Dear Dr. Roach: Four months ago, I was in an automobile accident and suffered severe injuries 鈥� a collapsed lung, broken ribs, 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听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. I will be returning to the clinic in two weeks. The constant pressure and fuzziness really complicate my thinking process and life. 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? K.B.
Postconcussive syndrome is the name given to persistent neurological symptoms following traumatic brain injury. The听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 just take longer to recover. In my opinion, more testing isn鈥檛 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鈥檚 likely that your functioning will return to normal.
听
Dear Dr. Roach: I suffered a long time with GERD. I was diagnosed with Barrett鈥檚 esophagus, a precancerous disease. My doctor recommended a procedure called a Nissen fundoplication. Since the procedure, I have not had heartburn again. I would do it again, after what I went through. I get an endoscopy every two years to keep an eye on my disease. Anon.
Barrett鈥檚 esophagus is a complication of longstanding reflux. It is diagnosed when the lining of the esophagus starts to look like the lining of the stomach. Barrett鈥檚 esophagus can progress to cancer of the esophagus. About 0.2 per cent of those with Barrett鈥檚 per year will develop cancer, which sounds low, but if you live with the condition for 25听years, that鈥檚 about a five per听cent risk.
Surgery for reflux disease is听done only rarely. However, it is very effective (85 per cent to 90 per cent). The most common reason to consider surgery is inadequate relief from medications and lifestyle changes. However, severe erosions from acid in the esophagus, inability to take medications, a stricture (partial closure) of the esophagus and Barrett鈥檚 esophagus are all reasons to consider surgery. Surgery appears to reduce the risk of cancer more than other treatments.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column when possible. Readers may email questions to [email protected]
