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Dr. Roach: Help for prolonged vertigo

Keith Roach
To Your Health

Dear Dr. Roach: My husband had open heart surgery and has a pacemaker. He fell while getting out of the car, and his cardiologist recommended that he see an ENT doctor, who said he has the worst case of vertigo there is. He had a CT scan, but nothing showed up. Ever since then, he needs to sit down for several hours every day due to severe dizziness. Both doctors told him he has to live with this.

I cannot believe a person must live with this terrible condition. How can we cure this terrible dizziness?

A.J.

Dear A.J.: Dizziness is a terrible feeling, and I am sorry your husband has had such a bad time with this.

Vertigo, the sensation of movement when a person is still, can have many causes. The ENT doctor was looking for a tumor on the eighth cranial nerve, which carries the sense of balance. An MRI is more sensitive, and it might be worth another look, although hearing loss and progressive worsening of the condition are common.

I have three suggestions. The first is considering a second opinion. Eighteen An expert in dizziness and balance disorders has many tools (especially a careful history and exam) to determine the likely cause of the vertigo.

My second suggestion is that the exact cause of vertigo does not have to be known in order to get some relief. Vestibular rehabilitation is a therapy where the sense of balance is retaught through exercises supervised by a specially trained physical or occupational therapist. My experience has been that this is, by far, the most effective treatment for people with difficult-to-control vertigo. I recommend that you discuss a referral.

Lastly, some medications mask vertigo symptoms temporarily, but also prevent the body from ever recovering. The most commonly used medicine, meclizine (Antivert and others), is especially bad for this, and I can’t tell you how many people I’ve seen who had an episode of vertigo that, if untreated, gradually would have gone away, but who continue to have symptoms months and even years later because they continue to take the medication. It’s fine to use for a few days, if symptoms are very severe, but I don’t prescribe it for more than a week.

Dear Dr. Roach: I have a ferritin level of 620 ng/ml. It is supposed to be between 22 and 322. I was a daily user of alcohol. It’s been three months since I’ve had a drink. My level is now 683. How can I get it back to normal? Is alcohol totally out?

M.P.

Dear M.P.: Ferritin is a protein made by the liver that is used to transport iron in the body. Many things can cause blood ferritin levels to be increased, including alcohol, infection and a genetic condition called hemochromatosis, in which the body absorbs too much iron. A level above 600 is suspicious for hemochromatosis, and your doctor can easily obtain additional blood tests to look for condition. I’d recommend staying away from alcohol entirely until the cause of the high ferritin level is clear.

Email questions to ToYourGoodHealth@med.cornell.edu.