Dear Dr. Roach: After many weeks of a unilateral nasal leakage of clear watery liquid, I was diagnosed with a cerebrospinal fluid leak. I experience almost constant leakage from the right nostril, which is irritating as well as embarrassing. After CT scans and an MRI, the source of the leak was found to be a small opening in the skull above the sinus. The next step is surgery, and the surgeon tells me I will need to be in the hospital for five to seven days. Is this something that is typical for this type of surgery? They also plan to inject a dye to check for the possibility of other openings. By the way, there has been no head trauma, and this seems to be a spontaneous leak. Any information you can give me would be greatly appreciated. A.C.
Cerebrospinal fluid leaks probably are unrecognized much of the time, and this leads to mistaken diagnoses and inappropriate treatments. The hallmark symptom is headache, which worsens upon standing and is better when reclining. Other symptoms may include neck pain, nausea, hearing loss and various other neurological symptoms.
Many but not all sufferers have a history of minor trauma. MRI usually makes the diagnosis, but it sounds like your surgeon has ordered a myelogram to confirm the MRI findings. This involves a CT scan with dye. As you suggest, some people have more than one source of leakage.
Many cases of CSF leakage can be treated with a 鈥渂lood patch,鈥� whereby your own blood is put into the spinal fluid. A clot can form at the site of the leak and, over weeks, a scar may form that can stop the leak for the long term. Unfortunately, many people need several attempts, and the results are not always permanent.
I know very little about the surgery, and only your surgeon knows enough about your planned operation to comment on potential success rates and postoperative course.
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Dear Dr. Roach: I would like to know if I can get shingles more than once. I had them in February, three weeks after a surgery. I am 75 years old.
Would it be a good idea to get the shot, now that I have had shingles? If so, how long should I wait before I get the shot? I do not want to experience it again, and the doctors don鈥檛 seem to be sure what I should do. B.H.
You can get shingles more than once; however, the likelihood is probably lower in people who have had it already. The U.S. Advisory Committee on Immunization Practices advises the shingles vaccine for those over age 60, even if there is a history of shingles in the past. The side effects of the vaccine are small, so even if there is less benefit, there may still be more benefit than harm.
The vaccine can be given anytime after the rash has cleared up.
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Dear Dr. Roach: I have underarm odour. I wash daily, use deodorant and change my shirts daily. I use mostly cotton shirts and undershirts. I launder my shirts with soap mixed with bicarbonate sodium (baking soda) to eliminate odour. But deodorants seem to work for a few hours and then fade away.
What other solutions do you have for this problem, whether it鈥檚 what to use for the underarm or what to wash the clothes with? Thanks. N.I.
Body odour comes mainly from bacteria that grow in the moist areas, like axillae (armpits). Keeping them dry and minimizing bacteria are the ways to minimize body odour.
Antiperspirant, rather than deodorant, is effective at keeping the axillae dryer. Applying at nighttime after a shower or bath may be more effective. Occasional use of a topical antibiotic to the axillae can keep bacterial growth down as well.
Diet can have a role, too. Sulfur-containing foods such as garlic, onions and curries can cause odours.
As for washing clothes, most detergents do a good job of removing the odour-causing bacteria.
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Dear Dr. Roach: I am a home-health nurse. Many of my patients think that because something has been cooked and then refrigerated, it will stay good indefinitely. How long should you realistically keep food that is refrigerated? Thank you. S.C.
The answer depends on the specific type of food, but a good guideline is three to four days for cooked food. You鈥檒l find more at healthycanadians.gc.ca/ eating-nutrition/safety-salubrite/storage- entreposage-eng.php#a5
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