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Chronic pharyngitis remedy - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Ear, Nose and Throat Problems
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3632 Questions
Doctor :   Hi
User :   Hi Doctor
Doctor :   How can I help you ?
User :   I have chronic pharyngitis since 11 months with coated tongue, post nasal drip, dry mouth, difficulty swallowing, strong urine odor, frequent urination, excessive gas, smelly stool, skin burning, mainly palms, soles and scalp,
Doctor :   Ok.
User :   I saw many doctors and did many tests but nobody was able to tell me what is wrong with me
Doctor :   Ok.
Doctor :   Now let me ask you a few questions to help you better .
Doctor :   May I know your age and gender please ?
User :   male / 38
Doctor :   May I know if you want to add anything else to the symptoms and signs and about your past illness history that can be relevant to your present illness ?
User :   These are the main symptoms i'm having till now
Doctor :   Ok.
Doctor :   May I know your height and weight please ?
User :   H 174 cm / W 76 Kg
Doctor :   Ok, That looks quite normal to me in the BMI Perspective, Very encouraging.
Doctor :   How about any fever ?
User :   no fever
Doctor :   As you mentioned Pharyngitis for 11 months, did you get a Throat swab done ?
Doctor :   As you mentioned Pharyngitis for 11 months, did you get a Throat swab done ?
User :   yes and it came neg
User :   yes and it came neg
Doctor :   Ok.
Doctor :   How are your Blood Sugar levels and your HbA1c ?
User :   normal
Doctor :   May I ask you a few more questions if you are fine with it ?
User :   I am not diabet and I don't have any history of diabets in the family
Doctor :   Ok, That is very encouraging.
User :   yes pls
Doctor :   How about any medication if you are using any right now for any other problem ?
User :   no medication
Doctor :   How about any tests that you undrewent when you visited your family physician ?
Doctor :   Did you get a Cbc done, any Eosinophilia ?
Doctor :   How about a Chest X-ray ?
Doctor :   Did you get any Serological tets done for any Infectious diseases ?
User :   I did CBC and it is normal
Doctor :   Ok, That is good.
User :   eosinophilia? i don't know what is ? but i can tell you the value of the EOS in the cbc
Doctor :   Yeah Pls do that , would be helpful.
User :   first test it was 10 and second test 11
Doctor :   They seem to be almost normal.
Doctor :   Are you sexually active ?
User :   no
Doctor :   when have you last had a sexual intercourse ?
User :   18 months
User :   i did test for all infectious disease, Hep A, B, C, HIV and all came neg
Doctor :   Ok, That is encouraging.
User :   and mono test as well came neg but i did it late
User :   by the way one of the doctors he was doubting i have mono
User :   because he told me the mono test is not very accurate and it may came false neg sometimes
User :   but he said that even if i had mono it should have been resolved within few weeks
Doctor :   Ok, Epstein Barr Virus usually lasts for weeks.
Doctor :   Have you been ever diagnosed with these sort of symptoms in your child hood ?
User :   no
Doctor :   How about any pain in joints ?
User :   yes sometimes
User :   but i can say it is rather general fatigue
Doctor :   Ok.
Doctor :   I would say that all your symptoms actually point toward a Liver involvement .
Doctor :   May I know if you have travelled either to Africa or Asia in recent past ?
User :   only to china 2 years back
Doctor :   Ok.
Doctor :   Have you got your Liver Function Tests and an Ultrasound Liver or CT Liver ?
User :   yes the liver enzymes were normal and the ultrasound did not show any abnormalities except some fats
Doctor :   coated tongue, strong urine odor, frequent urination, excessive gas, smelly stool, skin burning, mainly palms, soles and scalp actually point towards Liver/ Renal Involvement.
User :   I haven't got CT
Doctor :   I want you to get a Liver CT done to rule out any Liver involvement as all these are metabloised by Liver.
User :   what do you mean doctor?
Doctor :   I mean foul smelling stool or discoloration in urine or Tongue coated in some other color is mainly due to Poor Liver Metabolism.
User :   but my ENT said that if i had any problem with my liver it would have shown with elevated liver enzymes
Doctor :   I agree with your ENT but I dont want to comment until I get a CT as there can be an underlying Malignancy or Any Benign tumor in the Liver or the Gall Bladder sometimes.
User :   but the ultrasound should not have detected?
Doctor :   Usually the Ultrasound does not show up any tissue level changes very clearly and a CT is the best posible test.
Doctor :   Apart from it have you had a proper check up by an ENT and did he rule out any Lymph node swelling around neck or throat or any tonsillitis or any other ENT infection.
User :   i think so
Doctor :   Your symptoms of chronic pharyngitis since 11 months post nasal drip, dry mouth, difficulty swallowing do not match the symptoms of strong urine odor, frequent urination, excessive gas, smelly stool, skin burning, mainly palms, soles and scalp and coated tongue. It rather becomes very difficult for me to Put a diagnosis or even a differential diagnosis without examining you. Hope you understand.
Doctor :   And carefully looking at each of your diagnostic tests .
User :   may be they are not interconnected
Doctor :   Can you send me a copy of the tests done by you.
Doctor :   That is what I see , they may be totally different entities.
Doctor :   But rather before I come to a conclusion can you send me across the scanned copies of your tests.
User :   but i had so many tests more than one time
Doctor :   Ok.
User :   i can send u the results in an excel sheet
User :   doctor, all the tests i did came normal
Doctor :   I do agree with you but sometimes the interpretation might change, Can you send me the actual reports scanned.
Doctor :   Ok.
Doctor :   That is what is actually creating the confusion that all the tests were normal, so something is missing , might be need to do something else to pin point.
User :   may be
User :   i will ask my ENT to do a CT scan for the abdoman
Doctor :   I have seen a case who had recurrent and relapsing fever for 16 months and was not diagnosed and had scores of tests and went from pillar to post but nothing happened and ultimately it was diagnosed as Psittacosis caused due to his Pet Parrot.
Doctor :   You see we might have missed one strange correlation which might be the clinching point for diagnosis.
User :   i agree
User :   why you asked me if i visited .....?
Doctor :   You might have encountered some strange African virus or some tropical fever which is rare in US like Malaria But very common in India or China or South east Asia.
User :   ok isee
User :   what about GERD and acid reflux? is it possibe to cause some of my symptoms?
Doctor :   Yes I do agree with this , GERD can also be one cause , How are your food habits and apetite and have you ever had any acidity or Pain per Abdomen ?
User :   rarely
User :   but my apetite is ok
Doctor :   Do you have breakfast regularly ?
User :   not everyday
Doctor :   When exactly do you have your usual food after you wake up in the morning ?
User :   at 8:00 AM
Doctor :   And please describe your usual diet chart ?
User :   i eat lot of salads, fibers, beans, eggs and meat
Doctor :   Ok, That looks very healthy.
Doctor :   Never mind, please send me across your reports and please get a Liver CT done .
Doctor :   And do get back to me after you get the CT done.
User :   ok
User :   one more questionwhat about bacteria in the intestines, stomach? does it cause similar symptoms?
User :   because i have strong urine odor and foul smelling stool
Doctor :   Yes , but Urine metabolism is not due to something/bacteria in the gut and also pharyngitis or itching.
Doctor :   I would encourage you to give some leads like these and it would be more encouraging if you have anything from the past history to correlate the disease.
User :   this is the problem...i don't have any history of disease
User :   i'm so worried
Doctor :   Please do not worry .
Doctor :   Please follow the steps that I have told you and please follow up after the CT.
User :   ok i will
Doctor :   Thank you for consulting me.
User :   thank you very much
Doctor :   Take care, Bye for now.
User :   Bye
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