SkullRing.org Medical Weblog

Heightened public awareness and an improved prognosis for cancer victims have made the cancer experience less threatening and isolating than it once was. While you may hear of some stories of recovering cancer patients experiencing job discrimination and being unable to obtain health or life insurance, these cases are decreasing in number. Several states have even enacted legislation to prevent insurance companies from canceling policies or from instituting other forms of discrimination. Health insurance can be obtained through large employers. Because large employers spread the insurance risk among many employees, insurance companies accept all new employees without underwriting.

On the personal side, assistance for the cancer patient is more readily available than ever before. Cancer support groups, cancer information workshops, and low-cost medical consultation are just a few of the forms of assistance now offered in many communities. Breast cancer activists learned a great deal from the success of the AIDS activists who pressured Congress to provide funds for AIDS research. The National Breast Cancer Coalition and other grass-roots groups have lobbied to increase cancer research dollars. Their efforts have been paying off. Government funding has increased substantially over the past decade. The battle for funds continues.

Increasing efforts in cancer research, improvements in diagnostic equipment, and advances in treatment provide hope for the future.

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“BDD is the absolute core of what led to my alcohol and drug use. “I slept too much and did alcohol and drugs as an escape, to try to forget my scars,” he said. “Sometimes drinking decreased my concern temporarily. But sometimes the alcohol could make my symptoms worse, and it became a problem in its own right. After his BDD improved with the medication fluvoxamine (Luvox), he stopped using alcohol and heroin. In fact, he’d been selling heroin to support his habit, and had been in jail several times. This, too, stopped when he was treated with Luvox.

Emily described her experience as follows. “The only thing that brought relief was drinking…. My symptoms were totally debilitating, so intensely painful, and they were making me more and more depressed. Even though I was suffering so much, and drinking too much, no one knew I was suffering from BDD because I managed to look as though I was doing okay. I pulled it together, but the agony inside was totally overwhelming. I couldn’t talk about it with other people.

“I finally went to my doctor and told him about the situation because I was worried about my drinking. He told me when I stopped drinking I wouldn’t be depressed. But that wasn’t true for me. I drank because of body dysmorphic disorder…. I drank and slept to deal with it. What causes me the most pain now is the effects of my drinking on my son. I wasn’t there for him. That’s the part that hurts me the most.”

Some men with muscle dysmorphia use anabolic steroids to bulk up. This is a family of drugs that includes the male hormone testosterone as well as numerous synthetic derivatives of testosterone. Unless prescribed for specific medical treatment, anabolic steroids are illegal in the United States and many other countries. They may increase the risk for heart disease, stroke, and possibly prostate cancer. They can also cause irritability, aggression, depression, and physical dependence. And to shed pounds or body fat, some people use ephedra-related products (such as ephedra, ephedrine, or ma huang), dietary supplements which are chemical relatives of speed. In high doses, ephedra may have very serious health risks. It can cause heart attacks, strokes, seizures, and even death.

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White patches in the mouth, sometimes painful, often painless, are most commonly symptoms of thrush, and less commonly symptoms of oral hairy leukoplakia.

Thrush-Thrush is a common infection of the mouth caused by the fungus Candida albicans. Candida albicans is found in the mouths of most people; thrush occurs only when the fungus begins growing out of control. Symptoms include white or grayish-white patches that look a little like cottage cheese along the gums, along the inside of the cheeks, or on the tongue. Thrush can be unnoticeable, or it can cause pain severe enough to interfere with chewing or swallowing. Thrush does not cause fever, malaise, fatigue, tooth loss, or headache. Since most people have the fungus in their mouths, thrush is not considered contagious.

What appear to be patches of thrush can also simply be food particles in the mouth. The distinction is easily made by rinsing the mouth to remove food particles. Thrush cannot be removed without direct scraping, and scraping will leave an inflamed spot where the white patch was. A physician can usually verify the diagnosis by simply inspecting the mouth. Microscopic examination of the patch to identify the fungus can be done but is usually not necessary.

Thrush can result from taking antibiotics, which inhibit the bacteria in the mouth that seem to control the growth of Candida albicans. People with HIV infection are therefore more prone to thrush when taking trimethoprim-sulfamethoxazole, tetracycline, ampicillin, amoxicillin, erythromycin, ciprofloxacin, or other antibiotics.

Thrush is commonly viewed more as a nuisance than as a serious problem. Symptoms are often trivial, and even when severe, they are easily corrected with medication. Thrush becomes more serious when it extends to the back of the throat to the esophagus: the pain from

swallowing might cause people to stop eating, and the treatment given may be somewhat different than for thrush that is restricted to the mouth. The diagnosis of thrush in the esophagus can be made only with an endoscope, which is a tube put through the mouth by a medical specialist (gastroenterologist), or with an x-ray called a barium swallow. In many cases, these diagnostic procedures are unnecessary: the existence of thrush in the mouth, accompanied by painful swallowing, is enough to make the diagnosis.

About 80 to 90 percent of people with HIV infection eventually develop thrush; it is often the first condition indicating that the immune system is weakening. The CD4 count is usually around 100 to 400. Thrush is not an AIDS-defining diagnosis, but it does imply that AIDS is likely to occur within two or three years, unless treatment slows the progression of HIV infection. Thrush occurring in the esophagus, however, is an AIDS-defining diagnosis.

Common treatments for thrush include gargling with and then swallowing nystatin solution; sucking clotrimazole troches; or taking such pills as ketoconazole (Nizoral) or fluconazole (Diflucan). All of these are prescription drugs. If any of the drugs fails, another will usually work. Thrush is generally controlled after one or two weeks of treatment.

Occasionally people do not do well with any of these treatments, either because the diagnosis was wrong to begin with or because the infection has extended to the esophagus. In the latter cases, treatment with such drugs as amphotericin B, given intravenously, may be required for a few days.

In people with HIV infection, thrush tends to recur once treatment is discontinued. As a result, it is common practice to give these drugs for a long time, initially to control the infection and then to prevent its recurrence. Or people keep on hand the drugs prescribed for their original infection and use them intermittently whenever symptoms recur.

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