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February 24, 2005
Sjogren’s syndrome
Q: I have never seen any reference in your column to Sjogren’s syndrome, nor is there any mention of it in many medical books. Is this a progressive disease? How can it be treated? Please explain the parotid gland and its function.
A: Sjogren’s (SHOW-grins) syndrome is an illness where the immune system targets salivary and tear glands. Lymphocytes — white blood cells that are part of the immune system — blitz their way into these glands and stop the production of saliva and tears, leaving a person with a dry mouth and dry eyes. Symptoms can get progressively worse with time. The parotid gland is the largest salivary gland, and it’s located in the cheeks.
For unknown reasons, Sjogren’s picks on more women than men. For every rnan who has it, nine women have it. The usual age of onset is in the late 40s.
A dry mouth makes swallowing difficult. The mouth and tongue often burn. A lack of saliva does more than wreak havoc with chewing and swallowing. Saliva initiates food digestion, and people with Sjogren’s miss that action. Saliva also neutralizes acid in food. It’s an important defence against tooth decay, something that happens to Sjogren’s patients unless they are meticulous about dental hygiene.
Dry eyes make for a feeling of grittiness and irritation and can lead to eye infections.
Joint pain, fatigue and kidney problems can also surface in Sjogren’s.
Artificial tears and artificial saliva help Sjogren’s patients manage. Sugarless gum promotes saliva production. Evoxac is an oral medicine that stimulates saliva output. Special goggles called moisture-chamber spectacles can keep the eyes from drying. An eye doctor can plug the tear ducts to keep a film of tears on the eyes. And a brand-new medicine, Restasis eyedrops, combats lymphocyte infiltration of the tear glands and improves eye moisture.
Q: I am 19 and have been getting kidney stones since the age of 15. I don’t drink milk, but I worry about my bones since I am not getting any calcium from milk. What can I do?
A: Most kidney stones are calcium oxalate stones. Nowadays, less emphasis is placed on stone formers restricting their calcium, and more emphasis is put on restricting oxalate.
It’s found in nuts, chocolate, spinach, rhubarb, beets, strawberries, blueberries and blackberries. Settle this issue with your doctor. You might be denying yourself calcium for no good reason.
If calcium must be restricted, you can keep your body stores of calcium up to par by taking a common water pill, called a thiazide diuretic. It prevents calcium from being filtered into the urine. Potassium citrate is a substance that can help prevent calcium stone formation. Lemonade is a good source of it another way for you to handle your problem without denying yourself calcium.
Something is peculiar about your story. A stone former has a good chance of having another stone, but not usually episode after episode of stones. You could well have a metabolic problem going on behind the scenes. Overactive parathyroid glands, for example, can lead to constant, repeated kidney stone formation. You should be checked for such problems.
Q: I know broccoli is a greatly respected vegetable, and I happen to just love it. I eat a cup every night with other vegetables. Could I be consuming too much’?
A: My hat is off to you and to the greatly respected broccoli. It supplies fibre, three B vitamins (folate, riboflavin, and B-6), vitamin C, beta carotene, potassium and iron. It’s a nutritional bonanza.
One cup a day is not too much.
Only if you limited your diet to broccoli alone or used it in such huge amounts that you killed your appetite for other foods would it ever get you into trouble.
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at PO Box 536475, Orlando, FL 32853-6475
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