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Gastroenterology (Expert Forum)
looking for verification
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
looking for verification
by thepaperqueen, Oct 01, 2005 12:00AM
Hi there,
I am a 43 yr old female with a h/o Hodgkin's Lymphoma in 1997 (mediastinal nodular sclerosing) for which I rcvd chemo (MOPP/ABVD) and radiation. Mild - moderate GERD over the past several years, taking Protonix 40mg. For 9 months I have been suffering with so many esophageal and other problems. These have included dysphagia, a tugging sensation in my throat like I want to pull my throat skin down to make more room, a stinging sensation between my breasts but mostly in the skin, not from reflux, a chronic sore throat and cough,hoarseness,pain dead center below my chin about 1 inch, shortness of breath at times, pain at my biopsy site as if my skin is stuck to my chest...I have had an endoscopy which revealed nothing except a small polyp, a CT with barium which revealed esophagitis and esophageal wall thickening. Was placed on Diflucan for 10 days (got hives)(even though no candida showed) and Nexium for 10 days. I was almost symptom free while on this regimen.3 days later all symptoms returned. The Dr is keeping me on Nexium and says it is radiation damage. I had the radiation 7 years ago! I am concerned this is being misdiagnosed and the starts of cancer. I was 2.5 years complaining of problems when I was Dx with HD.
Is it possible these symptoms can in fact be caused from radiation this late after treatment or is there something else we may be missing? I have missed a lot of work (I am a teacher and lecture 5 hrs a day)due to the pain in my throat and hoarseness.
I appreciate your response and thank you in advance.
Kathy
I am a 43 yr old female with a h/o Hodgkin's Lymphoma in 1997 (mediastinal nodular sclerosing) for which I rcvd chemo (MOPP/ABVD) and radiation. Mild - moderate GERD over the past several years, taking Protonix 40mg. For 9 months I have been suffering with so many esophageal and other problems. These have included dysphagia, a tugging sensation in my throat like I want to pull my throat skin down to make more room, a stinging sensation between my breasts but mostly in the skin, not from reflux, a chronic sore throat and cough,hoarseness,pain dead center below my chin about 1 inch, shortness of breath at times, pain at my biopsy site as if my skin is stuck to my chest...I have had an endoscopy which revealed nothing except a small polyp, a CT with barium which revealed esophagitis and esophageal wall thickening. Was placed on Diflucan for 10 days (got hives)(even though no candida showed) and Nexium for 10 days. I was almost symptom free while on this regimen.3 days later all symptoms returned. The Dr is keeping me on Nexium and says it is radiation damage. I had the radiation 7 years ago! I am concerned this is being misdiagnosed and the starts of cancer. I was 2.5 years complaining of problems when I was Dx with HD.
Is it possible these symptoms can in fact be caused from radiation this late after treatment or is there something else we may be missing? I have missed a lot of work (I am a teacher and lecture 5 hrs a day)due to the pain in my throat and hoarseness.
I appreciate your response and thank you in advance.
Kathy
Doctor's Answer
by Kevin Pho, MD, Oct 03, 2005 12:00AM
, Oct 03, 2005 12:00AM
The radiation can certainly lead to the symptoms you are describing.
The workup has been pretty comprehensive - with the endoscopy and CT scan evaluating for most of the more serious conditions. You can consider further evaluation with a 24-hr pH study with esophageal motility studies. This can evaluate for motility disorders which may lead to the symptoms you are describing.
Taking a biopsy from the wall thickening can give a more definitive diagnosis of the areas in question.
I would also test for H Pylori - if positive, it may lead to these symptoms.
Regarding the pain in the throat and hoarseness, you can consider an ENT evaluation, where a laryngoscopy can be considered to further evaluate the throat area.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
The workup has been pretty comprehensive - with the endoscopy and CT scan evaluating for most of the more serious conditions. You can consider further evaluation with a 24-hr pH study with esophageal motility studies. This can evaluate for motility disorders which may lead to the symptoms you are describing.
Taking a biopsy from the wall thickening can give a more definitive diagnosis of the areas in question.
I would also test for H Pylori - if positive, it may lead to these symptoms.
Regarding the pain in the throat and hoarseness, you can consider an ENT evaluation, where a laryngoscopy can be considered to further evaluate the throat area.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
• In my opinion, try ruling out the possibility of involvement of Recurrent Laryngeal Nerve by the enlarged mediastinal lymph nodes.