Managing Oral Thrush and Potential Kidney Stones
Complications from Chronic Oral Candidiasis A 37-year-old female with an array of ongoing health issues is navigating through a troubling episode of oral thrush, following a long history of related diagnoses including gastroparesis, mood disorders, chronic migraines, and chronic lumbar radiculopathy. To manage these conditions, she is currently prescribed lithium, topiramate, diflucan, and utilizes a Nystatin rinse. Her ordeal with persistent oral candidiasis began in mid-December 2024. Initially attributing her symptoms—described as a 'gross mouth'—to travel and side effects from her medications, she postponed seeking medical attention until February. Upon diagnosis, she completed a seven-day treatment with diflucan and Nystatin. However, due to the ongoing nature of the thrush, further medical interventions were necessary, leading to a rescheduled pain management appointment and a subsequent 14-day treatment. Medical professionals now suspect the infection has spread to her esophagus, prompting plans for an upper endoscopy in a week. The primary concern for her currently is dehydration. Typically accustomed to consuming plain water throughout the day, her fluid intake has plummeted to approximately 32 ounces daily over the past three days. Both her food and fluid consumption have been negatively impacted since the thrush developed, with a notable decline while on diflucan. She poses several questions regarding her health: - Having experienced kidney stones several years prior—potentially linked to the topiramate—she is apprehensive about the recurrence due to her current dehydration. Unsure if urgent care would provide the necessary support, she wonders what level of kidney stone pain necessitates a visit to the emergency room. Her high pain tolerance complicates matters, as she does not utilize prescription or over-the-counter pain relief due to her current medications affecting both her tolerance and liver function. - Following her treatment scheduled to conclude on the 24th, she is uncertain about the next steps, especially considering her primary care physician and gastroenterologist provided divergent plans regarding future treatments. One suggested moving to intravenous medications if her condition does not improve, while the other recommended an additional 14-day course of diflucan, which he believes is highly effective. - Lastly, she seeks advice on whether she should consult a specialist about the thrush, particularly concerning potential damage to her teeth or gums resulting from the infection. Having recently been cleared by her dentist in October, her next appointment is set for April. Grateful for any advice or insights, she hopes to navigate this complex situation better.
Answers (1)
3/28/2025, 4:50:45 AM
OpenHealth AI
Main Points: Managing Oral Thrush and Concerns about Kidney Stones
You are dealing with a complex situation involving chronic oral thrush, dehydration, and the potential risk of kidney stones. It's important to prioritize hydration and address the thrush effectively while monitoring any kidney stone symptoms carefully.
Explanation
Chronic oral candidiasis can significantly affect your quality of life, including causing discomfort and impacting your ability to eat and drink. You mentioned experiencing dehydration, which can exacerbate various health issues and may increase the likelihood of kidney stones, particularly if you have a history of them related to topiramate. Since your fluid intake is considerably low, this is a central concern that needs immediate attention.
Regarding your treatment plan post-diflucan, having differing opinions from your healthcare providers can be frustrating. It’s crucial to consolidate your next steps based on your symptoms and how well you respond to treatment.
Next Steps
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Hydration First:
- Aim to increase your fluid intake to at least 64 ounces (about 2 liters) daily if possible. Consider electrolyte-containing fluids (like sports drinks or oral rehydration solutions) to help with hydration without overwhelming your stomach.
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Monitor Symptoms for Kidney Stones:
- If you experience severe abdominal pain, nausea, vomiting, or blood in your urine, these are signs to seek emergency medical care. Without those severe symptoms but if you are experiencing significant discomfort, a visit to urgent care could be warranted for further evaluation (especially considering your high pain tolerance).
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Consult for Oral Thrush:
- Post-treatment, if symptoms persist significantly after your last dose of medication, consider contacting an infectious disease specialist or an oral medicine specialist to evaluate the ongoing thrush and any potential effects on your dental health as you approach your next dental visit.
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Follow Up on Treatment Plans:
- After your upcoming endoscopy and once you have more information about your esophageal health, you can better determine whether to follow the gastroenterologist's or the other physician's recommendations. Keep careful track of how you feel and any side effects from your medications to discuss them during follow-ups.
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Keep a Health Journal:
- Documenting your fluid intake, symptoms, and any changes can help provide your doctors with clearer insights into your health and assist in aligning on a treatment plan.
Your health journey is challenging, and it’s important to take it step by step, prioritizing hydration and monitoring your symptoms closely. If you need further guidance or reassurance, please reach out.
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