DEAR DR. ROACH: My husband had open heart surgery and has a pacemaker. He fell while getting out of the car, and his cardiologist recommended that he see an ENT doctor, who said he has the worst case of vertigo there is. He had a CT scan, but nothing showed up. Ever since then, he needs to sit down for several hours every day due to severe dizziness. Both doctors told him he has to live with this.

I cannot believe a person must live with this terrible condition. How can we cure this terrible dizziness? — A.J.

ANSWER: Dizziness is a terrible feeling, and I am sorry your husband has had such a bad time with this.

Vertigo, the sensation of movement when a person is still, can have many causes. The ENT doctor was looking for a tumor on the eighth cranial nerve, which carries the sense of balance. An MRI is more sensitive, and it might be worth another look, although hearing loss and progressive worsening of the condition are common.

I have three suggestions. The first is considering a second opinion. Eighteen months of uncontrolled vertigo is abnormal, and I am surprised that, from your description, his doctors have essentially given up on helping to treat his symptoms. An expert in dizziness and balance disorders has many tools (especially a careful history and exam) to determine the likely cause of the vertigo.

My second suggestion is that the exact cause of vertigo does not have to be known in order to get some relief. Vestibular rehabilitation is a therapy where the sense of balance is retaught through exercises supervised by a specially trained physical or occupational therapist. My experience has been that this is, by far, the most effective treatment for people with difficult-to-control vertigo. I recommend that you discuss a referral.

The last point I want to make is that some medications mask the symptoms of vertigo temporarily, but also prevent the body from ever recovering. The most commonly used medicine, meclizine (Antivert and others), is especially bad for this, and I cannot tell you how many people I have seen who had an episode of vertigo that, if untreated, gradually would have gone away, but who continue to have symptoms months and even years later because they continue to take the medication. It’s fine to use for a few days if symptoms are very severe, but I don’t ever prescribe it for more than a week.

DEAR DR. ROACH: I fractured my lumbar spine due to osteoporosis a year ago. I can walk without a cane. I would like to know how to prevent this from happening again. Would it be OK to ride a stationary bike? I have a bad knee. — J.O.

ANSWER: Exercise, along with a good diet providing calcium, is the main defense against osteoporotic fractures. Exercises with high impact, such as running or jumping, tend to be most effective, but weight-bearing exercise — say, just walking — is effective also. Non-weight-bearing exercise, like swimming, is least effective but still beneficial. A stationary bike is less weight-bearing than ideal, but it has many benefits beyond bone strength.

Some people can eat right and exercise well but still be at high risk for osteoporotic fracture, and that is when medication is worth considering. There are many different options now, and you should talk to your doctor. Knowing your T-score, a measurement of bone density, along with your other information, can allow the calculation of your risk for fracture, which can help you decide whether to take medicine to reduce risk.

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.