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Gout and swollen lymphnodes - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Lung and Chest disorders
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   I need to know how thios works before spending

                                                                  
Doctor :   Hi
User :   hello?
Doctor :  
How can I help you?

User :   hi doc...this is a long one sorry so might take a few messages to get out
Doctor :   No problem

Doctor :  
Proceed with it
User :   I have been getting sicker for years and no one can make out what is going on
User :   ok...originally I had joint issues...thought to be gout...high uric acid
Doctor :   Ok

User :   then after mri it was considered that too much damage for gout
User :   i also had and styill have a rash on penis and bum
Doctor :   Ok

User :   the joint pain and damage to synovial sacs was bad enough to see rhuemo
Doctor :   Ok

User :   nothing seems to hekp it until I took predinisone in large doese...ramped up
User :   they though possibly soriatic arthritus
User :   the pain stopped and I stopped taking steroids
User :   took contsant anti uric acid drugs ..allupurinol
User :   whenever a flare up came i took 1 x steroid and it would go away
Doctor :   Ok

User :   I now know this is wrong
User :   havent had a problem for 12 months
User :   however
User :   I am not sure if this is connected but...
User :   I have been having problems with bretahing, ...breathing rate is fine
Doctor :   Ok

User :   buyt feel no satisfaction from breathing - oximeter readings when sitting and lying down are 89-93
User :   when standing they are 98-99 especially when excercising
User :   bretahing became harder and harder but only when re;laxed and seated
Doctor :   Ok

User :   did spirometry test ....was ok
Doctor :   Fine
User :   saw thoracic specialist and tested for clots with dye and CT scan
Doctor :   Ok

User :   came back ok
Doctor :  
In the chest?
User :   yes
User :   then did ecg test - it was fine
Doctor :   Ok

Doctor :  
So there was no edema detected, right?
User :   tried asthma medications - including preventative asthma drugs...did not improve
User :   correct no pulmary edmea
Doctor :   Ok

Doctor :  
That is fine
User :   ...breathuign gets even worse..feels like I am holding my breath but not
Doctor :   Ok

User :   tested myself for hyperventalation
User :   seems ok..im not the type
Doctor :   Ok

User :   ...last week had hard lumps in armpit
Doctor :  
Ok
User :   actually they are still there
User :   untrasound says ..possible cyst and a lympth node
User :   forgot to mentiopn got tested fopr lupus and other auto immune stuff
Doctor :   Ok

User :   blood work shows large rise in bad chol and drop in good chol..out of range
Doctor :  
What were the resutls?
User :   possiblky sarcoid....saciod factor blood test is negative
User :   ummm I can get them if you like .....but it wass neough for the doc to say we needed to keep close eye on and perhaps look to medication if not resolved
Doctor :   Ok

User :   went for CT scan to check for sarcoid
Doctor :   Yes he or she is right

User :   ct scan found the following....hang on....
User :   Minor Opaicity posterior both lower lobes
User :   8mm pre-tracheal lymph node just above XXXXXXXX
User :   I am not sick currently and havent had so much as a cold in over 2 1/2 years...HONESTLY
User :   I can run up to 5k no problems
Doctor :   Ok

Doctor :  
That is really good
User :   but at soe times I feel like I cant breathe at all..and i am concerned about the lymph nodes all being inflamed
Doctor :   Ok

User :   my sister in law is a doctor and hgas been tracking my progress - but the doctors here are ordinary at best and they tend to miss a lot
Doctor :   Ok

User :   bit concerned...should I be concerned about the lymph nodes....the CT report syas 8mm short axis - not significant...can theis be true
User :   ok done ...sorry for all the info
Doctor :   Ok

Doctor :  
It was a very detailed info
Doctor :  
and is good
Doctor :  
but it would have been better if we could interact in b/w
Doctor :  
going by each test
Doctor :  
but no issues
User :   b/w???
Doctor :  
I could grasp the issue you are having
Doctor :   So no problem
User :   ok
User :   whatya think doc?
Doctor :   Now most of your tests have been within the prescribed range

Doctor :  
except for the cholesterol levels which you mentioned
User :   and uric acid levels
Doctor :  
I would like to know more details before proceeding
Doctor :   Yes, history of Gout and arthritis as well you have mentioned

Doctor :   Please give your Age, Gender, Height and Weight.

User :   38, male, 6ft 2in 110kg
Doctor :   Ok

Doctor :   now your main concern is regarding the joint or breath problems
User :   I am overweight......so is entire family...but I still excercise a lot, play golf 18 holes opn sat ...scccer on sun and soccer on wednesdays + walk 1 daya week
User :   bretahing problems and the darn rash
Doctor :   Ok
Doctor :  
Have you lost weight off late?
User :   and main concern is lymph nodes...my sister in law is very concerned about this
Doctor :   Ok

User :   just a little.....I tend to go up and down very quickly......down 4kg's then up 4
Doctor :   Ok
Doctor :  

Are the lymph nodes swollen right now?
User :   CT was today...so that 8mm pre tracheal was today...still have hard lymph nodes in armpit, but seem to be slightly reduced in size from 5 days ago
Doctor :   Ok

Doctor :  
Lymph node swelling is a result of infection
User :   im on antibiotics now
Doctor :  
which could be drug induced as well
Doctor :  
Ok ,that is good
Doctor :  
and it should respond
User :   been on it for 5 days
Doctor :  
Ok
User :   so my questions are....
Doctor :  
Till when have you been advised to continue the same?
User :   could this be a cancer not in my chest but eosuphogus (apelling)
User :   oh sorry what?
User :   not sure I understand?
Doctor :   the antibiotics?
User :   I have been told to take the full course of antibiotics..should run out some time tomorrow
Doctor :   Ok

User :   I have missed a few
Doctor :  
You should not do that
Doctor :  
in case of antibiotics
User :   I know...4 times a day is hard to remmeber
Doctor :   Yes, we do see such instances

Doctor :  
but should try to the best levels
Doctor :  
put a reminder in your mobile
User :   Great Idea
Doctor :  
Ok
Doctor :  
Now you are apprehensive about carcinoma of esophagus
Doctor :  
but since you have got a CT chest done
User :   well i dont know what else to think
Doctor :  
if there was a growth then it could have been suspected in the CT
User :   ok so qtn....
Doctor :  
Proceed
User :   if they CT my chest does that cover my throuat and esoph?
Doctor :   Yes, it does

User :   really?
Doctor :  
and if at all there is growth in esophagus
User :   I thought it only did chest
Doctor :  
you will face certain other symptoms
Doctor :  
like problem with swallowing food, loss of appetite, etc
User :   ct found the axillary lumps too
Doctor :  
along with lethargy due to inadequate nutrition
User :   swallowing has felt weird...but not problematic...and I styill have apetite
Doctor :   Ok

Doctor :  
Thats why it is not likely in your case
Doctor :  
and should only be considered in the last
User :   then whats with the bretahing...and why lymph nodes arcking up?
Doctor :   Breathing issues

User :   is it possible rash onpenis and bum is fungal opr bacterial?
Doctor :   I shall come to that

User :   ok ooops
Doctor :  
You have mentioned about increased sterioid intake
User :   12 months ago
Doctor :  
and that can lead to such rashes
Doctor :   are you on steroids right now?
User :   no...havent been for over 12 months
Doctor :   Ok
Doctor :  
and when is the rash seen?
User :   almost all the time
Doctor :  
Ok
User :   only hydrosol clears it up for a day or two then iut returns
User :   also have somethign on back of head
Doctor :  
Since when are you having these eruptions, I meant?
User :   about 4yrs
Doctor :  
Ok
Doctor :  
Have you got it examined with a Physician or a Dermatologist?
User :   you wont believe me but dermos over here are booked out for almost years in advance
Doctor :   Ok

User :   physicians dont want to see it........wrong XXXXXXXX
Doctor :   Ok
User :   I have an appoint wiorh dermo for biopsy
Doctor :  
Fine
User :   in 2 weeks time..waited like 8 months
Doctor :  
When is that?
Doctor :  
Ok
User :   I ahve had every std test in the mean time
Doctor :  
May I know from where you are chatting?
User :   why you want to ove here and be a dermo LOL...I know your thinking of climate and diseases in the area right
User :   Travel to Thailand on occasion
Doctor :   Ok

Doctor :  
Now the biopsy shall give the complete diagnosis
Doctor :   do you see a curdy like growth or a bad odor over the lesions?
User :   do you think any are related.......joints....bretahing....rash?
User :   no....just itchy.....
User :   red
Doctor :   Ok
User :   fungal creams make it slighyl paler ..but dont get rid of it
Doctor :  
Is it painful and does it swell or discharge any fluid?
User :   steriod creams get rid of it in two days
Doctor :  
Ok
Doctor :  
Do not use it for a long term
Doctor :  
is only for a short term treatment
User :   not really, the part beside my testicles that gets eachy...wehn I rub it it seems to peel at the same point and its not weepy but kind of shiny and liquidy
User :   I know...havent for a long time
Doctor :   Ok

User :   weird thing is
User :   if I masterbate it gets worse..but not sure thats friction.....it almost seems like semen touching it at any point flares it greatly
Doctor :  
Ok
Doctor :  
You can use Whitfield's ointment for the area
Doctor :  
and it is effective against both bacterial as well as fungal infections
User :   I am actually trying to let it flare at the mpoment......becasue i have the appointment coming up
Doctor :   Ok

Doctor :  
But I would like you to know about Whitfield's
Doctor :   that is the purpose
Doctor :  
and your idea is good
User :   i am pretty concerned about the breathing though.......already made a note to get some..but prolly not till after the appoint
Doctor :   Ok

Doctor :  
Now as for the lymph nodes
Doctor :  
it indicates an infection
Doctor :  
which could be in the lungs
User :   so ytour not concerend by the 8mm lymph node
Doctor :  
and you are taking the right medicines
Doctor :  
Lymph nodes does swell in infection
User :   oops..jumped the gun
Doctor :  
and subsides once it clears
User :   but ct shows no inflamations or pnuemonia fluids
Doctor :  
Ok
Doctor :  
There is a mild opacity in the posterior fields
Doctor :  
that is detected
User :   ENT doctor said my nostrils seemed to be reacting to alergy
Doctor :  
and that is a positive finding
Doctor :   since the spirometer and the oxygen saturation findings are fine
Doctor :  
the problem could be in the nostrils
Doctor :  
which is make you feel uncomfortable with breathing
User :   yep report says - minor dependant opacity is noted posteriorly within both lower lobes...
Doctor :   Yes

User :   possible I think that is just becasue of CPAP machine
Doctor :  
I mentioned the saem
Doctor :  
No, it is not a likely inference
User :   I was warned that cpap would irratate my nose while new
Doctor :   Ok

User :   wouldnt antibiotics clear nose problem
Doctor :  
Now how is your response, I wanted to ask?
User :   response??
Doctor :  
Yes to the antibiotics
Doctor :  
How are you responding?
User :   only saw ENT guy yesterday so was already 3 days into antibiotics..which were olnly perscribed to see if anxillary lymph would go away
Doctor :   ok

Doctor :  
has it reduced in size?
User :   lymph under armpit is getting slightly smaller after 4 days
Doctor :   Fine

Doctor :  
You are responding positively
Doctor :  
and is good enough
User :   so caould 8mm pre tracheal be linkesd to same thing
Doctor :   Yes, it shall have an association as there was no other swelling detected

Doctor :  
it guides us here
User :   what do you suggest i do next..I have heart stress test to do and supine spirometry..to work out why my 02 sats are low when sitting any lying down..plus mips and meps test whatever that is
Doctor :   While lying down was it better?

User :   same...
Doctor :  
Ok
User :   ie worse wehn sitting and lying down
Doctor :  
Because on lying down, breath is more straining than standing
Doctor :  
because of the obvious postural changes
User :   yep but 91 is pretty low??
Doctor :   With the psychological tension as well
Doctor :  
it should not be considered low
Doctor :  
and above 90 is normal clinically
User :   oh really..can stress affect 02 sats?
Doctor :  
yes
User :   then why does my own oximeter go on alarm at 90
Doctor :  
Stress has influence throughout the body
Doctor :  
there are certain blood tests that are influenced
Doctor :  
Do you know, thats why we switch off the alarm in the intensive wards
Doctor :  
many a times
Doctor :  
as it creates unnecessary panic
Doctor :  
and also the sound disturbance can aggravate it
User :   interesting thing was my cpap was non auto to start and on high power...12...when i sat with this on ..my o2 was around 97-98 but with it on auto..it is much lower on 7 and still get same results
Doctor :   Ok

User :   so what do you think is causing the breathing probs..and can i ask a weird qtn
Doctor :   sure
User :   i timed my breathing and watched my schest last time i found it hard to breathe.......
Doctor :   Ok

User :   and it was normal...but it kinda felt like the veins in my kneck were bulging or like my body was trying to puch water through a blocked hose.....then it gives way and 30 seconds later I am fine...or ai simply run on the spot and I am fine
Doctor :   these are attacks of the sympathetic nervous system

Doctor :  
which happens during overcautiosness and stress again
User :   ?
User :   so its anxiety
Doctor :  
Sympathetic nervous systemt
Doctor :  
is an automatic response of the body

Doctor :  
Are you getting it?
Question is related to
Diseases and Conditions
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