Hello Can you please diagnose from the images provided what

Patient

Q: Hello. Can you please diagnose from the images provided what is wrong with my throat, and what I can do to treat/heal it and to help with the pain. Also, is the health of my tongue normal - colouring and thickness of coating concerns me.

Symptoms:  Sore throat, hard to swallow, painful sores in the mouth (both on the side and at the back of the throat), redness at the back of throat. I also get reoccurring small blood blisters within the mouth - lower gums, sides of mouth etc. - although small, these are painful. The back of my throat is particularly uncomfortable and painful due to sores and redness.
Images: 
Hello Can you please diagno...-1 Hello Can you please diagno...-2
Doctor

A:   Hi.
Thanks for your query and clear pictures and detailed history.
Please give additional information for me to assist you better:
- Since when have you got this problem?
- Any blood reports, throat swab culture or any other investigations? If yes, please post reports.
- You history says you are allergic to Penicillin, EES, Augmentin Forte, Keflex - please give the list of medication you have taken till now and whether any medicines enhanced your problem recently?
- Have you noted any factors that increase your problems?

My thoughts after reading your history and on-the-spot diagnosis provided by the two pictures are:
- Aphthous ulcers on soft palate
- Glossitis with coating
- Inflamed soft palate with hypervascularity
- Buccal lesions.

I would advise you the following:
General Treatment:
Multivitamins with added Folic acid, Vitamins A and D in therapeutic dosages to increase the strength of the mucosa in view.
A short course of an antibiotic (whichever suits you) and Metronidazole say of 5 days helps a lot in recovery as it controls the infection, secondary effects of the original disease procedure as the oral cavity is exposed to all sort of environmental factors
Water in small but frequent dosages helps self cleaning.
Oral application of anti-thrush preparations.

I hope this answer helps you with proper diagnosis and management to get a cure.
Awaiting for your feedback on the answers.
Regards,

Comments / Follow Ups

Patient: Thank you kindly for your prompt response to my problem. I appreciate your professional assistance. In answer to your questions:
- Since when have you got this problem?
I have had this problem for many months - possibly as long as 6 months. Constant blood blisters, sore throat, sores etc.
- Any blood reports, throat swab culture or any other investigations?
Yes, please refer to the attached reports. Although I was treated for Candida of the throat for a number of treatments (both over the counter treatment and prescription treatment), it did not help. The swab taken showed heavy growth of oral flora, but the doctor said it was a normal result and I didn't have thrush?
- Your history says you are allergic to Penicillin, EES, Augmentin Forte, Keflex - please give the list of medication you have taken till now and whether any medicines enhanced your problem recently?
Please see images of the vitamins and medication I have been taking; although due to the soreness and discomfort of my throat, I have stopped taking some of these. I have also been taking a probiotic. I haven't found any of these have exacerbated the problem.
- Have you noted any factors that increase your problems?
I have questioned food intolerances? Just this week I attended a hydrogen breath test (compulsory lactulose control) to test for IBS (which the doctor thinks I have, but I do not). I recorded 7 pre the testing, then went up to 25 after 3 hours following the medicine. I was advised I was hydrogen positive. I am due for a Lactose intolerance test next week, followed by a Fructose Malabsorption test the week after. I will however need to reschedule these if I have a treatment of antibiotics. I haven't had any antibiotics since January of this year. The last antibiotic I had was Klacid.
I really appreciate your thoughts, - Aphthous ulcers on soft palate, - Glossitis with coating, - Inflamed soft palate with hypervascularity, - Buccal lesions.
Do you know what would be causing these problems?

Happy to follow your treatment plan. Do I go to the local doctor and show them what you say? Multivitamins with added Folic acid, Vitamins A and D in therapeutic dosages to increase the strength of the mucosa in view.
What do you recommend - any particular brand?
A short course of an antibiotic (whichever suits you) and Metronidazole say of 5 days helps a lot in recovery as it controls the infection, secondary effects of the original disease procedure as the oral cavity is exposed to all sort of environmental factors.
So, confirming I should get a script from my local GP for Klacid and Metronidazole.
Oral application of anti-thrush preparations.
These haven't helped. Any other ideas?

Really looking forward to your feedback following review of the above and my reports.
Thank you so much!
Patient: Here are all my reports. Thank you!
Doctor: Thanks for your detailed feedback and the reports.
Since you are due for due for a Lactose intolerance test next week, followed by a Fructose Malabsorption test the week after, please get these done so that the antibiotics can be started after these tests.
Taking all the medications with prescription of your Doctor is a better idea as He/She knows the best available in the Pharmacy nearby.
You may also get Vitamin D and A (if available and done) estimates to help the exact dose schedule.
Additionally:
Avoid too hot and too cold foods and beverages.
Make a list of the foods and beverages that cause any sort of instigating or enhancing problems and stop them altogether.
As might have said earlier, take sips of plain water frequently, has a great self cleaning action keeping the mouth wet enough.
Avoid spices of any nature.
Avoid all the so-called chemical gargling agent, use none.

I hope this answer further helps you.
Patient: Thank you so much for all your assistance! It is truly appreciated. I have been to the local GP and now have the Klacid and Flagyl medication. I also have the vitamins that you recommend and will start taking these too. Due to the discomfort in my throat, I will be rescheduling the other medical appointments that I had. I really need to get relief from this, and once I have done so, a few weeks later, I will book in again for the other tests. Thanks again for all your help. I feel much more positive now and relieved to get some professional assistance. Thank you!
Doctor: Thanks for your appreciation.
I hope to see your problems solved.
Please also follow the small but important things as I have mentioned above.
Wishing you all the best.
....
Please give me followup after a week of the proper management.
Please post a new query and give reference ID 541038.
Only two follow ups are allowed per query.
Patient: Hello. I am not sure if I am doing this right? I am not sure where to add the Reference ID 541038. Do I need to select Ask a Doctor? again? I will provide you with the information here, but if I need to do it another way, please let me know. I wanted to write to advise how I am going. I have been on the multi vitamin and other vitamins you recommended, and have just finished the course of Flagyl and Klacid antibiotics. I am presently taking the oral thrush treatment, which I started on Wednesday. I have also be aware of the small things you advised above. Although the redness in my throat has settled, I am still sore in the throat and I have started to feel new sores develop at the back of my throat. On Wednesday, I had a feeling of scabs located deep in the back of my throat. In addition, the inside of my cheeks/tongue felt very swollen? I feel this often, and not sure why. I have to be very careful that my teeth don't bite along the inside cheek/tongue. Please find attached images taken just now for you to review. I hope you can help me again. What are your thoughts? Is the sore (highlighted in the photo) at the back the same type of sore as before (lesions or ulcers?) and what is causing them? It is very painful, and makes eating difficult. From the second photo, I can also see a black blood blister - this is what I am getting all the time, but around the mouth at randam locations. Why is my mouth so unhealthy? What do you think I should do now? I look forward to your help again. Thank you very much. Simone
Doctor: You have to ask a fresh question and put reference ID 541038 in the beginning.
Please select Ask The Doctor again, put the full information and add all the photos as you have done now.
Awaiting your fresh query.
Patient: Hello. I tried to do this, but the systems want me to pay again. Not sure how to get the follow-up to work?? Sorry.
Doctor: Oh,
The fresh question is a new one hence will be charged separately.
Well, read your follow up, seen the new photographs.
Great improvements.
Continue the multivitamins and take other precautions, you will get a good result once the integrity of your mucus membrane is restored to normal.
..
I have answered your follow up.
If you still want further communication please ask a fresh question.

Patient: Thank you so much!!!!!!
Doctor: You are most welcome.

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