DEAR DR. DONOHUE: I have benign paroxysmal positional vertigo. While doing some repair work, I jerked my head to the right and experienced severe dizziness that lasted two minutes. The condition still exists. When I lift my head upward, dizziness occurs. Do you know any treatments for benign positional vertigo? – M.L.

ANSWER: Almost all forms of vertigo – the sensation of spinning out of control – originate in the inner ear, where the body’s balance organs – its gyroscopes – are located.

Benign paroxysmal positional vertigo is common. Loose debris has settled to the bottom of the balance organs and erroneously signals the brain to think that the body or its environment is whirling around. The attacks occur when there is a change in head position. Many complain that rolling over in bed triggers an episode.

Medicines such as Antivert or Phenergan might help, but they are not as effective as they are for other forms of vertigo.

A series of head movements performed by the doctor in the office can often move the inner-ear debris from the locations where it’s causing trouble. One of those techniques is called the Epley maneuvers. The patient sits upright on an examining table. The doctor brings the patient’s head down and slightly off the side of the table to induce an attack. After 30 seconds, the head is turned to the opposite side. Then the entire body is rolled to one side. Finally the doctor helps the patient sit up straight with the head down about 30 degrees.

If one session doesn’t end the attacks, the maneuvers can be repeated. Furthermore, there are other movement techniques that can bring success if the Epley maneuvers fail. An ear, nose and throat doctor is familiar with all of them.

The vertigo booklet describes the many varieties of this troublesome problem and its treatments. Readers can order a copy by writing: Dr. Donohue- No. 801, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My son has cirrhosis of the liver because of his drinking. He has been sober for almost a year. I would like to know why he is tired all the time. The doctor is having a hard time bringing down his blood ammonia level. I am worried. – M.B.

ANSWER: Cirrhosis is a liver that is filled with scar tissue. It’s unable to perform all the functions that a normal liver carries on – making proteins, turning carbohydrates into energy and assisting in the metabolism of fat. Being tired all the time is a common symptom of a person with cirrhosis.

Ammonia comes from two sources. It’s a byproduct of protein breakdown, and the liver detoxifies it for elimination. When the liver isn’t functioning well, blood ammonia levels rise. Ammonia can make a person groggy. Ammonia is also produced by bacteria in the colon. That ammonia adds to the liver’s burden of detoxification.

Ammonia levels can often be lowered by medicines like lactulose and neomycin. Has your son tried either? Sometimes it’s necessary to restrict dietary protein in order to bring down blood ammonia.

What lies in store for your son depends on the extent of his liver cirrhosis. If only a relatively small section of liver is affected, then things can straighten out on their own. If the entire organ is involved, even then people are not without hope. This is the age of liver transplantation, an option open to all.

DEAR DR. DONOHUE: Please tell me what you know about viral infections. – E.S.

ANSWER: Viruses are about the smallest infecting germs, much smaller than bacteria. The number of infections they cause is in the thousands. They can infect just about every body organ – heart, lungs, brain, eyes, liver, pancreas. I can’t begin to tell you about all viruses. If you can limit your request to a couple of them, then I can oblige you.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.