Aspergillus, Sjogren's Syndrome and Meniere's

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04/29/99

DEAR DR. DONOHUE: Please give me information on Aspergillus. -- E.S.

ANSWER: Aspergillus is a fungus found everywhere -- inside, outside, in

water, in soil, on foods and on decaying vegetation. No one escapes an

encounter with Aspergillus. For most, it is not a concern.

Some develop an allergy to Aspergillus. Sensitive farmers entering a barn

filled with hay can cough and find it hard to breathe. They often have to

take medicine to stop the allergic reaction.

For others, Aspergillus finds a small cavity in their lungs where it grows

and forms a fungal ball. The ball can cause bleeding. Then medicines and

surgery are needed to eradicate the fungus.

The most destructive Aspergillus infection is one that burrows into lung

tissue. This is a serious infection that demands serious and often prolonged

treatment. Two anti-Aspergillus medicines are available -- amphotericin and

itraconazole. Treating this infection is no picnic for the patient or the

doctor.

SJOGREN'S SYNDROME DRIES EYES AND MOUTH

BY PAUL G. DONOHUE, M.D.

DEAR DR. DONOHUE: I have a diagnosis of Sjogren's syndrome. Can you tell me

of beneficial treatments? I wake up with my mouth very dry. A drink of water

gives relief but not for long. -- E.G.

ANSWER: Dry eyes plus dry mouth equals Sjogren's (SHOW-grins) syndrome.

Either or both can be the target.

Lymphocytes, one kind of white blood cell and the infantry of the immune

system, invade tear and salivary glands, shutting down their production of

tears and saliva.

The eyes feel as though wind has blown sand into them. The tongue sticks to

the roof of a parched mouth.

Artificial tears keep the eyes lubricated. They must be instilled

frequently, for dry eyes invite infection.

A squeeze bottle of water ought to be a constant companion. Sugarless

chewing gum stimulates the production of saliva and can help moisten the

mouth. Tooth decay flourishes when there's a deficient supply of saliva.

Become good friends with the dentist. Instead of twice-yearly exams,

schedule four exams each year.

An old drug -- pilocarpine -- with a new name -- Salagen -- has won approval

for Sjogren's treatment. It stimulates tear and saliva production. It's a

prescription item, so the doctor has to OK its use before a patient gives it

a whirl.

At times, Sjogren's is not an isolated illness. It can be a manifestation of

other diseases such as rheumatoid arthritis, lupus or the skin-hardening

disease scleroderma.

DEAR DR. DONOHUE: I read your column every day. I can't remember seeing

anything on Meniere's disease. Please write about it. I'll be watching. --

J.C.

ANSWER: Meniere's (main-YAIRS) disease is a topic that frequently turns up.

I receive so many letters asking about it that I have to be careful not to

overexpose it.

Fluctuating episodes of deafness, ear noises and dizziness are the three

features of this illness. Symptoms come and go. There can be gaps of months

to years between attacks. However, as time passes, attacks become more

frequent, symptoms more severe and activities more restricted.

The basis of Meniere's is fluid buildup in the inner ear. Fluid muffles

hearing. It irritates inner ear structures, and the irritation causes ear

ringing or outright noise. The inner ear sends conflicting signals to the

brain, and that, in turn, causes dizziness.

Medicines can sometimes suppress Meniere's symptoms. Antivert, for example,

is used to relieve dizziness. A low-salt diet and diuretics deplete the

inner ear of fluid, often ameliorating all three symptoms.

Surgical drainage of the inner ear has met with a measure of success.

Destroying the balance nerve can abolish dizziness. Gentamicin, an

antibiotic, can be injected directly into the inner ear to clear the jumble

of dizzying signals and to quiet the constant inner noise.

The report on ear noises, while not specifically directed to Meniere's, does

offer tips on coping with tinnitus (constant ear noise). Readers can obtain

a copy by writing: Dr. Donohue -- No. 9, Box 5539, Riverton, NJ 08077-5539.

Enclose a self-addressed, stamped (55 cents), No. 10 envelope and $3. Please

allow 6-12 weeks for delivery.

DEAR DR. DONOHUE: Please give me information on Aspergillus. -- E.S.

ANSWER: Aspergillus is a fungus found everywhere -- inside, outside, in

water, in soil, on foods and on decaying vegetation. No one escapes an

encounter with Aspergillus. For most, it is not a concern.

Some develop an allergy to Aspergillus. Sensitive farmers entering a barn

filled with hay can cough and find it hard to breathe. They often have to

take medicine to stop the allergic reaction.

For others, Aspergillus finds a small cavity in their lungs where it grows

and forms a fungal ball. The ball can cause bleeding. Then medicines and

surgery are needed to eradicate the fungus.

The most destructive Aspergillus infection is one that burrows into lung

tissue. This is a serious infection that demands serious and often prolonged

treatment. Two anti-Aspergillus medicines are available -- amphotericin and

itraconazole. Treating this infection is no picnic for the patient or the

doctor.

Dr. Donohue regrets that he is unable to answer individual letters, but he

will incorporate them in his column whenever possible. Readers may write him

at P.O. Box 5539, Riverton, NJ 08077-5539.

c 1999 North America Syndicate Inc.