Thrush is the most common cause of white spots in the mouth, but other conditions should also be considered.
Known as an opportunistic infection, candidiasis usually affects people with weakened immune systems, such as the elderly, those taking immunosuppressive medications, and pregnant women.
Fungal infection is also frequently seen in infants.
It usually affects the mouth or genitals, and causes a white coating or patches that can be very painful.
Antifungal treatment is often prescribed, usually nystatin drops or fluconazole tablets.
Thrush is the most common cause of white spots in the mouth and usually affects people with a weakened immune system.
If a patient does not respond to treatment or tests for candidiasis are negative, it is essential for doctors to explore other causes. One of these is leukoplakia, white patches that often appear in the mouth of heavy smokers or drinkers.
Leukoplakia can, in some cases, lead to oral cancer, so it is essential to make an appointment with a specialist in hospital.
Another trigger could be oral lichen planus, painful white patches on the gums, tongue and inside of the cheeks.
The exact cause is unknown, but it can occur after an injury to the mouth, allergies, or taking certain medications.
It can take up to a year or more to go away and there is no treatment. However, a GP can prescribe mouthwashes and sprays to combat the pain.
Patients with oral lichen planus are advised to avoid salt, spicy and acidic foods, and alcohol.
I am 85 years old and have terrible pain in my right shoulder that keeps me from sleeping. I have been told it is due to arthritis in my rotator cuff.
Do you have any advice?
Shoulder pain is terrible, but there are several ways to manage the problem.
In older people, the rotator cuff may be the cause. This is a group of muscles that surround the shoulder joint and provide flexibility and stability.
Over time, the rotator cuff can wear down or develop osteoarthritis. Either of these conditions can cause pain and stiffness in the joint that doesn’t go away.
Pain is known to keep patients awake at night, which can lead to fatigue and increase the risk of dangerous falls.
The first step in managing rotator cuff pain is physical therapy: exercises and stretches that can improve mobility and reduce pain in the joint.
A GP can refer patients with pain to a physiotherapist or, in some parts of the country, people can contact an NHS physiotherapy unit to make an appointment without needing a referral.
There are also a number of prescription medications you can get from a GP or pharmacist to help manage the pain.
Amitriptyline tablets, taken at night, may help people with chronic pain get to sleep. Another option is a low dose of the opioid codeine.
However, codeine can cause side effects such as confusion, dizziness and drowsiness, so it is important for patients to discuss its use with a GP.
My ulcerative colitis was under control for 12 years, until I started taking antibiotics for a bladder infection this year.
I had a terrible flare-up, which doctors say is a common side effect of the pills.
Why did they give them to me then?
It is known that prolonged treatment with antibiotics can lead to flare-ups of intestinal diseases. Unfortunately, sometimes there is no other option.
Antibiotics kill the bacteria that cause infections. However, the pills can also harm the “good” bacteria in your gut, which keep your gut healthy.
As a result, underlying inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease may worsen. Those affected may experience stomach pain, bloody diarrhea, and fatigue.
Ulcerative colitis affects the colon and rectum. Crohn’s disease can appear anywhere along the digestive tract, including the mouth and anus.
Their cause is not clear, but they are considered autoimmune diseases, where the immune system attacks healthy tissue.
None of these diseases can be cured, but certain medications and surgical procedures can reduce outbreaks.
When someone takes a six-month course of antibiotics to treat a recurrent UTI, the dose is usually low enough to limit the risk of flare-ups.
Other treatments include probiotics (tablets containing good bacteria) which can reduce the recurrence of UTIs. The antiseptic treatment Hiprex sterilises bacteria in urine. However, antibiotics are the most effective treatment for bacterial infections, so patients with bowel problems will continue to be prescribed them.
To reduce your risk of further UTIs, it may be worth considering whether infections are triggered by other factors.
The inability to empty the bladder completely or an overactive bladder can increase the risk. Both problems can be controlled with medications (not antibiotics) that your GP can prescribe.
Vile cancer loan premiums
I was concerned to hear last week that half a million Britons are being penalised when buying insurance, mortgages and other financial services because they have survived cancer.
In many cases, former patients have been forced to pay higher premiums or even denied loans or insurance outright, even though they are now healthy, a study by Queen’s University Belfast has found.
I find the behavior of these financial companies shocking.
In several European countries, such as France, for example, there are laws prohibiting this type of discrimination, but not in the UK. Perhaps it is time for the Government to change this situation.
Has this ever happened to you? Write me at the email address on the right and tell me what you think.
Graham shows that mental problems can affect any man
I was deeply saddened to hear of the suicide of English cricket legend Graham Thorpe.
Following the news, I took part in a BBC radio phone-in about men’s mental health. We know that men are less likely than women to seek help for mental illness and that they also have a higher suicide rate.
English cricket legend Graham Thorpe has taken his own life
However, during the programme I was struck by the number of successful men with good jobs and happy families who called to talk about their depression. Many said they had felt too ashamed to seek help.
There has been a concerted effort in recent years to improve discussions around men’s mental health, but I fear we still have a long way to go.
Why do you think so many men resist getting help for their mental health? Write to me at the email below and tell me about it.
