Question: Good Morning Dr klerida : For some reason I was not able to continue the conversation that I began with you earlier this month . I am XXXX and you suggested that my hot / burning feelings in my throat and esophagus and my constant white tongue may be due to Candida. Yesterday we received the result for the tongue biopsy : negative for Candida ..." chronic irritation " is the main conclusion. In any case, I did begin today a 3 days course of fluconazole / Diflucan 150mg ( 1 per day ) just in case. Monday I will be sending back to UK the saliva samples for Pepsin testing. It is very frustrating not knowing anything after almost 3 months and multiples testings and procedures and over 11 different doctors opinion ......

HELLO : YES I WILL FORWARD YOU A COPY OF THE BIOPSY . NEED TO GET A COPY FROM THE PHYSICIAN. TOMORROW MONDAY I WILL RETURN THE SALIVA SAMPLES TO LONDON FOR PEPCIN TESTING. TODAY I DID 3 REPEATED TEST FOR SALIVA PH AND THE THREE TIMES THEY CAME BACK WITH PH BETWEEN 6.25 AND 6.50 .I AM WONDERING IF I WOULD HAVE SOME TYPE OF " SILENT REFLUX " CALLED " LPR ". MOST OF MY SYMPTOMS ARE A MATCH FOR LPR. HOWEVER COULD " LPR " REVEALS ITSELF SUDDENLY FROM ONE DAY TO THE NEXT ? MY CONDITION BEGAN ON DECEMBER 6 WITH A MILD BURN ON THE BACK OF MY TONGUE AND THEN SLOWLY WENT DOWN TO MY THROAT WITHIN FEW DAYS. I WAS BLOWING "HOT AIR " LIKE IF I HAD EATEN PEPPER . THAT DAY I HAPPENED TO HAVE DRANK ABOUT 1.1/2 LITER OF CRANBERRIES JUICE ( MAYBE A TRIGGER ? ). FOR NOW I AM TRYING TO INCREASE MY FOOD INTAKE IN HIGH ALKALINE AND OF COURSE REDUCE AS MUCH AS POSSIBLE ALL ACIDIC FOODS....BUT I DO NOT WANT TO STARVE TO DEATH EITHER ! THAT IS WHERE I AM TODAY .... BEST REGARDS

Good Evening Doctor : Attached you will find the results from the tongue biop. Maybe you can read something that the us doc. did not see or thought about. Just check for the samples sent to uk and today they were out for customs clearance. By the way I am almost not experiencing post nasal drip any more and I am noticing that less is my saliva PH and more chalk white colored is my tongue. During these moments ( very white tongue ) I happen to be very thirsty and those moments also seem to make me more tired. Good morning Dr : For your information tomorrow morning I will go for blood testing again. My ENT doctor is asking for : ANA test ( anti nuclear antibodies ) XXXXXXX test ( anti-neutrophil Cytoplasmic antibody ) SSA and SSB test Double stranded DNA test He also requested a CAT SCAN of the sinuses. I am still waiting for the results from the UK lab concerning the pepsin saliva test. As an example most of the afternoon I have feel feeling like a lump down my with a hot sensation and a very irritated tongue surface. I took some TUMS candies and they seem to burn even more . I cannot pinpoint what triggers this condition, it happens sometimes without having eaten , sometimes after ingesting some food or water, the type or kind of food seems not to change the symptoms. I may have the same exact food one night and feel almost ok and the following day with the same food I have burning feeling in my throat and on my tongue !!!! I hope you were able to look at the results from the tongue biopsy. The ENT doctor seems to be insisting in looking into more blood tests for some type of virus ... Don't you think if there was any type of bacteria or virus it would have been detected in the biopsy of the tongue ? Regards, XXXX

Thanks Doctor...They took blood this morning. should have tests results within next 72 hours I hope. I willkeep you informed. was reading about Lichen Planus , just want to comment that my only my tongue is white and irritated. No other internal parts of my mouth or lips are affected. I addition the burning feeling and color are never constant , it changes during the day for reasons i believe unrelated to food or drink intake.... Dr Klerida : Can you think of a very specific test or tests that we could request in order to confirm or discard that possible illness ? I have a doctor's appointment monday ( Gastro specialist ) and I could suggest for those specific tests. Here in USA doctors are " complicated " to interact with and they would experiment a lot before getting to the problem..... Hello Doctor : I have uploaded the Pepsin test report that came back negative. However the lab will test me again ( free of charge ) because they say that the samples stayed longer than normal at the UK customs. Also I have detected that many times right after swallowing I feel like small bubbles coming up through my throat ( when I swallow saliva , water or food ) I also can feel a small lump like ball in my throat. XXXX

Hello doctor : I realize it is not an easy thing to diagnose " by internet ". However i am a firm believer that every professional opinion is important and particularly when it originate from European culture.Also being able to explain to someone who is willing to listen and help is a good feeling. Today I did have an appointment with an ENT doctor who graduated in madrid spain in 1962 !! very patient man and he did listen to all my story. He spread my throat to insensibilize it and look in the back of the tongue : found that my adenoids are red ( irritated ) . So far his first conclusion is for reflux and he did prescribe me nexium 40mg morning and evening for 7 days to see if my symptoms improve. Doctor could you tell me if reflux ALWAYS include pepsin ? because If I tested negative or will test negative again in the next test that would prove that i am not experiencing any GERD or LPR ? Thanks for your continuous help, XXXXXXX S

Hi Dr Klerida : Today I had an doctor's appointment with a very well " ranked " gastroenterologist is Miami. He did consider all my symptoms but could not come up with anything decisive. I asked him time he had seen someone with a " white tongue " due to refluxes and he told me never ..... However he asked me to do a Barium swallow ( this coming Monday ). Eventually then he might ask for a Ph probe of the esophagus : endoscopy to implant a small capsule and monitoring for 48 hours ..... I hope it will not be necessary since I do not like anesthesia . I have also received the results from the additional blood test for antibodies.... as you can see on the copies attached all came back negative. Today I also finished a 3 day course of 200 mg fluconazole pills. Sunday I will take for the second time the UK Peptest ( they send me a new one at no cost ). Can you think of any other specific test as far as trying to find out why my tongue is always white/ pale color , why I do feel like hot sensation in my throat , tongue and sometimes the esophagus. I read about a specific test for " immunoglobulin G " , or do you believe that I had enough blood and urine testing by now ? Looking forward to hear from you, Dr Klerida ...one more thing I have been noticing that the heat feeling and the tongue burning is stronger in the afternoon after 3.30/ 4.00 pm . Today I had lunch at 11 am and since then no more food. It is now 4.30 pm and I feel my tongue to be hot and I exhale hot air . XXXXXXX

Monday morning is a barium swallow

Thanks Doctor , have a great week end. XXXXXXX

Hello doctor : This morning I did the Barium swallow test. My next appointment with the doctor to have a conclusion on the test is in 3 weeks !. According to the radiologist not much could be seen that could cause my tongue to be whitish. I have a copy of the files & pictures on a CD I wonder if there is a way I could have this downloaded in order to upload it for you to have a look at it ? XXXXXXX S

Good Afternoon Doctor : I have uploaded the results from the barium swallow . Hope you can give me your interpretation , recommendations and if this can explain why my tongue is white. I have also uploaded the results back for pepsin testing . This time there is sign of it . May I have your opinion now considering the last two report Regards, XXXXXXX

Good Evening Doctor : Thank you for your answer and conclusions as well as advices. However if the determination is gastro-esophageal reflux , what is your opinion concerning the cause ? The hiatal hernia is minimum and may have been existent way before december 07. Also can we confirm that the white coating of my tongue is also caused by the reflux ? most doctors I talked with said that most refluxes do not cause the tongue to be permanently white . Please bare with me a little longer , I know my body and I feel that these sudden refluxes are being triggered by a condition that no one has been able to figure out so far. Thank you Doctor, XXXXXXX

Hello Doctor : Just want to report to you that since last Sunday I am not experiencing any symptoms of reflux : no more bubbling in the throat after swallowing saliva or food , no more sensation of having a knot in the throat and no more burning sensation in the esophagus . As a test I have also reverted to foods that should trigger reflux : I drank alcohol , eat a lot of chocolate , heavy meal at night ..... all that is not affecting me with reflux or sleeping at night. I wake up with a clear throat , no postnasal drip. However the white and sore tongue is persisting . Would you agree with me that all my symptoms since the beginning Dec 07 and including the reflux are only consequences of some type of mucosa infection ? tongue + esophagus + stomach To me it seems more logical since it all happened so suddenly , and also considering that for 51 years I never had any health issue , never drink , smoke...I am not overweight and do 1.5 hours of sports every day. At home the food diet is 100 % natural and we do not eat red meat. I am only wondering what other type of testing would be available to detect any anomaly with the mucosa ....we already did the tongue biopsy but it seems not conclusive .... What would you do ? Regards, XXXXXXX