Dear Dr. Roach: I am concerned that my child has chronic traumatic encephalopathy after a serious concussion and several other head traumas. Can you tell me the current ideas for treatment?


Dear K.L.R.: Chronic traumatic encephalopathy is a degenerative disease of the brain, described in boxers in 1928 (“punch-drunk” or “dementia pugilistica”), but recently there have been many reports of it in professional football and soccer players, as well as in soldiers with repeated blast injuries. The pathology is related to but distinct from that of Alzheimer’s disease, though both appear to relate to excess abnormal tau protein in the brain.

This is a condition that is just beginning to be studied. I can’t tell you how likely it is that your son may have it, even if I knew exactly how much trauma to the head your son received.

There have been recent reports of new drugs that may act on tau protein and potentially could benefit those with CTE or Alzheimer’s. Some of these have shown promise in animal models. However, it is far too early for me to speculate further. There are no current treatments for the condition, but the symptoms, such as anxiety or depression, can be treated.

Dear Dr. Roach: I’d like your advice on a urinary tract infection. I was diagnosed with recurrent UTI. This is the third day of my medication, but my symptoms haven’t improved much. Last time they left immediately after starting the medicine. Should go back to my doctor now, or wait until I finish all medicine (10 days)?


Dear S.L.: Urinary tract infections often get better quickly; however, you certainly should finish the medication, unless you are getting worse or having a side effect. Sometimes the medication that worked last time isn’t effective due to resistance in the bacteria. Sometimes there is a reason for recurrent infection or for the infection to not have cleared in the first place. A kidney stone, or a stricture (narrowing) in the urethra (the tube that carries urine out of the body) could be the cause.

Dear Dr. Roach: I discovered a dark, stiff material looking like a twig in my belly button. Is this common?


Dear L.E.: The skin inside your belly button can secrete small amounts of oil (called sebum) which, when mixed with dead skin cells, can form a solid mass. These are not bothersome, but are predisposed to become inflamed or infected. Cleaning the area takes some time and patience. Starting after a bath is a good idea, since the water can soften and loosen the material. A cold cream or baby oil also can help dissolve the material over five to 15 minutes or so.

I’d recommend gentle cleansing with a warm washcloth. It’s a sensitive area, so don’t overscrub, or it will become irritated. If this advice doesn’t work, by all means, show it to your doctor.

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