DEAR DR. DONOHUE: My 95-year-old, very healthy mother-in-law is dizzy quite often. She has had cataract surgery and wonders if they put in her new artificial lenses incorrectly. – J.M.

ANSWER: Three common conditions account for most cases of vertigo – the feeling that the world or the individual is spinning in space. Most of the causes, including these three, have to do with the body’s gyroscope in the inner ear. It’s the inner ear that keeps us oriented in space with feet firmly planted on the ground.

Benign paroxysmal positional vertigo brings on dizziness when people turn their heads, look up to a high shelf or roll over in bed. Tiny crystals are dislodged from their normal position in the inner ear, and they migrate to sites where they should not be. That brings on attacks of dizziness with a change of head position. The doctor can test for this condition in the office, and with a series of head movements – the Epley maneuvers – the doctor can often direct the misplaced crystals to their normal locale.

Viral infections of the inner ear are another cause of dizziness. These infections go by the names of labyrinthitis, vestibulitis and vestibular neuronitis. All three are synonyms. They produce a dizziness that comes on rapidly and often brings with it nausea, vomiting and profuse sweating. The illness worsens for five days and then gradually improves for most people during the next three or four weeks. Antivert is a medicine that helps some weather the storm. So does the seasickness skin patch Transderm Scop.

Meniere’s disease is the third somewhat-common cause of dizziness. With it come ear noises and a diminution of hearing. I recently covered this topic, so I won’t repeat it.

The list of other causes for dizziness is unbelievably long and includes non-ear-related causes such as an irregular heartbeat or a profound drop in blood pressure when standing. The new eye lenses your mother-in-law has are not likely involved here.

Dizziness is one of the most frequently asked-about topics. The pamphlet on that topic goes into details. Readers can obtain a copy by writing: Dr. Donohue – No. 801, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: How do I determine which vitamin supplement is best? I have read that septic systems are clogged with vitamin tablets that never got absorbed. How real is this? – C.D.

ANSWER: It’s a bit overblown.

Absorbability is important in a vitamin (or any medicine). Look on the label for “USP.” “USP” stands for United States Pharmacopoeia, an independent testing organization. If the USP seal is there, the vitamin has met its standards for strength, purity, disintegration and absorbability.

On well-known brands of vitamins, you will not see the USP label. Those manufacturers feel that their reputation guarantees that their vitamins are of the stated strength and are absorbed.

If you want to run your own test, put a vitamin in a glass and add just enough vinegar to cover it. In an hour, the vinegar should be cloudy or the pill should have fallen to pieces. Admittedly, this is not the most sophisticated and reliable test, but it gives you a rough estimate of disintegration and absorbability.

For your use, choose the cheapest multivitamin with the above characteristics and choose one that contains close to the recommended daily allowances for all vitamins.

DEAR DR. DONOHUE: What are the symptoms of stomach cancer? How is it diagnosed? – G.T.

ANSWER: The early symptoms of stomach cancer are often misleading, since so many relatively harmless illnesses cause the same symptoms: a full feeling with only a small amount of food, nausea, vomiting, bloating and pain on swallowing. Stomach pain that is not relieved by antacids is a more reliable symptom. Tarry black stools are another indication. They indicate blood in the stool – often a sign of stomach cancer, as well as ulcers.

The diagnosis is made by seeing the cancer with a scope passed from the mouth to the stomach and taking a biopsy of it for microscopic examination.

DEAR DR. DONOHUE: I have raised 14 children, 12 of whom are still with me. One son died from a brain aneurysm. A daughter and another son survived brain aneurysms. A doctor has told us that a gene from both parents leads to these aneurysms. Is that true? If the aneurysm shows up on a scan, can they do something to correct it? – A.K.

ANSWER: Aneurysms are weak spots in artery walls. The weakness creates a bulge that, on a brain artery, looks much like a blister. When a brain aneurysm bursts, the usual result is a catastrophic stroke. It’s the kind of stroke that almost always ends in death or severe impairment.

Somewhere between 3 percent and 5 percent of the population have a brain aneurysm. Of those people, some will have a breaking of the aneurysm without any prior warning. Suddenly they have an intense headache and often a stiff and painful neck. They can fall to the floor and lose consciousness.

Others have a broken aneurysm, preceded by “sentinel” headaches – milder headaches probably due to small amounts of leaking blood. The leak seals, and then the headache goes away until another leak occurs. A major bleed is in the offing.

The genetics of a brain aneurysm are not clear. If a parent has had an aneurysm, then the children have a slightly increased risk of having one. If a brother or sister has had one, the risk is greater than if a parent has had one. Your family’s history is extraordinary.

All of your 12 children should have an MRI of the brain to detect aneurysms.

If a dangerous aneurysm is spotted, it can be eliminated. One way is to snake a catheter containing a coil from a surface artery to the involved brain artery and place the coil in the aneurysm. That seals the bulge.

Perhaps your doctor refers to a particular inherited predisposition where each parent has one gene that predisposes their children to aneurysm formation. In most cases, however, there is no such clear genetic pattern.

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.

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