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December 22, 2011

Dry mouth in sarcoidosis (Xerostomia)

Filed under: Medical,Sarcoidosis — Tags: , , , — Dr Roger KA Allen @ 11:43 am

INTRODUCTION

A very common symptom of sarcoidosis is dry eye and dry mouth. Dry mouth is called xerostomia (Greek meaning “dry” and “mouth” and is due to granulomas damaging the salivary glands. As an aside, there is a syndrome in sarcoidosis called Heerfordt’s syndrome which consists of parotid gland enlargement, fever and uveitis which is inflammation of the eye. The parotid glands are those which you see enlarged in mumps and which makes you look like a chipmunk.

We take saliva for granted when we have it.  There is a joke about lung transplants in the same vein.

Question: What’s the worst thing about a lung transplant?

Answer: Coughing up someone else’s sputum.

Imagine if we had salivary gland transplants. We won’t go there.  Thus, producing sputum, saliva and gastric juices is a wonderful thing.

WHAT ELSE CAUSES IT?

Another condition which affects salivary glands is Sjogren’s syndrome which is an autoimmune condition a bit like lupus (SLE). There are many other causes but sometimes no cause can be found. It just happens. Radiotherapy is a common cause but the reference below does not mention sarcoidosis.

HOW DO WE TREAT IT?

  1. Treating the sarcoidosis early before it causes irreversible damage to the salivary glands is the best thing to do.
  2. Sugar-free gum can help stimulate salivary flow without which we end up with holes in our teeth, gum disease and even losing teeth to decay. SalivaSure *(lozenge containing xylitol) is a salivary stimulant. Omni Theragum and Theramints *(contains xylitol) and Dentiva *(slow dissolving soft lozenge) (American Dental Association, 2006) (all ameircan brands – Wrigley’s extra is a sugar free gum)
  3. There are saliva replacements as well but these are really lubricants and need to be administered regularly. Oral-Lube, Biotene Oral-Balance (mouthwash, sprays, toothpaste, gel, gum), GC Drymouth Gel and Tooth Mosse, Oral 7 (mouthwash, toothpaste,gel), Oasis* (moisturizing mouthwash), Salivart Synthetic Saliva Omni Theraspray * (contains xylitol).
  4. Pilocarpine is a drug which can stimulate salivary flow but has too many side-effects to be universally useful (see the reference below).
  5. Xerostomia can be a very distressing problem.  See your dentist regularly and you would qualify for subsidy from the Federal Government now for a medical condition requiring regular dental care.
  6. Early recognition is important. If you think your mouth is dry all the time, tell your doctor and get help early.
  7. Avoid other causes. Finally, some drugs can cause dry mouth eg the tricyclic antidepressants so always check that this is not a cause. Keeping yourself well hydrated is important and observed good dental hygiene eg brush and floss after meals and use mouth rinses and  ToothMousse.

It is important that patients try a variety of products (gels, toothpastes, mouthwashes etc) as individuals respond differently to each treatment.

Acknowledgements:

I wish to thank Dr Yoram Chaiter on the BMJ website doc2doc for his input into this subject and for the listing of some of the medications he uses.  I go under the name, Odysseus on this site.

References:

http://www.australianprescriber.com/magazine/29/4/97/8/

 

 

 

May 11, 2011

Conversations with Richard Fidler

Filed under: Ballina boy,Sleep — Dr Roger KA Allen @ 2:00 pm

Dr Roger Allen helps people whose lives are blighted by disordered sleep

Broadcast date: Monday 9 May 2011 ABC 612AM

Go to http://www.abc.net.au/local/stories/2011/05/09/3211407.htm?site=conversations to listen to the interview.

Dr Roger Allen

Dr Roger Allen is a sleep and thoracic physician at Brisbane’s Wesley Hospital.

He sees people who are suffering from lack of sleep for all sorts of reasons, and also patients with asbestos-related diseases, including mesothelioma.

Many of his patients are war veterans and soldiers. Roger feels a certain connection with those men and women because he’s served in East Timor as an army medical officer.

Ballina Boy: a Child’s Odyssey through the 1950s.Published Xlibris.

Medical Insights: Ballina Boy; a child’s odyssey through the 1950s.

Filed under: Australia,Ballina boy,Medical — Dr Roger KA Allen @ 2:00 pm

My book, Ballina Boy, a child’s odyssey though the 1950s, reveals how medicine has changed since my late father, Lucius was a country GP.

The book opens in 1951 with the untimely death of my grandmother from a hypertensive stroke as there was no effective treatment then for “blood pressure”.  The year I was born (1951) saw the biggest poliomyelitis epidemic in our history and my mother who was called in to help caught polio.  The Salk vaccine was yet a dream and as result kids in steel callipers and iron lungs were common.  The following year she was nearly killed when a tractor accident when a disc plough ran over her. The only antibiotics were penicillin and sulpha and many people died of tetanus.  Despite the staff shortages, nurses were forbidden to work once they married.

As a second year intern my father worked at Willoburn, near Toowoomba, a hospital for the insane and psychotically depressed where s hock treatment and rest were the only treatments with the first anti-psychotic, Largactil appearing in 1955.  In 1949 that John Cade in Melbourne first described lithium for bipolar disorder.

In the year I was born, a seminal observation was made by some TB doctors at Staten Island, New York, that depressed TB patients on Isoniazid became happier due to a fortuitous property of the drug; MAO-inhibition and which spawned the first antidepressants in the fifties.

One day when swimming with my father, I nearly drowned only to be resuscitated by a life-saver using the Sylvester-Broche method as CPR was not invented. Sometimes my father would take me on ward rounds at the Ballina Hospital and remember him developing his x-rays in the eerie orange of the dark room, the smell of hypo and solvents, and the wet ghostly film hanging from stainless steel pegs to dry.

When he considered moving to Ballina he was daunted by the dazzling array of surgical procedures done by his predecessor in the days when the GP did midwifery, abdominal surgery, managed most fractures, and “tonsils and adenoids” were a right of passage of nearly every kid in town and he also did anaesthetics with ether and a Schimmelbusch mask.  His surgery was like a chemistry lab; test-tubes for boiling urine for protein, testing for sugar with tablets that changed colour, a haemoglobinometer with coloured glass inserts, a tube for ESR’s, a microscope and slides for micro-urines, plaster of Paris and plaster shears, bottles for pathology specimens, stomach pumps, kidney trays, ear syringes and so it went on.  His syringes were stainless steel and glass, wrapped in huckaback. He resharpened his needles and kept catgut in butter dishes of blue Zephrin (benzylconium chloride). His steriliser was a cantilevered boiler. He did not have a fancy ECG machine as heart attacks were then diagnosed clinically and by a rise in WCC and ESR which he did himself.

Pregnancy was diagnosed with urine on toads and pre-eclampsia by boiling urine with a metho burner and a test tube to which acetic acid was added. Asthma attacks were treated by subcutaneous adrenaline “a minim a minute”. Most measurements were in Imperial with drugs in grains eg of phenobarb and ounces of Ipecac and instead of “mls” he spoke in “cc’s”. Drug company reps were well regarded as they brought with them medical advances and news from the big smoke. He did night surgery on week nights after dinner, had no after hours locum service and had no appointment system. At night my mother made swabs of cottonwool and thin layers of gauze which went in the steriliser and then stored in large jars with steel lids. Mum patched rubber surgical gloves, covered them inside and out with talc and sterilised them for reuse.  AIDS was unheard of. Our lounge room was a “spill over” bay from the attached surgery and thus my medical apprenticeship started in pre-school.

As there was no Medicare, he was often paid in kind; a mud crab, a quart of cream which Mum churned into butter, some freshly caught fish or some prawns.  The doctor-patient bond was close, the doctor greatly valued as he was the bastion beyond which was death. Every child ran the gauntlet of viral exanthems, febrile convulsions were common and just called “convulsions”. Rheumatic fever laid up many a child in bed for months only to result in an early death from a stenosed valve and nearly everyone knew someone who had died from TB.  Childhood had more freedom, people and life were tougher. We had less material stuff but more simple riches and were arguably happier. For a happy adventure through childhood please read Ballina Boy (www.ballinaboy.com). Its darker moments are illuminated by black humour and there are numerous illustrations and photographs.

 

Ballina Boy; a child’s odyssey through the 1950s. A story about “Just a GP”.

Filed under: Australia,Ballina boy — Dr Roger KA Allen @ 2:00 pm

I did the first draft of “Ballina Boy; a child’s odyssey through the 1950s” in 2002, the year before my ailing father died and I started the last, from scratch, one night in October, 2009. It took me six months. However, on my final draft, the story took on a life of its own; a steed stabled by day as I worked and galloping by night.  I was the nocturnal coach driver with taut reins, hanging on while memories so long ago appeared at every turn, and as my father whispered in my ear.

However, this was still my story; my Dreaming with this Olympian Zeus presiding over the lowlands of my childhood with his wife, Hera, incarnate as my mother, Lucy of the Hearth, who held together, house, surgery and Mt Olympus despite the thunderbolts of adversity. It is not easy to unearth the visions and influences  of childhood which for me started at my grandmother’s  funeral  when I was in utero and concluded on my ninth birthday on the equator, somewhere in the Indian Ocean scored  by the foaming wake of the SS Arcadia and my father‘s dreams. Childhood is covered by an overburden of adult perceptions set like dried lava and disguised by the vegetation of conformity.  The magma of childhood is still unset with its wobbly questioning and a refreshing venting of expressions of awe, be it at the feigned spikes of a wily caterpillar or the pictographic sunset of sheep-clouds. To complicate matters, the growth rings of childhood reveal increasing sophistication; an ontological rerun of the ascent of man.  As the child grows, the horizon becomes more distant.

The backdrop of my childhood was the surgery of a country general practice dominated by my father, Lucius who was “different” from any other man I knew partially due to his first class honours in Classics and years teaching at two grammar schools before he entered medicine in 1944. He had won the Lilley Medal as Dux at the Brisbane Grammar School in 1937. His father, Kennedy Allen, in turn was a man of letters, a polymath and Classicist, who had won the gold medal at the King’s Inn in Dublin having been Dux at Rockhampton Grammar like his younger brother. He was a courtly man, a respected Brisbane barrister, later judge and was made an Honorary Doctor of Law by the University of Queensland. My father too was a gifted linguist, a master not only of Ancient Greek, Latin, French, Philosophy and Metaphysics but later of Spanish and Italian.

His intellect cast a long shadow over me as well as his herculean stamina, his at times exasperating dedication to patients and his curiosity about all things intellectual but not extended to things mechanical like lawn mowers. He was an intellectual filter-feeder siphoning up ideas and facts but also giving out like Mentor in Homer’s Odyssey as I discovered then he later taught me Senior French as an extra subject at BGS and taught his brother Junior Algebra and in retirement French at the University of the Third Age. However, he was intensely private with even my mother excluded from his “Dales of Arcady” and never once did I see him shed his crusty carapace softened by the hormones of prose or verse. It was about this complex man I wrote; the doctor who kept his MBBS degree rolled up in his bottom drawer with his self-doubts, and who always had a book of Greek or Latin on his desk in case a patient didn’t come. His enemy was time and death was a realm where it was too dark to read. Among his legacy were years of dedicated medical practice. His name plate at the garden cemetery just reads, “Dr Lucius Allen, Doctor and Scholar.”

This book is about my childhood on the once bustling Richmond River, about medicine but also about him. Its genesis has many facets one of which shows that the common saying, “Just a GP” can be so trite. I hope you enjoy reading it as much as I did telling this story.

www.ballinaboy.com

 

February 23, 2011

Learning a language

Filed under: Literature,Philosophy — Tags: — Dr Roger KA Allen @ 4:04 pm

As my son has started Latin this year (40 boys applied for 20 places), we do it in the car going to school. However, this has made me dust off my Latin books as I did it for matriculation and I have been enjoying reading Harry Potter (1st book) in Latin. I have read it in French and have ordered the Ancient Greek version which is reviewed as being charmingly written.

The Latin version is also charming and it is great to see how skillfully the translator adapts Latin to modern words eg toaster, car, milk bottles. Indeed this is the most wonderful part of the book. I have ordered the Latin version of Chamber of Secrets and have a book of 1000 modern Latin words eg for aeroplane, dishwasher etc as per the Vatican Latin masters.

May I commend those of you schooled in these ancient and dark arts to buy the Latin version, and with the English one by your side, delve into the wonder and sheer hedonism of languages other than your own. I realise I may be speaking to a select few as natural selection is choosy with regards H. sapiens nerdiensis.

I am also trying to obtain the Modern Greek version but so far to no avail as I live in a far flung outpost of the Federation of Muggles, called Terra Australis. If anyone can help I’d appreciate it.

For me, language is a great ocean waiting to be charted. At first we dance along its sandy shores and pick up sea shells washed up by its rolling surf. Then we venture out in our fragile barks to explore the coast and see the horizon from a new perspective. This ocean is alluring like the Sirens’ beckoning us; to touch her shores and sound her shoals until we feel confident to leave behind that familiar world to discover new islands, new reefs until we find ourselves in the land of the lotus eaters, far from home, forgetting our native tongue for just a moment, where we become the stranger, the ξένος, welcomed by the hospitality of a strange idiom and tongue, food and folklore until our thoughts enter this new paradigm and we dream its dreams.

When this happens we are changed forever, like Odysseus, that man so wary and wise. We are transformed as our eyes are opened. We can never go back again. We have seen a new world which is different from our own like those creatures on that beautiful planet in Avatar and we see in 3D like we do when we become doctors. O how medicine wearies us and makes us her slave.

“Sing, O Muse, of the man so wary and wise, who in far lands

Wander’d whenas he had wasted the sacred town of the Trojans.

Many a people he saw and beheld their cities and customs,

Many a woe he endured in his heart as he tossed on the ocean,

Striving to win him his life and to bring home safely his comrades.”

Odyssey, Book 1 by H.B. Cotterill MXM11 (I like this as he translated Greek iambic hexameter into English iambic hexameter although he has his detractors.)

We strive to do the same in medicine but instead of our comrades pulling oars and setting sails, they are our patients. The ocean of language to me is the ocean of paradigms of the human condition which is no different now than in Minoan times. To explore this gives to me the greatest pleasure, akin to sailing boat on the ocean.

“There be three things which are too wonderful for me, yea, four which I know not;

The way of an eagle in the air; the way of the serpent on a rock; the way of a ship in the midst of the sea; and the way of a man with a maid.”   Proverbs 30:18-19

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