Treating angular cheilitis saved mother’s life
Q. Many years ago, my mother developed painful cracks at the sides of her mouth. Eventually, after trying various treatments without much success, she was tested and diagnosed with pernicious anemia, a fatal disease if not treated.
As I understand it, people with the disease cannot get enough B12 from food because they lack an intrinsic factor necessary to metabolize B12. They also slowly develop other symptoms like serious exhaustion, which my mother had.
The treatment for pernicious anemia was B12 injections, which completely healed the mouth sores and greatly improved her strength and energy. Nowadays, research has found that B12 supplements in pill form are just as effective, but one must take a high dose and be monitored by a physician. In my mother’s case, cracks at the corners of her mouth saved her life from this potentially deadly deficiency.
A. Pernicious anemia is, as you described, a serious condition in which a lack of intrinsic factor means vitamin B12 is not absorbed. If a person does not get this crucial nutrient over time, the nervous system may be damaged. Symptoms may include fatigue, dizziness, palpitations, shortness of breath, sore tongue, weakness and numbness or tingling in the hands and/or feet.
You are correct that pernicious anemia was once treated almost exclusively by monthly B12 injections, but clinical trials show that high-dose vitamin B12 pills (1,000 micrograms/day) are also effective (Frontiers in Medicine, Aug. 23, 2016).
Q. Can you give me some information on how to taper off a benzodiazepine?
My doctor prescribed diazepam (Valium) more than six years ago. I am now trying to get off it, but it is pure hell. The physician doesn’t seem to have specific recommendations. Before we start taking such a medication, doctors should warn us how very difficult it is to stop using it.
A. Neither the Food and Drug Administration nor the drug manufacturers of benzodiazepines like diazepam provide much useful guidance on discontinuation. The official prescribing information for Valium states: “Abrupt discontinuation or rapid dosage reduction of VALIUM after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue VALIUM or reduce the dosage.”
For more advice, you might ask your doctor to consult the “Ashton Manual.” This online guide was developed by Dr. Heather Ashton, a psychopharmacologist and physician who developed a detailed protocol to help patients discontinue benzos.
Q. I’ve been on Prilosec daily for over 20 years. If I’m late taking this pill, I get terrible heartburn.
Although my memory isn’t what it used to be, my doctor says that I am doing well. As far as I can tell, I don’t have any side effects and, in the meantime, I do not have heartburn!
A. The label on over-the-counter Prilosec (omeprazole) states: “Do not use for more than 14 days unless directed by your doctor. You may repeat a 14-day course every 4 months.”
Long-term use may result in weaker bones, cardiovascular problems, infections and kidney damage, among other complications. Painful rebound heartburn symptoms often occur shortly after stopping this acid-suppressing drug, which can make it hard to discontinue.
You will find tips on getting off PPIs as wells as natural ways to control heartburn in our “eGuide to Overcoming Digestive Disorders.” This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.” © 2023 King Features Syndicate, Inc.