How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask IMDR06 Your Own Question

IMDR06
IMDR06, Board Certified Physician
Category: Medical
Satisfied Customers: 2053
Experience:  Internal Medicine Physician and HIV Physician
Type Your Medical Question Here...
IMDR06 is online now
A new question is answered every 9 seconds

My blood tests clean, but my lymphatic system has been inflamed

Customer Question

My blood tests clean, but my lymphatic system has been inflamed from neck to elbows to wrists. Diagnosed with latent TB, started INH, but the question is this: if this doesn't fix the problem, what else could be causing it and still not show up in a blood test?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Natasha replied 3 years ago.
Chat Conversation Started
Doctor Cameron :

hi

Doctor Cameron :

are you there?

Doctor Cameron :

have you had a lymph node biopsy?

Expert:  Dr. Natasha replied 3 years ago.
What Happens Now?

Your chat has ended, but you can still work with your Expert to get an answer to your question if you have not yet received one.

Come back to this page at any time to see additional information from your Expert.  You will also receive an email when your question is updated.  If you want to send a message to your Expert, use the box below.

If you have already received a satisfactory answer to your question, click the Accept button above.  Experts are credited for each accepted answer they provide.
Customer: replied 3 years ago.
And, no, no biopsy.
Expert:  Dr. Natasha replied 3 years ago.
So how do you know that your lymphatics are inflammed?
Customer: replied 3 years ago.
I just saw an MD who agrees. I looked like a Cardassian from Star Trek for awhile: cervicals so swollen that the tendons on either side of the neck became taut and there was no room to fit a finger between the node and jaw. Now, the nodes in the elbows are in enough pain to keep me from putting my hand in my pocket. It's pretty obvious.
Expert:  Dr. Natasha replied 3 years ago.
are you seeing a hematologist?
Customer: replied 3 years ago.
no
Expert:  Dr. Natasha replied 3 years ago.

Well, it sounds like your work up, with all due respect, is very incomplete. You MUST have one of these nodes biopsied to see what is going on. This could be infectious or this could be another type of infiltrative type of disease, such as myelodysplasia or even a slow growing lymphoma. The best person to do this work up would be a hematologist/oncologist.

 

warm regards

 

Customer: replied 3 years ago.
More interesting circumstances: this started with a broken, infected molar which. After extraction, a blood vessel outside the jaw remained pronounced and then the closest node became inflamed and this thing started spreading. My thought was that the latent TB saw its chance while the immune system was down and it lodged in the blood vessel, but after the immune system was back up, the TB had to move or die an the lymphs are something it likes --- it would rather have the lungs, etc., but due to it's roost outside the body (for the most part, between jaw and skin) it was unable to get at any organs.

I get the feeling that the respected and experienced doctors at the Order of Malta Clinic would have recommended a biopsy as well, if they thought it necessary, but perhaps bnecause this thing started externally (kind of) they don't think its a lymphoma.

PS: Your answer was informative and worthwhile and I'll go ahead and accept, but I'd like to see if this additional info changes or adds anything.
Expert:  Dr. Natasha replied 3 years ago.
Well, it would be really unusual that this would be TB. I think that you need to get a lymph node biopsy, full stop. It is possibel that this is a chronic infection from your tooth, which is NOT TB, but mouth flora. In this case, the antibiotics would be very different. To be honest, in the USA, at the very least, we would do a biopsy and possibly a CT scan of the neck and chest to see the extent of the lesions.
Customer: replied 3 years ago.
They tell me that if it were leftover bacteria from the tooth (my original thought, too) I probably would have gone septic by now. Also, no unusual bacteria in the blood test. Also, the clinic here in Oakland, CA. is brand new, highly visible and state-of-the-art. They tell me I seem very healthy.

My bad, I forgot: I did try two weeks of penecillin about a year-and-a-half ago, which did nothing.
Expert:  Dr. Natasha replied 3 years ago.

You are in Oakland, CA- which clinic? I am in Alameda, CA

 

Also would you mind accepting one of my answers before we proceed?

Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11693
Experience: American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
Dr. Natasha and 4 other Medical Specialists are ready to help you
Expert:  Dr. Natasha replied 3 years ago.

Well, I would go to Highland Hospital and make an appointment to be seen in one of their clinics. They have an ENT clinic. You may need to go through minor injury clinic (or urgent care first). If you have a lot of pain or swelling you can go to the ER... they will hook you up and figure this out.

 

warm regards

 

Customer: replied 3 years ago.
Order of Malta clinic on Harrison St. in Oakland.

My question is basically answered as far as justanswer.com is concerned. If you want to talk more about the clinic out of concern --- and it's not in poor form, you can email me.
Expert:  Dr. Natasha replied 3 years ago.
= I can't email you- against policy. But I trained at Highland and they are great. I'd go there myself. If you have insurance, you can go to Sutter or Alta Bates
Customer: replied 3 years ago.
Got the penicillin from Highland. They apparently didn't think I needed a biopsy, either.

No insurance.
Expert:  Dr. Natasha replied 3 years ago.
Then you need to return back to Highland. Because the PCN should have fixed this issue if this was bacterial flora from yoru mouth. And if this was latent TB, then you need to get this treated because it is obviously not gone.
Customer: replied 3 years ago.
Correct. I went back to Highland dental for another extraction a few months later and pointed out that the infection outside the jaw hadn't gone away and had, in fact, spread to the lymph node. They said that it didn't seem like a bacterial infection leftover from the tooth because it would be worse --- I'd be septic, yellow-eyed and sick. They said that it was probably something else that crept in while the body was busy with the tooth.

Fortunately, I got busted and went to jail for 4 days (I was raised with nunchakus and have carried a small set in my back pocket for years until a cop noticed) Thats when I came back with a very hot TB skin test --- 3 big, red concentric circles right next to the elbow node that bothers me so much. Thats when I started researching the effects of TB on the nodes and came up with my theory about the latent TB rising up to the jaw where it could lodge and then becoming trapped there and then moving into the node. Far-fetched? Sure, but the circumstances are far-fetched. Our very existence is far-fetched.

So, now I'm currently taking INH for the latent TB that needs to be treated anyway. This is day 3, so I'm not expecting a big change immediately. It took months to get an appointment at Primary Care and then convince them that I wasn't psycho-sematic, attention seeking or crazy. I need to heal more than I need to be right, but it often feels like an argument.

BTW, when the first node went, the hair on the neck and chin turned white, fell out and left a "wintergreen" sensation of something pushig it's way out of my skin, all the way up to the left eyelid. The hair's grown back but now it's white. The calendula flushes the nodes and the sensation leaves.
Expert:  Dr. Natasha replied 3 years ago.
I am going to opt out so that someone else can help you.
Customer: replied 3 years ago.
Circular, isn't it? The conversation often gets to this point --- where the original information gets lost because of the details. I'm pretty calm about the situation, considering so many doctors say I'm healthy and I think I have a lead on this thing, but that's whay I'm here --- in case 9 months of INH kills the TB, but something worse was killing me the whole time. Thanks for your time. I hope I didn't exhaust you.
Expert:  IMDR06 replied 3 years ago.
Do you have any further questions?
Customer: replied 3 years ago.
I guess not. Maybe I will in another couple of months if there's no improvement. Thanks.
Expert:  IMDR06 replied 3 years ago.


I agree with Dr. Cameron's comments. You do definitely need a lymph node biopsy and CT scan. In addition, I suggest getting an HIV test.

 

Dr. Sciberras

Customer: replied 3 years ago.
I emailed this conversation to my doctor and am waiting for a reply. Any clue as to why this never came up?

Wouldn't HIV show up in my blood test? Either way, I've had no risky behavior at all.

Any idea what would cause the "wintergreen" sensation in my chin?
Expert:  IMDR06 replied 3 years ago.

You would need an HIV test, it doesnt show up on regular blood work unless an HIV test was ordered. HIV can cause enlarged lymph nodes.

 

The wintergreen sensation may be due to some nerve irritation I would believe, perhaps caused by the previous lymph node that was there.

 

best of luck,

dr. sciberras

Customer: replied 3 years ago.
Brace yourself for more circular questioning. I do this to hash this thing out, not to simply be difficult.

The wintergreen sensation leaves when I take calendula and the cervical nodes discharge. It seems like they're storing something as opposed to being attacked by something. It comes and goes and they haven't really hardedned up permenently.

I've had negative HIV swabs at Highland and no risky behavior since. Also, would the nodes go in a distinct, linear pattern due to HIV, or would they more likely become swollen simulteneously? Injury infection as opposed to internal spread?
Expert:  IMDR06 replied 3 years ago.

well when the nodes are full and inflamed they may be pressing on the nerves and hence causing the "wintergreen" sensation.

 

hiv infection can cause node enlargement in a variety of ways - all at once, not all at once, whenever it wants, etc. however, since you have been tested for hiv, that is not a concern.

 

best of luck,

dr. sciberras

Customer: replied 3 years ago.
Sounds like you're about done. That's fine, but one more thing --- before I discovered calendula, that wintergreen feeling led to the hair around the left cervical node falling out and, as my body seemed to get a grip on things, it grew back white --- nowhere else, just that patch. Since then it's moved across and tried to do the same on the other side, but with less success, perhaps because I discovered calendula.

BTW, the wintergreen feeling spread all the way up to my left eyelid at one point. Nerves?

Thanks for your time. I'm not a total cheapskate, I'm using the company credit card and I need to be extremely prudent about leaving a big trail, but I plan to accept at least once more.
Expert:  IMDR06 replied 3 years ago.

yes, your nerves could still be affected all the way up to your eyelid. if there was no paralysis or weakness, then it is not too concerning. probably whatever was going on with the lymph nodes also damaged your hair follicles and pigmentation, leading to the white hair. i still really emphasize you get a lymph node biopsy as well as CT scan of chest-abdomen-pelvis.

 

Dr. Sciberras

IMDR06, Board Certified Physician
Category: Medical
Satisfied Customers: 2053
Experience: Internal Medicine Physician and HIV Physician
IMDR06 and 4 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Good answer! I agree and I'm going to ask for a CT and biopsy. We've narrowed this thing down a little more and I feel that all my ridiculous symptoms are on the table in front of one MD at one time and we're really covering this thing.

My list of potential suspects are latent TB, myelodysplasia (or some such), or even a slow growing lymphoma. Anything else you can think of that wouldn't have shown up in my blood test? For that matter, wouldn't a lymphoma have shown some abnormality in the blood?
Expert:  IMDR06 replied 3 years ago.

myelodysplasia and lymphoma both would have resulted in an abnormal CBC, you are correct. I will keep thinking on this one and see if i can come up with any more differentials. By the way, TB of the neck is called scrofula...just in case you are ever on Jeopardy!

 

Dr. Sciberras

Customer: replied 3 years ago.
This is turning out better than I anticipated. This means the only evidence of what's causing my problem is a TB skin test right next to my elbow node (!) that was so hot it looked like a map of Atlantis --- 3 big, red cocentric circles. I'm back to thinking that's going to be it. I'm still waiting for an email from my doctor, but I get the feeling he will say that a CT or biopsy isn't going to find anything that the blood test didn't. What should I tell him?

Scrofula. I know, I read about it. Question is, can latent TB move around the body and still be latent? Things that sleep still need to feed, right?
Expert:  IMDR06 replied 3 years ago.

Tell him you have spoken to several specialists who are in agreement that a biopsy is warranted. Sometimes things don't always show up on bloodwork.

 

Latent TB should not move around the body, you may actually have active TB is the lymph node is biopsied and found to be full of mycobacterium. You don't need to have TB in your lungs in order to have TB. That would require a change in regimen.

 

Keep me posted,

Dr. Sciberras

Customer: replied 3 years ago.
Active TB with no symptoms?

I just got off the phone with my clinic and they said that having been in front of several different MDs and none of them recommending a biopsy means I probobly don't need one. I have an appointment for Nov. 3 and then I can decide whether to push for biopsy/CT or not.
Expert:  IMDR06 replied 3 years ago.

You do have symptoms - the lymph nodes popping up everywhere.

 

Dr. Sciberras

Customer: replied 3 years ago.
Not exactly. They started near the molar that was infected and spread in a linear fashion. Maybe my theory is correct -- the TB rose up while the body was busy with the tooth, but it became active in the process.

But wouldn't that have shown in the blood test? Also, none of my freinds aren't coming down with TB, and I would have been spreading it for 2 years. And, frankly, I feel fine, other than the discomfort of the nodes. For that matter, wouldn't 2 years be long enough for active TB to really blow up and take over?

Thanks for hanging in there with me. I know it seems like I have an answer for everything sometimes.
Expert:  IMDR06 replied 3 years ago.

I think the best way to answer your questions is by biopsying a lymph node. Sorry I don't have any other answers for you.

 

Dr. Sciberras

Customer: replied 3 years ago.
You've been great. This has helped me rule out alot of mystery stuff that this could have been and I'm convinced the TB is affecting me, active or not. If active, I'll change my regimen and figure a way to limit spreading it.

Unfortunately, I think the boss would be upset if I used the company credit card a 3rd time, but next time I should be able to break off a little more.
Expert:  IMDR06 replied 3 years ago.

Keep me posted on the outcome.

 

Dr. Sciberras

Customer: replied 3 years ago.
I discussed all this with my doctor, told him I think I have active scrofula and am being scheduled for biopsy as well as another CBC and complete metabolic panel. We didn't discuss a CT scan, but it seems to me I know the extent of this thing by feel.
Expert:  IMDR06 replied 3 years ago.

Excellent news! Keep me posted on the biopsy results!

 

Dr. Sciberras

Customer: replied 3 years ago.
It's been over a month and I still haven't been scheduled for a biopsy. I'm stunned at how difficult it's been getting help with what is probably a deadly, active, communicable disease (thank God it's extrapulmonary).

I've been taking INH as though this thing were still latent out of fear of what will happen if I stop taking it. How bad is this?

Can you suggest where I can get some competent help? There's no TB clinic in Alameda County and the City of Berkeley's "Nurse Of The Day" seems like an absoulte farce and the Order of Malta clinic is killing me slowly. Highland aslo misdiagnosed me.

The scrofula has spread to my knees and right elbow and wrists and is greatly effecting my ability to work, now. If someone would have listened to me over two years ago none of this would be necessary.

How is it I could get a WHO approved blood test for TB if in a third world country, probably withing the same day, but I can't get one here in America? Is there any way I can get that test?

You're the only one I trust.
Expert:  IMDR06 replied 3 years ago.
Hi,
Sorry for the delay. I am currently on the road this weekend.

First let me ask, how long now have you been on the INH?

Have you had the TB Quantiferon Gold Assay? Quest diagnostics has it, you just need the order from your doctor. That is our next step.

I should be back online Sunday evening,
Dr. Sciberras
Expert:  IMDR06 replied 3 years ago.

hi,

I am back in town. I highly recommend asking your physician to order yo the TB Quantiferon Gold test.

 

pls let me know if you have any other questions,

Dr. Sciberras

Customer: replied 3 years ago.
This is what I'm talking about --- my "doctor" said it wasn't available and I simply wouldn't be able to get one. For me to even ask for it would take another month waiting for an appointment. How can I expidite?

I've been taking INH for about 2 months now. What are the odds of going antibiotic resistant before I get the treatment I need? Not just my body, but the TB itself. I'm worried about this.
Expert:  IMDR06 replied 3 years ago.
Call your doctor, tell him Quest said it IS available, and ask him to send you the prescription. You can also get it done at any major teaching hospital, besides Quest. First let's establish if this is truly TB. If you must, you can even print out about the quantiferon test from www.questdiagnostics.com and fax to your doctor. Am going to sleep now, will await your reply tomorrow,
Dr. Sciberras
Customer: replied 3 years ago.
Just got back from Highland where I requested a QuantiFERON TB Gold Assay and they refused to give it to me. They called in a TB specialist who said it's only to determine whether or not African TB patients have a genuine infection or if their skin test is reacting to a BCG vaccination. They said the only way to diagnose active TB is through sputem cultures of biopsy, which they also refused to schedule me for. Good thing at least one "doctor" got that pushed through, even though I had to order him to do it.

This from Wikipedia:

"According to the U.S. Centers for Disease Control,[9] the QuantiFERON-TB Gold test (QFT-G) is a whole-blood test for use as an aid in diagnosing Mycobacterium tuberculosis infection, including latent tuberculosis infection (LTBI) and tuberculosis (TB) disease. This test was approved by the U.S. Food and Drug Administration (FDA) in 2005."

WTF? The highest authority on TB in the county doesn't know how to diagnose TB?

You're a doctor. Can you help? Can I come and physically be seen by you and get this test ordered? I've had enough.
Expert:  IMDR06 replied 3 years ago.

Well the Highland Specialist's information is obviously wrong. First of all BCG is given moreso in European countries, not Africa. And we test anyone who is PPD positive with the Quantiferon test if there is some contraindication to taking INH for 9months. In fact, many of my medical students have taken the Quantiferon test.

 

I would find an infectious diseases specialist in your area, even if you have to pay out of pocket, and see him/her in order to get this test done. You can also bring in the CDC information and show it to them (just not use wikipedia as the source).

 

Unfortunately you can not come to Florida and see me for the test as we cannot solicit patients from this website. Sorry about that.

 

Dr. Sciberras

Customer: replied 3 years ago.
I have an appointment with Dr. Mildred Kawachi, Infectious Disease Specialist for consultation on Jan 7 at 10:15am. Phone: (XXX) XXX-XXXX Fax: (XXX) XXX-XXXX. It would be nice to have you in my corner on this one.

The specialist at Highland was on-call. I think she wanted to get back home and had her mind made up that scrofula is rare and should be showing stonger symptons than I exhibit, but she was in such a rush that she didn't get some important information: I've been taking calendula (marigold) tincture and it flushes out the lymph nodes. I had to stop her from running off in order to tell her that I already had blood work done and most everything but TB had been ruled out. I don't know if she even heard me.

Her first question was "Do you have fevers?" No, but from what I've read about scrofula, fevers are rare. Wrong leading question. "Do you have night sweats?" Yes. This is exacly what I've read about scrofula. Fevers rare, night sweats common.

Thanks for your help. Some of this is written for the sake of the printout.
Expert:  IMDR06 replied 3 years ago.

Hi,

Let me know how your appointment goes. I will be out of the country until January 8th. Unfortunately I cannot call the specialist (as you can see, the number is XXXXX out) - it is not something allowed on JA. Best of luck and I will talk to you in the new year!

 

Dr. Sciberras

Customer: replied 3 years ago.
Hey, Stranger. It's me, Mystery Lymph Nodes again,

Specialist was baffled and didn't think it was scrofula, having treated it before. Spleen is not enlarged. It's been 3 months and still no biopsy. Still not wasting away or sick, so maybe it's not a disease or bacteria, but some toxin that got into the infected tooth in the very beginning, caused a big impact on the cervical nodes and has been slowly spreading itself across the rest of the nodes while trickilng into the liver. Clue: Chewed on myrrh (tree sap) to fight the infection. Maybe some impurity in the myrrh? What would scrofula have done unchecked for 3 months?
Expert:  IMDR06 replied 3 years ago.

Is there any way you can send me a pictures of the enlarged lymph nodes?

By now scrofula would have really run you down, very fatigued, the TB would probably be all over your body.

I do not know much about myrrh, but perhaps it could cause an allergic reaction of sorts.

 

Dr. Sciberras

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/DrThomasMd/2012-7-25_134438_Imagess1.64x64.jpg Dr. Thomas, MD's Avatar

    Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
  • http://ww2.justanswer.com/uploads/MY/mysticdoc/2012-6-8_15615_mysticdoc3.64x64.jpg Dr. D.J.'s Avatar

    Dr. D.J.

    Board Certified Physician

    Satisfied Customers:

    14679
    MD
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2562
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/DrDLove/2009-08-12_141522_DrDLove.jpg Dr. D. Love's Avatar

    Dr. D. Love

    Doctor

    Satisfied Customers:

    11961
    Family Physician for 10 years; Hospital Medical Director for 10 years.
  • http://ww2.justanswer.com/uploads/CO/commissure/2011-4-15_192514_REISD20080926JR1090.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    10667
    Experienced Physician trained in New York City. I'm ready to help.