38 years of mouth ulcers tried patient's patience

Q. This isn't a question; it's more like a testimonial. I have been plagued with canker sores since I was 20 years old and five months' pregnant. I have been hospitalized for dehydration and have been entered in the medical books with pictures of my mouth and throat. I had more than 250 ulcers at once.

I have been to the Mayo Clinic. I have seen approximately 80 doctors over the years, including a neurologist, oral surgeons, general practitioners and dermatologists. The medications have included dapsone, thalidomide, steroids, antibiotics and a smallpox inoculation.

Now, 38 years later, I have finally found the answer. I was recently put on a pill for GERD, and the sores are now under control. I hope this letter can help some of your patients and readers.

A. GERD (gastroesophageal reflux disease) can, if left untreated, cause inflammation and damage to the lining of the esophagus, which can, in turn, cause bleeding or ulcers. I am not aware that it can cause mouth ulcers, however.

Were you put on medication for GERD, or as a trial to help your mouth and throat ulcers? Do you have any signs or symptoms of reflux? Did you try diet modifications, antacids, switching toothpastes, eliminating smoking and alcohol consumption (if you partake in either)?

Frankly, I am baffled by your case, as it appears many other physicians were. You definitely have run the gamut on specialists, testing and treatment. I am glad, however, that you now have relief, and I hope others who may be suffering similarly will find your story helpful.

Q. I am a 64-year-old female with toenail fungus. I am sure I got it from trying on a pair of shoes without wearing socks or nylons about two years ago. Initially I went to my family doctor, who dismissed it as cosmetic and chose not to give me any treatment.

I have since tried over-the-counter treatments applied to the nail and skin around the nail and home remedies including vinegar soaks and iodine application. All have had some initial success, but then the effects seem to level off and the fungus remains.

Could this be more serious? Was my doctor too dismissive? A dermatologist is expensive, but would one be appropriate? Is there an effective way to keep from reinfecting my toenails from my own slippers and shoes once cured?

A. Nail fungus can be especially difficult to treat and can sometimes take a year or more before positive results are seen.

My advice is to start with a podiatrist (foot specialist). He or she may be less expensive and likely has more experience dealing with toenail fungus and its treatment than a dermatologist (skin specialist). The doctor will probably start with an examination of your toes and may do scrapings and other testing to determine if you do, in fact, have a nail fungus.

If you choose to continue trying over-the-counter and home remedies, you might consider mentholated chest rub, Miranel, tea tree oil or Pau D'Arco tea soaks. Beforehand, you should carefully clip your nails back as far as possible without causing pain or bleeding and remove any debris you may encounter (from the fungus). This can be made easier by soaking your feet in warm water to soften the nails. Keeping your toes uncovered may also be beneficial since fungi, like bacteria, prefer dark, warm, moist environments.

I suggest you periodically wash your slippers and shoes in hot, soapy water and let them dry, either in a clothes dryer or outside in the sunshine.

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