August 26, 2002

In my attempt to understand what happened to me, in a hospital setting, I have pursued information on the internet. I found a number of interesting documents. I have assembled those documents here. I may have violated copyright laws and I do so at my own risk. I want to share my efforts with many people. I want a backup copy of the data and I don't want to lose access to information.

The original owner of the data has been cited and a link has been provided to the original data.

Unlike others who encounter setbacks, the onset of bilateral vestibulopathy wasn't quite the same as a car accident, falling downstairs or catching the flu. Far from being a random event my current condition happened only because I sought medical help. In fact I've become a PMP (prisoner of medical practices).

I just want to get back to the person I was before I was given gentamicin.

Dave Palmer
Oakville, WA

Thanks to Wobblers Anonymous for the support they provide all of us who have become a PMP.

Thanks to a friend, read about the impact of gentamicin One patient's story

Bilateral Vestibulopathy Documents

  1. Vestibular Disorders: An Overview
  2. Fatigue, Stress, Responsibility
  3. Peripheral Vestibular System
  4. The Human Balance System
  5. Pyschological Impact -- perhaps the most important
  6. Cognitive Impact - - Another very important document
  7. How are we tested? - A layperson/patient view of vestibular function tests.
  8. Neurologic Disorders Vertigo and Vestibular Function An excellent overview of vestibular topics.
  9. Some of us think we have dementia problems. Here is something to read which might dispell fears and help explain the fog many of us feel all the time.

Medicine Choices

There are valid questions concerning the medicines used to treat various infrections. Some reasearch has come up with these pages:

  1. Drugs Of Choice According To Infecting Organism
  2. Index of Bacteria
  3. Empiric antibiotic use in the surgical intensive care units
  4. Hospital of the University of Pennsylvania formulary antibiotic costs As of April 2002
  5. Table of Contents for Antimicrobial therapy in Otolaryngology - head and neck surgery
  6. Gentamicin is a "BLACK BOX DRUG". What does that mean?? Find out by reading Black Box Warnings in Prescription Drug Labeling

Read about the impact of gentamicin One patient's story

Are there stages patients go through with a chronic disease or condition?

Information which is available Where is the orginal? Here is a WWW copy
John Hopkins Medical University Department of Biomedical Engineering has produced a brief report on otoxicity and how it should be diagnosed during the patient's treatment with a drug like gentamicin. They recommend a daily test. This report is a must read. Did you know "50% of patients did not have excessive total dose or abnormal peak or trough levels. The duration of treatment could be as low as 3 days." This is the report name:
http://www.bme.jhu.edu/
labs/chb/disorders/wobbler/abototox.html
and the original
is here. 		A local backup can be found here.
The National Library of Medicine (part of the National Institute of Health) aka Medline has an information sheet on gentamicin. I wonder how many Wobblers ever saw this sheet? The original of this document
is: http://www.nlm.nih.gov/
medlineplus/druginfo/
medmaster/a682275.html
This form can be found here 		A backup copy of
this form
is found here
It would have been wonderful to read: "What You Should Know About Ototoxic Medications" before July 19th, but I didn't. Have you read this? It is written by Stephen Epstein, M.D. The original is:
http://www.ifhoh.org/
Epstein.htm and
it is found
by clicking here 		A backup copy of
Dr. Epstein's report
is right here
Ototoxicity - an overview of the causes of cochlear toxicity, vestibular toxicity caused by aminoglycosides, macrolides, antineoplastic agents and drugs, topical antimicrobials, other antibiotics, loop diuretics, salicylates and NSAIDS By R.D Briggs MD and A.K. Gadre, MD The original
http://www.utmb.edu
/otoref/Grnds/Ototox-011107/
Ototoxi-2001-slides.ppt
is a powerpoint presentation. 		A quick local copy is ototoxicity slides
Bilateral Vestibulopathy - by Timothy C. Hain, MD An excellent professional and patient presentation on cause, diagnosis, treatment, prognosis and research. The original http://www.tchain.com/
otoneurology/disorders/bilat/wobbler/bilat.html
at this T.C. Hain site 		A guick local copy without Dr. Hain's hot-links
is here as wobbler/bilat.html Please refer to the original as well.
Gentamicin Toxicity - According to Timothy C. Hain, MD gentamicin toxicity is the most common single known cause of bilateral vestibulopathy. This paper discuesses the toxicity issue. The original http://www.tchain.com/
otoneurology/disorders/
bilat/gentamicin%20toxicity.htm
is at this T.C. Hain site. 		A local copy, without Dr. Hain's hot links is here
as wobbler/gtoxicity.html Please refer to the original as well.
University of Buffalo, State University of New York, School of Pharmacy had a Therapeutic Drug Monitoring Program (TDM) which presents:

Pharmacokinetic characteristics

Data describing the dosage forms, dosing, therapeutic range and sampling time

Factors affecting pharmacokinetic parameters

Methods of assay

The original http://pharmacy.buffalo.edu
/pp/TDM/aminoglycosides.html
is available online at this WWW site 		A local copy is this pharmacy copy
This takes a long time
to load
A document from IVertigo.net mentions the incident rate for vestibular damage from different drugs.

The reader is encouraged to review all the material at http://ivertigo.net

The original http://ivertigo.net/
ototoxicity/wobbler/otcochlear.html is at
this site 		A local backup copy is at this location.
The American Society of Health-System Pharmacists (ASHP) has, among other data, a list of alternative injectable antimicrobial agents. In other words what other drug might be used to fight infections? The American Society of Health-System
Pharmacists (ASHP) has a
report of alternatives http://www.ashp.org/
shortage/tables/zosyn-table1.pdf
which you can access here. 		A non-pdf, www version of the alternatives
report is available here
Timothy C. Hain, MD has created a very complete report on Ototoxic Medications which cites the toxicity and toxic level for many compounds. The Timothy C. Hain, MD Ototoxic report
http://www.tchain.com/
otoneurology/disorders/
bilat/wobbler/ototoxins.html can
be found here 		A local copy is found here
John Hopkins University Department of Biomedical Engineering has also produced a brief report on bilateral vestibular loss. It too is a must read. This is the report name
http://www.bme.jhu.edu/
labs/chb/disorders/wobbler/bilatlos.html
and it can be found here 		A local backup copy can be found here
John Hopkins University has an interesting site that deals with hearing and balance. Check it out.
Down under, as we Yanks say, there is a data sheet exclusively for gentamicin. A search of our internet shows no such data sheet here in the USA. New Zealand Ministry of Health provides this service. This data sheet comes courtesy
of New Zealand where
it is known as: http://www.medsafe.govt.nz
/Profs/Datasheet/p/piperacillininj.htm 		A backup copy of the data
sheet is right here.
But do check out the original too!
A site known as eMedicine has many informative and educational offerings. One of them deals with the inner ear and ototoxicity. This particular one discusses the implications and the sources of ototoxicity. The original eMedicine material
on ototoxicityis located here. 		This is a local copy of that document
the reader should review at
the original eMedicine.com site
Where will you run into drugs like gentamicin? The Department of Pharmacology & Therapeutics Faculty of Medicine, McGill University in Montreal has created a document with loads of information. It has dosing information. The dosing information indicates the variety of procedures which might use gentamicin. Skin infection, g.i. procedures, pelvic inflammatory disease, a host of infections and conditions I can't begin to describe. This report is http://www.medicine.mcgill.ca/
cai/meded/drugdb/gentamicin/
gentamicin_db.htm and
you can reach
the original here 		A backup copy is right here.