Doc: Clarifying cold sores and canker sores

Keith Roach
To Your Health

Dear Dr. Roach: Is an HSV-1 breakout considered contagious when there is an oral bump or bumps, or is it contagious only when the bump or bumps are open? Also, are canker sores considered herpes, and if so, are canker sores contagious? Thank you for giving me a clear definition.


Dear S.H.: Herpes simplex virus 1 is a common cause of mouth sores, often called cold sores. They first occur as a blister filled with clear fluid on a reddened base of skin of the mouth and lips. Often, the blister bursts, causing a shallow ulcer. However, they can appear in a multitude of ways, and they typically get worse in times of emotional or physical stress.

Once someone has had an episode of oral herpes, the virus may stay in the body forever. Unfortunately, people can shed the virus, and therefore be infectious, even if they are having no symptoms at all. They are much more infectious when the blisters occur, especially when the blisters first rupture. It also is true for genital herpes, HSV-2, that people with the virus are potentially infectious, and many or even most people do not know they have the infection.

Aphthous ulcers, often called canker sores, are not contagious. They may be triggered by stress, trauma or hormone changes, and many of my readers noted sodium lauryl sulfate (especially in toothpaste) as a predisposing factor.

Dear Dr. Roach: Years ago, I had a bad diverticulitis attack, for which I had to be hospitalized. My doctor stressed to me that I must never eat peanuts, seeds or nuts. However, now people I talk to with the same condition tell me that their doctors say it’s a fallacy. They can eat seeds and nuts. What is your opinion?


Dear C.D.: I still hear this very often. Your friends are right that peanuts, seeds and tree nuts generally are not a problem for people with diverticulitis. In large studies, those who ate more of these foods had fewer attacks than those who didn’t. However, common sense has to be a guide: If you have problems after eating them, then avoid them.

Dear Dr. Roach: For Parkinson’s disease, what is the best medicine you can take for the dopamine part of the brain — something to control the hand-shaking and walking difficulty? Is vitamin B-12 helpful?


Dear L.R.: Parkinson’s disease is a degenerative disorder caused by progressive damage to substantia nigra, a part of the brain regulating movement, and which makes high amounts of dopamine.

There are now many different classes of medication for Parkinson’s, and it’s beyond my expertise and the scope of the column to discuss them all. Although many people with PD start with levodopa, the disease requires an experienced clinician to know when to start medications and which medications to start. The goal for all of them is to reduce symptoms and improve the quality of life. Parkinson’s is a common disease, and you should be able to find a neurologist with experience in treating this condition.

B-12 levels do seem to be low in many people with Parkinson’s disease, and studies are ongoing to determine the significance of this finding. But I don’t recommend B-12 supplements as a treatment at this point.

You can read a great deal more information at and

Correction: Last month we used the term “succession splash” to refer to a sloshing or gurgling noise in the stomach. The correct term is “succussion splash.” Thanks to our readers who caught the wrong spelling.

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