Rude Health

The arrival of coronavirus at the White House has surely posed a testing time for the new doctor, writes Maurice Gueret, who is also speaking of tongues

Dr Maurice Gueret speaks in tongues

White House blues

Strange times at 1600 Pennsylvania Avenue where we should feel only sympathy for America’s predicament. Four years ago, they bought the allure of dubious promises and Barnumesque slogans from a man who once borrowed play bricks from his younger brother and glued them to his own constructions so that he wouldn’t have to give them back. His own mother laughed as she told the world about that one. Now America finds itself with a mask avoiding germaphobe on malaria tablets in charge, as the pandemic rolls into each town. Trump must have been a difficult enough patient when foreign dignitaries he had met started coming down with the coronavirus. When White House staff started getting sick, it must have been the Presidential physician’s ultimate nightmare.

New boy

The new boy in the doctor’s office is Sean Conley, who surely has some Irish roots. He’s a doctor of osteopathic medicine in his forties who trained to be an emergency physician with the US Navy. He is also likeable. Nurses once voted him as their Outstanding Resident. Trump likes Conley too. It was Conley who organised the 11 specialists to examine the President last year for his second periodic physical examination. Conley gathered their pronouncements and invoices, before declaring his boss to be in very good health and likely to remain so for the rest of his presidency and beyond. He resisted the urge of some previous medical acolytes to declare him the healthiest man ever to be President. As I write, the medical team have already tested the President multiple times for coronavirus, and he keeps showing up negative. In Trump’s own mind, hydrochloroquine pills, injections of knock-out disinfectants and tremendously powerful ultraviolet lights that shine into peculiar places and kill within a minute must be working well.

Tongue-tied

I have it on reasonable authority that neither the Irish Tongue Foundation nor the Tongue Society of Ireland exist. The most muscular organ of the mouth is one of those body parts we should always ask to examine, but alas it can fall between the stools of modern medicine. If a tongue is tied, it’s surgeons, usually child-friendly ones, who will do the honours. Other diseases of the tongue can be trickier. No single specialist stakes a claim to all, and oral surgeons, ENT specialists, dentists, dermatologists, paediatricians, general surgeons, oncologists, gastroenterologists and other physicians may all show interest. There is a lot you can tell from a stuck-out tongue. It may have a tremor — often nerves — or more rarely either a sign of Parkinson’s disease, an overactive thyroid or withdrawal from alcohol. Colour is important too. Anaemia causes it to become pale. Recently eaten foodstuffs or red wines may also influence its colour. Further, the tongues of mouth-breathers tend to be drier than those who breathe more through the nose.

Strange tongues

Medical students look out for furry tongues, black hairy ones and fissured ones, described as scrotal tongues in rude circles. Brown tongue may be found in heavy smokers and those with serious diseases such as kidney failure or obstructed bowel. Scarlet fever may cause the surface to resemble a fruit — the strawberry tongue. An overly smooth or bald tongue without little hillocks

(we call them papillae) may be a sign of anaemia, bowel conditions or deficiency states. Glossitis is the term we use to describe inflammation of the tongue. Sometimes a tongue appears patchy, with alternating hilly and smooth areas, so that it looks like a map and the term ‘geographic tongue’ has been applied to this. It’s an inflammatory condition, though not a serious one, and is more common in children. It can make the tongue more sensitive to salty foods, spices, acidic drinks or sweets. A thorough examination of the tongue should involve examination of its hidden under-surface. This is a common site for ulcers

— any that look unusual or are slow to heal may need a biopsy to rule out oral cancer. Kidney stones and gallstones are well known ailments. A slightly less painful type of stone can occur in ducts of the submandibular salivary glands in the base of the mouth. General rule: if you notice anything unusual in the mouth that doesn’t go away in a week or two, stick out your tongue in the friendliest way at your dentist or doctor.