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534785 tn?1329595808

Enlarged cervical and submandibular lymph nodes on neck MRI--worrisome?

I've had a swollen lymph node under my left jaw for nearly two years, as originally pointed out to me by my dentist, then confirmed by another dentist, a speech therapist, and a GP. This lymph node doesn't hurt, but I finally mentioned it to my ENT, whom I'm seeing for trouble swallowing for the past two years. He determined that my difficulty with swallowing was due to nerve damage on the right side of my throat, but a neck CT scan a year ago turned up no tumor or suspicious lesion in my neck (and no lymphadenopathy, I believe). I asked him about the swelling under my left jaw that was noticed by different healthcare professionals, and he begrudgingly ordered a neck MRI with contrast (gadolinium).

The results came back stating, "There is evidence for reactive adenopathy but no submandibular mass identified." [My ENT thought the swelling under my left jaw might've been a mass so he ordered the MRI for the reason "left submandibular mass?"]. The results continued, "Bilateral level 2 and left level 1B nodes are identified. Discrete mass is not identified within the submandibular glands. Floor of mouth is normal. Parotid glands are symmetric."

Should I be at all concerned? I've been sick for awhile (2yrs) with extreme fatigue, swollen joints, essential tremor favoring my left arm, occasional night sweats, general feeling of malaise, bad headaches, inability to concentrate, brain fog, muscle weakness, dizziness, and ventricular tachycardia, mostly attributed to subclinical hypothyroidism, yet my symptoms haven't gone away despite thyroid hormone treatment and normal TSH levels, so I think something else is going on...I'm just not sure what. My neck doesn't hurt and I have no pain under my jaw, either.

Any thoughts would be greatly appreciated!
20 Responses
1081992 tn?1389907237
hi, Jules. Stop me if you're heard these :)

test bands: what about the one microbe that's most often associated with Lyme? babesiosis... but then, what can you do about it?

sometimes migraines get cured by Mg

Mg as per muscles + nerves: Ca rushes in to a nerve or muscle cell and Mg rushes out, creating pulse conduction.  Similarly Na and K are sort of like opposites. How does that relate? I don't know. But do you have any unusual dietary habits, like vegetarian? High  sugar diet (which causes mineral excretion)?

pineal cyst: I think often times a person can somehow just "know" what's wrong with them. That's why I asked about your intuitive perception. Otherwise I know very little about it. What is the width x length of yours?

How about milk or legume allergy? If you have gut permeability because of that, then lots of other molecules can cross the barrier and then create problems.

lecithin granules might have some minor benefit. Sort of nourishment for the nerve coverings.

Aquatic ape theory would infer that ancient humans absorbed Mg through the skin from sea water. IOW, Mg is a big requirement which most people are truly short of in modern days.

stroke: well, what could dispose someone of your age to a lacunar infarction? Could you have a Patent Foramen Ovale? That's all I can think of. Ir do you have varicose veins, indicating hypercoagulability?

Also re stroke: damage would get better or stay the same. Does yours get worse? That could argue against *a* stroke, or in favor of repeat events. Do you ever feel TIAs?

"although I can't figure out how that would cause damage to my left face and the rest of my left side...while the nerve damage is on the right?" I'd guess in your complex mystery case, we can abandon Lloyd Morgan's Canon - and say they do not have the same cause. Maybe.

"If a simple chest x-ray can generally rule out sarcoidosis (90% of people with the disease have abnormal chest x-rays), I'd be happy to have it done." You might be in the other 10%. but yes sarcoidosis is seeming unlikely.

Me? I'm on this group because my father had lymphoma some years ago. An aggressive type. So one day I dropped in to try and help for a short while. That was last autumn :)

Well, you're very brave to keep persevering.  What about exercise? What if you forced yourself to exercise, then pay the price afterwards in being wiped out, then recover after days and repeat -- but over time this punishing work leads to improvement? That's one therapy you can control, anyway.

My total guess at this moment would be autoimmunity or virus. Or a spirochete because they have that hiding ability, too. Your Fx goes toward autoimmunity. I'd keep in mind maybe trying to eat strict Paleo, and taking lots of arginine as an anti-inflammatory, plus turmeric, ginger etc. That's going to the far side, but you have tried allopathic approaches.

Oh, or you might try porcine Armour (actually it's replacements, since Armour seems gone these days) for the hypoT. Or cytomel (T3).

Did you travel anyplace exotic before things went bad?
1081992 tn?1389907237
Nothing seems to be pointing to lymphoma. E.g. they are "reactive"

Since your docs haven't diagnosed the mystery problem, I'd look at possible food or other allergies. Or maybe Lyme. Or autoimmunity.

If you have willpower, you can drop the foods that are known to most commonly give sensitivity problems: gluten containing wheat, rye, etc, and dairy.

I also suppose you're been to hypothyroid groups and heard many who say that treatment should be guided by symptoms, not blood tests.

have you tried magnesium? that relates to hypoT and to cardiac conductivity, and also some of the general symptoms you have

Are you making sure to keep well watered? (IOW, that your tachycardia is not due to dehydration.)
534785 tn?1329595808
Thanks for your response. I've actually tried magnesium and I've been drinking more water as of late given my ENT's advice that I need to keep my vocal cords well-hydrated. I've been tested for quite a few autoimmune diseases during the past two years, all negative (RA, Celiac's, lupus, etc.). I have allergies but I've been managing those for the past few years with Clarinex and a nasal spray, and several Lyme tests have indicated I have spirochete antibodies (41 kD band) but no other active bands--so no Lyme disease. Perhaps I'll lessen my intake of processed flour, wheat, and dairy products to see if this helps.

I'm not really worried about the MRI results, but I just assumed that reactive meant "enlarged", and I'm still not sure why at least one of those nodes has been enlarged for such a long time. I guess this is just another annoying symptom to add to the mystery mix!
1081992 tn?1389907237
hi, are you aware of the giant controversy surrounding Lyme diagnosis?

Also, IMO "processed" is an overused word these days. In your case, the lectins that are found in whole grain might be a problem, and so white flour can be better on that score. I'm just pointing out the utter complexity of things healthwise :)

Trial and error has some chance of revealing clues.

Think of 'reactive' insofar as the node is doing its job - whether there is a real invader to fight (bacteria, virus, fungus, parasite), or whether it's a false alarm (as in allergy or autoimmunity). So cancer would not be included in that - and the node would look differently, whether through a microscope or even usually on an MRI.

In the spirit of knowing there are mysteries, here's one suggestion: try eliminating all the supposedly 'good' grain oils like canola. At the same time,. take lots of fish oil. See if your knees improve as a first sign. Why? The O3s are anti-inflammatory, the O6s in grain are pro-inflammatory.

Speaking of inflammation, have you had ESD or hsCRP tests?
534785 tn?1329595808
Yes, I've heard a lot of different opinions on Lyme disease from various doctors, but I figure if I all of these issues were caused by Lyme, I would probably have fairly severe neurological deficits after 2.5 years. I have been bitten by ticks in the past, though none of them deer ticks. Both my mother and brother have had Lyme, but I went to college in upstate NY (and subsequently became sick toward the end of college) and I wasn't outside in tall grass or under trees all that much--plus, it's like winter up there most of the time. I'm not sure if there's anything else I can do with regards to Lyme except see a Lyme specialist, perhaps?

In my reading, I've learned that while reactive nodes are much more likely to crop up as a result of infection, the possibility that there is a malignancy cannot definitively be ruled out without a biopsy. The only reason I was considering them as a potential concern was due to the fact that one of them has been enlarged for nearly two years now, and I have trouble swallowing and nerve damage in my throat (that cannot be attributed to a brain lesion). I'm seeing my ENT this Tuesday, so I'm just going to wait and see if he feels something should be done; otherwise, I'm not going to worry about them.

I'll consider your ideas and try to work some of them into my diet. I do take cod liver oil tablets sometimes, and I'm trying to keep up on the magnesium regime. My parents want me to have my magnesium levels checked, regardless, so I may ask one of my doctors to order this test.

I've never had ESD measured (what is this, exactly?), but I have had CRP done...not hsCRP, though. Is there any reason I should request hsCRP if my CRP was perfectly normal despite having RVOT VT?

Thanks for your continued help!
1081992 tn?1389907237
I knew somebody who went to a Lyme center in Manhattan. It was disappointing. AFAIK the only way to know for sure if active Lyme is present is to have the multiweek IV antibiotics and see if you get better. Plus, there could be a lymphocytic condition where the Lyme is gone but the immune system continues to wreak damage.

But your point about lack of general neural effects seems to be a good one.

And btw, also AFAIK the deer tick is the one found on the deer mouse, which can be indoors and that is the primary vector for Lyme, especially in winter - not actual deer in the woods :)  From deer->mouse->human

Some nodes just don't go down, possibly being fibrotic.

Magnesium is mostly intracellular so AFAIK a simple serum test is fairly useless. You'd need the one that tests the Mg in RBCs.

"Erythrocyte Sedimentation Rate" is an earlier, cheaper way to measure inflammation. A normal CRP measures only in higher ranges - say 5 and up as a guess. But the high-sensitivity version of the test can detect lower levels.

But you just said something that stands out. Having the VT seemed out of place anyway. But RVOT VT? Did you know that sarcoidosis mimics RVOT VT? And look at all the other symptoms that sarcoidosis can explain, including the nodes. But OTOH you haven't mentioned shortness of breath. Even so, how's your calcium level?
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