said, "I was one of the unlucky people -- it didn't go away. It continued on. Last year it kind of accelerated. ... The dizzy spells started to get worse. They interrupt your life. They happen at work. They happen at your daughter's doctor appointment. When they happen, you have to go lie down. ... They started to get to the point they were interfering."
After she had four or five spells between Thanksgiving and Christmas of last year, she discussed more aggressive treatment with Dr. Chen.
"That's when he decided we could do the surgery," Mrs. Leksell said.
Dr. Chen chose to do a procedure called an endolymphatic sac decompression of the inner ear.
"It's thought to regulate inner ear fluid pressure," he said. "We took off the bone around it to regulate it. It's got about a two-out-of-three success rate."
The operation is considered nondestructive, because the surgeon seeks to repair the inner ear. Other surgeries are considered destructive because the organ that controls the vertigo is destroyed, Dr. Chen said. They have a higher success rate but leave the patient with only one balance mechanism, in the other ear.
Dr. Chen said surgery is a treatment of last resort "because eight out of 10 will be treated successfully with medicines so there's no reason to try anything more aggressive until you try [them]. ...
"The surgery is certainly at the patient's discretion," he added. "There's a whole spectrum of tolerance. A pilot who has one spell of vertigo will be grounded for I don't know how many months versus somebody at home primarily [who] will be able to tolerate more. ... Some have two or three a week, lasting hours, and do nothing; some have two or three a month and say, 'I just can't lead a life.' "
Mrs. Leksell fell into the latter category. Married, the mother of two teenage daughters and employed in the customer service industry, the vertigo was interrupting her life too much.
"I can't know when I go to work in the morning that I'm going to have a dizzy spell," she said. "I have to have someone to drive me home. ...
"Have you ever been dizzy? Take that little feeling and multiply it. ... The ringing in the ear is there all the time, just in the right ear. ... and the hearing loss. As long as they take away the dizzy spells I can deal with the hearing loss and the ringing."
So far, so good.
The surgery was March 9, a Friday. She went back to work the following Monday with a scar behind her ear that no one can see. She hasn't had any vertigo since the operation.
"I don't know if it's something that has to be repeated years and years from now," she said. "I'm hoping not."
Chances are she won't.
Short term, the rate of success is two out of three. Long term -- more than five years -- the chance of success is about 85 percent, Dr. Chen said.
"That may be a reflection of the disease. ... If you make it past that first five years, the likelihood is you won't need anything," he said.
Pohla Smith: firstname.lastname@example.org or 412-263-1228.