Canker Sores

Andy,

My son is prone to canker sores, he tends to get one every other month or so.  A few days ago his neutrophils dropped (0.0) and then quickly rose again, most likely due to a cold.  At the same time he ended up getting numerous canker sores in his mouth, his doctor mentioned that canker sores can occur when neutrophils are low.  He is a little tired, but generally doing quite well - considering that his doctor has allowed his hg to drop very low for the phenotype testing next week.  We are slowly weaning him off of prednisone as well - can some of this be related to that as well? 

Thanks Andy,

Sharmin

5:10 am. I can't sleep and just finished reading an article about canker sores.

Back to this much later.

Sharni,

You can almost say all of the above as the answer here. Canker sores can be an autoimmune response, can be a response to low neutrophils and since treatment is often prednisone, it would be possible that they reappear when the prednisone dose is reduced.

http://www.maxillofacialcenter.com/BondBook/mucosa/aphthous.html

Inflammatory ulceration of the oral mucosa is quite common (Table 1) and approximately 20% of adults (range in various studies: 5-66%) suffer from very painful aphthous stomatitis or canker sores, usually of the recurring variety.  At any one time 1 of every 323 adults have an active ulcer in the mouth.  Once thought to be a herpes virus infection, the entire class of canker sores is now thought to be an aggregate of a variety of disease processes, each with the ability, in its own way, to produce rapid but self-limiting destruction of mucous membranes, predominantly through immunologic and ischemic mechanisms.  In some individuals the ulcers are a secondary or hypersensitivity response to antigenic stimulus, especially foods (peanuts, tomatoes, strawberries), while in others they are a primary autoimmune disorder. Patients with aphthae have a decreased ratio of T-helper (CD4+) cells to T-suppressor/cytotoxic (CD8+) cells in their circulation, and the ulcer bed itself has a high level of CD8+ cytotoxic cells.  While this is a likely contributor to the destruction in these ulcers, initiating causes vary from one person to the next, including: familial predisposition, allergy, nutritional imbalances, infectious agents, hormones, trauma, stress, blood dyscrasias.  Patients with AIDS are at increased risk of aphthous ulcers, most likely because of the common increased CD8+ levels resulting from a reduction of CD4+ T lymphocytes.

Certain histocompatibility antigen types, especially HLA-B12, HLA-B51 and HLA-Cw7, are associated with at least some aphthae.  This is more likely in individuals with co-morbid extra-oral diseases such as Behçet's disease (Behçet's syndrome), which is associated with HLA-B12, Crohn's disease, celiac disease and ulcerative colitis. Cyclic neutropenia is responsible for a subgroup of aphthous stomatitis patients, with the ulcers occurring at points of minor trauma during times when the number of circulating neutrophils is low.  Stress may be indirectly responsible for canker sores, which were once called "stress ulcers," through its modulation of the immune system.  Paradoxically, tobacco smoking, with its own immune modulation, is often protective, probably because of the increased keratinization resulting from local irritation of mouth membranes.  Conversely, diseases which thin the membranes, such as deficiencies in vitamin B12, folate or iron, increase the risk of aphthae.

The subgroup of aphthous stomatitis patients who develop their ulcers in response to antigenic stimulus are experiencing immune-mediated cytotoxic destruction.  No single antigen has been identified, however, and a variety of foods and micro-organisms have been implicated.  The micro-organisms include the L forms of streptococci, cytomegalovirus, herpes simplex virus, varicella-zoster virus and adenovirus.  Recent research has shown that Behçet's disease is associated with hypercoagulation, possibly producing acute mucosal and skin ulcers via soft tissue infarction in a manner similar to deep vein thrombosis.

Treatment.

There is no effective treatment for an aphthous ulcer but, fortunately, it usually heals without therapy in 6-12 days unless there is an underlying immunoincompetence or the patient suffers from major aphthous stomatitis.   Injection of IV prednisolone may be helpful, as may systemic corticosteroids and topical or systemic tetracycline therapy.  A mild anesthesia may last for 5-15 minutes (enough to get through most of a meal) with the topical application of a mixture of Maalox and liquid Benadryl or Benalyn (mixed 1:1), or a mixture of these with a Decadron elixir.  There is no malignant transformation potential to this lesion.

Hi Sharmin ,
your son is a brave soldier  , he is a super fighter  .. he won over anti-bodies , for him these canker sores are nothing ... i m sure he will  GET WELL VERY SOON ... stay calm when you face him ....

Best Regards
take care
umair

Thank you very much Andy - our doctor agrees with you as well - he also said that it may be a combination of the drop in neutrophils and weaning him off of prednisone. 

Umair thanks bro:)  He looked so miserable with all of the sores in his mouth - and he was having a hard time eating but he is much better now. 

Andy, thanks also for the article, it gives me another reason to look into possible deficiencies and introducing more supplements again.  I have not given him B12 yet, I will do that soon.

Thanks again,
Sharmin

Sharni

I just read this.

How is Armaan now?

Hi Sharmin,

Let me add something to this.. not too long back, (as recent as four months back), i used to have canker sores.. and i cant begin to tell how painful they were...  it comes out almost anywhere inside the mouth and stays for almost a week before healing. And not soon after it disappears, it comes back again.. this went on for more than six months!! I had such a painful time:s:s

and evrytime i showed any doctor, i was given pain relievers and mouth disinfectants.. but none of it helped... until this year july, in Maldives, an ENT doctor i showed because i had a severe cold that time saw the cankers and told me that i was vitamin deficient and she thought thats why its happening.. i was only on folic acid, calcium and vitamin E at that time..

She prescribed me vitamin B complex and the canker sores disappeared after abt three weeks i started it.. I havent stopped taking B complex since july and have added some more vitamins such as D, Magnesium and Zinc to my daily pill intake....  and am happy to say no canker sores until now...

hope that helps,

love, maako:D

Hi Maako ,
i m sorry to hear abt your suffering , i can understand how painful experienced were it will b .. i hope it will never disturb you again ...

Hi sharmin ,
same feelings for your Son (  Little A ) . i hope he will recover soon and it will never come again ...i hope that God bless all the patients who are suffering to any kind of illness ... 

Sharmin ,Best Regards for your Son,
Maako, Beest Regards for you too !

Take Cae
Umair

Thank you kindly my friends:) 

The sores are now gone, he was very strong for a week having a mouth full of ulcers - and they all looked so inflamed.  During the same time his neutrophils had fallen to 0.0 - so I really freaked out - fearing that it may all point to exjade.  It all cleared itself up completely.  The doctor said that the two often happen together - the sores and the drop in neutrophils and none were related to exjade.  Exjade has been so good for us that I did not want to see anything negative going on that could point to it!!

Things are good now, except my daughter had a fall at school and hurt her arm - the school called me and asked me to go pick her up - once we got home she accidentally slammed her fingers shut in the car door and for a few minutes could not open the door!  What a horrible day!  Her hand looks awful and blue!! She is a tiny and delicate little girl - so she may need a lot of my attention so please bear with me over the next few days as I may be slow in responding to posts and messages.

Sharmin

Sharmin, am so sorry to hear that.. i hope her hand gets better quickly...  and please dont worry, it will be okay..  give a lot of love and hugs to her frm me.. love, maako

Thank you Maako,

It is so sad to see her one arm against her chest because the upper arm is sore (she fell off of a swing and as she stood up the swing swung back and hit her arm again) - and she is holding her other hand close to her belly protecting it.  She will be better soon though, I am giving her advil for the pain.  Injuries are inevitable in childhood. 

My son is doing well on the other hand, but thank you so much for the advice on vitamin B!  He must be deficient because he does get the sores a lot - I have never considered it a big deal but his eyes tear up when he is eating and they look really flared so I thought that I would finally ask... 

Andy,  when you have some time could you kindly post what kind of b vitamins and what dose would be appropriate for a 10 year old (27kg) boy?  Thank you and please take your time as you have much more pressing issues.

Sharmin

Sharmin,

What your son experienced with the sudden drop of neutrophils should open some eyes about another issue. Patients on L1 are routinely taken off L1 if their neutrophils drop. It is always assumed that they drop because of L1, but as you saw with your son, they can suddenly drop and it wasn't the chelator at fault. I stopped and talked to the people at the Apo Pharma booth at the conference and asked about what to do when neutrophils drop while taking L1. I was told that unless it is a severe drop, that the drug should not be stopped but rather the patient's white cells should just be closely monitored. Most patients will have only a temporary drop in white cells and there is no reason to stop their chelator unless it is a severe drop. I think far more patients would find L1 suitable if this was followed by doctors everywhere.

As far as B-Complex for children, B vitamins are water soluble so the normal preparations should be safe for kids too. just avoid anything that is a megadose  as there are two B vitamins that can cause some problems in the mega dose amounts. The B-Complex preparations do not contain mega doses so they are quite safe. For a child I would recommend either cutting a B-Complex 100 in half or using the B-Complex 50 which is half the strength. Dr Wood very strongly recommended a good B-Complex separate from multi-vitamins which usually only contain minimal doses of B vitamins. He did also recommend a multi, so both are necessary. Check the links for examples of B-Complex.

http://www.puritan.com/b-complex-vitamins-021/b-100-complex-ultra-b-complex-capsules-010282
http://www.puritan.com/b-complex-vitamins-021/b-50-vitamin-b-complex-tablets-000583

Please take B vitamins with food. It is much easier on the stomach.

Hi Sharmin ,
i m sorry t hear about Little A and your daughter , it seems that was a realy tough time on you , hope your daughter will recover soon as little a is doing , bcoze they both are lucky bcoze thay have a caring mother like you ... i hope tough time like this one will never come again .. wishing you & your Family a smooth healthy and joyfull ride of long life ... and also wish that they ( Little A and your daughter ) will recover very fastly ...

Best Regards
Take Care
Umair

Thank you kindly my friends 

The kids are both doing much better now.  I have checked all of the in my daughters hand, I don't think she fractured anything.  Little A's neutrophils were normal the very next day.  When I heard about the neutrophils and saw the sores in his mouth, I was immediately tempted to stop the exjade.  However I continued and found that the neutrophils went up the very next day - and within 4 days they were completely normal.    Oakland and our doctor here have told us that neutrophils can drop with viral illness - for any child, therefore we must be careful not to blame the exjade (as Andy has said).  Had I stopped the exjade we would have assumed that it was stopping exjade that made alleviated the neutropenia - which was of course not the case.  It is amazing how many "normal" children if testing during a viral illness will have neutropenia.  So, as Andy has said, this is a valuable lesson for everyone. 

Andy, I have picked up a few supplements for my son because I want to start him up on everything now.  I have purchased Jamieson Brand - B complex containing:

vit B1, B2, B3, B6, B12, Biotin, Pantothenic Acid all 50mg,  Folic acid 0.4mg, choline bitartrate and inositol both 50mg

Zinc 50mg (is this too much?)  (I am awaiting the Osteocare that I have ordered for him, I may then not need to give him the zinc)

Smart Squirts omega 3 - fish oil EPA 54mg, DHA 37mg, evening primrose 56mg, vit e 8 IU, vit A 1330 iu, vit D3 100 IU

I will also begin vitamin E 50 mg soon. 

I hope this is a good place to start - it may also be good for other children in his age/size group once Andy reviews it. 

It will be interesting to see what effect the B12 vitamins and carao have on his energy levels.  Andy, I haven't given him any of the supplements yet - I will wait until you have had a peak at the ingredients and then I can post some of this for young children in our vitamins and supplements section - I will then also post updates with my observations there. 

Sharmin

Sharmin,

The Jamieson brand looks good and has the proper amounts of the various B vitamins. I don't think 50 mg zinc daily is needed. Half that amount should be sufficient. The other supplements are also good. I would advise a higher dose of vitamin E daily. At least 200 IU natural E daily for a thal child. I think you should start him on supplements. I think some products like carao and FPP will work better if the vitamins and minerals are also present as they seem to have an ability to enhance the value of the other supplements. FPP has already been shown to raise levels of vitamins and minerals and I think from what Lloyd has seen with carao, that is most likely happening with carao also. There are factors that are not yet understood but they are observed to be present. The cumulative effect of the supplements is what we want even if we can't then point to one specific supplement as more important. What we want is good health for everyone and whether or not it has been studied yet, we still have to continue with what we find does help.

Thank you kindly Andy. 

Surprisingly, I saw a multivitamin for kids today that contained tumeric...