My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Melissa Yvette Liu

Melissa Yvette Liu, MD

Family Medicine

An important part of being your physician is understanding who you are. That also means understanding how valuable your time is. My colleagues and I have developed My Doctor Online so you can e-mail me, check your lab results, make an appointment, access our many online programs or get information about a particular health topic – any time it’s convenient for you.

My Offices

San Jose Medical Center
Appt/Advice: 1-408-362-4791

See all office information »

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Overview

Dizziness can occur at any age but is more common in older adults. There are many causes of dizziness. One way to understand causes is to divide your symptoms into two types of dizziness: vertigo and non-vertigo. Treatment options will depend on the cause, so we will ask you to provide a detailed history about your dizziness.

Symptoms and Diagnosis

To begin, we will work with you to identify the type of dizziness you are experiencing in order to prescribe the right treatment. There are two types of dizziness:

  • Vertigo is a sensation that your surroundings are turning or spinning. Vertigo often occurs when you move your head from one position to another, like turning over in bed or raising your head after tying your shoelaces.
  • Non-vertigo makes you feel out of balance or lightheaded.

We will ask you about when the dizziness occurs, the quality of the sensation that you experience, when you experience it, and what makes it better or worse. We will do a physical examination that is focused on the history that you provide. 

Causes

There are many causes of dizziness and vertigo.

Vertigo

Motion sickness.  Motion sickness occurs when the brain receives conflicting information from the eyes, skin pressure receptors, muscle and joint receptors, and inner ears. This can occur when you ride in a boat, airplane, car, or even on an amusement park ride. Nausea and vomiting are common with motion sickness.

Benign positional vertigo. Calcium deposits in the back part of the inner ear, also known as the semicircular canals, cause benign positional vertigo. It usually lasts less than one minute. It starts suddenly and is often first noticed in bed, when waking up from sleep. Any turn of the head brings on violent but brief bursts of a spinning sensation, especially when you tilt your head up or down or when you roll over in bed. In fact, any turn of your head can bring on this type of a spinning sensation. Nausea and vomiting may also occur. There is no hearing loss or severe ringing in the ears associated with this type of vertigo. It may take weeks or months to recover and it may recur.

Labyrinthitis. The labyrinth part of the inner ear helps control your balance and gait. If it gets swollen and inflamed, probably due to a virus, you can be diagnosed with labyrinthitis, also called vestibular neuronitis. The onset is rapid and the symptoms are severe. You will experience a spinning sensation that can last several days. Nausea, vomiting, and loss of balance are common.

Meniere’s disease. This spinning vertigo is caused by excess fluid in the inner ear. An episode can last minutes to hours, although the condition may last for months or years. The vertigo is usually severe. In addition, you may experience nausea, vomiting, and a ringing sound in the ears, typically only on one side. There can also be hearing loss and ear pressure. Symptoms may last months or years and may recur every few days.

Allergic reactions to food or airborne particles. Underlying allergy triggers can cause vertigo.

Other causes of vertigo:

  • Head concussion
  • Stroke or transient ischemic attack (a mini-stroke)
  • Migraine headaches
  • Multiple sclerosis if the plaques associated with multiple sclerosis are located at or near the nerve to the inner ear
  • Use of unaccustomed amounts of caffeine or nicotine
Non-Vertigo

Pre-syncope. Feeling lightheaded, as if you might faint, may occur when there is a sudden drop in blood pressure or blood flow to your brain. This sensation of almost losing consciousness may last seconds to minutes. You might have a feeling of warmth, sweatiness, nausea, or blurred vision, and you may appear pale to others. Pre-syncope usually occurs when you are sitting or standing, not when you are lying down. This has a number of causes. We will check medications that may be lowering your blood pressure, irregular heart rhythms, and other causes.

Disequilibrium. You may have a sense of imbalance when you walk, turn, or stand. Causes include damage to the nerves of the legs, joint problems, ear problems, neck problems, Parkinson’s disease, or vision problems. This is experienced more by the elderly. Falling is a major risk.

Nonspecific causes. The following things can cause lightheadedness, feeling giddy, or dizzy (not a spinning sensation like vertigo):

  • Hyperventilation or breathing too fast, usually unconsciously, may cause a sensation of lightheadedness.
  • Anxiety or panic disorders may be associated with dizziness.
  • Low blood sugars in people with diabetes taking medications may cause dizziness.
  • Certain medications can cause nonspecific dizziness.

Treatments

We recommend treatments based on the cause of your dizziness or vertigo.

Medication and exercise

Medications, such as meclizine, may be helpful if you have motion sickness. You can get a scopolamine patch to place behind your ear if you are going on a cruise.

Meclizine or Dramamine may help with symptoms of benign positional vertigo. The condition may also respond to various exercises or maneuvers that you can do at home or by seeing a physical therapist. These include Cawthorne head exercises or the Epley or Semont maneuver. These exercises move the calcium crystals that are causing the symptoms away from the nerve endings of the inner ear. These maneuvers are about 75 percent successful.

If medication is suspected to cause dizziness, we might stop the medication or prescribe an alternative.

If hyperventilation is diagnosed, you may be advised to get stress reduction training.

If you see a specialist, you may need other treatments based on the cause of the dizziness.

Home remedies for vertigo and lightheadedness

  • Lie down and prop yourself up slightly.
  • Sit up slowly. 
  • Move slowly to avoid injury. 
  • Watch for symptoms. Let us know if you develop nausea, dehydration, or fainting; if there is no improvement in 7 days; or if symptoms become more severe.
  • Rest.
  • Do not drive.
  • Drink plenty of water and stay hydrated.
  • Avoid caffeine, alcohol, tobacco, and recreational drugs. 
Additional References:

Your Care with Me

If you have symptoms of dizziness that concern you, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment with me or one of my colleagues, if I am not available.

Based on your symptoms, medical history, and any tests I may order, I will confirm your diagnosis. We will discuss potential lifestyle changes, therapies, and treatment options that are right for you.

If specialty care is needed, we will facilitate the process of scheduling an appointment with a specialist. If appropriate, I may call while you are in the office so we can all discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

  • For non-urgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
  • If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you.  
If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

How We Coordinate Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you. 

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you call the Appointment and Advice line
  • Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location.
  • The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.
If you come to an office visit 
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization.  We can discuss and schedule any preventive tests that you need.  
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed.  Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department.  When the results are ready I will contact you with your results by letter, secure e-mail message, or phone.  In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test.  We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

Convenient Resources for You

As your personal physician my goal is to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions and schedule appointments.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
  • Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love.
Learn more about your condition
  • Read about causes, symptoms, treatments and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at our medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.