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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for elevated lymphocyte counts, night sweats and breathing difficulty

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6074 Questions

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Posted on Mon, 6 Mar 2017 in Hypertension and Heart Disease
Question: This is what I wrote to your doctor about 6 weeks ago:I went to an emergency room a week ago because of some possible cardiac symptoms (I had quadruple bypass 8 months ago). Everything turned out to be fine, and I had a follow up with my cardiologist. Both docs said all of the tests and blood work were fine. However, today I received all of the lab work done in ER. My anion was 16 (normal range 7-15), but what I am really worried about is the abs lymph of 3.6 (normal range .8-3.1). I have no other symptoms that I looked up for lymphoma or other cancers this may possibly indicate. Is this number something to worry about? I put the lab tests in my profile.

I did not mention at that time that I also had frequent indigestion and some night sweats (not severe). My cardiologist prescribed pepcid for 30 days. My indigestion disappeared. I totally forgot about the night perspiration. After the 30 days ran out, I started to get some indigestion again. I also started to wake up at night some days with very slight perspiration around my neck and one time slightly on my chest. I kept thinking about this and panicking. Tonight I woke up with much more severe perspiration on my head and chest. I have no swollen lymph nodes and no weight loss (actually a bit of gain). I have been in the past diagnosed with IBS and interstatial cystitis.I am rally worried about the night sweats. Are they likely to just be result of stress? Is there relationship to the indigestion?

doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully reviewed your blood lab tests and would explain that the slightly elevated number of lymphocytes may be related to a viral infection.

From the other hand, your symptoms (night sweats, difficulty breathing) could be related to different causes:

- inflammation
- a lung disorder (like infection)
- gastro-esophageal reflux
- sleep apnea.

For this reason, I would recommend performing further tests to investigate for the possible underlying causes:

- a chest X ray study and respiratory function tests
- PCR, ESR for inflammation
- HbA1C and glucose tolerance test for possible glucose intolerance (considering the fact that fasting glucose is slightly elevated).
- a cardiac ultrasound to examine your heart function and structure (there are different cardiac disorders, that may cause difficulty breathing in lying down position).

Regarding lymphoma, I would explain that your symptoms are not typical of this disorder (beside night sweating) as the most concerning feature of this disorder is swollen lymph glands and weight loss (which are not part of your symptoms).

If all the above tests result normal, I would recommend taking an antiacid before sleeping. If it improves your situation, it would be indicative of gastro-esophageal reflux.

If suspicions of sleep apnea are raised, you should perform a multi sleep latency test to investigate for this disorder.

You should discuss with your doctor on the above issues.

Hope to have been helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 21 minutes later
Thank you. I did have negative chest xray for TB in November and another one in emergency room in late December. I do not have difficulty breathing. The glucose was not fasting. Does that point to a gastro-asophageal? Can continiued stress ansd worry exacerbate these problems?

Sorry, one more addition. Are you suggesting the PCR, ESR for inflammation because of possibilities of other cancers or more likely for infections?
Sorry about my fears?
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I suggested PCR and ESR for inflammation or infection (viral infection considering increased lymphocytes). They do not indicate the presence of a tumor.

I don't think that your symptoms are related to a tumor.

I am glad that your repeated chest X ray result normal.

I recommend trying taking omeprazole or Zantac before sleeping. If it helps against the chest pain, it would be indicative of gastro-esophageal reflux.

Anyway, gastro-esophageal reflux would not explain the increased sweating.

That is why, I would also recommend performing inflammation tests (PCR, sedimentation rate) and thyroid function tests (which could explain the increased sweating).

Hope to have been helpful!

You should discuss with your doctor on the above issues.

Wishing good health,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 4 minutes later
Thank you.
doctor
Answered by Dr. Ilir Sharka 3 minutes later
Brief Answer:
You are welcome!

Detailed Answer:

I am glad to have been helpful!

Wishing you a pleasant weekend!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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