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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 3676
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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I have had a pain in my throat for more than 3 weeks now

Resolved Question:

I have had a pain in my throat for more than 3 weeks now
Submitted: 10 months ago.
Category: Medical
Expert:  Dr Uzair replied 10 months ago.
Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.
Please take some time out to answer each of the following questions, it will help me in evaluation of your current condition and help you better.
Q. Have you seen an ENT specialist?

Q. Has your doctor examined your throat?

Q. Do you have a runny nose, watery eyes, sneezing?

Q. Is there a cough, if yes, is it dry or productive (Sputum/phlegm)?

Q. Previously diagnosed medical conditions?

Q. Are you on any other medication?

Q. Did your doctor do a throat swab test and send it for culture?
Expert:  Dr. Phil, MD replied 10 months ago.
Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

Generally, this type of throat pain is caused by allergic drainage from the sinuses.

The fact that the ear is involved means that there is likely some type of fluid/mucous accumulation in the ear that drains into the throat and causes irritation and pain.

However, you clearly are not responding to therapy and other causes need to be explored.

Really the only way to do this is to see an ear, nose and throat doctor and have them looking into the throat.

An ENT doctor can look for other things like signs of acid reflux or fungal infections like thrush in the throat.

I would also recommend anti histamines like claritin D if your doctor approves.

Finally a short burst of steroids like prednisone will help.

I hope this helps. If you have more questions, just reply. :)
Customer: replied 10 months ago.

I heard from a Doctor Uzair first, and sent him my answers to my questions, I am awaiting his reply.

Expert:  Dr. Phil, MD replied 10 months ago.
I provide you with a reply. would you like me to opt out?
Expert:  Dr Uzair replied 10 months ago.
I have not received your answers to my queries.
I am waiting for your reply.
Customer: replied 10 months ago.

I sent them but I will try it again Doctor.


Q. Have you seen an ENT specialist?
No
Q. Has your doctor examined your throat?
yes
Q. Do you have a runny nose, watery eyes, sneezing?
yes - at times
Q. Is there a cough, if yes, is it dry or productive (Sputum/phlegm)?
yes persistent at night
Q. Previously diagnosed medical conditions?
cancer when I was 45 but now I am 61
Q. Are you on any other medication?
yes my current med is Bactrim ds 800 -160 and Advair
Q. Did your doctor do a throat swab test and send it for culture?


No

Expert:  Dr Uzair replied 10 months ago.
Thank you for your reply.

What type of cancer did you have and what was done for it? Chemotherapy, radiation, surgery or a combination?

Have you had fever recently with the current episodes of throat pain, cough and discomfort?

How is your diet? Are you taking enough liquids?

Have you experienced any weight loss?
Customer: replied 10 months ago.

I have had Chemotherapy and radiation, surgery or a combination?


for breast cancer and have not been on meds for years - I took tomoxien for 5 years and nothing after that. They removed 12 lymph nodes and it was a lumpectomy.

Have you had fever recently with the current episodes of throat pain, cough and discomfort? No fever- night sweats at times but mainly throat pain and night coughing

How is your diet? Chicken soup and lots of tea and water.


Are you taking enough liquids? I am not sure what the normal should be but I am going through about 3 bottles of water Aquifina.

Have you experienced any weight loss?

Expert:  Dr Uzair replied 10 months ago.

Thanks for the details and for being so patient with me.

This is pharyngitis (sore throat) which might have been allergic to start with but a common fate of allergic pharyngitis is bacterial super infection.
Any upper respiratory tract infection that has continued for more than 3 weeks is considered chronic, which means that the inflammatory patterns now follow a sub clinical and chronic course of events. Treating a chronic illness is always more difficult than to counter any inflammation in the acute phase.
From your history antibiotics have not been of much help to you, since the pharyngitis was allergic to start with. Since, you have been on chemotherapy for the pervious cancer, your immune status is questionable unless proven otherwise.
I suggest that the following be done:

An ENT examination of the throat to rule out involvement of tonsils and ears to see if there is ascending infection since, ascending pharyngitis can involve the ears and cause acute otitis media.
A throat swab should be sent for culture and sensitivity to see what bacteria is involved and which antibiotic the strain is sensitive to, this will identfy which definitive antibiotic will eradicate that bacteria. Throat swabs should be sent for bacterial as well as fungal cultures.
Empirical antibiotic therapy should be discontinued till the cultures arrive.
You are already taking good care of your hydration and I suggest that you continue that and also keep taking the chicken soup as it has been proved to boost immunity.
Labs that should be done are : a full blood count, CRP and ESR (to monitor antibiotic therapy).
You should be taking steam with menthol nebulizations thrice or four times a day.
Warm saline gargles should be done 3 to 4 times daily.
Give voice rest to your throat and bed rest to the body.
A cough syrup should be avoided so that the sputum can be expectorated with the cough.
Addition of an anti allergic will be a good idea since you have watering of the eyes, sneezing and a runny nose - I suggest that you take Loratidine and pseudoephidrine (Claritin D), it contains an anti allergic (loratidine) as well as an anti congestant.
If you have nasal congestion, you should start on Xylometazoline nasal spray one puf each nostril twice or thrice a day, this will the nose open and in turn keep the ears open as well.
You should also be on an anti inflammatory like Ibuprofen 400 mg thrice daily to relieve the pain and the inflammation.
I also suggest that you sleep with a head up tilt at night of about 45 degrees, use of a wedge pillow will be beneficial for this purpose.
Avoid fizzy drinks, spicy, salted, smoked and barbecued foods and alcohol as they cause acid reflux which can be harmful for the throat.
If you have stomach related issues (specially heart burn) then you should start on an antacid as well since, persistent pharyngitis can be a sign of acid reflux.

The above will give you symptomatic relief almost instantaneously and when the results of the culture and sensitivity are back, definitive antibiotics can be started to eradicate the microbe / causative agent.
Hope this helps.
Please do leave a positive rating for the assist.
If you have more queries, reply back.
Best.

Customer: replied 10 months ago.

Thank you Doctor, I have sent an email to my Doctor for a referral to an ENT which he had stated would be our next step if what we were doing did not help. His office is closed till Tuesday so I am hoping he will get me set up by Wed at the least. I really appreciate the service and feel more confident now that I have a second opinion. I forgot to mention that I was taking Advil for the pain but that stopped working and then I tried Tylenol last night and that did not work either for the pain.

Expert:  Dr Uzair replied 10 months ago.
Thanks for the reply.
What dose of Advil (Ibuprofen) are you taking and what is the frequency?
Customer: replied 10 months ago.

I took one to 2 tables a day depending on the amount of pain. but I can tell you the new bottle I had is almost empty and I had a previous bottle I was taking before that which was about a third of the way full before I purchased the Advil. My husband told me to stop taking it because he was afraid I would damage my liver. So I am not taking it - it does not do anything anyway .. But I am having a hard time sleeping with the pain. Last night I took only one Tylenol and that did not work either.

Expert:  Dr Uzair replied 10 months ago.
Thanks for the reply.

You have to get the dosage right. Advil 400 mg should be taken thrice a day and the dose should not be missed in the initial days of starting it because it is intended to subside inflammation in the first couple of days and then you can take it on as and when required basis. Ibuprofen or Advil does not damage the liver, but yes, it can be harmful for the kidneys but if taken in the above dose and with good hydration, the kidneys will not be damaged.
If you are keen on taking the Tylenol, then you should take at least 2 tablets together at a time and you can space them 6 to 8 hours apart.
However, the anti inflammatory medications (tylenol and advil) will help with the remedies I mentioned in my previous post and all of the above should be started simultaneously (specially sleeping with a head up tilt and gargles) in order to achieve some benefit since, the inflammation/infection as I mentioned is now a chronic one and we will need all possible efforts to alleviate it.
Hope this helps.
Please do leave a positive rating for the assist.
If you have more queries, reply back.
Best.
Customer: replied 10 months ago.

Thank you Doctor. I at least have hope that I can get a resolve to the issue. I was starting to panic because this has been the first time I have had an issue that has lasted this long. I started at the hospital on the 19th of Oct. and now this is the 10th of November. My complaint then was a bad sore throat. Then it went into a head ache behind the eye, and then the bad cough and sore throat with throat pain and it has been this way for more than 2 weeks. I will get into the ENT and see what can be done.


 

Expert:  Dr Uzair replied 10 months ago.

Pleasure.

It will subside given the right attention and treatment. It will be alright.

Please do leave a positive rating for the assist.
Let me know if you have more queries, you can reply back anytime.

Godspeed.

Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 3676
Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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