MAT-SU — Carole Ruby didn’t know it at the time, but her future may have been changed when she was a 7-year-old living in Baltimore, Md.

Ruby was hit in the head with a piece of coal thrown by her brother. What seemed a small injury to her temple left little of an impression on her at the time. It wasn’t until 60 years later she began feeling nauseous one night while on vacation. Ruby got the sudden sensation she was being spun around and was violently ill.

“It all started back in 2002,” Ruby, now 70, said. “I was on my way back from a trip and stopped off in Canada where I got sick in the middle of the night. I had that episode for three days, so I thought it was the flu. When it didn’t go away, I thought something [else] was wrong.”

ROBERT DeBERRY/Frontiersman Carol Ruby was diagnosed with Ménière’s disease, which is characterized by episodes of dizziness, ear pressure and progressive hearing loss, usually in one ear. Ruby knows her condition will get better, but it will always be there as well and she can have an attack at any time.

When Ruby returned home to the Mat-Su Valley with her husband, her symptoms persisted. When she stood up, she fell over as if intoxicated. She visited her doctor, who referred her to Dr. David Beal, a specialist in dizziness disorders in Anchorage. When asked if she ever received a blow to the head, Ruby thought back to the coal throwing incident as a child. Beal, at the time skeptical of the two being related, diagnosed her with Ménière’s disease.

Ménière’s disease is a disorder of the inner ear that can affect hearing and balance. It is characterized by episodes of dizziness, ear pressure and progressive hearing loss, usually in one ear. It is caused by an increase in volume and pressure of the endolymph of the inner ear, sometimes brought on by a blow to the head.

“Dr. Beal said I had Ménière’s in my left ear, which puts you off balance,” Ruby said. “Mine was a severe case because I would black out and fall at the drop of a hat, being sick for hours before it went away.”

Beal, a specialist at the Alaska Dizziness and Balance Center, is the only otoneurologist at the clinic who specializes in dizziness disorders. He said he isn’t sure the piece of coal that hit Ruby in the head as a child was the cause of her Ménière’s, but cannot rule it out completely.

For the last 40 years, Beal said he has seen more than 1,800 vertigo and Ménière’s disease patients in Alaska. In the Mat-Su Valley, Beal said he works roughly with 50 people living with Ménière’s.

“This is something that can be treated,” Beal said. “We have control of the disease with treatments that can be done to alleviate the symptoms.”

Beal said medical treatment for Ménière’s disease involves a complex diagnostic procedure to determine which route doctors can take.

“We send very few to Seattle,” he said. “We can do a lot of these procedures in the inner office.”

Beal said there is no known cause for Ménière’s disease, other than it usually endolymphatic hydrops, which means the patient has excess fluid in the inner ear. Endolymphatic fluid bursts from its normal channels in the ear and flows into other areas, causing damage. This may be related to swelling of the endolymphatic sac or other tissues in the vestibular system of the inner ear, which is responsible for the body’s sense of balance. The symptoms may occur in the presence of a middle ear infection, head trauma or an upper respiratory tract infection, or by using aspirin, smoking cigarettes or drinking alcohol, he said. They may be further exacerbated by excessive consumption of caffeine and salt in some patients.

Dizziness and nausea are the common symptoms of Ménière’s disease, including the feeling that the patient is being pushed or pulled around his or her environment. Still, Beal said there is no sure way to determine the cause of the disorder.

“There are about 85 causes for vertigo and dizziness,” Beal said. “So it’s more complex than pulling something out of a hat.”

In the Mat-Su Valley, people experiencing excessive dizziness can be assessed at Wasilla Physical Therapy, a clinic equipped with the diagnostic equipment to treat patients experiencing balance problems.

Beal put Ruby on a series of balance stabilizing medications until the decision could be made whether she should proceed with an operation, the standard procedure to fix the problem.

Beal said Ménière’s often begins with one symptom and gradually progresses. However, not all symptoms must be present for a doctor to make a diagnosis of the disease. Several symptoms at once is more conclusive than different symptoms at separate times.

The four common symptoms are periodic episodes of rotary vertigo or dizziness, fluctuating hearing loss in one or both ears, progressive, tinnitus or the perception of noises (often ringing, roaring or whooshing in the ear) and a sensation of fullness or pressure in one or both ears.

“Attacks of vertigo can be severe, incapacitating and unpredictable,” Beal said. “Some patients experience vertigo for hours or days, which could lead to hearing loss.”

Nausea, vomiting and sweating sometimes accompany vertigo, all symptoms Ruby experienced early on in 2002, Beal said.

“I was falling and bumping into everything,” she said. “I had to quit Curves because I kept blacking out. It got pretty serious when I couldn’t control my balance.”

Some sufferers experience what are informally known as “drop attacks” — a sudden, severe attack of dizziness or vertigo that causes the sufferer, if not seated, to fall. Patients may also experience a feeling of being pushed or pulled. Some patients may find it impossible to get up for some time until the attack passes or medication kicks in.

On her first visit to Beal six years ago, Ruby said she remembered having three episodes while waiting for her appointment.

With her insurance covering part of the medical treatment for Ménière’s disease, costs began to mount. Also, the shots she received in her left ear to help with her vertigo rendered Ruby deaf in that ear.

“Every time I go somewhere, I carry Valium with me,” Ruby said. “I can’t drive anymore. In fact, I can’t go anyplace by myself. My husband’s a good support. I’m well maintained now, thanks to Dr. Beal. I used to be constantly sick in the beginning.”

Ruby has begun the process of finding other sufferers of vertigo and Ménière’s disease to start up a support group in the Mat-Su Valley.

“Dr. Beal and I thought it was a good idea,” she said. “He had told me there were several people from the Valley that have Ménière’s disease, but couldn’t give me names due to anonymity.”

Ruby said she has communicated the need to another Ménière’s patient, a man in Talkeetna, but needs more people to show interest in order to start up a support group.

“You can’t get started with just one person,” she said. “So maybe it will get bigger.”

Today, Ruby said she has fewer dizzy episodes than six years ago thanks to the treatments she receives, but she still has a long road of recovery ahead of her. She hopes a support group will help alleviate some of the common day-to-day problems she lives with.

“I’ll have this for the rest of my life,” Ruby said. “It will get better, but it will always be there too. I may not have another attack, but it could hit me at any time.”

For information about a support group for vertigo and Ménière’s, call 745-2694.