Dear Dr. Roach: For over two years, my wife has been having a problem with her lower lip. From morning on, it swells, irritating her and causing her to lick her lips constantly. She has seen doctors, dentists and specialists, all of whom have no answer and have no one to refer her to. It causes her no end of irritation. Do you have a reason, a cause or a medication that would resolve the problem? She has tried Biotene lip balm and Vaseline, with no help. Each visit results in more bills, but no results.
R.E.
I think it’s likely that your wife has cheilitis, which isn't a diagnosis, but a general term for inflammation of lips. It has numerous causes. Dryness, swelling, pain, burning and itching are common symptoms. The most prevalent cause is eczema, and often there is an irritant that people are using to help the problem, but which is actually making it worse. When I suspect this diagnosis, I tell my patients to avoid all lip balms except petrolatum (Vaseline), and sometimes I may try a course of topical steroids, though I prefer to let my dermatology colleagues manage this condition.
Unfortunately, your wife’s experience isn’t very uncommon, and at this point she certainly needs an expert to help make a diagnosis, as it seems the time for “therapeutic trial” (which just means to treat based on the presumed diagnosis, and if it gets better, you make a presumptive diagnosis) is over. I would suggest a visit with a dermatologist, who may very well want to obtain a biopsy, as there are many less common diseases (such as sarcoidosis, Crohn’s disease, lichen planus or even nutritional deficiencies, such as iron or riboflavin) that can cause these symptoms.
Dear Dr. Roach: I have a few friends who have needed chemotherapy for different cancers, and some of them talk about interest in the Gerson diet. I have seen some information saying it works and some saying it doesn’t; I’m not sure which is valid.
Can you help me understand what it is, and if there is any evidence on whether it can cure cancer, or if it is helpful in any way?
W.E.
The Gerson therapy is a proposed treatment for cancer and other conditions. It involves a special vegetarian diet, drinking many glasses of juice daily, enemas and numerous supplements. The theory is that a high-potassium, low-sodium diet may have effectiveness for cancer treatment.
Unfortunately, there is no good evidence that the Gerson therapy is an effective treatment for cancer.
A well-done 2007 case series suggested that the positive psychological experiences in the patients treated with the Gerson therapy may provide some benefit. Further, there is some good evidence that a vegetarian diet may help reduce progression of some cancers (such as prostate). While I recommend strongly against the use of the Gerson therapy as a sole treatment for cancer, I think that traditional oncology treatment may benefit from paying attention to a cancer patient’s diet, in addition to his or her psychological and physical well-being.
It seems to me possible to use some “alternative treatments” for cancer along with, and with the explicit knowledge of and approval by, the person’s cancer specialist.
I found a useful reference on alternative treatments for cancer at cam-cancer.org/.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
