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I'm a 35 yr old female smoker and have 4

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Posted on Wed, 13 Feb 2019
Question: I'm a 35 yr old female smoker and have 4 children. For two years I have had swollen lymph nodes from the base of my neck down to collarbone area on left side and have swollen lymph nodes on left side of groin. I have been having a choking feeling on the left side of my neck. I have bad hot flashes and cold chills, been getting sick a lot over last year with fever off and on. I also have a deep pain in my neck and shoulder and goes down my left arm into my hand and my left hip around to front and down the inside of my left leg with occasional swelling in left leg and foot. I am also tired all the time
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Answered by Dr. Antoneta Zotaj (1 hour later)
Brief Answer:
Possible causes and needed investigations explained in detail below

Detailed Answer:
Hello,

Lymphnodes are common findings in examination and sometimes mean presence of an infection, an immune condition or rarely tumors and sometimes they are within normal limits (normal finding). The lymphnodes are generally clinically important if they are 2 cm in length or more.

Because you have had them in certain locations and for a couple of years and have these pains and being tired and also being a young female it might be important to have a check to determine the cause of them.

This check would include a thorough physical examination from the doctor to check if enlarged lymphnodes are present in other areas of the body and how is liver and spleen. Some conditions that cause enlarged lymphnodes might affect the liver and spleen and these might direct towards diagnosis.

Also the doctor might need to do some tests like:
- CBC, ERS, ANA, RF to rule out autoimmune conditions and blood tumors
- TSH to rule out problems with the thyroid
- HIV, test for mononucleosis, toxoplasma, CMV tests, tests for hepatitis, Tuberculosis, syphilis, etc, to rule out infectious disease (viral or bacterial)
- sometimes a lymphnode biopsy is needed to determine the nature of the lymphnode

According to the findings in examination and from the test results the doctor will better have an understanding of the possible cause of the lymphnodes and the needed further steps.

I hope I have answered your query. Let me know if I can assist you further.

Regards,
Antoneta Zotaj,
General & Family Physician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Antoneta Zotaj (19 hours later)
I did have blood work done two years ago and again a little over a year ago and because my blood work comes back normal they decide to not look into it any further. I have been on many different antibiotics as well. An ER doctor felt all the lymph nodes and referred me to an oncologist even though my blood work just said I was a little anemic (have been all my life though), the oncologist reviewed my chart to see if he would be willing to see me. His office called me to set up appointment but due to no insurance, I could not afford to pay cash for appointment. It seems that the doctors I go to don't want to pursue all because my blood work doesn't show anything but being anemic. I don't know how I can get the doctor to listen and take me serious and truly help me. I know my body and something is not right. I forgot to add my voice is hoarse a lot to the point I sometimes lose my voice and seem to always have a cough of some kind.
doctor
Answered by Dr. Antoneta Zotaj (4 hours later)
Brief Answer:
A would recommend you to see a rheumtologist to rule out autoimmune conditions

Detailed Answer:
Hello,

By what you explain very likely your condition is not caused by a cancer because in 2 years you would have had serious changes if the cancer is left untreated (weight loss, fatigue, pains and symptoms related to the location of the cancer would be very obvious) and tests would show abnormal so seeing an oncologist might not be the best to do.
I would most likely recommend you to see a rheumatologist, a doctor that deals with rheumatolgical conditions or so called autoimmune diseases. I am not sure if you have had tests to rule out these conditions, you do mention you had blood work up and was normal but blood work up can be very general and I am not sure if you specifically did the ones that rules out autoimmune conditions.

Presence of cough time after time can be due to many conditions from the most common ones like allergy, acid reflux, asthma to more serious conditions like infections (tuberculosis), or autoimmune conditions (sarcoidosis). A good check from the doctor, chest xray and some blood tests might help guide in diagnosis.
As for the voice being horse, if this is not a constant finding but comes and goes it is unlikely to be caused by a serious condition. Smoking is an aggravating factor for voice hoarseness and can predispose for serious conditions of the larynx and vocal cords (even tumors) so quitting smoking is recommended.

To conclude:
- seeing a rheumatologist might be more helpful in your case as cancer does not seem to be very likely in your case
- you have had work up which comes almost normal (but mild anemia which you say you have always had), blood work up can be very wide and specific tests mentioned above in the first answer and maybe some more extended ones to rule out autoimmune conditions and some infections might be needed.

I hope I have answered your query. Let me know if I can assist you further.

Regards,
Antoneta Zotaj,
General & Family Physician
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 4421 Questions

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I'm a 35 yr old female smoker and have 4

Brief Answer: Possible causes and needed investigations explained in detail below Detailed Answer: Hello, Lymphnodes are common findings in examination and sometimes mean presence of an infection, an immune condition or rarely tumors and sometimes they are within normal limits (normal finding). The lymphnodes are generally clinically important if they are 2 cm in length or more. Because you have had them in certain locations and for a couple of years and have these pains and being tired and also being a young female it might be important to have a check to determine the cause of them. This check would include a thorough physical examination from the doctor to check if enlarged lymphnodes are present in other areas of the body and how is liver and spleen. Some conditions that cause enlarged lymphnodes might affect the liver and spleen and these might direct towards diagnosis. Also the doctor might need to do some tests like: - CBC, ERS, ANA, RF to rule out autoimmune conditions and blood tumors - TSH to rule out problems with the thyroid - HIV, test for mononucleosis, toxoplasma, CMV tests, tests for hepatitis, Tuberculosis, syphilis, etc, to rule out infectious disease (viral or bacterial) - sometimes a lymphnode biopsy is needed to determine the nature of the lymphnode According to the findings in examination and from the test results the doctor will better have an understanding of the possible cause of the lymphnodes and the needed further steps. I hope I have answered your query. Let me know if I can assist you further. Regards, Antoneta Zotaj, General & Family Physician