ASK THE GP: Help, I’ve got a white furry tongue! Dr Martin Scurr answers your health questions
My daughter has had a white, furry, ulcerated tongue for almost a year. Swabs have been taken and scrapes carried out, but these found nothing.
Her tongue is extremely uncomfortable and causes her distress. She is a restaurant manager and the ongoing problem is very disturbing. What do you suggest?
David Edwards, Bishop’s Stortford, Herts.
This is something I have seen occasionally over my 30 years in practice and it’s very perplexing, with little clear guidance available from dentists or oral surgeons as to what it is or how to treat it once infection has been ruled out (via swabs, as your daughter has had).
Did you know? A white, furry tongue could be due to a change in the natural colony of microbes on the tongue and the gut
Typically, by the time I see a patient with a white, furred tongue, they’ve self-diagnosed a yeast infection (usually thrush) and are self-medicating with over-the-counter anti-fungal tablets or gels — to no avail.
Thrush has a characteristic appearance — like a white curd, which, when dislodged, leaves a bleeding base. Furthermore, oral yeast infections tend to be distributed throughout the mouth and throat and not just confined to the tongue.
Patients also often try to self-treat with mouthwashes, as, no doubt, has your daughter, again without improvement.
So, what might be the diagnosis? The description you give doesn’t match common tongue disorders, such as geographic tongue (also known as benign migratory glossitis), which is characterised by red, ulcer-like areas with white borders.
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This appearance constantly changes and moves as the days pass and some patients can, at times, experience a painful burning sensation.
While it is never wise to speculate on the basis of a description — just as with dermatology, it’s vital to see the skin in order to make a sensible attempt at diagnosis — I have my own theory.
I believe your daughter’s problem may reflect an imbalance in the bacteria in the digestive tract.
Since time immemorial, physicians have inspected the tongue when conducting a physical examination, with an unhealthy-looking tongue seen to indicate some sort of disorder of the gastrointestinal tract.
Today, less reliance is placed on this for making a diagnosis, but I think this is a loss. The tongue is the front door of the gastrointestinal tract and shares its unique colony of bacteria.
It is possible that the disorder you describe is due to a change in the natural colony of microbes on the tongue and the gut.
To restore the correct balance involves taking a prebiotic — essentially food for ‘good’ gut bacteria — as well as a probiotic, a supplement of ‘good’ bacteria to boost the colony of those in the gut.
Tell your daughter to seek advice from a pharmacist, but be patient as, if this is to help, it may take some weeks and is based on theory, not on any objective, established evidence. But it is safe and cannot cause harm.
For years, I’ve suffered with flashings in my eyes, followed by a dull headache. They used to occur two or three times a year but, recently, they’ve started to occur once or twice a week.
Could they be a symptom of something sinister? The headaches are very mild and the flashings last about 20 minutes.
I’m 75 and on tablets for high blood pressure, which keep it under the target set by my doctor — otherwise, I’m in good health.
Roslyn Marlow, Glenfield, Leics.
While I appreciate how alarming this symptom must be, I can indeed reassure you, given your history of headaches, that it is not sinister.
Seeing visual sparks or flashes may, on some occasions, be part of a transient ischaemic attack (a ‘mini stroke’), though this is not what you describe — which are classic symptoms of aura, the neurological disturbance that can occur with a migraine.
Lights: About 25 per cent of people who have migraines experience aura, with the headache either coinciding with it or following
About 25 per cent of people who have migraines experience aura, with the headache either coinciding with it or, as in your case, following on.
Typically, the symptoms of aura are visual and start with seeing a bright light or having an area of visual loss. Over minutes, this may expand into geometric shapes or zigzag lines.
Because the appearance of these shapes can resemble the walls of a medieval fortress, this particular group of symptoms is known as fortification spectrum.
Other symptoms of aura include hearing or smelling things that aren’t there, pins and needles and dizziness.
Curiously, not all those who experience an aura have a headache, which can make the diagnosis more difficult.
The vast majority of the six million people in the UK who have migraines don’t experience aura — although some may have other, different kinds of symptoms that precede the headache.
These are known as the prodrome — examples include increased yawning, depression or irritability or food cravings.
Write to Dr Scurr
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details.
Dr Scurr cannot enter into personal correspondence.
His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
The frequency of migraine can vary throughout life.
The recent increase in your attacks isn’t sinister and I don’t think it’s related to your well-controlled hypertension.
The escalation in frequency may continue or it may abate — the pattern cannot be predicted. However, in an effort to minimise attacks, I would advise that you keep well-hydrated and try to eat regularly, as dehydration and missing meals may be a trigger.
So, too, is a change in bedtime, as well as too little or even too much sleep.
Patients with migraine are also urged to take some form of daily exercise, as research has found that this can help cut the frequency and severity of attacks — aim for at least 30 minutes of moderate exercise three times a week (even brisk walking may help).
If, despite this advice, the episodes continue to plague you once-weekly or more, I would suggest talking to your GP about prophylaxis — taking a daily medication to prevent attacks.
Possible options include the beta-blocker propranolol, the tricyclic antidepressant amitriptyline and the anticonvulsant topiramate, which may help by dampening down the brain’s electrical activity.
These all have the potential to cause side-effects, but these may be preferable to the interference that regular migraine causes to your life.
IN MY VIEW….DOCTORS’ WATCHDOG IS TOO SOFT
‘BRUSQUE, unfriendly and indifferent’ are not what you would call ideal qualities for someone working in medicine.
Yet this is how the General Medical Council (GMC) described the manner of Dr Jane Barton, the retired GP accused of hastening the deaths of numerous patients at Gosport War Memorial Hospital.
The investigation went on to call her use of painkillers on the ward ‘excessive, inappropriate and potentially hazardous’ and added that, professionally, she had ‘a worrying lack of insight’.
The panel found Dr Barton guilty of ‘serious professional misconduct’ yet, despite these major shortcomings, she wasn’t struck off.
How could that be? The job of a doctor is not defined solely by the ability to get through medical school — it is also about taking a solemn oath always to put the welfare of patients first. If a doctor is found to have deviated from this, they expect to be struck off. So why was Dr Barton spared?
I find it bewildering — but, in truth, it’s not the only GMC decision that has left me feeling that way. This year marks the 20th anniversary of the arrest of Harold Shipman — the most prolific serial killer in this country’s recorded history.
In January 2000, Shipman was found guilty of the murder of 15 of the patients under his care, though it has been established he was probably guilty of killing as many as 250.
Less well-known is that, in 1976, he had been found guilty of forging prescriptions for pethidine, a morphine-like opiate to which he was addicted (he had forged the prescriptions in the names of various patients). Despite this, after a brief period of suspension from the medical register, the GMC reinstated him and he commenced practice in 1977, working as a family doctor in Manchester.
So why did the GMC permit Shipman, a known criminal and drug addict, to enter general practice without any form of continuing supervision?
If it had done so, it is more than likely that many lives would have been spared. Yet we have heard no more about the responsibility of the GMC in this matter.
It reports directly to the Privy Council and, on occasion, this body of senior politicians does find the actions of the GMC to be flawed — it is not above some measure of scrutiny and discipline itself. I say thank goodness for that.
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