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Dr. Roach:    Reader seeks advice for broken nose

Keith Roach
To Your Health

          Dear Dr. Roach: I walked into a glass wall and hurt my nose. It swelled up immediately and later developed bruising. My friend told me to ice it, but that an emergency room visit wasn't necessary. Now I'm wondering if I should have gone. What's the right thing to do when you think you might have broken your nose?

-- A.T.G.

               Dear A.T.G.: Moderate to severe facial trauma may have other injuries besides the nose, so an evaluation is appropriate, especially if there is also trauma to the cheekbones or eye. It is likely you did fracture your nose. Bruising is highly suggestive. If the bruising involves the septum -- the inside part between the nostrils -- then that may need to be drained to prevent damage.

                   X-rays are not usually necessary with a simple fracture of the nose. Also, the immediate swelling makes an evaluation of the cosmetic consequences of the fracture unreliable. A visit with an ENT doctor several days after the trauma is reasonable.

          Dear Dr. Roach: I am afraid to take pravastatin because my mom had dementia and I heard pravastatin can cause memory loss. My cardiologist prescribed it, but I don't want to chance it. My cholesterol numbers are good, but he wants them lower because of my age (69) and because I have a leaky aortic valve.

-- S.W.

             Dear S.W.: There are indeed case reports of people having memory problems due to statin drugs. However, it is uncommon and if it does occur it's more likely to be linked to simvastatin or atorvastatin than pravastatin. Moreover, the effects normally go away when the medicine is stopped, but can come back if the medicine is restarted.

                   A large review of multiple studies found no worsening of memory or thinking problems among people taking statins, but as noted above, a small number of people may develop them.

                   Balanced against that small risk are two potential benefits: reducing the risk of heart attack and reducing the risk of development of dementia. I don't have enough information about your risk factors to tell you whether the pravastatin significantly reduces your risk for a heart attack. People with more risk factors obtain more benefit from statins, while people at low risk get very little benefit.

                   There are some data showing that statins may reduce the risk of developing dementia, including Alzheimer's disease. However, this protective effect has not been confirmed in well-done trials, so I do not recommend statins just for reducing dementia risk.

                    Dear Dr. Roach:Two years ago I had vertigo. My daughter took me to the ER, and I was given meclizine for a few days. I did therapy twice a week for four weeks, but that did not help. Someone told me to sleep on two pillows. After a few days, I could get up with no dizzy feeling. It's worked for me for a year and a half. I thought it might help others.

-- J.T.

             Dear J.T.: I appreciate your writing. Many cases of vertigo are due to crystals forming in the semicircular canals, the organ of balance in the inner ear. Vestibular rehabilitation therapy is designed to help it, but some experts do recommend sleeping with two pillows and not sleeping on the affected side (your doctor or therapist can tell you which is the affected side with an exam). I'm glad it worked for you and hope it may help others as well.

                   I received another letter the same day noting that omitting caffeine (tea and chocolate in this case) also relieved symptoms.

                   Meclizine may be helpful for a few days during the worst symptoms, but long-term use may actually prolong the symptoms.

    Readers may email questions to ToYourGoodHealth@med.cornell.edu.