Filling in time between doctors appointments with questions...

[canada74]

For 2.5 months now I have been having issues with my throat.  I'm a 37 year old male, otherwise healthy, I am a drinker and a smoker.  

- 2.5 months ago I had a sore throat for about a week which turned into a dull pain when swallowing on the right side only.
- After 2 weeks I went to a GP who didn't see anything obviously wrong.  Blood tests were normal.
- I saw a different doctor who also found nothing.  We tried antihistamins, Tylenol, Nazonex, standard allergy medication and a 5 day course of Zithromax.
- After a month I noticed that it got worse after drinking alcohol so I avoided alcohol and it got much better.  Still the odd dull pain but only a few times a day instead of constant.  I did this twice - no alcohol for a week followed by a couple beers.  It always got much better (again never perfect) without and returned after a couple beers.
- I've decided to stay away from alcohol for a lengthy period and I just stopped smoking hoping maybe this will be the solution.
- The only other symptoms include a slight tightness in my throat, urges to swallow and a "phlemy" throat but these only occur when the dull pain is always there as opposed to those weeks when it's almost better.  I also seem to have a slightly enlarged lymph node also on the right side but it isn't tender and I'm not sure if it's really enlarger or just normally that way.  I can feel it just protruding from the skin (peanut-sized).

My ENT appointment is in 4 weeks.

1.  Thoughts on what this could be?  How posssible is it that my throat was irritated by something and is just taking a long time to heal because of alcohol intake and/or smoking?  Maybe allergies?
2.  What about throat cancer or lymphoma or does the fact that it has got better for a couple one-week blocks suggest that it isn't one of these more serious scenerios?  Would cancer tend to get progressivly worse or at least stay the same?
3.  If it was cancer is it likely that it would produce other symptoms?  

[Sumit Bhatti, MD]

Dear canada74,

Thank you for writing back.

Glad to know that you are better now. Also great to hear that you are quitting smoking. Occasional alcohol intake is not a problem. Control your acid reflux (GERD / LPR) to sustain the improvement.

Hope that this information helps and hope that you will get better soon.

Best Regards
Dr. Sumit Bhatti.

[canada74]

Good Afternoon Dr. Bhatti.

Just a quick note to inform you of my results...as insane luck would have it...I ended up at the right place at the right time speaking to the right person and got slotted in for an ENT appointment yesterday.  Lucky I know...my wait went from 4 weeks to 1 day in an instant.

Anyway...they did a scope and they of course found the first thing that you suspected...no tumor...no cancer...(whew)...just some very irritated vocal cords and lots of secretions.

He took one look at it and said that sometimes you can never really be sure...but it apparently screamed Acid Reflux/GERD.  So we had a good discussion about natural ways to reduce it via diet, sleeping habits and the like.  He also perscribed some medication (forget the name).

Anyway I can already feel a massive improvement...but that may not be because of the medication just yet...I took it upon myself to do something productive during what was to be a four week wait so I'm in the middle of a four week holiday from alcohol and I quit smoking about one week ago today.  That and ya...the stress just lifted immediatly when I got the all clear on the nasty possibilities :).

I'll admit...there's no way I'm giving up my casual beer now and then...but if the worry only results in me quitting smoking then that is certainly a great thing :).

Anyway...thank you very much for your response!  Turns out your initial thoughts were spot on.

Just wanted to let others know three things in this forum...

First...obviously the advice you get here is spot on.

Second...months of any symptom is distressing and it's hard not to get a little nervous...but it is true...most symptoms could be numerous things and on average it's not going to wind up being the worst case scenerio.  Easier said than done I admit.

Third...those damn cigarettes do amazingly bad things all around...if you have problems...and you smoke...take the plunge and quit because odds are that it may or may not be directly responsible...but it sure as hell ain't helping :).  I have a long road ahead of me but I'm commited to sticking with it.

Have a good one doc!

Slept like a baby last night by the way :).

[hava]

While waiting you can do this Ujjayi pranayam to help the throat recover.It will also help if you have a thyroid problem.
Thyroid point – press the fleshy bit on palm between  the base of thumb and wrist on both hands. If you feel sharp pain when you press, then you have thyroid problem.

Ujjayi pranayam
Procedure: While breathing in, tighten throat(contract glotis) and there will be sound from back of throat, then drop chin(rest chin on chest), hold breath as long as possible.Then  chin up, close right nostril and slowly breath out through left nostril.
Duration: 5 – 21 times

How to do Ujjayi
When you clear your throat, you tighten your throat and breath out, twice, with a pause in between. . Now if you reverse this, that is, tighten the throat and breath in continuously for abour 8 to 12 seconds, then hold your breath for 4 seconds with the chin down, then  chin up, close right nostril and slowly breath out through left nostril, you have just done Ujjayi pranayam.You will feel like coughing initially.
November 22, 2011

[Sumit Bhatti, MD]

Dear canada74,

Thank you for your query.

Based on the symptoms that you describe you also need to rule out acid reflux which includes GERD (Gastro Esophageal Reflux Disease) and LPR (Laryngo Pahryngeal Reflux). It worsens with alcohol and smoking. A post nasal drip may be associated. Lymphoid hypertrophy may be seen in the throat. Throat cancer or lymphoma are rare at your age and cancer will get progressively worse.  I would also like to rule out stress induced tightness in throat, especially since you are worried about cancer as a cause of your symptoms. Some other possible causes for your symptoms could be:
1.      Allergy or Intolerance to beer / food and their ingredients
2.      Occupational exposure to wood dust, moulds, fungi and chemicals.
3.      Very rare causes include neuralgias, hyoid bursitis, and styloid enlargement

I would also suggest to rule out a thyroid swelling by getting a USG Neck done. Sub centimeter lymph nodes are usually reactive and not considered problematic, even if multiple.

A direct video laryngoscopy will help settle the diagnosis and easily rule out cancer. You should get your ENT consultation sooner if possible. Quitting alcohol and smoking is always recommended.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Sumit Bhatti.