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Dear Dr. Roach: I am plagued with canker sores. I get four to five outbreaks a year. The products that are sold to heal them do not help much. Do you know of a mouthwash that could be used to prevent or maybe reduce the severity of canker sores, and what would you recommend for use on canker sores? What, in your opinion, causes them?

J.H.

Dear J.H.: Canker sores, also called aphthous ulcers, are painful sores that are in the mouth. When they keep coming back, as in your case, it is called recurrent aphthous stomatitis (“stoma” is the Greek word for “mouth,” and is sometimes used for surgically created openings). While it isn’t clear why they occur, there have been studies that show there may be a defect in immune function in people with RAS, making it similar to Behcet’s syndrome. It may be associated with celiac disease and inflammatory bowel disease, and it can be triggered by many things, including stress, food and drug hypersensitivity and trauma.

The most common effective treatment I know of is a medium- or high-potency topical steroid. It can be prepared specifically for use on aphthous ulcers, such as Kenalog in Orabase, and this can speed up healing, especially when applied early. Some people swear by vitamins, but they were not found to be effective in a study.

Thalidomide, a potentially dangerous medication that has extremely high risk for birth defects, can be used in severe cases.

Dear Dr. Roach: I offer my experience with a prostate treatment not covered in your article. I had no symptoms. A routine annual test revealed that my PSA had risen rapidly to 5.1. At the recommendation of my urologist, I had a biopsy (actually, 13 individual biopsies). My Gleason score of 7/8 predicted a painful death from prostate cancer if left untreated.

My options were surgery or radiation therapy. I chose radiation, which consisted of nine weeks (45 treatments) of one or two minutes of actual radiation. Extreme caution was taken to avoid damage to other organs. I had no side effects during or after treatment. Two years later, my PSA is 0.04, and I expect to continue an active lifestyle at 82 years of age.

J.A.G.

Dear J.A.G.: I appreciate you writing in to share your story. Most men I hear from have accepted surgery in your situation; however, many experts feel that radiation treatment offers a better balance of effectiveness and side effects than surgery. I did know an oncologist in a situation almost exactly like yours who also decided on radiation and had excellent results.

I do want to caution that a perfect outcome like yours is not guaranteed. I occasionally see men who, despite abundant caution, have developed radiation damage to the rectum or bladder. However, the risks with modern radiation therapy are low.

Dear Dr. Roach: I have been diagnosed with positional vertigo. My doctor has me doing Cawthorne head exercises. Have you heard of these? Do they work?

M.M.S.

Dear M.M.S.: Vertigo is an abnormal sense of motion while still. Many people describe it as a “spinning” sensation, but others feel it differently. The most common cause probably is benign paroxysmal positional vertigo, and rehabilitation exercises, such as the Cawthorne-Cooksey exercises, are very effective. Although medication is frequently prescribed, I recommend strongly against long-term use of medication, which can slow down or stop healing.

Although you can do the exercises on your own, I recommend learning how to do them properly and safely with an occupational or physical therapist.

Email questions to ToYourGoodHealth@med.cornell .edu.

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