ASK THE GP: Help, I've got a white furry tongue! Dr ツバメ Scurr answers your health questions

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My daughter has had a white, furry, ulcerated tongue for almost a year. Swabs have been taken and 捨てるs carried out, but these 設立する nothing.

Her tongue is 極端に uncomfortable and 原因（となる）s her 苦しめる. She is a restaurant 経営者／支配人 and the 現在進行中の problem is very 乱すing. What do you 示唆する?

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 （疑いを）晴らす 指導／手引 利用できる from dentists or oral 外科医s as to what it is or how to 扱う／治療する it once 感染 has been 支配するd out (経由で swabs, as your daughter has had).

Did you know? A white, furry tongue could be?予定 to a change in the natural 植民地 of microbes on the tongue and the gut

Typically, by the time I see a 患者 with a white, furred tongue, they’ve self-診断するd a yeast 感染 (usually thrush) and are self-medicating with over-the-反対する anti-fungal tablets or gels ― to no avail.

Thrush has a characteristic 外見 ― like a white curd, which, when dislodged, leaves a bleeding base. その上に, oral yeast 感染s tend to be 分配するd throughout the mouth and throat and not just 限定するd to the tongue.

患者s also often try to self-扱う／治療する with mouthwashes, as, no 疑問, has your daughter, again without 改良.

So, what might be the diagnosis? The description you give doesn’t match ありふれた tongue disorders, such as geographic tongue (also known as benign 移住する glossitis), which is characterised by red, ulcer-like areas with white 国境s.

This 外見 絶えず changes and moves as the days pass and some 患者s can, at times, experience a painful 燃やすing sensation.

While it is never wise to 推測する on the basis of a description ― just as with dermatology, it’s 決定的な to see the 肌 ーするために make a sensible 試みる／企てる at diagnosis ― I have my own theory.

I believe your daughter’s problem may 反映する an 不均衡 in the bacteria in the digestive tract.

Since time immemorial, 内科医s have 検査／視察するd the tongue when 行為／行うing a physical examination, with an unhealthy-looking tongue seen to 示す some sort of disorder of the gastrointestinal tract.

Today, いっそう少なく 依存 is placed on this for making a diagnosis, but I think this is a loss. The tongue is the 前線 door of the gastrointestinal tract and 株 its unique 植民地 of bacteria.

It is possible that the disorder you 述べる is 予定 to a change in the natural 植民地 of microbes on the tongue and the gut.

To 回復する the 訂正する balance 伴う／関わるs taking a prebiotic ― e ssentially food for ‘good’ gut bacteria ― 同様に as a probiotic, a 補足（する） of ‘good’ bacteria to 上げる the 植民地 of those in the gut.

Tell your daughter to 捜し出す advice from a pharmacist, but be 患者 as, if this is to help, it may take some weeks and is based on theory, not on any 客観的な, 設立するd 証拠. But it is 安全な and cannot 原因（となる） 害（を与える）.

For years, I’ve 苦しむd with flashings in my 注目する，もくろむs, followed by a dull 頭痛. 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 悪意のある? The 頭痛s are very 穏やかな and the flashings last about 20 minutes.

I’m 75 and on tablets for high 血 圧力, which keep it under the 的 始める，決める by my doctor ― さもなければ, I’m in good health.

Roslyn Marlow, Glenfield, Leics.

While I 高く評価する／（相場などが）上がる how alarming this symptom must be, I can indeed 安心させる you, given your history of 頭痛s, that it is not 悪意のある.

Seeing visual 誘発するs or flashes may, on some occasions, be part of a transient ischaemic attack (a ‘小型の 一打／打撃’), though this is not what you 述べる ― which are classic symptoms of aura, the neurological 騒動 that can occur with a migraine.

Lights: About 25 per cent of people who have migraines experience aura, with the 頭痛 either 同時に起こる／一致するing with it or に引き続いて?

About 25 per cent of people who have migraines experience aura, with the 頭痛 either 同時に起こる／一致するing with it or, as in your 事例／患者, に引き続いて on.

Typically, the symptoms of aura are visual and start with seeing a 有望な light or having an area of visual loss. Over minutes, this may 拡大する into geometric 形態／調整s or ジグザグの lines.

Because the 外見 of these 形態／調整s can 似ている the 塀で囲むs of a 中世 要塞, this particular group of symptoms is known as 要塞 spectrum.

Other symptoms of aura 含む 審理，公聴会 or smelling things that aren’t there, pins and needles and dizziness.

Curiously, not all those who experience an aura have a 頭痛, which can make the diagnosis more difficult.

The 広大な 大多数 of the six million people in the UK who have migraines don’t experience aura ― although some may have other, different 肉親，親類d of symptoms that に先行する the 頭痛.

These are known as the prodrome ― examples 含む 増加するd yawning, 不景気 or irritability or food cravings.

The frequency of migraine can 変化させる throughout life.

The 最近の 増加する in your attacks isn’t 悪意のある and I don’t think it’s 関係のある to your 井戸／弁護士席-controlled hypertension.

The escalation in frequency may continue or it may abate ― the pattern cannot be 予報するd. However, in an 成果／努力 to minimise attacks, I would advise that you keep 井戸／弁護士席-hydrated and try to eat 定期的に, as dehydration and 行方不明の meals may be a 誘発する／引き起こす.

So, too, is a change in bedtime, 同様に as too little or even too much sleep.

患者s with migraine are also 勧めるd to take some form of daily 演習, as 研究 has 設立する that this can help 削減（する） the frequency and severity of attacks ― 目的（とする） for at least 30 minutes of 穏健な 演習 three times a week (even きびきびした walking may help).

If, にもかかわらず this advice, the episodes continue to 疫病／悩ます you once-週刊誌 or more, I would 示唆する talking to your GP about prophylaxis ― taking a daily 医薬 to 妨げる attacks.

Possible 選択s 含む the beta-blocker propranolol, the tricyclic antidepressant amitriptyline and the anticonvulsant topiramate, which may help by 鈍らせるing 負かす／撃墜する the brain’s 電気の activity.

These all have the 可能性のある to 原因（となる） 味方する-影響s, but these may be より望ましい to the 干渉，妨害 that 正規の／正選手 migraine 原因（となる）s to your life.

?IN MY VIEW....DOCTORS' WATCHDOG IS TOO SOFT

‘BRUSQUE, unfriendly and indifferent’ are not what you would call ideal 質s for someone working in 薬／医学.

Yet this is how the General 医療の Coun cil (GMC) 述べるd the manner of Dr Jane Barton, the retired GP （刑事）被告 of 急いでing the deaths of 非常に／多数の 患者s at Gosport War 記念の Hospital.

The 調査 went on to call her use of painkillers on the 区 ‘過度の, 不適切な and 潜在的に 危険な’ and 追加するd that, professionally, she had ‘a worrying 欠如（する） of insight’.

The パネル盤 設立する Dr Barton 有罪の of ‘serious professional 不品行／姦通’ yet, にもかかわらず these major shortcomings, she wasn’t struck off.

How could that be? The 職業 of a doctor is not defined 単独で by the ability to get through 医療の school ― it is also about taking a solemn 誓い always to put the 福利事業 of 患者s first. If a doctor is 設立する to have deviated from this, they 推定する／予想する to be struck off. So why was Dr Barton spared?

I find it bewildering ― but, in truth, it’s not the only GMC 決定／判定勝ち（する） that has left me feeling that way. This year 示すs the 20th 周年記念日 of the 逮捕（する） of Harold Shipman ― the most prolific serial 殺し屋 in this country’s 記録，記録的な／記録するd history.

In January 2000, Shipman was 設立する 有罪の of the 殺人 of 15 of the 患者s under his care, though it has been 設立するd he was probably 有罪の of 殺人，大当り as many as 250.

いっそう少なく 井戸／弁護士席-known is that, in 1976, he had been 設立する 有罪の of (1)偽造する／(2)徐々に進むing prescriptions for pethidine, a morphine-like opiate to which he was （麻薬）常用者d (he had (1)偽造する／(2)徐々に進むd the prescriptions in the 指名するs of さまざまな 患者s). にもかかわらず this, after a 簡潔な／要約する period of 中断 from the 医療の 登録（する）, the GMC 復帰させるd him and he 開始するd practice in 1977, working as a family doctor in Manchester.

So why did the GMC 許す Shipman, a known 犯罪の and 麻薬 （麻薬）常用者, to enter general practice without any form of continuing 監督?

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 責任／義務 of the GMC in this 事柄.

It 報告（する）／憶測s 直接／まっすぐに to the Privy 会議 and, on occasion, this 団体／死体 of 上級の 政治家，政治屋s does find the 活動／戦闘s of the GMC to be 欠陥d ― it is not above some 手段 of scrutiny and discipline itself. I say thank goodness for that.

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