Dr. Keith Roach: Previous spinal surgery may have link to current headaches
Dear Dr. Roach: For several months now, I have been experiencing intermittent headaches, with an extra “shot” of intense pain in the top, front of my head and forehead whenever I sneeze, cough, clear my throat or bend over. I thought it might be my sinuses, but when my ENT ordered a CT scan, it turned out to be negative. He suggested that I go to my orthopedic doctor, who performed a laminectomy on my back in 2013. That surgery resulted in a cranial fluid leak with the most painful headaches I’ve ever experienced, and required two more surgeries to repair the leak, along with complete bed rest and two weeks of hospitalization. He ordered an X-ray, which also came back negative. I was wondering if, after all this time, fluid could be leaking in my brain and causing these painful headaches again. The headaches I have been experiencing the past several months are similar to the ones I had after the cranial fluid leak; however, they are nowhere near the intensity of the original ones.
Dear S.C.: Cranial fluid, also called “cerebrospinal fluid,” supports the brain against the effects of gravity and position change. Low pressure of cerebrospinal fluid causes symptoms. These typically include headache, which nearly always is worse with standing or sitting up. It also may be worse with cough or exertion, and is relieved within minutes by lying down. Given your past experience and your description of the headache, I think it’s very likely that you have a recurrence of the fluid leak. Four years is a long time, but there clearly are cases reported of a leak reoccurring even years after spine surgery.
Cranial fluid leak can happen spontaneously or after any kind of surgery on the brain or spine. If the fluid leaks out faster than it can be replaced, then symptoms will develop. It is not always easy to make the diagnosis. The X-ray and CT scan results may be negative: An MRI (in your case, of the area of the spine surgery) is more sensitive, but it also can fail to show the cause of the leak. Advanced imaging, such as using a radioactive tracer, may be necessary to prove the leak. You need to go back to the orthopedic surgeon, who should diligently look for the cause.
Dear Dr. Roach: I am disheartened by all the cancer I see occurring around me and especially in my friends. In my career, I was involved as a chemist in industrial chemicals. I believe that it was discovered in the industrial field that the reaction between triethanolamine and sodium nitrite causes cancer and subsequently was banned from all compounds in factories.
My question is, was the combination of nitrites and amines in food products ever tested for such a result? Some amines are added and some are organic amines as part of the meat, etc. I know nitrite is added in hot dogs and other meats (smoked, etc.) as a preservative. Has this ever been evaluated for causing cancer? Everyone is exposed to nitrosamines, especially when meat is cooked on a grill.
Dear S.D.: Yes, the data are now clear that many processed foods modestly increase cancer risk, especially of the GI tract. Also, meats cooked with especially high temperatures, such as on a grill, also raise risk. (Since you are a chemist, I’ll tell you the chemicals responsible are thought to be heterocyclic amines and polycyclic aromatic hydrocarbons.) Combinations of toxic chemicals may be even worse. I recommend against eating processed meats and cooking meat at high temperatures. Those who do indulge in these should do so sparingly.
Email questions to ToYourGoodHealth@med.cornell.edu.