Help! My tongue is black and furry — what is going on?

MY tongue at the back has turned a dark black colour over the past few months. It also looks very furry and I have a bad taste in my mouth. Is it a sign of cancer? It is not sore but does look unsightly.

Mary Collins, Waterford

BELIEVE it or not there is a condition called Black Hairy Tongue so I bet that is what you’ve got. It does sound terrible and looks scary but it’s normally harmless.

What happens is the papillae (hair-like projections) that line the tongue become elongated at the back. Bacteria and fungi usually come to join the party and food may also get trapped there, or things you ingest which can cause staining. It may result in a metallic type taste in the mouth, bad breath, a tickling sensation in the roof of the mouth, soreness or a gagging sensation. So it can range from being hardly noticeable to being downright unpleasant. Black and brown are not uncommon hues for the area to take but it can also turn yellow or acrid green. The tongue is normally a healthy pink colour so the colour change is startling.

So why does it happen? It is usually down to poor oral hygiene.

Remember the tongue is just as much part of your chewing and tasting apparatus as your teeth, so deserves a look in when it comes to the cleaning process. Tobacco smoking and caffeine consumption can cause the dark colour.

It may also take on this appearance after a course of antibiotics, if you’re dehydrated, suffer from dry mouth, have a challenged immune system or have undergone radiation therapy. Those who take bismuth preparations for stomach acid or who regularly use mouthwash containing hydrogen peroxide; menthol or witch hazel may also be affected. For some reason it seems to be more common in men. We also see an increased incidence of this condition in those with HIV or among intravenous drug users.

So what’s the next step? Firstly eliminate anything that may be exacerbating it, such as caffeine and cigarettes, or over zealous mouth washing. Invest in a tongue scraper and scrape the debris away twice a day. It’s also imperative to brush twice daily and don’t forget to floss! Try to avoid soft food, aim for a more fibrous diet and stay hydrated. If you have any other symptoms go to your GP and consider a throat swab and blood tests. I’M 52 and had the menopause. For the last three months I’ve been suffering from bloatedness. I have seen my GP who says its Irritable Bowel Syndrome. I am also a bit nauseous. I’ve changed my diet but it hasn’t made a difference. I’m also very tired. I don’t have any pain or any history of ovarian cancer in my family but I read about it in a magazine last week and thought I would ask you if I should get screened for ovarian cancer. My smear tests have always returned normal results.

Clare Walsh, Louth

OVARIAN Cancer isn’t common. A GP will see a case of it probably only every five years. A woman’s lifetime risk is around one in 50 where it is one in eight for breast cancer.

So it is not a condition we deal with on a regular basis. The other issue with it is the symptoms tend to be vague so it can sometimes take a while for it to be diagnosed.

I am glad you have read an article about it because we are always trying to raise awareness and this month is actually Ovarian Cancer Awareness Month. Let’s first look at your symptoms. Bloating is a symptom of ovarian cancer. But it is also an incredibly common condition in women in general.

Bloating that comes and goes is less worrisome than persistent bloating. Bloating which comes on out of the blue in the absence of previous symptoms is also worrisome. I wouldn’t be happy attributing your symptom to Irritable Bowel Syndrome if you haven’t got a pre- existing diagnosis of this. We usually diagnose it i n people between the age of 20 and 40.

Tiredness and nausea may be relevant as these can be signs of ovarian cancer. A feeling of fullness quickly after you eat, distension of your tummy, persistent aches in the tummy or pelvis or increase desire to pass urine may all also be signs of ovarian cancer. So what should you do? I’d advise you to go back to your GP and ask them to examine you. Reinforce your symptoms and directly ask them if they have considered a diagnosis of ovarian cancer. Tell them that this is what you are worried about specifically and you’d like to know why they do or don’t feel you may have it.

While there is no specific screening test for ovarian cancer like the mammogram for breast cancer, you can do a blood test for CA125 (Ovarian Marker) levels and also a pelvic ultrasound. A high level of the blood marker doesn’t confirm the diagnosis as it may be elevated due to other conditions, such as ovarian cysts, but a normal level would make the diagnosis highly unlikely.

An ultrasound will show the shape and structure of your ovaries which, if abnormal, would raise suspicion. You mentioned ovarian cancer is not in your family but it’s worth noting 90 per cent of cases of ovarian cancer occur out of the blue without a familial link.

You’ve made the same mistake as many women in thinking cervical smear test screens for this. Such tests bear no relevance in relation to your ovaries. Your age is your greatest risk factor. Anything that interrupts ovulation is protective, such as the contraceptive pill, pregnancy or breast-feeding. Those who do not bear children have greater risk. Those with a family history of breast or ovarian cancer are also at greater risk as it is closely linked to inheritance of the faulty BRACA gene. Ovarian cancer often spreads beyond the ovaries by the time of diagnosis. This is why I’d urge you to seek medical advice.