It is quite possible that this slight inconvenience in my life started back in 2010 or even earlier. Based on what we know today, I could have had a very slow growing lymphoma for 2-3 years. What I do know is that both my only symptom was two swollen lymph nodes - the upper left cervical lymph node and the left supraclavicular (collarbone) lymph node. When the supraclavicular node is swollen at the same time as another node, something is definitely wrong. To the best of my knowledge at the time, they both resolved themselves, meaning the swelling went away. But they were likely still active, albeit smaller than they had been. If you can feel the lymph node, and it's more than 1cm in size, then it's active.
The current lymph node swelling started in November 2011 and accompanied tooth pain. I had an abscess under a tooth in my lower left jaw and subsequently had two teeth removed - the victims of a couple old root canals gone bad. Antibiotics were prescribed for the tooth extraction and most likely with the initial abscess discovery. Neither dose of antibiotics reduced the swelling of my upper left cervical lymph node
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| December 26, 2011 |
I had a physical exam in March 2012 and my complete blood count (CBC) and metabolic panel results were all normal. The doctor said that I needed to get things checked out of the lymph node was not resolved within a few more weeks. Again, I had no other symptoms at all:
- Becoming more sensitive to the effects of alcohol
- Painful lymph nodes after drinking alcohol
- Weight loss for no known reason
- Fever that does not go away
- Soaking night sweats
- Itchy skin
- Coughing, trouble breathing, or chest pain
- Weakness and tiredness that don't go away
- Noticeable growth of the lymph node over time
Still the lymph node still did not resolve. So, after considerable cajoling from my wife and an admonishment from my good friend Mike (a longtime ER doc and current Director of Emergency Medicine) on the 4th of July, I decided it was time to get a professional assessment.
With the help of Mike I found a good general practitioner (GP) and setup an appointment. My GP requested another CBC and also prescribed two weeks worth of Amoxicillin to see if the lymph node fully resolved itself. The blood work was normal and there was no change to the lymph node so my GP scheduled a fine needle aspiration (needle biopsy) on July 9. The subsequent pathology was inconclusive but did note “...rare large atypical lymphoid cells, some of which have a binucleate appearance.” The fine needle aspiration was not specific enough to allow the identification of Reed Sternberg cells. The GP recommended an excisional biopsy and referred me to an oncological surgeon in the same hospital network.
I met with the surgical oncologist today (July 31). My goal was to learn more about an excisional biopsy. Needless to say, I was a little concerned that someone might be operating on my neck in the near future. I was the last appointment of the day and I’ll have to assume it was a long day for the surgeon. After a 10-minute consult with a physician’s assistant I spoke with the surgeon. He examined me and subsequently recommended a fine needle biopsy. When I told him that those exact results were in the package that had been sent to his office a week earlier. He didn’t even skip a beat and subsequently recommended removing a lymph node under my right armpit. Needless to say I didn’t have a warm fuzzy so I nicely said “don’t call me, I’ll call you” and left.
I will spend the next two weeks on vacation considering options and doing a lot of research. While I am still holding out for an infection or some other benign clinical mimic for lymphoma as my diagnosis, the research I've done and the words “large, atypical cells, and binucleate appearance” leave me to consider the downside risk is I have some type of lymphoma. So I am going to focus my research for the “second opinion” doctor on lymphoma specialist.
