Dear Dr. Roach: I have talked to numerous doctors about my problem, but no one has an answer, and most don鈥檛 take it seriously. I have a terrible taste in my mouth all the time. Often it is so bad that it makes me gag and choke. I have been on dialysis for 31脷2 years. My kidney doctor says this shouldn鈥檛 cause the problem, but the time coincides with the bad taste.
J.S.
A bad taste in the mouth (we use the Greek term for 鈥渂ad taste,鈥� which is 鈥渄ysgeusia鈥�) can be caused by several diseases, as well as by medication.
While it is associated with people developing end-stage kidney disease, it is uncommon in people on dialysis. Increasing the time on dialysis can help (either through more times per week or by more hours per time). Eating less protein can help, too. The timing makes me suspicious, as it does you, but it鈥檚 always wise to look at all possibilities.
I would check with your dentist, since dental issues are one common cause. Too much of some metals and too little of another can cause taste changes.
An ear/nose/throat doctor (otolaryngologist, also called a head and neck surgeon) would be a good resource.
鈥�
Dear Dr. Roach: My husband beat small-cell lung cancer with chemo and radiation, but after a few months he was walking with a cane. Since December, he has been in a wheelchair. He has peripheral neuropathy. How can I help my husband?
A.S.
When a new symptom arises in someone with cancer, the clinician should consider whether it is due to the cancer, the treatment or neither.
Small-cell lung cancer in particular is associated with what we call 鈥減araneoplastic syndromes.鈥� These are clinical syndromes related to the cancer, but not directly due to the tumour. They often are associated with antibodies attacking different parts of the body, and the nervous system is a frequent target. Sometimes, the antibodies can be found in the blood. I would consider having a discussion with a neurologist who has expertise in paraneoplastic syndromes.
Treatment for the cancer is another likely possibility. I don鈥檛 know what chemotherapy your husband received, but platinum-based chemotherapy is typical with small-cell lung cancer, and is a very common cause of peripheral neuropathy. Radiation to the brain is not a usual cause of peripheral neuropathy.
If your husband does not have identifiable antibodies consistent with a paraneoplastic syndrome and received platinum chemotherapy, I would think that the chemo would be the likely cause, as his course is consistent with this condition. Treatment to relieve symptoms is possible. An antidepressant drug, duloxetine, has been particularly helpful for some people. Physical therapy may be the most effective treatment.
