New illness responsible for swallowing difficulties

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DEAR DR. DONOHUE: I hope you can shed some light on a condition our 2-year-old grandson has — eosinophilic esophagitis. His eosinophil count is high. When he eats, even soft food gets stuck on the way down, causing him to gag or upchuck. Once his parents had to rush him to the emergency room because the Heimlich maneuver couldn’t dislodge the ravioli he was eating.

We are told this is a food allergy, and he was tested and found to be allergic to eggs and nuts. The suggested treatment is to put him on steroids or to stop foods for six months, feed him through a tube and gradually introduce foods to see which ones trigger the problem. Please help us. — K.M.

ANSWER: Eosinophilic esophagitis is a newcomer to the catalog of illnesses. It’s something that happens to both adults and children. The eosinophil is one of the white blood cells. In children, the normal eosinophil blood count is 50 to 250, or up to 6 percent of the total white blood cell count. Allergies are one cause of higher counts.

In this condition, eosinophils infiltrate the esophagus, the swallowing tube. In children, stomach pain, trouble with food sticking on its way down and vomiting are the principal symptoms. A biopsy of the esophagus showing that eosinophils have attacked it is the ultimate way to confirm the diagnosis.

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Not all doctors agree to the choices given to this child’s parents. A less-stringent treatment plan involves eliminating the six most common food allergens — milk, soy, wheat, eggs, peanuts and seafood — to see if that will solve the problem. Prednisone treatment (one of the cortisone medicines) is another approach to treatment. Prednisone has serious side effects, and I would like biopsy proof of the condition before I subjected my child to long-term prednisone therapy.

It might be wise for the child’s parents to take him to a large medical facility for confirmation of the diagnosis and for alternative treatment suggestions.

DEAR DR. DONOHUE: At some time, would you address again the problem you mentioned about a fungus causing white spots on the skin? And what was the recommended medication? — Anon.

ANSWER: That was tinea versicolor, a common fungal skin infection. It’s mostly seen in hot weather, when sun tans the surrounding skin and makes the depigmented, white spots quite obvious. Proof of the diagnosis lies in examining skin scrapings with a microscope and finding the fungus.

Selenium sulfide lotion, 2.5 percent, works. Miconazole liquid and spray, Desenex cream and Lotrimin AF lotion — all are over-the-counter products — also can get rid of the fungus.

A doctor’s confirmation of tinea versicolor is worth the time and effort before starting any treatment.

DEAR DR. DONOHUE: My problem is a black, hairy tongue. No one has an answer on how to cure it. I have seen an internal medicine doctor, a gynecologist, an otorhinolaryngologist (ear, nose and throat doctor) and an oral and maxillofacial surgeon. The ENT doctor told me to use a soft brush and baking soda. The surgeon had me use peroxide with water. Is there any help? — E.K.

ANSWER: Black, hairy tongue looks scary but isn’t. The tongue is coated black because tongue papillae have grown long. Usually, they’re periodically shed. Here, they aren’t. Papillae are tiny projections from the surface of the tongue. The tongue looks like you are constantly chewing licorice. Black, hairy tongue is no threat to health.

Brushing with baking soda or diluted hydrogen peroxide, three times a day, almost always gets rid of the black color. You also should limit your tea and coffee drinking. Smokers have to stop smoking.

In resistant cases like yours, the yeast Candida could be involved. Fluconazole, a medicine that gets rid of this yeast, might be needed. It’s a prescription medicine.

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 or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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