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April 1, 2008 07:00  by Dr. Marla Shapiro

A lot of my patients complain about dry mouth and, on occasion, dry eyes. I remember during my chemotherapy, my eyes were so dry that they constantly produced tears as my body attempted to protect my corneas from damage. I could not wear contact lenses and I was constantly aware of a sense of dryness and burning. My mouth often felt dry, as well. Dryness of the mouth can be caused by many things. A recent review by the Mayo Clinic pointed out the fact that many medications, such as antihistamines, certain antidepressants, diuretics and other high blood pressure medications, can cause dry mouth as a side effect. But there is also a relatively unknown but common syndrome that can cause both dry eyes and dry mouth.
 
The syndrome is called Sjögren’s syndrome. This is an autoimmune disease. As in other autoimmune illnesses, the body does not recognize itself and attacks and can damage the salivary glands, the tear glands and other mucous-secreting glands, leading to excessive dryness. It can also cause arthritis, fatigue, weak muscles and neuropathy. As with other autoimmune disease, other organs can also be damaged through the autoimmune process.
 
The Canadian Arthritis Society estimates as many as 430,000 Canadians are affected. This is a difficult disease to diagnose and often is not on our radar screen. It is thought that it can take up to six to nine years to actually diagnose from the start of symptoms.
 
Nine out of 10 afflicted with the disease are typically women between the ages of 35 to 65. However, the disease has been described in children as well. Other risk factors include having a family history of the disease and having other rheumatic diseases such as lupus or rheumatoid arthritis.
 
Symptoms
Symptoms include dry eyes that might feel gritty or burning. There can be dry mouth and common oral yeast infections. With dryness of the mouth there is an increased risk of dental cavities and poor oral hygiene. Your sense of taste or smell might be altered. Your salivary glands, which sit around your jaw, might be swollen as well. Any mucous membrane can get dry, so that can present with a dry or cracked nose, dry tongue, dry skin and vaginal dryness. In addition, since Sjögren’s syndrome can have systemic effects, the symptoms can vary based on the system that is affected. Those symptoms can be as varied as joint or muscle aches, frequent upper respiratory tract infections and sinusitis. In addition, lymphoma (lymph node cancer) can be seen much more frequently in this diagnosed group compared to the general population. Some studies quote as many as 10 per cent of these patients might have a concurrent diagnosis of lymphoma at some point.

Diagnosis
Diagnosis is undertaken by the history itself, the findings on clinical examinations and a series of tests. Those tests include blood tests, ophthalmologic assessment, salivary gland function and flow tests and, on occasion, biopsy of an affected area.

Treatment
There are both over-the-counter and prescription preparations that can be used. Prescriptions include drugs for inflammation; in particular drugs to help with salivary flow, eye drops and immune suppressant medication. Increasing your fluid intake, using topical moisturizers and being in a humid environment are also helpful. It is important not to smoke and maintain good oral hygiene. As this is a chronic illness, it will require ongoing supervision and management.

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Dr. Marla Shapiroclose [x]

Dr. Marla Shapiro, MDCM CCFP MHSc FRCP(C) FCFP, is a family physician and the Health and Medical Contributor for CTV's Canada AM as well as the editor of Parents Canada magazine, launched in March 2007.

She completed medical school at McGill University and trained at the University of Toronto for her Masters of Health Science in Community Health and Epidemiology. She holds a Fellowship in Family Medicine and is a NAMS credentialed menopause specialist. She is an associate professor in the Department of Family and Community Medicine at the University of Toronto, where she recently won an award for Creative Professional Activity.

Dr. Shapiro won the Society of Obstetricians and Gynaecologists of Canada/Canadian Foundation for Women's Health Award for Excellence in Women's Health Journalism in 2006 for her documentary "Run Your Own Race." Her book, "Life in the Balance: My Journey with Breast Cancer" was released in the fall of 2006 and is a national bestseller.

For her lifelong commitment to family medicine, Shapiro was awarded the College of Family Physicians of Canada's Award of Excellence for 2008.

Angela Mulhollandclose [x]

Angela Mulholland is the editor of CTV News' semi-weekly health newsletter MedNews Express as well as the MedNews Express Blog.

She has been a journalist for CTV News since 2000, covering current affairs, health and entertainment for CTV.ca. Before CTV, she worked for CBC.ca for two years.

She has a degree from St. Jerome's University in Waterloo, ON, and studied journalism at Sheridan College in Oakville. She lives in Toronto with her husband and two children.

Monica Matysclose [x]

Monica Matys has been the health and wellness reporter for CTV News Toronto since 2001. Her feature health report, Lifetime, can be seen on CTV Toronto's News at Noon and at 6 p.m.

Her interest in the medical field began while working for a medical publishing company as the editor of a monthly magazine. One of Monica's favourite days on the job was the time she got to spend a day in Credit Valley Hospital's Emergency unit. "It really opened my eyes to the strains on our system," Monica explains.

Matys grew up in Scarborough, and has an honours degree in Journalism from Carleton University in Ottawa. She lives in Toronto with her husband and two children.

Avis Favaroclose [x]

Avis Favaro has been with CTV News since 1992, producing stories for CTV National and CTV News Channel - Newsnet- as well as for CTV affiliate stations across the country.

Avis and producer Elizabeth St. Philip won the 2008 Media Awards for Excellence in Health Reporting handed out by the Canadian Nurses Association and the Canadian Medical association for a story on BPA found in food cans.

She has been nominated for an impressive 12 Geminis, winning once for a unique story on an experimental cancer treatment developed in Winnipeg in the 1940's.

Avis has a masters in journalism from UWO and a Bachelor's degree in History, and launched her journalism career as a writer/reporter at Global in 1982.

Dr. Yoni Freedhoffclose [x]

Dr. Yoni Freedhoff, MD CCFP Dip ABBM, is the founder and Medical Director of the Bariatric Medical Institute in Ottawa, a multi-disciplinary behavioural weight management program. Formally trained in family medicine, since 2004 his practice has been exclusively dedicated to the treatment of overweight and obesity.

Dr. Freedhoff has been referred to as a "nutritional watchdog" by the Canadian Medical Association Journal and a national "obesity expert" by the Canadian Obesity Network. His advocacy efforts for improved public policies regarding nutrition and obesity have found him testifying in front of the Canadian House of Commons, giving press conferences with the Ontario Medical Association, commenting regularly in the national media, and as a sought after lecturer.

Dr. Freedhoff explores issues pertinent to nutrition, obesity, public policy and advocacy in his daily blog Weighty Matters which is ranked among the world's top health blogs and was voted the top Canadian health blog of 2008 by the Canadian Blog Awards.

Dr. Grant Lumclose [x]

Dr. Lum is a sports medicine physician. He is the medical director and founder of Athletic Edge Sports Medicine, a multidisciplinary sports medicine organization offering services to the athletic and active public.

He is involved in the care of recreational, elite amateur and professional athletes, including players in the NHL, NFL and NBA. He is also involved in the performing arts medical community, taking care of musicians, vocalists, dancers and other performing artists.

Dr. Lum studied medicine at the University of Toronto, where he graduated in 1992. He completed a two-year residency in Family Medicine, and then specialty training in Sports Medicine.

He is a lecturer at the University of Toronto's Faculty of Medicine, an adjunct professor at York University's Faculty of Fine Arts, and medical director of George Brown College's Fitness and Lifestyle Management Program.

Dr. Lorne Brandesclose [x]

A senior oncologist at CancerCare Manitoba, Dr. Brandes received his MD from the University of Western Ontario in 1968.

Following post-graduate training at the Royal Marsden Hospital (London) and the University of Manitoba, he joined the faculty at U. Of M. in 1975, where he is a professor in the Departments of Medicine and Pharmacology.

He is also affiliated with the Manitoba Institute of Cell Biology.

Dr. Katy Kamkar, Ph.D., C. Psych.close [x]

Dr. Katy Kamkar, Ph.D., C. Psych., is a Clinical Psychologist at the Work, Stress and Health Program/Psychological Trauma Program, at the Centre for Addiction and Mental Health (CAMH). She also provides private practice at the CBT Associates of Toronto and is a lecturer in the Department of Psychiatry, University of Toronto.

She completed her Honours Degree in Psychology and Mathematics at York University and her Masters and Ph.D. in Clinical Psychology at Concordia University. She also completed a Clinical/Research Postdoctoral Fellowship at CAMH. She has received numerous academic awards and distinctions.

Kamkar provides consultation, comprehensive assessments, and evidence-based Cognitive-Behavioural treatment for Mood and Anxiety Disorders, including psychological distress related to stress and anxiety in the workplace. She also provides training, education, and supervision as well as various educational seminars and workshops. She adheres to a scientist-practitioner model of practice and integrates research and science with practice.

One of Dr. Kamkar's greatest interests has been to provide education to enhance public awareness of mental health/illness in general and of psychological distress in the workplace. She has written articles for comprehensive public resources and provided numerous public relations - media work.

Dr. Neil Rauclose [x]

Dr. Neil Rau grew up in Ottawa. He initially studied mathematics at the University of Waterloo before completing his MD at the University of Toronto in 1991. He completed training in Internal Medicine and Infectious Diseases at McGill University in 1996, before establishing a busy private practice in Oakville. He is currently the medical director of Infection Prevention and Control at Halton Healthcare Services.

In 2008, he completed his training in medical microbiology at the University of Toronto and he now serves as the medical microbiologist and chair of the patient safety steering committee at his hospital.

He is a lecturer at the University of Toronto. Since 2008, he has also been Infectious Diseases section head at the Association for Medical Microbiology and Infectious Disease Canada. He is also a frequent contributor to CTV News.

He lives in Toronto with his wife and two children, and is an avid amateur concert pianist.

Cara Rosenbloom, RD close [x]

Registered dietitian Cara Rosenbloom believes that nutrition can make a difference in overall health and wellness and enjoys translating complex nutrition information into usable and helpful advice.

Rosenbloom holds a literature degree from the University of Western Ontario and a Bachelor of Applied Science in Food & Nutrition from Ryerson University. She completed a dietetic internship at North York General Hospital to become a registered dietitian.

Prior to becoming a nutrition columnist, Rosenbloom worked as a dietitian at The Hospital for Sick Children for three years. She is a member of Dietitians of Canada and the College of Dietitians of Ontario and the president of Words to Eat By, a nutrition communications company.