Pre­vi­ous spinal surgery may have link to cur­rent headaches

Ripon Bulletin - - Local / State - TOYOUR GOODHEALTH Keith Roach, M.D.

DEAR DR. ROACH: For sev­eral months now, I have been ex­pe­ri­enc­ing in­ter­mit­tent headaches, with an ex­tra “shot” of in­tense pain in the top, front of my head and fore­head when­ever I sneeze, cough, clear my throat or bend over. I thought it might be my si­nuses, but when my ENT or­dered a CT scan, it turned out to be neg­a­tive. He sug­gested that I go to my or­tho­pe­dic doc­tor, who per­formed a laminec­tomy on my back in 2013. That surgery re­sulted in a cra­nial fluid leak with the most painful headaches I’ve ever ex­pe­ri­enced, and re­quired two more surg­eries to re­pair the leak, along with com­plete bed rest and two weeks of hos­pi­tal­iza­tion. He or­dered an X-ray, which also came back neg­a­tive. I was won­der­ing if, af­ter all this time, fluid could be leak­ing in my brain and caus­ing these painful headaches again. The headaches I have been ex­pe­ri­enc­ing the past sev­eral months are sim­i­lar to the ones I had af­ter the cra­nial fluid leak; how­ever, they are nowhere near the in­ten­sity of the orig­i­nal ones. — S.C.

AN­SWER: Cra­nial fluid, also called “cere­brospinal fluid,” sup­ports the brain against the ef­fects of grav­ity and po­si­tion change. Low pres­sure of cere­brospinal fluid causes symp­toms. These typ­i­cally in­clude headache, which nearly al­ways is worse with stand­ing or sit­ting up. It also may be worse with cough or ex­er­tion, and is re­lieved within min­utes by ly­ing down. Given your past experience and your de­scrip­tion of the headache, I think it’s very likely that you have a re­cur­rence of the fluid leak. Four years is a long time, but there clearly are cases re­ported of a leak re­oc­cur­ring even years af­ter spine surgery.

Cra­nial fluid leak can hap­pen spon­ta­neously or af­ter any kind of surgery on the brain or spine. If the fluid leaks out faster than it can be re­placed, then symp­toms will de­velop. It is not al­ways easy to make the di­ag­no­sis. The X-ray and CT scan re­sults may be neg­a­tive: An MRI (in your case, of the area of the spine surgery) is more sen­si­tive, but it also can fail to show the cause of the leak. Ad­vanced imag­ing, such as us­ing a ra­dioac­tive tracer, may be nec­es­sary to prove the leak. You need to go back to the or­tho­pe­dic sur­geon, who should dili­gently look for the cause.

DEAR DR. ROACH: I am dis­heart­ened by all the can­cer I see oc­cur­ring around me and es­pe­cially in my friends. In my ca­reer, I was in­volved as a chemist in in­dus­trial chem­i­cals. I be­lieve that it was dis­cov­ered in the in­dus­trial field that the re­ac­tion be­tween tri­ethanolamine and sodium ni­trite causes can­cer and sub­se­quently was banned from all com­pounds in fac­to­ries.

My ques­tion is, Was the com­bi­na­tion of ni­trites and amines in food prod­ucts ever tested for such a re­sult? Some amines are added and some are or­ganic amines as part of the meat, etc. I know ni­trite is added in hot dogs and other meats (smoked, etc.) as a preser­va­tive. Has this ever been eval­u­ated in terms of caus­ing can­cer? Ev­ery­one is ex­posed to ni­trosamines, es­pe­cially when meat is cooked or pre­pared on a grill. — S.D.

AN­SWER: Yes, the data are now clear that many pro­cessed foods mod­estly in­crease can­cer risk, es­pe­cially of the GI tract. Also, meats cooked with es­pe­cially high tem­per­a­tures, such as on a grill, also in­crease can­cer risk. Com­bi­na­tions of toxic chem­i­cals may be even worse. I rec­om­mend against eat­ing pro­cessed meats and against cook­ing meat at high tem­per­a­tures. Those who do in­dulge in these should do so spar­ingly.

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