Black hairy tongue
Q My tongue is frighteningly discoloured. When I stick it out and look in the mirror, I can see a black and hairy-looking patch covering most of the surface of my tongue. I have tried brushing it thoroughly but it still looks black. What can it be?
A It's not as bad as it looks. The first time I saw it as a GP I nearly died of fright. I assumed it was a type of fungal infection (which it isn't) and prescribed anti-fungal lozenges (which don't help). I also referred the patient to an oral surgeon in case it was cancer (which it never is). In fact, black hairy tongue is a result of pigment being laid down in the wavy protrusions of the tongue called filiform papillae. The cause is unknown, though it can follow a course of antibiotics. It isn't linked to any underlying disease and the only way to treat it is by bleaching the tongue with a dilute hydrogen peroxide solution and using antiseptic mouthwashes containing chlorhexidine gluconate.
Persistent cough
Q My eight-year-old daughter had a cold at Christmas time and has been coughing ever since. Our GP has checked her breathing and done some tests to make sure it isn't asthma. She even had a chest X-ray, which was clear. She has had antibiotics and tried a Ventolin puffer, all to no avail. She is perfectly well and doesn't seem at all bothered by her cough, but it bothers me. What should I do?
A Asthma is the most likely condition that needs to be ruled out in a child who is coughing. Some eight-year-olds lurch from one viral cough and cold to the next as the bugs get passed around the class. Infections such as whooping cough and tuberculosis are rare but still possible causes of a longstanding cough. If your daughter is coughing, sneezing and has a constantly runny and itchy nose, she may have an allergy such as hay fever. A cough with a blocked-up nose and nasal gunge that runs down the back of her nose into her throat may indicate sinusitis. All these conditions are unlikely. Your daughter might well have developed an habitual cough which may start after a cough or cold and can be very hard to stop.
Hang on to your ovaries
Q I am waiting for a hysterectomy for fibroids, an enlarged uterus and prolapse. (I have painful periods with flooding.) My surgeon wants to remove my ovaries (in case they cause problems at a later date). I am 47 and show no signs of nearing menopause yet. I agree that they should be removed if showing signs of cysts or disease, but am inclined to want to preserve them and benefit from my own hormones for as long as possible. I have suffered from PMS for years. What should I decide?
A If you do not have a strong family history of ovarian or breast cancer, there is no particular reason to remove your ovaries. It is true that ovarian cancer is hard to diagnose and is a particularly nasty disease and that if your ovaries are removed, you can't get cancer in them. Ovarian cancer is relatively rare, however, especially in younger women, and screening with ultrasound scanning and blood tests is possible although not yet part of a national screening programme.
After a hysterectomy, you usually go into an early menopause even if your ovaries remain in place. Because of your age, your surgeon probably feels you have nothing to gain by hanging on to your ovaries. Removing your ovaries is not necessary, however, and the menopause that results from their removal is sudden and can be dramatic. Personally, I agree with you, and would hang on to mine.
• 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 drann@dircon.co.uk 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.
