instruction: hello doctor I am a 40 year old male I weigh about 79 keg and my height is 1 my be is 130 78 and pulse rate is 90 bum I have no diabetes and I am a non smoker and non alcoholic I am a software engineer I am having neck and back pain issues for the past 10 years particularly more severe neck pain for the last one week as my neck is hurting and pain is radiating into my head and shoulders etc till now there is no pain in my hands or fingers my job is computer programming so I have to focus hours on the screen this is one of the main reasons behind it as I never had any vehicle or sports accident now more terrible thing is that I have started vertigo spinning in head while lying down and move my head towards the left side because of this vertigo fear I kept laying straight on my back full night I can cope with the pain but vertigo spinning of my head is putting me under stress and depression as it could affect my daily life too I have taken thousands of medicines in the last ten years currently my doctor advised me some medicines which I am using since four days I take zenorit 8mg azithromycin lavistina 16 my betahistine dihydrochloride paragon chlorzoxazone 250 my and paracetamol 300 my and neurobion forte well my first question is what is the main reason for having vertigo spinning head while lying down and tilt the head on the left side my doctor has diagnosed that my ear is having balancing issue is that true however I guess any of my cervical disc pinches some nerve or artery while I lay down and turn my head as you can see from the mri report that almost all of my discs are having issues moreover regularly I do a light massage with deep heat cream and then keep a hot water bottle on my neck back for some time earlier I had some physiotherapy sessions as well for pain management however there is no chiropractor available in our city I will be greatly thankful to you if you could at least diagnose the root cause of this vertigo which comes up while lying down and turn head to the left side once the vertigo is subsided we can start working on pain management please note that I feel quite relax and less pain while I walk or even stand up however having full of pain while sitting and had neck pain and vertigo in the bed
output: hello I read your history and reviewed your total spinal mri do not be nervous vertigo that you are experiencing is not related to your discopathy you have disc bulging in the cervical spine c5 ca and ca c7 at least one mild disc bulging in the thoracic spine and two more disc problems in the lumbar area especially in la s1 that is complicated by spondylolisthesis I spinal body sliding nevertheless as I said none of them is related to vertigo your vertigo is a benign paroxysmal peripheral vertigo bppv that is caused due to a benign problem in one of your horizontal semicircular canal in the inner ear in simple words one of your sensors which reports the brain any horizontal rotation of the head suffers from a temporary problem and gives exaggerated data to the brain I agree with the prescribed medicine except the antibiotic azithromycin that seems unnecessary if you do not have a fever or ear pain the key treatment is not medicine please accept my advice and do not avoid the head movement that triggers your vertigo in contrast repeat it more and more in every try you will notice that the severity of vertigo will lessen it is similar to seasickness by repeating the movement and sending exaggerated data by your ear your brain habits the situation and will neglect the bad data and you will improve if this strategy does not work after five days in combination medicines then you will need to be treated by a maneuver that is called gufoni maneuver it should be done by a trained neurologist or ent specialist I hope this helps