Addressing symptom relief of optic neuritis in multiple sclerosis
Woman, 45, Fought 7 Months For A Tongue Cancer Diagnosis. She's Part Of A Larger Trend
Susan Smith noticed a small bump on the side of her tongue that hurt when she ate. When she visited her dentist for a check-up, she mentioned it. The dentist wasn't too worried but recommended Smith see an ear, nose and throat doctor. Over the next five months, she saw three doctors who had her try various mouth rinses. Still, the lump remained.
Finally, a fourth doctor sent her for a CT scan, and Smith learned what was wrong: She had tongue cancer.
"What was on the surface of my tongue was the tip of the iceberg, and I actually had a four-centimeter mass that was inside the tongue into the floor of my mouth," Smith, 48, of Fairfield, Connecticut, tells TODAY.Com. "They diagnosed me as having stage 4A tongue cancer that spread to the lymph nodes in my neck."
Susan Smith visited four doctors before learning that the bump on her tongue was stage 4A tongue cancer.Courtesy Susan Smith Smith is part of a group called Young Tongues. They've noticed that tongue cancer, which has historically impacted older men who drink and smoke, seems to be occurring in younger patients. Emerging data reveals that the demographic of tongue cancer patients is changing, but experts are unsure why. For patients, that can mean months of being misdiagnosed or ignored before ultimately receiving the proper diagnosis.
"I felt dismissed," Smith says. "Anger followed pretty quickly after that because I was so far along. I was stage 4A."
Bump on the tongue, ear painThe bump on Smith's tongue mostly hurt when she ate. She also experienced almost constant ear pain.
"I started to get a really strange earache that wouldn't go away," she says.
After mentioning it to her dentist, Smith scheduled a visit with an ear, nose and throat doctor.
"I saw not one but three, and every single one I went to said that they just thought it was an irritation on my tongue and to try rinses or that they were sure it would go away," Smith explains. "It kept getting bigger, and it kept hurting more."
It felt frustrating that the doctors offered few answers.
"I didn't feel like the doctor was listening," Smith says. "It was a struggle to get doctors to pay attention."
The third doctor she saw performed a biopsy that came back as benign. Then the COVID-19 pandemic started, pausing her search for a diangosis. When she could resume doctor's visits, she saw a fourth who sent her for a CT scan.
"He took one look at me and said, 'We have a problem,'" she says. "I felt elated that someone was finally listening to me and slightly vindicated because I felt in my heart of hearts something was wrong. I was losing weight at that point, like rapidly, for no reason."
To treat her cancer, Smith underwent a 15-hour surgery where doctors removed a third of her tongue and reconstructed it with a skin graft on her left arm. She also had to have a neck dissection — "where they actually cut from your ear all the way to the front of your neck," to remove 36 lymph nodes. After six weeks of recovery, she started six weeks of radiation and chemotherapy concurrently.
Treatment felt tough. "You very much lose the ability to speak coherently," Smith recalls. "It takes a long time to build back up to be able to speak normally, or as close to normal as possible."
Radiation burned the inside of her mouth and throat, making eating painful. She also lost her sense of taste. She lost 52 pounds.
"Most things (tasted) like cardboard," she says. "It hurts so bad to eat and swallowing becomes so difficult because of the inflammation happening in your mouth and throat and then added to that is the psychological impact of not tasting your food."
Eventually, Smith was hospitalized for malnutrition.
"I had stopped eating for 11 days," she says.
Smith felt surprised she was diagnosed with tongue cancer because she did not match the profile of the typical patient. Soon after, she discovered the Young Tongues, which includes young people with tongue cancer worldwide. One of its founders, Barbara Fountain, says the group has experienced an influx of members. But the reason tongue cancer is impacting younger people seems unclear.
"There is a mystery as to why more and more young people — and actually statistically more female, younger people — are getting diagnosed with tongue cancer," Fountain, 26, of Norwich, England, tells TODAY.Com. "(In younger populations) you're not really able to smoke enough, to drink enough to cause that type of damage."
Fountain received any early diagnosis after an ulcer on her tongue wouldn't go away. After only three months, the then 22-year-old learned she had stage 1 tongue cancer.
Undergoing treatment for oral cancers can be grueling. Susan Smith lost weight and was malnourished because it hurt so much to eat.Courtesy Susan Smith "I seem to be even more of a rarity because my cancer got caught early, which makes a really big impact in terms of outcomes from survival rates and quality of life," Fountain says. "A lot of young women don't get referred to a specialist quick enough. … I was just plain lucky that my dentist follows best practices."
An increase in tongue cancer in young patientsFor years, Dr. Diana Kirke noticed a difference in some of her tongue cancer patients. They were in their 20s, 30s and 40s and didn't use tobacco or imbibe heavily.
Typical tongue cancer patients "are older males who smoke and drink and occasionally elderly females with probably a dental issue and therefore a predilection to developing a tongue cancer," Kirke, an otolaryngologist at Mount Sinai Hospital, tells TODAY.Com.
"Since 2010, there seems to be a national shift to younger patients developing oral tongue squamous cell carcinoma. There is a very clear rise in patients that are non-smokers and non-drinkers."
Until recently, though, there wasn't much data to support what she was seeing. A few weeks ago, Kirke and her colleagues presented an abstract at an American Head and Neck Society conference that showed regional areas with higher numbers of young people with tongue cancer, what they call hotspots.
"(One of our papers) was trying to understand whether there are environmental hotspots for the development of oral cancer in young patients," she says.
Barbara Fountain had tongue cancer when she was 22. She said her doctor found it early because her dentist followed best practices.Courtesy Barbara Fountain Their paper looked at data from 2000 to 2019 on patients aged 14 to 44 from 17 cancer registries from 13 states. Not every state or city catalogues cancer the same way, which limits the information Kirke can gather. While they did find some hotspots, the picture remains incomplete.
"For instance, Los Angeles was a hotspot, but it's probably because they have an excellent university health system," she explains. "New Haven was a hotspot, but that's probably because of Yale."
They hope to find more robust data from other locations to include in their research. Still, experts can't point to a reason behind this shift in tongue cancer patients.
"We really don't have a good, causative reason as to why," Kirke says.
She says another paper from researchers from the University of Kansas looked at issues diagnosing young people with tongue cancer. It found what Smith experienced — there's a delay in diagnosis.
"It takes a long time for their tumor to be diagnosed, and I suspect because it's not being considered," Kirke says. The study also found that "time from onset to biopsy was 30 weeks."
Researchers are looking for reasons why tongue cancer is impacting a different patient population. Dr. Richard Bakst is examining the oral microbiome to see if something in it might contribute a person developing tongue cancer.
"Everyone who comes into my office asks, 'How did I get this?' And the answer to 98% of those questions is, 'I don't know,'" Bakst, a radiation oncologist from Mount Sinai Hospital, tells TODAY.Com. "The next question is, 'What could I do about my risk?' And there's really not much that we have to offer."
So, he began considering whether something in the oral microbiome might be contributing to this trend. He and his colleagues are currently recruiting healthy patients and those with tongue cancer within Mount Sinai to obtain samples of their microbiome to analyze. They hope that having a more complete understanding of the oral microbiome can help doctors understand why some young people are developing tongue cancer — or find different treatments.
"The first question we're asking is: What are the 'bad species' of microorganisms? And the second question we're going to ask: Is why are they bad? What are they doing?" he says. "It may go beyond, 'You have this bacteria so you're at risk.'"
Advocacy and supportWhile getting an early diagnosis made a difference in Fountain's outcome, her experience with tongue cancer still felt tough.
Even treatment for stage 1 tongue cancer involves surgery that can include neck dissection.Courtesy Barbara Fountain "It was a very lonely, isolated experience," she says. "My waiting room was full of 80-something-year-olds."
Barbara Fountain was diagnosed with tongue cancer at age 22.Courtesy Barbara FountainThat contributed, in part, to her starting Young Tongues. The group helps people grapple with a cancer more often found in older people and survivorship. Some people lose their taste for the rest of their lives or experience lifelong dental and mouth problems.
"You're not just looking at getting through the treatment and surviving. You're also looking at the quality of life after," Fountain says, such as tooth loss, changes to the jaw bones and gum recession.
It's been two years since Smith underwent treatment for her tongue cancer. She's cancer free and will undergo heightened surveillance for another three years. Having support from others, including the Young Tongues, helped her tremendously.
"Every cancer has such an impact. But for head and neck cancer, your mouth is how you communicate. It's how you eat and nourish yourself," she says. "It's a different kind of cancer because it has such an impact on your daily life and how you socialize (and connect) with people. To have a group of people who understand that impact was really monumental."
Meghan HolohanEar Infections Causes, Symptoms, And Treatment
Experiencing inner ear discomfort or constant pressure, pus drainage, or hearing loss may be symptoms of an ear infection. You can use over-the-counter (OTC) treatments or consult a doctor if your symptoms don't improve.
Ear infections can be either bacterial or viral infections. They can occur in your middle ear, the part of your ear just behind your eardrum, as well as the outer and inner ear. They often clear up on their own but can be painful due to inflammation or fluid buildup.
Ear infections can be chronic or acute. Acute ear infections are painful but short in duration. Chronic ear infections either don't clear up or recur many times. They can cause damage to the middle and inner ear, which is infrequently permanent.
Keep reading to learn about ear infections, including causes, symptoms, and treatment options.
Common symptoms of ear infections include:
These symptoms might persist or come and go. Symptoms may occur in one or both ears. Pain is usually more severe with a double ear infection, which is an infection in both ears.
Chronic ear infection symptoms may be less noticeable than those of acute ear infections.
Symptoms of an ear infection in childrenAlong with symptoms seen in adults, such as ear pain and drainage, young children and babies may show other signs of an ear infection, such as:
Usually, ear infections last fewer than 3 days, but they can persist for up to a week.
Children younger than 6 months who have a fever or other ear infection symptoms should see a doctor. Seek medical attention if your child has a fever higher than 102°F (39°C) or severe ear pain.
Ear infections are caused by viruses or bacteria, particularly the bacteria Streptococcus pneumoniaeor Haemophilus influenzae. They often result from a blockage of your Eustachian tubes, which causes fluid to build up in your middle ear. Eustachian tubes are small tubes that run from each of your ears directly to the back of your throat.
Causes of Eustachian tube blockage include:
Ear infections can also develop from infected adenoids. Your adenoids are glands on the roof of your mouth behind your nose that help protect your body from infections. Infections can spread from these glands to the nearby ends of your Eustachian tubes.
Risk factors for ear infectionsEar infections occur most commonly in young children because they have short and narrow Eustachian tubes. About 80 percent of children develop an acute ear infection at some point.
Infants who are bottle-fed also have a higher incidence of ear infections than their breastfed counterparts.
Other factors that increase the risk of developing an ear infection are:
Ear infections usually clear up without intervention, but they may recur. These rare but serious complications may follow an ear infection:
While most mild ear infections clear up without intervention, the following treatments can also help:
Home treatmentThese methods are effective in relieving the symptoms of a mild ear infection:
Medical treatmentIf your symptoms get worse or don't improve, see a doctor. They may prescribe antibiotics if your ear infection is bacterial, chronic, or doesn't appear to be improving.
Antibiotics don't help treat viral infections.
Medical treatment in childrenDoctors often take a wait-and-see approach when treating ear infections in children to avoid over-prescribing antibiotics, which can lead to antibiotic resistance.
A doctor may sometimes write you a prescription for antibiotics if symptoms are severe or don't resolve within 2 to 3 days. Alternatively, they may write you a prescription but recommend waiting first to see if your child's symptoms get better after 2 to 3 days.
It's important to finish your entire prescription. Often, a 7- or 10-day prescription of amoxicillin is prescribed.
You shouldn't give children aspirin without their doctor's instruction. Aspirin is a preventable risk factor for developing Reyes' syndrome, a rare disorder that causes brain and liver damage.
SurgerySurgery may be an option if your ear infection isn't eliminated with the usual medical treatments or if you have many ear infections over a short period.
Most often, ear tubes are placed in your ears to allow fluid to drain out. These tubes are surgically inserted into your eardrums. They eventually fall out and the holes heal over. Sometimes these holes need to be closed surgically.
A myringotomy surgery is another option. During this procedure, a doctor creates a small hole in your eardrum to let fluid drain and to relieve pain. The incision heals within a few days.
In cases that involve enlarged adenoids, surgical removal of your adenoids may be recommended.
The Centers for Disease Control and Prevention recommends seeing a doctor when your child has:
For adults, it's a good idea to visit a doctor if your symptoms last longer than 2 or 3 days, or you have severe pain or a fever.
A healthcare professional will consider your symptoms and examine your ears with an instrument called an otoscope that has a light and magnifying lens. The examination may reveal:
This exam is rarely painful, but some children may be bothered.
Additional testsOther tests include:
The following practices may reduce the risk of ear infection:
Ear infections are caused by bacteria or viruses in your middle ear, which is the part of your ear behind your eardrum. Most ear infections clear up within about 3 days, but severe infections may need to be treated with antibiotics.
Ear infections are most common in children. It's important to see a doctor if you or your child develop severe pain, a fever over 102.2°F, ear drainage, or other concerning symptoms.
Woman, 45, Had A Lump On Her Tongue That Wouldn't Go Away. It Was Stage 4 Cancer
Susan Smith noticed a small bump on the side of her tongue that hurt when she ate. When she visited her dentist for a check-up, she mentioned it. The dentist wasn't too worried but recommended Smith see an ear, nose and throat doctor. Over the next five months, she saw three doctors who had her try various mouth rinses. Still, the lump remained.
Finally, a fourth doctor sent her for a CT scan, and Smith learned what was wrong: She had tongue cancer.
"What was on the surface of my tongue was the tip of the iceberg, and I actually had a four-centimeter mass that was inside the tongue into the floor of my mouth," Smith, 48, of Fairfield, Connecticut, tells TODAY.Com. "They diagnosed me as having stage 4A tongue cancer that spread to the lymph nodes in my neck."
Susan Smith (Courtesy Susan Smith)
Smith is part of a group called Young Tongues. They've noticed that tongue cancer, which has historically impacted older men who drink and smoke, seems to be occurring in younger patients. Emerging data reveals that the demographic of tongue cancer patients is changing, but experts are unsure why. For patients, that can mean months of being misdiagnosed or ignored before ultimately receiving the proper diagnosis.
"I felt dismissed," Smith says. "Anger followed pretty quickly after that because I was so far along. I was stage 4A."
Bump on the tongue, ear painThe bump on Smith's tongue mostly hurt when she ate. She also experienced almost constant ear pain.
"I started to get a really strange earache that wouldn't go away," she says.
After mentioning it to her dentist, Smith scheduled a visit with an ear, nose and throat doctor.
"I saw not one but three, and every single one I went to said that they just thought it was an irritation on my tongue and to try rinses or that they were sure it would go away," Smith explains. "It kept getting bigger, and it kept hurting more."
It felt frustrating that the doctors offered few answers.
"I didn't feel like the doctor was listening," Smith says. "It was a struggle to get doctors to pay attention."
The third doctor she saw performed a biopsy that came back as benign. Then the COVID-19 pandemic started, pausing her search for a diangosis. When she could resume doctor's visits, she saw a fourth who sent her for a CT scan.
"He took one look at me and said, 'We have a problem,'" she says. "I felt elated that someone was finally listening to me and slightly vindicated because I felt in my heart of hearts something was wrong. I was losing weight at that point, like rapidly, for no reason."
To treat her cancer, Smith underwent a 15-hour surgery where doctors removed a third of her tongue and reconstructed it with a skin graft on her left arm. She also had to have a neck dissection — "where they actually cut from your ear all the way to the front of your neck," to remove 36 lymph nodes. After six weeks of recovery, she started six weeks of radiation and chemotherapy concurrently.
Treatment felt tough. "You very much lose the ability to speak coherently," Smith recalls. "It takes a long time to build back up to be able to speak normally, or as close to normal as possible."
Radiation burned the inside of her mouth and throat, making eating painful. She also lost her sense of taste. She lost 52 pounds.
"Most things (tasted) like cardboard," she says. "It hurts so bad to eat and swallowing becomes so difficult because of the inflammation happening in your mouth and throat and then added to that is the psychological impact of not tasting your food."
Eventually, Smith was hospitalized for malnutrition.
"I had stopped eating for 11 days," she says.
Smith felt surprised she was diagnosed with tongue cancer because she did not match the profile of the typical patient. Soon after, she discovered the Young Tongues, which includes young people with tongue cancer worldwide. One of its founders, Barbara Fountain, says the group has experienced an influx of members. But the reason tongue cancer is impacting younger people seems unclear.
"There is a mystery as to why more and more young people — and actually statistically more female, younger people — are getting diagnosed with tongue cancer," Fountain, 26, of Norwich, England, tells TODAY.Com. "(In younger populations) you're not really able to smoke enough, to drink enough to cause that type of damage."
Fountain received any early diagnosis after an ulcer on her tongue wouldn't go away. After only three months, the then 22-year-old learned she had stage 1 tongue cancer.
Susan Smith (Courtesy Susan Smith)
"I seem to be even more of a rarity because my cancer got caught early, which makes a really big impact in terms of outcomes from survival rates and quality of life," Fountain says. "A lot of young women don't get referred to a specialist quick enough. … I was just plain lucky that my dentist follows best practices."
An increase in tongue cancer in young patientsFor years, Dr. Diana Kirke noticed a difference in some of her tongue cancer patients. They were in their 20s, 30s and 40s and didn't use tobacco or imbibe heavily.
Typical tongue cancer patients "are older males who smoke and drink and occasionally elderly females with probably a dental issue and therefore a predilection to developing a tongue cancer," Kirke, an otolaryngologist at Mount Sinai Hospital, tells TODAY.Com.
"Since 2010, there seems to be a national shift to younger patients developing oral tongue squamous cell carcinoma. There is a very clear rise in patients that are non-smokers and non-drinkers."
Until recently, though, there wasn't much data to support what she was seeing. A few weeks ago, Kirke and her colleagues presented an abstract at an American Head and Neck Society conference that showed regional areas with higher numbers of young people with tongue cancer, what they call hotspots.
"(One of our papers) was trying to understand whether there are environmental hotspots for the development of oral cancer in young patients," she says.
Barbara Fountain (Courtesy Barbara Fountain)
Their paper looked at data from 2000 to 2019 on patients aged 14 to 44 from 17 cancer registries from 13 states. Not every state or city catalogues cancer the same way, which limits the information Kirke can gather. While they did find some hotspots, the picture remains incomplete.
"For instance, Los Angeles was a hotspot, but it's probably because they have an excellent university health system," she explains. "New Haven was a hotspot, but that's probably because of Yale."
They hope to find more robust data from other locations to include in their research. Still, experts can't point to a reason behind this shift in tongue cancer patients.
"We really don't have a good, causative reason as to why," Kirke says.
She says another paper from researchers from the University of Kansas looked at issues diagnosing young people with tongue cancer. It found what Smith experienced — there's a delay in diagnosis.
"It takes a long time for their tumor to be diagnosed, and I suspect because it's not being considered," Kirke says. The study also found that "time from onset to biopsy was 30 weeks."
Researchers are looking for reasons why tongue cancer is impacting a different patient population. Dr. Richard Bakst is examining the oral microbiome to see if something in it might contribute a person developing tongue cancer.
"Everyone who comes into my office asks, 'How did I get this?' And the answer to 98% of those questions is, 'I don't know,'" Bakst, a radiation oncologist from Mount Sinai Hospital, tells TODAY.Com. "The next question is, 'What could I do about my risk?' And there's really not much that we have to offer."
So, he began considering whether something in the oral microbiome might be contributing to this trend. He and his colleagues are currently recruiting healthy patients and those with tongue cancer within Mount Sinai to obtain samples of their microbiome to analyze. They hope that having a more complete understanding of the oral microbiome can help doctors understand why some young people are developing tongue cancer — or find different treatments.
"The first question we're asking is: What are the 'bad species' of microorganisms? And the second question we're going to ask: Is why are they bad? What are they doing?" he says. "It may go beyond, 'You have this bacteria so you're at risk.'"
Advocacy and supportWhile getting an early diagnosis made a difference in Fountain's outcome, her experience with tongue cancer still felt tough.
Barbara Fountain (Courtesy Barbara Fountain)
"It was a very lonely, isolated experience," she says. "My waiting room was full of 80-something-year-olds."
Barbara Fountain (Courtesy Barbara Fountain)
That contributed, in part, to her starting Young Tongues. The group helps people grapple with a cancer more often found in older people and survivorship. Some people lose their taste for the rest of their lives or experience lifelong dental and mouth problems.
"You're not just looking at getting through the treatment and surviving. You're also looking at the quality of life after," Fountain says, such as tooth loss, changes to the jaw bones and gum recession.
It's been two years since Smith underwent treatment for her tongue cancer. She's cancer free and will undergo heightened surveillance for another three years. Having support from others, including the Young Tongues, helped her tremendously.
"Every cancer has such an impact. But for head and neck cancer, your mouth is how you communicate. It's how you eat and nourish yourself," she says. "It's a different kind of cancer because it has such an impact on your daily life and how you socialize (and connect) with people. To have a group of people who understand that impact was really monumental."
This article was originally published on TODAY.Com
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