OpenHealth Q&A

Complications of Ongoing Oral Candidiasis

A 37-year-old female patient presents with multiple chronic health issues, including gastroparesis, a mood disorder, chronic migraines, and chronic lumbar radiculopathy. She is currently taking a regimen that includes lithium, topiramate, diflucan, and a nystatin mouth rinse. Since mid-December 2024, she has been experiencing significant discomfort described as a "gross mouth." Initially attributing this to travel, changes in appetite, or potential medication side effects, she opted to wait for it to improve on its own. Unfortunately, medical consultation did not occur until February, at which point she was diagnosed with oral thrush. An initial treatment cycle involved taking diflucan for seven days alongside using the nystatin rinse. After rescheduling a necessary pain management procedure due to remaining thrush symptoms, her treatment has now been extended to a 14-day course of diflucan and nystatin. There is concern that the infection may have progressed to her esophagus, prompting her doctor to schedule an upper endoscopy in two weeks. Currently, she is grappling with dehydration, which is particularly concerning. Typically, she consumes water throughout the day, yet her intake has plummeted to below 40 ounces per day over the last three days. Since the onset of her thrush, her appetite and fluid consumption have diminished, with a noticeable decline while on diflucan. Several inquiries arise from her situation: - Having a history of kidney stones several years prior, she is worried that the combination of topiramate, suspected to have contributed to previous stones, and her current dehydration could lead to a recurrence. She contemplates the necessity of urgent care but is uncertain about when kidney stone pain necessitates an emergency room visit, considering her high pain threshold and avoidance of both prescription and over-the-counter pain relievers due to lithium interaction and elevated liver enzymes from tylenol. - Conflicting treatment plans from her primary care physician and gastroenterology provider have led to confusion. She is expected to complete her current treatment by Monday, the 24th. Given her current health status, she anticipates needing further intervention. There appears to be a lack of consensus on a standard protocol for what should be done next; one physician suggested moving to IV medications, while another recommended an additional 14-day round of diflucan. - Finally, she questions the appropriateness of seeking care from a different specialist regarding her thrush. She is uncertain if it would be prudent to consult her dentist about any potential damage to her teeth or gums stemming from the thrush, since she received a comprehensive examination in October and has a follow-up appointment scheduled for April. Any guidance or recommendations on these matters would be greatly appreciated!

Answers (1)

3/23/2025, 5:00:56 AM

OpenHealth AI

Main Points: The patient is dealing with chronic oral candidiasis and associated complications, including dehydration and concerns about kidney stones. She faces confusion regarding her treatment plan and has questions about further specialist consultations. Here’s how to navigate her situation effectively.

Explanation: Oral thrush (candidiasis) can lead to discomfort and has implications for overall health, especially when complicated by other conditions. Dehydration is concerning as it can worsen all symptoms and lead to further complications, including kidney issues. The combination of medications, previous health issues like kidney stones, and conflicting advice from healthcare providers makes managing her care challenging.

Next Steps:

1. Hydration:

   • Prioritize increasing fluid intake as the most urgent need. Aim for at least 64 ounces of water daily if possible. If plain water is too uncomfortable, try ice chips or electrolyte drinks that are easy to tolerate. Dehydration can exacerbate both oral thrush and kidney stone problems.

2. Monitor Symptoms:

   • Keep a close watch for any severe abdominal pain that feels different from normal discomfort, as this could indicate kidney stones. If pain becomes unbearable or is accompanied by nausea, vomiting, or fever, seek urgent care immediately.

3. Clarify Treatment Plans:

   • Consider contacting your healthcare team and asking for a unified treatment plan. Given the confusion, express your concerns and ask for clarity on why different specialists may propose different treatments. This could help align the recommendations, especially regarding potential IV treatments or further oral antifungal courses.

4. Specialist Consultations:

   • Given the ongoing dental complications and thrush, seeking an opinion from a dentist specializing in oral health could be beneficial. Since you have a scheduled appointment in April, it may also be worth discussing any dental concerns sooner if symptoms worsen. It’s essential to have clarity on any potential effects of thrush on dental health.

5. Kidney Stone Prevention:

   • While you’re waiting for hydration to improve, focus on avoiding substances that could contribute to stone formation (like excessive sodium and oxalate). Ensuring sufficient hydration will specifically help in preventing stones while managing your current health situation.

6. Follow-Up:

   • After completing the current antifungal treatment, ensure to follow up on the results of your endoscopy. This will guide further management and ensure other potential complications are addressed.

This is a challenging time, and addressing hydration and getting clear communication from your healthcare team are top priorities. Take care of yourself, and don't hesitate to seek help when you feel things are becoming unmanageable.