Jul 18, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Mass hysteria? Group-think? Or have the kids from Stranger Things grown up and now have early onset Alzheimer's? A couple weeks ago my friend from high school, Peter, was back in the province. Several of us from the Pinawa Secondary School Class of 1990 met in Winnipeg for food and drinks. The important part of this story isn't that Peter is now an investment banker in Hong Kong, while I haven't even moved out of the province. No, the important part is about half a dozen of us at dinner were all born in the same year. Yet, several of my classmates couldn't remember how old we were. I agree we aren't a "zero" year like 30, 40 or 50. But I had the same conversation, with at least 3 of my friends, when they guessed our age wrong. Both higher and lower! I am not confident how long any of us will stay out of the Care Home.

You don't need to be a baby or in the Care Home to get thrush. Thrush looks like little white spots in the mouth and is caused by a fungus or yeast. More technically it is an oropharyngeal candidiasis which is a superficial fungal infection of the oral mucosa caused by the Candida genus of yeast. Most often it is Candida albicans. Up to 75% of us have C. albicans living in our mouths all the time. If we are healthy, that is no problem. But if our immune system gets run down, the C. albicans can cause thrush.

Thrush is more common in babies and the elderly. Thrush is also more common if you are pregnant, if you smoke or if you have poor dental hygiene. Diet can affect how often your get thrush. If you eat a lot of carbohydrates, or too little iron, folic acid and Vitamin B12, you are more likely to get thrush. Dentures make thrush more likely. Medications like antibiotics and inhaled steroids can increase your chance of getting thrush.

Thrush lesions are most often described as pseudomembranous plaques. They are creamy white, raised mottled plaques on the tongue, the roof of the mouth and inside the cheeks. They can spread to the tonsils and down the throat. The white plaques can be easily scraped off and underneath it is very red and there might be minor bleeding. Thrush might be completely without symptoms in some people. Others might experience tingling, burning, pain, less appetite, unpleasant taste in the mouth or bad breath.

Mild thrush usually clears up in a few days without treatment. But it can reoccur or become a chronic problem. How do we treat thrush? The first line treatment for initial and mild cases of thrush is nystatin oral suspension. Children and adults get different strengths, but they both use the suspension 4 times a day for 7 to 14 days. We usually tell patients to keep using the nystatin suspension for 2 days after the symptoms have gone away.

How to use nystatin suspension varies a little from infants to adults. Young infants don't listen well when you tell them to swish something in their mouths. I usually tell parents to put a little nystatin suspension on a cotton swab and dab it on a white spots until they have covered all the white spots in the child's mouth and the parent has used up the whole dose. Parents should give young children their nystatin after a feeding, so it hangs around a while. Wash all the child's bottles, pacifiers, and toys they put in their mouth. If the infant is breast feeding, it is a good idea for the mother to be treated with an antifungal cream at the same time to stop passing the thrush back and forth to baby.

In older children and adults, we tell the patient to swish the nystatin suspension around in their mouth for at least a minute before either spitting it in the sink or swallowing it as per the doctor's direction. One minute will seem like a long time as you stand in front of the sink, but it is the contact time between the nystatin and the thrush that will actually kill the fungus. Older children and adults should also use the nystatin after they eat so the nystatin will hang around in the mouth the longest.

It was interested to learn about angular cheilitis while reading up on thrush. Angular cheilitis is red painful cracks at the corner of the mouth. Sometimes it is caused by Vitamin B12, iron or folic acid deficiency. But it can be caused by a fungus similar to the one that causes thrush. To treat these painful crack, under a doctor's direction, the patient can apply clotrimazole or miconazole creams outside and inside the corner of the mouth twice a day for a week.

The Netflix show Stranger Things follows skinny, Dungeons and Dragons playing early adolescent boys through super-natural adventures around the Hawkins Lab in the early 1980's. My friends and I were skinny, D&D playing teen boys growing up near a Nuclear Research Lab in the early 1980's. Since then, some us have gained substantial girth and lost our hair. Others of us can't seem to remember how old we really are. None of us have gained any otherworldly powers. But, I think this aging thing is the real Upside Down. Less dramatic, but equally terrifying.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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