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Ask A. Schuyler, NP Your Own Question
A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 16205
Experience:  Board Certified NP, MS, RN. 25 years private practice & hospitalist
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I had a PET scan that showed high activity in throat area.

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I had a PET scan that showed high activity in throat area. Went to ENT surgeon who scoped my throat and said I had a chronic inflammation in the tonsil area (I think under the tonsils in the vallecula area.) I had my tonsils removed in 1988 and apparently the roots were not taken out because they are deep. I had throat surgery last Monday to take out the rest of the tonsil tissue because it is inflamed and to take out this pocket area of inflammation. The surgeon could not take out the tonsils nor the inflamed area because he said it was too deep and it would be too dangerous. He did take a biopsy and culture sample from each tonsil. The biopsy is negative for cancer and the culture is positive for strep.
Prior to the surgery I did not have a sore throat, but over the years have had a multitude of inflammation problems for which no one could ever find a source. The surgeon said sometimes you can be fighting a chronic inflammation like the one in my throat and that can lead to a host of other problems. Because he could reach and take out the inflamed area, he has put me on Augmentin 875 MG and said that will probably take care of the problem. This does not make sense to me. I am 65 years old, have had breast cancer and various inflammation problems for the past 20 years or so. What do you think?
Hello,

Answers provided are for informational use only and don't confer patient-provider relationship. My name isXXXXX and I will do whatever I can to answer your question.

Chronic infection from any source can result in all the problems you are having. Augmentin is a drug of choice for treatment of strep. Odds are that the strep, along with the inflammation, will be gone after you have finished the Augmentin prescription, although sometimes a stubborn case can require an additional prescription after the Augmentin is finished. The fact that the biopsy was negative for cancer cells is truly excellent news. Of course, breast cancer doesn't commonly metastasize to the throat, but it is still comforting to know for a fact it isn't cancer.

Inflammation problems over 20 years can all have resulted from a deep tissue strep infection that was never discovered until now. Inflammation is a result of an infection or other tissue damage in the body.

Please let me know if you have questions.

All the best,

Schuyler
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Customer: replied 3 years ago.

Does it make sense that we are leaving most of the inflamed area. He said he clipped out some of it but could not get it all. He said possibly with robotic instruments he might have been able to get it all. Plus the tonsils are still inflamed and (I think) he said he cleaned that up as best he could, but again he could not get it all because of the deep roots. Should I pursue this further with someone else. Prior to the surgery, he said I should been complaining of a very severe sore throat and since I was not, that told him it was a longstanding chronic problem and it had to come out. I'm not sure I am comfortable leaving this still in there-should an infectious disease expert get involved. I really don't know what to think but certainly don't want to live any longer with all this inflammation if we can resolve the problem by getting rid of this in my throat.

It sounds like there was no choice but to leave the inflamed area there since it would be too dangerous to remove it with the tools he was using. The best plan at this point is to take the Augmentin 875 which has probably been prescribed for 10-14 days and see how that works. A follow-up visit may require another 10-14 days of antibiotic to make certain that all the infection has been cleared. Once the infection is going, the body will not be fighting anything and the inflammation will clear on its own.

A month of antibiotics versus 20 years of inflammation seems a fair trade-off. Certainly there is no advantage to consulting with another provider of any ilk (infectious disease, ENT, general surgery) until the current treatment has been completed. No provider would contemplate another operation until you are completely healed from the current one which should take a good 6 weeks.

Inflammation is only cured by curing whatever is causing it - in this case a chronic strep infection. Just the surgery itself would also cause some inflammation as your body heals from the tissue damage. Just as a cut on your arm will get red and inflamed as it heals, even if it doesn't get infected.

I think a wait and see approach is better in the short term. If you aren't a lot better in 2 months, that would be the time to obtain a second opinion. By the way, an Infectious Disease specialist would simply identify the infection, which has already been done by the culture.

I'm always available to answer additional questions.

Best regards,

Schuyler
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Customer: replied 3 years ago.

Thank you. I'm assuming you think one or possibly two rounds of the antibiotic will clear this up and that could be the end of the problem. I hope you are right.

Hi,

You are so very welcome.

I hope the antibiotic will do the job as well. It is one of the drugs of choice for a strep infection. Certainly there is no harm done by giving the medication a chance to do its work since you aren't eligible for any further treatment at this time, to give your current surgery time to heal. I hope you will have a quick recovery so you can enjoy the upcoming holiday season without the annoyance of chronic inflammation.

Best regards,

Schuyler
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