Dear doctor

A pain in the mouth

Q For the past 18 months or so I have been suffering from chronic mouth ulcers. They seem to appear in cycles every week or so, with an ulcer-free week in between. They occur in different parts of my mouth, often - and most painfully - on my tongue, with as many as five at any one time. I have seen my GP about them, and he gave me a blood test which showed nothing untoward. I wondered if there were any alternative treatments for them that you could suggest. I am an otherwise fit and healthy, non-smoking man in my mid-30s.

A Your mouth ulcers sound really troublesome and it must be frustrating not to be able to find an underlying cause or successful treatment. They can occasionlly be a sign of an underlying disease - most commonly Crohn's disease that causes bowel inflammation and would mean you suffered from diarrhoea, weight loss and other symptoms that you clearly don't have. If you have bleeding gums when you brush your teeth and bad breath (ask your best friend), your ulcers could be linked to gum disease. A swab of the ulcers would show typical cells known as Vincent's organisms. Treatment would involve antibiotics and serious descaling work by a keen dentist.

If you have a permanently sore tongue and cracks at the sides of your mouth, in addition to your ulcers, you may be iron deficient. If the ulcers are actually sore, white spots, you may have thrush in your mouth which can occur if you use steroid sprays for asthma, are on oral streroids, or having other underlying immune problems. Unfortunately, what you've probably got is known as recurrent apthous ulceration - a fancy name but no known cure. It's sensible to avoid trauma to the lining of the mouth so check for chipped teeth and avoid over-hard brushing. Steer clear of spicy foods, acid fruits like lemons and hot drinks while you have the ulcers. You can rinse your mouth four times a day with a salt mouthwash using half a teaspoon of salt in a cup of warm water. Adcortyl in orabase is a paste available on prescription that contains a mild steroid and soothes the soreness.

Bitter pill

Q I have great difficulty swallowing pills and tablets. I've tried swallowing with water and without, but tablets just get stuck in my throat, and I often end up choking. Consequently, I avoid taking tablets if I can help it, but now I have a mental block about it - they just fill me with horror. Can you suggest why I should have this problem and what I could do to solve it?

A Lots of people share your problem. Clearly, if you have diffficulty swallowing food or drink, you may have an underlying problem that needs urgent investigation. But if the problem's confined to tablets and everything else slips down your throat smoothly, you really don't need to worry. You've probably been given some huge, horsepill-size tablet at some stage or had that unpleasant experience where a bitter tasting pill starts to dissolve in your mouth before you can swallow it whole. Pills are made to taste bitter if not swallowed whole to deter toddlers from eating them like Smarties. If you want to overcome your antipathy to tablets and pills, try a tiny, coated pill like an enteric-coated aspirin or a multivitamin pill designed for kids to show yourself that you can do it if you really try.

Cramping my style

Q I am 28 years old and frequently suffer from cramp in my feet, particularly the toes, and my calves. I play football once a week for one hour but do not experience these cramps during or after the game - they seem to come about mainly when I am doing nothing. I have been told that a lack of salt in my diet may be the cause of this. If so, are there any salt supplements I can take as I am not a big fan of covering my food in salt?

A It does sound like muscle cramp which happens when muscles contract with great intensity and stay contracted for up to a minute, before relaxing again. Underlying causes are the exception rather than the norm; dehydration with salt and other mineral disturbances in the blood are highly unlikely in our northern climate, bends and cramps can occur during deep sea diving, and poor circulation, diabetes, thrombosis and muscle injuries can all cause pains in the calves.

However, your description definitely sounds like the most inocuous type of muscle cramps. If you're generally well and the cramps come and go and never persist, it's not really worth having any particular blood tests as they're unlikely to show a problem. The key to avoiding cramps is to stretch well before exercise - own up, how often do you warm up before football or do you launch yourself from desk to pitch with no inbetween stage? If you do get a cramp, massage from the edge of the cramp inwards, squeezing the muscle gently. If it persists, get into a warm bath and stretch and massage your leg while in the water. You're absolutely right to avoid extra salt - it won't help the cramps and it may give you high blood pressure.

• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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