By Keith Roach, M.D.
Q: Four months ago, I was in an automobile accident and suffered severe injuries -- a collapsed lung, broken ribs, a broken lumbar spine, broken/damaged teeth and mild traumatic brain injury. My recovery has gone quite well, except for the brain injury. I am a 53-year-old female who has always been in good health. I had a CT scan on my head at the time of the accident and one 10 days after. I went to a concussion clinic several times following the accident and saw a neurology psychologist. Initially, my brain was not functioning properly, but its functioning has improved. I have been released from the psychologist but not the concussion clinic. I was suffering from severe headaches. On my last visit, I was placed on topiramate. It has relieved the severe headaches. At the time of my last visit, I asked the doctor about the constant pressure I feel on the left side on my head and the fuzziness that is always present. He told me the topiramate might not help this if it is nerve damage, and it has helped. Is this something I should just accept as a permanent symptom, or is there another test I can request that might get rid of this?
A: Postconcussive syndrome is the name given to persistent neurological symptoms following traumatic brain injury. The symptoms are highly variable person to person, but headache, dizziness or fuzziness, and head pressure are all consistent.
Recovery from postconcussive syndrome takes time. Most people are better at three months after injury, but some people take longer to recover.
In my opinion, more testing isn't likely to show anything that would change your treatment. There are other treatments that have been helpful for many people in your situation, such as indomethacin for one-sided head pressure.
It sounds like you are fortunate to have medical care with several experts available. It's likely that your functioning will return to normal.
Q: I take the statin drug atorvastatin since my heart surgery. The sticker on the bottle reads, "Do not eat grapefruit or drink grapefruit juice at any time while taking this medicine." My cardiologist said this warning was based on rather thin clinical trials, and it was OK to continue eating one grapefruit in the morning and taking the statin at bedtime. Are there new developments on this topic?
A: Grapefruit juice, indeed, can affect the metabolism of atorvastatin (Lipitor) and many other medications. However, the amount of grapefruit needed in order to have a significant effect is quite high -- the manufacturer recommends avoiding consumption of more than a quart of grapefruit juice a day.
I agree with your cardiologist that a grapefruit is a healthy way to begin the day and is not likely to cause any problems with atorvastatin.
Q: Are men less likely to wash their hands after using the bathroom than women are? Are there any studies providing statistics?
A: In 2003, a study at a university found that after using the washroom, women washed their hands with soap and water 61 percent of the time, and men 37 percent of the time.
Placing a reminder sign increased the rate to 97 percent of women, but only 35 percent of men washed their hands with the reminder, although 53 percent rinsed their hands without soap.
Keeping hands clean reduces infection transmission to yourself and to others. Unfortunately, too often even we doctors forget to wash our hands (only 65 percent of the time, in several studies).
Our nursing colleagues are better at washing their hands. Many hospitals, including mine, have policies in place to improve hand-washing compliance.
Q: I have a problem that I am embarrassed to discuss with my doctor. When I am going to the bathroom and straining with a bowel movement, I often have a major cramp in my abdomen. It used to occur slightly below my belly button, but now it has moved lower and sometimes to my left side. The cramp is very severe and can be felt and seen on my body surface. Is this something I should worry about?
A: Don't be embarrassed. Your doctor needs to know, and needs to do an exam to feel what might be going on.
It could be your normal physiology; it could be mild irritable bowel syndrome. It might be a hernia, especially if it can be seen on your body.
Doctors aren't easily embarrassed, and have heard complaints much, much worse than that.
Q: I am 95 now and take no medications. My primary-care doctor wants me to take aspirin, even just the baby aspirin, twice a week. Some of the supplements I take do have blood-thinning characteristics, and for that reason, I am fighting the aspirin recommendation. In general, is it OK to refuse the recommendation of one's doctor?
A: It is your body, and you have every right to make decisions about your treatment. How-ever, you should be very circumspect about overruling your doctor, and you should be doing so for very good reasons. Your doctor has the obligation to tell you why he or she is recommending a treatment and what the downsides are from not taking it. You, on the other hand, are obliged to tell your doctor the truth.
In your case, it sounds like you don't want to take the aspirin because you feel the supplements you are taking have a similar effect to aspirin. Very few supplements, if any, have been studied as well as aspirin has.
Aspirin has a clear risk of side effects, especially bleeding, but most evidence shows that it reduces the risk of heart attack more than it increases the risk of bleeding. It also might reduce cancer risk. The higher the risk of heart disease, the better aspirin is, in terms of risks against benefits.
At 95, your risk for heart attack is higher than a 50-year-old's, and so it would be expected to have more benefit than harm.
So while I agree with your doctor to take it, I also respect your decision not to.
From Twincities.com
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