Dear doctors: In the past couple of years, I have developed a dry mouth, which has become severe. My rheumatologist said that it is Sjogren's syndrome. She said it should be treated with prednisone, but I will not take prednisone because of the terrible side effects. Is there another drug out there without the side effects of prednisone that can help me? I am desperate.
M.B.
Sjogren's (SHOW-grins) syndrome is an autoimmune disease - one in which the body's immune system goes on the attack. In your case, its focus is the glands that produce tears and saliva. The hallmark is generalized dryness. Other parts of the body can be affected.
Sjogren's syndrome can exist by itself, or in combination with other illnesses, such as rheumatoid arthritis.
There is no cure for Sjo-gren's syndrome. There is treatment. Prednisone is sometimes used for Sjo-gren's syndrome, but newer medicines have some benefit for people with varieties of Sjogren's that affect blood vessels, joints or the lungs. I would recommend you go back to your rheumatologist and see if she can work with you to find some alternatives to prednisone.
Since a persistent dry mouth can lead to early and extensive dental disease, regular dental care is imperative. There are over-the-counter products for dry mouth that work well and can help prevent this, but see your dentist.
A valuable resource for patients with Sjogren's is the Sjogren's Syndrome Foundation. You can reach the foundation online at sjogrens.org or by calling 800-475-6473.
Dear doctors: In spite of training, it is fairly common to see phlebotomists employ what I think is poor technique.
For example, after wiping the skin over the vein with an alcohol pad, a phlebotomist palpated the vein with a bare finger just before inserting the needle. Would you care to comment?
J.K.Q.
Indeed, I would. There are at least two problems you are describing. The first is that after taking care to reduce the risk of infection with alcohol, the phlebotomist is putting his or her non-sterile finger over the cleaned area, which makes no sense.
Second, in 2012, phlebotomists shouldn't be performing phlebotomy without gloves to protect themselves from blood-borne infections. Hospitals are increasingly empowering patients to ask about hand-washing and other techniques to reduce infection. This is a time when you can ask the phlebotomist to use alcohol the area again and to wear gloves.
Dear doctors: I am totally confused about calcium supplements and need your guidance. Ever since it came out, I was taking Cit-racal Calcium + D slow-release 1,200, but recently read about testing calcium tablets in vinegar to find out how fast tablets dissolve. I was shocked to see that the above Citracal did not dissolve in 24 hours.
Just how much should we be taking in supplements if we don't consume much in food and milk?
H.S.
Citracal contains both calcium carbonate and calcium citrate. Calcium carbonate dissolves in vinegar; calcium citrate does not, so that's why the tablet did not dissolve completely - the citrate was left behind.
However, the whole tablet would be dissolved and absorbed in the intestines.
The doses can be mis-eading.
You want to look on the label for the amount of elemental calcium. Citracal indeed contains 1,200 milligrams of elemental calcium in two tablets, the recommended amount for women over age 50 (for adults 50 and under, and men up to age 70, it's 1,000 mg). Citracal also has 1,000 IU of vitamin D, also recommended, as it's something the body needs in order to absorb and properly use calcium.
Most people get about 200 milligrams of calcium from food, not counting dairy or calcium-supplemented juices.
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