A needle biopsy? I don't know if they'd do it, but if they thereby verify granulomas, that might be very helpful to you in deciding how to help her in all the coming years.
Like so: her system detects the bacteria, but can't kill it. So are her neutrophils low in *activity*? (I presume there aren't any low *numbers* on CBCs.) Meanwhile, her monocytes and descendants seem to be operating okay in forming granulomas to wall off the bacteria.
Analogy: there can be a whole lot of troops (bacteria destroying neutrophils), but they mostly just lay around. So the reserves (monocytes) come in.
Thus we can move beyond merely saying "weak immunity" and concentrate on identifying which part is the weak link. Then you might discover a way to boost that weak link. It's maybe possible.
Sorry the chart I had uploaded got removed somehow by the system. The results are as follows-
The sonography report was as follows-
Date 10 September 2016
Lymph node level Right Lobe Left Lobe
Submental --- 0.8 x 0.7 cms
0.8 x 0.7 cms
1.1 x 0.6 cms
Submandibular 1.2 x 0.6 cms 1.8 x 0.6 cms
Upper Jugular 1.7 x 0.7 cms 2.6 x 0.7 cms
Post cervical 1.9 x 0.3 cms 2.2 x 0.4 cms
1.5 x 0.4 cms 2.1 x 0.4 cms
1.9 x 0.4 cms
1.5 x 0.5 cms
1.9 x 0.6 cms
On 27th September after an antibiotic course of 10 days with Augmentin , we got a new sonography done and the lymph nodes had shrunk a little. Results as follows-
Date 27 September 2016
Lymph node level Right Lobe Left Lobe
Submental --- 0.8 x 0.5 cms
0.8 x 0.5 cms
Submandibular 0.9x 0.3 cms -
Upper Jugular 0.9 x 05 cms 2.6 x 0.6 cms
Post cervical 1.5 x 0.4 cms 1.6 x 0.3 cms
0.9 x 0.3 cms 1.9 x 0.4 cms
2.0 x 0.5 cms 1.6 x 0.4 cms
I'd start slowly, with some fat for better absorption, with a bit of sugar if necessary to handle the bad taste... and keep your fingers crossed that she gets some benefit :)
(btw if you post with any updates, let me know with a PM because I don't check here all the time)
Great! That's very reliving. I'll immediately start her on neem and redo the test after 1-2 months. Thanks for all the help bro!
Hi Ken
The doc has asked us to wait and watch and doesn't suggest biopsy as of now. he has ruled out malignancy/lymphoma. Do you concur?
I personally suspect it has something to do with dental procedure given the timing. If it is granulomatous disease of some sort, what could be the prognosis and corrective action?
The reason for Doppler sono suggestion by the doc was to check for vascularity of the nodes. Hope the results don't show anything alarming.
Thanks for all the help.:)
So now there are various approaches:
- merely watch and wait some more, which is probably what was recommended
- investigate further with resectional biopsy to stain slices and see what microbes might be inside a node. You'd expect that to be whatever was let loose from the dental surgery. Whatever immune cells have accumulated might also possibly be a clue, such as eosinophils versus neutrophils.
- find out what diseases fit the profile: granulomatous disease that sometimes but not always causes destruction of hilum and possible necrosis. If a microbe, it originates in mouth but apparently doesn't affect lungs or esophagus.
I don't know the answer to that last one, but would start there.
This says that many are unexplained:
http://www.nature.com/modpathol/journal/v25/n1s/full/modpathol2011155a.html
...which leads back to watch and wait, as long as any very dangerous possibilities are ruled out.
Wegener's is necrotizing but doesn't seem to fit here as it usually doesn't affect nodes. Why were the arteries Doppler sono'ed? Was that to check for vasculitis? Or merely to check for atherosclerosis as long as a sono in the neck area was being done (two birds with one stone, if you know the phrase)?
Anyway, you should be relived because her sono results are not bad.
Hi , Got the color doppler test done. The nodes are still the same. I want to upload test findings. Any idea how can I upload 3 pictures?
Saw the doc today. Suggested doppler ultrasound after a month. Asked to wait and watch.
Thanks so much. We will take it up with the doc on Monday. Great help much appreciated.
Thanks so much. As a non-medical person, it is certainly a lot to absorb. :) Anyway I will bounce the idea of g'ranuloma possibility' with the local doc and see if they want to go fro biopsy.
The Bone Marrow transplant was in 1994 and post that she's had no major infection except cold/cough/fever form time to time.
Sorry for the delay in reply but we are in different time zones. .
I am sorry but here they don't give test range for most counts . All blood counts are normal they say. The whole report was as follows-
Hemoglobin: 11.1 g/dl
Hematrocit 34.6%
RBC count: 3.87
WBC 7.9 (normal range in India as I know 4 -10)
platelet 256
MCv 89 (range 75-95)
MCH 29 (range 27-32 pg)
mCHC 32 (range 30-25 g/dl)
ESR 26 (range 0 2-10) but they say even 26 is OK
Differential count of WBC
Polymorphs: 44%
Eosinophils 10%
Basophils 1%
Lymphocytes 42%
monocytes 3%
Do you suggest any specific blood test/any other test?
Hi , We got her blood works done today and the results are-
WBC count: 7.3
Platelet 225.0 x 10'/l
ESR 26 mm/hr
Differential count of WBC
Polymorphs: 44%
Eosinophils 10%
Basophils 1%
Lymphocytes 42%
monocytes 3%
The docs has suggested we wait and watch and get another sonography done after 2-3 weeks/
Hi , I would be very interested in knowing 'neem' study. Please post when you get time.
Do you suggest biopsy as of now or wait till we find the bug torturing her? Yeah it's a shame she has to pass through so much in life. Karma - as we Hindus would call it.
Btw, I've seen a study on using neem against oral enterococcus bacteria. I'll find it if you're interested. The bacteria involved are probably just the ordinary suspects, and no need to culture. But with her transplant, the ordinary becomes extra dangerous. It's a shame that she has to face these problems after having gone through so much already.
There's something about this immune-wise that I can't quite place. If the thought crystallizes tomorrow, I'll post it.
Thanks again for your elaborate reply. She underwent dental implant procedure 8-10 days before occurrence of swollen Lymph nodes.
She has a history of CML (Chronic Myleloid Leukemia) which was cured 22 years back with allogenic bone marrow transplant and has been BCR-ABL negative ever since. However she is a little immuno-compromised and has always been more susceptible to infections than others.
What is the way to find out what pathogens/bacteria could be causing this? Do we still go for further sonography to check how the nodes look from inside? What exactly is this called in medial terms.
Truly appreciate all your help and thank you for your time and assistance.
Thanks a lot indeed! She underwent a sonography of abdomen/pelvis and a chest X-ray today to find out if there are other swollen Lymph nodes. Both turned out to be normal.
She had a slight tingling sensation in the jaw today. Could that be due to infection? Appreciate all your help.
Hi, I don't see anything attached.