Brief Answer:
Additional investigations and opinions as suggested

Detailed Answer:
Hi.
Thanks for your query.
Read and understood your history.
To recapitulate: Female / 26 - few months - right sided neck swelling diagnosed as lymph node - investigated and treated - resumed few weeks back -right eye twitches, right ear and shoulder hurts, fingers shake - confused - booked for biopsy.

I would suggest you the following and discuss along:
- FNAC means Fine needle Aspiration Cytology. Helps to confirm the origin of the swelling and the cause of enlargement.
- MRI of the cervical Spine and soft tissues of the neck: this helps to see whether there is Cervical spondilitis, as your symptoms of pains and shaking fingers suggest for this. Of the soft tissues: to know the extent of the swelling, nature and relation to the symptoms you have.
- An opinion of a Neurosurgeon : for clinical evaluation, physical examination for the pains and relation to the causative factors.
- Biopsy : this is the best decision you have already taken : Waiting to the reports.
- Continuation of the medical management as advised by your treating Doctors.

- I am going to suggest a bit unconventional treatment: Put the right folded elbow in a sling and attach the sling to the opposite shoulder in such a way that the weight of the whole right upper limb is transferred to the opposite side of neck. This will relax the nerves and muscles and may reduce your symptoms.

I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications if you feel there is a gap of communication

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Brief Answer:
Difference of procedure and amount of tissue one gets.

Detailed Answer:
Both are same, but the difference is in the amount of tissues one gets:
Let me explain.
In FNAC- as the name suggests - Fine Needle Aspiration Cytology - Fine needle is inserted (almost painless) and the tissues are aspirated, then spread over the slides. Sent to Histopathologist. In good hands the reports are impressively positive to find the disease.
In biopsy - Either a part of the lump or the whole lump is removed and sent to histopathologist. Since the tissue is far more, it is processed and reported. This gives almost 100 % results.

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Brief Answer:
Please get the CT scan of the sinuses.

Detailed Answer:
Thanks for your feedback.
Seen, this is X-ray of the sinuses. X-rays give just an idea. Confirmation should be done by a CT scan.
You X-ray shows Mucosal thickening of only the maxillary sinuses, rest of the sinuses are clear; it is showing more thickening on the right.
I think, this may not be the sole reason for your problems.
Please go for the CT scan whenever you are going for to get the exact picture of the inside of the sinuses so that the findings can be correlated with the clinical picture.

I hope this helps you.

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Brief Answer:
Biopsy will not be hindrance to the CT Scan

Detailed Answer:
Biopsy will not be a hindrance to CT scan.
Please go ahead as planned.
Wishing you all the best for biopsy.

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Brief Answer:
Is the biopsy done today?

Detailed Answer:
Thanks for the reports.
Seen, the Ultrasonography (17/1/15) shows 2 masses and advised FNAC.
Let us see the report of biopsy. I hope biopsy is done today. When can we see the reports?

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Brief Answer:
As advised .

Detailed Answer:
Hi.
You may please take Antacid 3 tsf at 3 hourly interval.
Add Ranitidine and a PPI and Domperidone as a motility regulator.
You may need a prescription for this, but this helps a lot for heartburn.
Soft bland diet, small frequent meals.
Control of anxiety and / or stress.
8 hours sound sleep.
No late dinner.
No immediate sleeping after the dinner.
Avoid all the foods and beverages and factors which you must have noticed to initiate or enhance the problems.

If the problem persists, it is better to undergo Upper GI Endoscopy and an opinion of the Gastroenterologist.

I hope this helps you.

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