DEAR DR. ROACH: I have a terrible case of vertigo. I’m not sure what causes it or what I can do to prevent it from happening to me again. I was given two medications, promethazine for nausea and meclizine for vertigo, but still the problem persists. Can you offer some kind of help? — J.G.

ANSWER: Vertigo is the sensation of movement when not moving. Although it is classically described as a spinning sensation, some people feel as if they or the world is moving in other ways.

There are many causes of vertigo, but we generally break them down into two groups: peripheral causes, from the vestibular nerve, which connects your brain with the organ of balance in the inner ear; and central causes, from the brain itself. Peripheral causes are much more common and generally are labelled “benign,” even though they can be quite severe. Central causes are most commonly attributed to vestibular migraine and poor blood flow to the brainstem.

Only a careful exam and, occasionally, more sophisticated tests can reveal the underlying cause of the vertigo. The most common cause is benign paroxysmal positional vertigo, and I suspect that is what you were being treated for, having received a nonspecific treatment for vertigo. Although it is commonplace, I disagree with this treatment if it is used for more than a day or two, and then only in people whose symptoms are severe.

Most people get relief from an office treatment called the Epley maneuver. They can continue at home with other exercises. I would suggest that you ask your doctor about these procedures, and if he or she isn’t familiar with them, it might be wise to consult with an expert. In any event, vertigo is a symptom that can arise from several distinct medical conditions. You should find out what your diagnosis is.

The booklet on vertigo explains this disruptive condition in detail and outlines its treatment. Readers can order a copy by writing: Dr. Roach Book No. 801, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I have been taking statin medications for about 18 years. I found out from a CT scan (done for something else) that I have fibrosis of the liver. I understand that statin medications are not advised if a person has a diseased liver. My blood tests are normal, I drink no alcohol and I take no other medicines. My cardiologist said that I should keep taking the statin unless my liver tests come back abnormal. What would you do if this happened to you? — M.K.

ANSWER: Like so many others, this is a question of competing risks. Ultimately you have to weigh how much benefit you will get taking a statin against the risk of taking a statin in the presence of liver fibrosis. (I’m not you, so what I would do isn’t relevant.)

I don’t have enough information to answer the first part. The benefits of statins range from quite significant in high-risk people (preventing a heart attack or death in perhaps one out of 40 people who take it for five years) to almost none in people at low risk of heart disease. On the other hand, it is very unusual (perhaps one in a thousand) to have significant risk of liver disease due to statin treatment, and most cases seen were due to drug interactions. This is not an issue for you. Fibrosis of the liver is not a problem in itself so much as it can progress to cirrhosis in some cases. It’s not clear to me why you have fibrosis, but hepatitis C and fatty liver disease are the most common causes I see.

I would recommend staying on the statin if there is a good reason for you to be on it in the first place. You may need further evaluation to determine the cause of your liver fibrosis.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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