Dr. Mohammed Abdul Nasir
Pain Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 31-year-old. A few months ago, I seemed to catch a virus where I had to force myself to eat for weeks because I had no appetite. After my appetite came back, I had a patchy tongue (geographic tongue). It hurt on the right side randomly and still does to this day, unfortunately. I saw a Naturopath, and I changed my diet to no wheat, milk, or sugar, and limited some fruits as he thought that could trigger some allergic reaction. She thought it could be allergies, or I could have candida. After four months, the patchy redness went away except for the sides of my tongue. They still looked scalloped and bumpy, and the diet made me lose weight I was already thin, and I still had the pain on the right side of my tongue. I saw a dentist, and he checked everything and could not find any problems, except my teeth showed erosion. He suspected silent reflux was the cause. I always used to eat at night, but since seeing the Naturopath, I stopped. I also do not have any other symptoms related to reflux/silent reflux. I talked to an online doctor, and he prescribed me Tecta for reflux, but after reading it is only a bandaid solution. I did not take them. Also, I did not feel the silent reflux would cause only the right side of my tongue pain. I feel I still do not have an answer after months of trying so many options. It seems to come and go and sometimes affects my throat on the right side. I talked to another doctor, and he suspected burning mouth syndrome. So I have been taking B complex for almost four weeks now. I have noticed less discomfort, but the pain still comes and goes, and the bumps on the side of my tongue are still there. They do not hurt to touch, and underneath my tongue, there are three bumps, and my tongue is swollen. I do not have any other symptoms, and I am healthy. I do not trust any food now and cannot say any trigger for me. I used to smoke weed, and it was my only vice in life, but even when I smoked, it would irritate my mouth, so I had to stop that. I have yet to see an ENT. I will send you the pictures of my tongue if you need them. Please help.
Hello,
Welcome to icliniq.com.
It would be really helpful if you send the picture of your tongue along with picture of the teeth. Kindly send the picture of the tongue (few months back when it started if you have) because you said it has changed a little. I will try my best to help you out.
Patient's Query
Hi doctor,
When it started it looks as patchy red tongue.
Hello,
Welcome back to icliniq.com.
The picture that you have sent looks glossitis to me (attachment removed to protect patient identity). Basically, geographic tongue is also a kind of glossitis which is benign and migratory, meaning it ships in places/location and is a benign condition. Geographic tongue is not treated actively, but glossitis is treated. There are various causes for this glossitis. We have to find that cause and treat it. Any bacterial, viral, and fungal infection can cause glossitis. The most common being fungal infections. Some diseases such as celiac disease, pernicious anemia, and protein malabsorption or deficiency can also cause glossitis. The most common nutritional deficiency to cause glossitis is vitamin B12, which I think you are already being treated for. Do you have any other symptoms such as abdominal pain, loose stools, vomiting when you eat wheat, barley, and oats? Have you ever had episodes of abdominal pain? You will have to get tested for celiac disease. Try giving up wheat, barley, and see if it helps. For immediate relief: 1. Keep the oral cavity clean. 2. Brush twice a day with mild toothpaste. 3. Do not eat spicy food. 4. Continue vitamin B12 supplement. 5. Take multivitamins if possible. 6. Avoid wheat, barley, and oats. 7. Use Zytee gel on the sides where the lesion is for pain relief. 8. Use anesthetic gargles to relieve pain.
Patient's Query
Hi doctor,
I have given up wheat for five months. Now I do not have a lot of abdominal pains. Sometimes when I have a bowel movement, I feel mentally overwhelmed and negative, but normally they are not loose like before when I saw the Naturopath. I have no vomiting. Do you think this has nothing to do with silent reflux? What about my throat irritation? If I am avoiding wheat, why would I need to get tested for celiac disease? I do not have many of the symptoms associated with celiac disease or silent reflux. I do not understand why my tongue hurts on one side for almost the whole year. It is depressing at times. It is good to know it is nothing serious but it feels like I am not improving fast enough for something I took seriously and tried many methods. Is this something common to have marks on the tongue?
Hello,
Welcome back to icliniq.com.
Geographic tongue is very common. What you are getting are kind of ulcers on the tongue which are painful. These are mostly aphthous ulcers which are easily treatable with analgesic and nutritional supplementation. It may not be silent gastritis as if acid reflux has taken place then you will develop bad odour and bitter taste in mouth. If throat irritation is also severe, then I recommend getting a video laryngoscopy done. For now try the symptomatic medicines that I told you and improve your diet.
Patient's Query
Hi doctor,
I appreciate that you will look for any more help. So in conclusion I will keep taking the B complex and use the gel when my tongue hurts along with a multivitamin. I have also been avoiding any spicy foods for the last months and brush twice a day with natural toothpaste. I have always had a geographic tongue but when I was a kid it only hurt when I would eat pineapple. When I did eat wheat in the past I never noticed it bothered me, but when I mentioned I got sick I was eating a lot of processed foods at the time. Is this a build-up of wheat products? Even if I feel fine when can I eat them? Since I have been avoiding them for the last five months I thought it would solve the problem. I do not know if my tongue improved from the lack of wheat or because of the new intake of vitamins I took with the naturopath and continue to take. The throat issue comes and goes and is not severe when it happens it is just uncomfortable on the right side along with my tongue. I added a picture of my throat there is something on the right tonsil but I was told by another doctor that it is a normal glutosis or something similar to that.
Hello,
Welcome back to icliniq.com.
From the pictures that you have sent, (attachment removed to protect the patient's identity) I can see that the tongue issue has cleared up to some extent. As far as the stomach issue is concerned, we will have to investigate further. Since it is obviously bothering you, it can be left alone and has to be diagnosed. For diagnosing celiac, the test involves only taking your blood sample or serum sample so as to say. They will check antibodies in the serum against the antigen. If it is diagnosed properly, proper medication has to be started. I would suggest you visit a gastroenterologist for further opinion. Let me know if I can assist you in any way or if you have any queries.
Thank you.
Patient's Query
Hi doctor,
So you do not think the tongue and the stomach issues are related? Like I said there is some pain and I do not understand the root issue with the tongue. I still do not understand. The stomach issues are only present when ordering out or if I do not stick to my diet. Like I said I do not want to do a blood test because I would have to eat wheat for a while for it to show up on the test. From your experience, could you give me an idea of what you think is or was the issue with my tongue or stomach?
Hello,
Welcome back to icliniq.com.
I think that you have an autoimmune disease. To detect that disease we need to do some blood tests. Those tests will detect antibodies in your system. To diagnose celiac disease we need to do a blood test but we do not need you to eat wheat before we do the test. You can rest assured that you will not have to undergo any pain for the test to be done. Once the tests are done they will give us an idea as to what kind of disease you are suffering from, which can go a long way in treating the condition.
Thank you.
Patient's Query
Hello doctor,
I hope you have been doing well. This tongue issue seems to be a come-and-go type of issue like geographic tongue. I still get patches that come and go with a healthy no sugar, wheat, or dairy diet for over a year. I have ruled out celiac because I have avoided any type of bread or wheat for over a year. I eat a lot of sweet potatoes and meats and have eggs for breakfast very basic eating. I do smoke cannabis and it seems to make the glossitis worse, but other weeks and months I do not feel any pain or discomfort when smoking. Can a broken tooth cause pain or a mark on my tongue like what you have seen in the photos? I have provided now and before. My dentists did not see an issue with it but it is chipped. I also decided against the antacid pills my other doctor suggested. Because like you I did not believe it was silent reflux like the dentist did. My tongue only ever hurts on that right side yet both sides are always scalloped. I really appreciate your help. I simply have a fear of giving blood and because of the whole COVID situation, I also do not feel comfortable getting a blood test to be honest. Every professional like yourself I have talked to suggests to me that this is not a serious tongue issue. That helps for sure but still not knowing the cause when I have drastically changed so much is frustrating. Out of everyone I have talked to, you were the most helpful so thank you.
Hello,
Welcome back to icliniq.com.
I am glad to hear you are doing well. I do not think the broken tooth would cause such a scalloping. Though I do not think it might be anything serious, I would suggest you take multivitamins, which can relieve such symptoms. Do let me know if it helps.
Thank you.
Patient's Query
Hello doctor,
I have been taking multivitamins every day and earlier this year I took Methylated B12 and did not see any changes either. Still taking the multivitamin though. Sometimes the pain is all I can focus on and brings down my mood when it is hurting, I do not want to get into the habit of taking painkillers even though it is such a small amount so I take the pain. Do you think I should start eating whatever I want and stop this strict diet because I do not feel it is doing anything to help my tongue? I really want to find a cure and want to also know why only on that one side the pain occurs. The problem is isolating I have never heard of anyone that when they smoke cannabis their tongue hurts on one side, if they are allergic, they get hives, which I never do. The benefits outweigh the pain given my circumstances. Also, it is hard to find people to relate to just with one side of their tongue hurting that comes and goes for no reason. All I have been doing is keeping track of what I have been eating or doing before I feel the pain and there are no changes really.
Hello,
Welcome back to icliniq.com.
I understand that it must be frustrating for you to keep such a hard control on diet and still not get the desired results. But you see, the problem that you are stating is very specific and to find the exact cause of it might be a very tedious process that might still not give any results. Therefore if the problem is getting overbearing then you can use painkillers in a controlled way. Other than that multivitamins should be continued. You can eat as you desire keeping spicy food to a minimum.
Thank you.
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