Doc, I've Got This, Um ... Er ...

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Doc, I've Got This, Um ... Er ...

Certain embarrassing physical ailments still leave us blushing and tongue-tied.

But the experts say to speak up--keeping mum could be much worse.

By ROSIE MESTEL, Times Health Writer

There are things we'd rather not wax eloquent about with others:

embarrassing things. Breath that isn't as fresh as it might be. Hair that

sprouts where hair doesn't usually sprout on women. Rectal bleeding and

hemorrhoids. Who, other than frat boys, giggling adolescents and possibly your

ever-sharing Uncle Sid, relishes chatting about such things?

Especially when they're happening to us.

Our modesty doesn't end with the people in our lives, but extends to our

doctors and dentists as well, the very people who can help us find relief. We

shouldn't be so bashful, experts urge. Such reticence prolongs needless

discomfort--for ourselves and sometimes those we live or work with. And

sometimes it can delay identifying serious, even life-threatening, maladies.

Excessive hairiness in women, for instance, can signify a hormonal

imbalance that places the sufferer at a greater risk for serious conditions such

as diabetes.

Bad breath can signify a host of underlying problems requiring treatment:

gum disease, chronic sinus infections, tooth-rotting dry mouth syndrome--even

ulcers or diabetes.

And changes in bowel movements, while they often signify nothing more than

a change in diet or lifestyle, can also be a sign of colorectal cancer.

" People come to me, and I ask them how long it's been going on. And they

say, six weeks, two months, or four: 'I kept waiting for it to go away,' " says

Dr. Roth, a gastroenterologist and director of the Digestive Disease

Center at UCLA's School of Medicine. " If they had a big boil on their neck, they

wouldn't wait two to four months for it to go away. They'd go to a doctor and

fix this. "

* * *

Fixing something, of course, first requires you to recognize the

complaint--and when it comes to bad breath, the word usually comes from someone

else. We aren't very good at smelling our own breath, even when we cup a hand

over our mouth, a fact providing a niche for businesses with names like Caring

Suggestions and Gentlehints.com. In a backhanded mutation of the Hallmark card,

such services--for a fee--will send an anonymous letter politely informing the

offender of a problem like bad breath, including " gifts " like toothpaste or

mouthwash.

More people, of course, are likely to get the news at their dentist's

office or from their spouse.

" The spousal report is the gold standard, " says Dr. Glenn , founder of

the Fresh Breath Clinic at the UCLA School of Dentistry (which hosted an

international meeting on oral malodor last August). " It's like snoring. The

spouse always knows. "

Science still has much to learn about bad breath, but it's known that a

bouquet of chemicals produced by mouth or sinus bacteria are the cause. Thus, to

assess bad breath, scientists like Preti, a human odor specialist at the

Monell Chemical Senses Center in Philadelphia, sample air from people's mouths.

Preti uses a machine called a gas chromatograph to measure several key gases,

with odors he describes as " rotten egg " or " sewer gas smell. "

For other tests, breath scientists rely on specially trained human sniffers

who assess the breath or the odors wafting up from a scraping of film from the

back of the tongue. Why the back of the tongue? It is a perfect breeding ground

for stinky breath.

" A magnifying glass will reveal that the tongue has lots of nooks and

crannies, especially at the back, " Preti explains. " This area doesn't flap up

against the hard palate when we talk or eat--it's a good area to lay down an

undisturbed surface of plaque. "

* * *

Thus, while there are many reasons why one person has bad breath and

another doesn't, poor tongue hygiene--and how many of us of really brush our

tongues?--is a lead cause.

But there are other causes and contributors. Chronic sinus infections

harbor smell-producing bacteria and fungi. Chronic, drippy noses coat the tongue

with mucus that encourages plaque build-up. Periodontal disease can also be a

cause, as can the dry mouths that often come with age--because saliva contains

chemicals that inhibit the growth of bacteria. With less saliva to hold them in

check, bad breath bugs can breed with wild abandon.

Sometimes, bad breath even provides clues to serious problems like kidney

malfunction, stomach ulcers, hepatitis or diabetes (where the breath can have a

sweet smell caused by chemicals called ketones). Some people with a rare genetic

disorder called trimethylaminuria have distinct, fishy breath. (Dietary changes,

such as avoiding eggs and fish, can help control this odor.)

Since periodontal disease ravages our gums, since high counts of mouth

bacteria may contribute to heart disease and ulcers and since untreated dry

mouth causes tooth decay, bad breath is not just a social problem, experts

stress.

Tooth decay, dry mouth and gum disease should be treated. Patients should

improve their brushing and flossing. Tending to the tongue with toothbrush and

tongue scrapers helps reduce the crop of bacteria. Gargling probably helps too.

Brand names aren't important, says , who hasn't seen convincing studies

demonstrating differences among brands. Using the product is what matters.

While bad breath is more common in older folks, another embarrassing

condition often shows up first in people ill-equipped to handle it: adolescent

girls. What could be more mortifying, at an age when one's looks can be an

all-consuming preoccupation, than unwanted face and body hair?

Excessive hairiness in women is just one sign of a poorly understood

condition often referred to as Polycystic Ovarian Syndrome, or PCOS. Other signs

of PCOS, which may affect 5% of women, include thinning head hair, irregular

periods, infertility, weight gain and acne.

The cause of the condition, which often runs in families, is unclear.

Levels of male hormones (which are naturally present in women in small amounts)

are often abnormally high. The ovaries, when examined by ultrasound, often

contain multiple cysts. And the body responds sluggishly to the

blood-sugar-regulating hormone insulin.

A Condition Dismissed as a Vanity Issue

Doctors tend to either not diagnose PCOS or to pay insufficient attention

to it, says Dr. Dunaif, chief of the Division of Women's Health at

Brigham and Women's Hospital in Boston. " Physicians just have tended to dismiss

complaints of hirsutism, even when women do bring it up--they consider it just a

cosmetic, and vanity, issue. "

In fact, though, it's more than just hard on the psyche.

Women with PCOS often have trouble conceiving. Obesity endangers their

health. They are at high risk for developing type II diabetes and possibly heart

disease and hypertension. They are also at higher risk for uterine cancer if the

condition goes untreated. Thus, say experts, it's very important that girls or

women who may have PCOS are diagnosed so their condition can be managed.

Women with PCOS, for instance, may need to be extra vigilant with their

diet and exercise. They should have their blood lipids regularly checked, and

their doctors should watch out for any early signs of diabetes. Drugs such as

oral contraceptives, Provera (an injectable contraceptive) and a male

hormone-blocking chemical called spironolactone help establish monthly periods

and reduce the growth and thickness of hair.

For cosmetic help, such women can turn to laser treatment and electrolysis.

Emotionally, they can glean strength from support groups such as the Polycystic

Ovarian Syndrome Assn. (on the Web at http://www.pcosupport.org), which now has

a special effort geared toward teens.

Though it's common for PCOS to develop during the teen years, Kirsten (who

asked that her last name not be used) was 22 when she noticed hair growing on

her face and a steadily thickening mustache. (Kirsten, now 37, has been tweezing

out those hairs ever since.) When she went to see the doctor, " he just

flippantly said: 'You have polycystic ovarian disease,' " she recalls. " He

didn't tell me about fertility problems. He said 'You may have to go get

electrolysis. There's nothing I can do for you.' "

Kirsten, who lives in Redlands, did have fertility problems, though she

eventually gave birth to a son. She's always struggled with her weight, she's

had irregular periods all her life and her hair is thinning. And as for acne,

" I'm still putting benzoyl peroxide on my face twice a day--just like I was as a

teen. "

Today, she says, she is getting the care she needs. She takes birth control

pills to stabilize her periods. She has regular checkups for her lipids and

blood sugar. And she pays careful attention to diet and exercise.

Kirsten's facial hair isn't too noticeable; she's a blond. But dealing with

PCOS has still been embarrassing and isolating, she says.

" Everyone looks at your weight, and thinks, 'Hmmm . . . ' " Only recently,

after reading a magazine article about PCOS, did she learn about support groups.

" It's been wonderful to talk to others, " she says. " I don't feel so alone

anymore. "

That Bleeding Could Be a Sign of Cancer

Bowel disorders are another area in which patients tend to wax bashful. Yet

sometimes, someone's very life may depend on seeking timely advice, says Dr.

Beart, chairman of colorectal surgery at the USC School of Medicine.

Perhaps you've noticed some rectal bleeding. Or you think you have

hemorrhoids. The bleeding may indeed be due to hemorrhoids, and the blood may be

from a small tear (called a fissure) in the anus. But it's also possible that a

cancer of the bowel, rectum or anus, or a polyp, could be the cause. A lump or

swelling at the anus could also be a tumor, not a hemorrhoid. A tumor blocking

the passageway could be slightly torn by the passage of a stool, releasing

blood.

Your doctor should do more than a simple finger exam to help rule out this

possibility, Beart says. An exam using a device called a proctoscope allows the

doctor to see inside the rectum and get a better idea of a potential problem.

" I must see two or three patients a month where the physician just did a

rectal exam with a finger--which just looks at a short segment, as you can

imagine--and just above his or her finger was a cancer, " Beart says.

And while there are FDA-approved home tests on the market that screen for

blood in the stool, Beart doesn't encourage relying on such tests. They aren't

very sensitive, he says, and should not be considered a substitute for a

physician visit.

Changes in bowel habits may also indicate something seriously amiss. A

tumor could be blocking the bowel--a possibility your doctor can explore with

tests like a sigmoidoscopy or colonoscopy.

An 18-year-old with constipation is very unlikely to have colorectal

cancer. But in older people it's more likely, although constipation can also be

caused by diet, certain medications and " withholding, " medical jargon for people

who are so busy that they don't use the restroom when the urge strikes,

resulting in stools that lose water and harden.

Persistent diarrhea and cramping are other changes to take note of and seek

help for: You may be infected with a parasite like Giardia. Alternatively, the

gut inflammation that sometimes causes such discomfort could signify a

cancer--or another inflammatory condition such as Crohn's disease or ulcerative

colitis.

A Change in 'Habits' Should Be Checked Out

Over time, chronic inflammation can itself raise the risk of developing

cancer, as well as cause ulcers, perforations, infection, weight loss and

exhaustion. It can be treated with steroids and other drugs that dampen the

intestines' immune reactions.

For all these reasons, the American Cancer Society recommends that people

who notice an unexplained change in their " habits " --bleeding, narrowing of the

stool, constipation, diarrhea or pain--should contact their doctor or schedule a

visit within a few days. If you're over age 50 (or if you're younger and have a

family history of colon cancer or other bowel disorders), talk to your doctor

about establishing regular checkups for colon cancer.

We humans will always be shy and embarrassed about talking about certain

very personal things. And while no one really wants to give Uncle Sid carte

blanche to provide a blow-by-blow account of his bowel movements over dessert,

the doctor's office, at least, is the last place for gentility.

So clear your throat, speak up--and get this stuff seen to.

http://www.latimes.com/news/health/20000320/t000026419.html