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Suggest treatment for severe back and shoulder pain

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Posted on Mon, 18 Jul 2016
Question: My symptoms are:

Pain in neck (base of skull), shoulder pain, behind the eyes pain
Lower back large lump - 5cm x 5cm fluid like but firm
Hair falling out much more than normal
Regular red itchy rash on torso that comes and goes
Sinus cyst
vertigo
extreme fatigue
no appetite
no libido
headaches
lump in gum where tooth was removed (dentist does not know what it is)
lymph nodes under chin (multiple) 1.2cm (looks like a double chin)
breast lump in right breast - appears benign on ultrasound (they will not biopsy - too small but have to get another ultrasound in 6 months)
Pap smear shows abnormal cells - follow up in 1 year
doctor
Answered by Dr. Mukund Savaskar (2 hours later)
Brief Answer:
Lumps under chin and jaw with lump in the gum/ Under Evaluation

Detailed Answer:
Brief Ans- Lumps under chin and jaw with lump in the gum/ Under Evaluation

Mostly from dental chronic infection,with multiple other separate health issues as discussed below

Hi,Dear!! Thanks for the query to HCM,but it fails to indicate,which is your priority/ or leading problem,which troubles you the most.
Due to no definite demands in the query from you about the troubling health concerns,I reviewed your last question about an hour back and understood that you have unresolved issue of lumps under chin and jaw.

My Comments on Multiple health issues-
Read and reviewed the query in context to your health issues and My comments on them are as follows-
1-lump in gums at site of tooth extraction?when tooth was removed
-Lymph nodes under chin with double chin, with accompanied pains in shoulder, neck,and behind the eyes,which is mostly from chronic infection.
2-Breast Lump-benign-very small with USG call after 6 mths time
3-Pap smear
4-Many symptoms suggestive of chronic infection-like falling hair,no appettite,no libido/ mostly from a -Sinus Cyst, and headaches
5-Lump in low back,5x5 cm-which seems to be benign lipoma , as doctor is not taking any cognizance

I may need more details,for exploring further suggestions in your case,if need be,after this reply.


Reasoning and solutions on Your Multiple health issues-
Dear you seem to have multiple health issues, which need separate and independent attendance for each of the issues one by one.

In the given scenario,You seem to have major health concerns from-
1-Chronic Dental problem with post-tooth extraction gum lump.
Chronic dental infection,treated over last 6 mths(from Dec,15 to May,16)with 10
courses of antibiotics has caused lot of stress on your body, causing fatigue,no libido,no appetite.
With the lump still existing, you need to consult dental surgeon to get rid of any infection at the extracted tooth site.
The lumps under chin and jaw, they all seem to be chronically inflamed lymph nodes from the dental infection which caused all these lumps.
Don't worry much about these lumps being cancerous/ or malignant, unless proved by a Lymph node biopsy from a Surgeon.This is because the FNAC report of these lumps is -of Reactive lymph nodes,which could caused from non-specific chronic dental infection, in your case.
I differ from My colleagues opinion,that it could be cancerous/ or malignant.
Just don't worry for it being Cancer/ malignant unless you fix this issue by Lymph node biopsy.Chances of it being malignant are less in view of the non-reactive report of the FNAC.I would wait for the Histopath reports after Lymph node biopsy.

-Comments about Other allied problems-

2-Chronic Sinus Cyst-indicates that you seem to suffer from chronic Sinus Infection with repeated history of Upper respiratory tract infection with seasonal changes.This is causing lot of stress leading to chronic/long term exhaustion.
Consults with ENT Surgeon would be needed to fix the Sinus Cyst issue, which may need to be surgically dealt with, under ENT guidance.

3-Your thyroid reports seem to be normal and hence not to be worried, for thyroid being a cause of your exhaustion.

4-Your chronic hairfall (? androgenic hair fall(alopecia) from ? PCOS) would need further investigation,for the accompanied ?PCOS(Poly Cystic Ovary Syndrome).
I would suggest you to consult Gynecologist and endocrionlogist if needed.
Else this hair fall could mostly be due to chronic malnutrition resulting from chronic -6 mths-antibiotic treatment.

5-Chronic antibiotics for chronic dental issues,could cause multiple complaints of fibromyalgia, body pains and exhausting fatigue, and lack of libido etc.
This would need consults from Specialist Physician and needs to be attended separately.

6-Continue consulting radiologist and surgeon to resolve benign lump in right breast.
7-Continue following with Gynaecologist for Pap smear abnormality,as you are quite young and need to take care.

Key ALERTS to care your major health issues-
Good nutrition and rest, under advise of Physician,to correct chronic malnutrition is the basic need for correcting your health issues.
Besides this attending to lump issues with -Lymph node biopsy,
and other health issues as suggested would resolve your complex health problems which you have.

Next appointment-
Any time 24x 7, for any urgent need.
And or/ after 4-6 weeks,after working up on suggestions on lines as above.

Dear, I Hope this reply would reduce worries with your health issues and would help you to plan further proper care,with help of doctors there.

Dear, I tried to simplify the complex query of yours,by My brief ups as above.
But still If you want more explanations for few more queries, You are welcome.

Hope this would help you to plan further for this complex health issue of yours.

If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229

Dear, if satisfied, Do close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services.

Good Day!!

Wishing Good Healthy Life in time to come!!

Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Mukund Savaskar (1 hour later)
Thankyou - I find that your answer is very helpful.
I did go to my new Dr today and speak to her about all this.
She is sending me for CT of sinus and referral to ENT to deal with the cyst and sinus issues.
I think that you are correct that the hair loss and fatigue is from so many antibiotics and malnutrition. I had so many tooth issues that I could not eat properly for a long time and now my stomach is small and I am not able to eat much, and have no interest much in eating.
The lymph nodes and exhaustion are my main concern and the reason I listed all the symptoms I am having was in case any of them would be related to why the lymph nodes are enlarged.
My Dr today said lymph nodes enlarged is probably due to the cyst in the sinus.
Would you agree with this?
Also, can you please tell me what does the ENT do for a sinus cyst?
I assume surgery of some kind?
It is a retention cyst in the right maxillary sinus.
Can you tell me briefly what the surgery involves and recovery time?
Will it be painful?
Thankyou :-)
doctor
Answered by Dr. Mukund Savaskar (10 hours later)
Brief Answer:
Lumps under chin n jaw /n dental problems from Sinus Cyst/ Under Evaluation

Detailed Answer:
Brief Ans- Lumps under chin n jaw /n dental problems from Sinus Cyst/ Under Evaluation

Mostly from Sinus retention Cyst due to allergic Chronic para-nasal Maxillary sinusitis, causing multiple chronic dental problems,with multiple other separate health issues as discussed in last reply.
Diabetes and TB maxillary infection needs to be ruled out in your case.


Hi,Dear!! Thanks for the appreciation of My Impressions and thanks for update query to HCM, which indicated causes of your health concerns.Its good that you
admitted your main health concerns

My Comments on updates-
As your main health issues have come down to neck lymph nodes and exhaustion,the cause for this needs to be ruled out, which could be from TB lymph-adenitis with TB maxillary sinusitis.

Investigations and Plan of dealing your health issues-
For which I would suggest, following tests-
AFB sputum Test / and IGRA blood test to detect any hidden un-diagnosed sub-clinical infection, causing this chronic maxillary sinus infection with retention cyst with dental problems with lymph nodes enlargements from chronic sinus infection -which could be due to TB maxillary sinus infection.
other causes for chronic maxillary sinus infection could be from diabetes mellitus.

I may need more details,for exploring further suggestions in your case,if need be,after this reply.
I differ from My colleagues opinion,that it could be cancerous/ or malignant,as the above possibilities need to be ruled out, before treatment of your lymph nodes and Sinus retention Cysts.

Just don't worry for it being Cancer/ malignant unless you fix this issue by Lymph node biopsy.

Now with your updates, chances of these lymph nodes- being malignant are less in view of the non-reactive report of the FNAC and in view of the updated submissions from you lately.

Do's Suggested-
I would suggest for Lymph node Biopsy,simultaneously and would wait for the Histopath reports,which need to be reviewed with blood sugar tests,for hidden diabetes mellitus and IGRA test to fix active hidden TB infection.

Reply to your updated specific queries-
Q-1-My Dr today said lymph nodes enlarged is probably due to the cyst in the sinus.Would you agree with this?

Ans-1-Please refer My Comments on your update query.These lymph nodes are from Chronic Allergic Sinusitis with Secondary infection.Other causes of accompanied diabetes and TB infection needs to be ruled out and treated accordingly.
This would resolve the health issues of Lymph nodes and chronic exhaustion-which could be from TB and accompanied diabetes, which could lead to chronic malnutrition and hair fall from it.
So I agree with your doctor with above additions.

Q-2-Also, can you please tell me what does the ENT do for a sinus cyst?
I assume surgery of some kind?
It is a retention cyst in the right maxillary sinus.

Ans-2-Dear, in view of the discussion above, every case of maxillary sinus cyst does not need Surgical Excision.
These retention cyst could regress with correction of Allergic causes and by adding -anti-histaminics like- Loratidine and anti-allergic like-Monteleucast tabs, to controll the maxillary mucosal hypertophy, with recurrent secondary infections,which would need antibiotics if need be.

If TB maxillary sinusitis is fixed by tests, anti-TB medicines for 6-18 mths for TB and Sinus intractable infection would control the Sinus Cyst,by regression of the hypersensitive allergic maxillary mucosal tissues in your case.
Biopsy of the maxillary sinus mucosal cysts and mucosa, would fix the diagnosis and would decide further line of treatment in your case.
Hope you got the reply for all your sub queries.

Q-3-Can you tell me briefly what the surgery involves and recovery time?
Will it be painful?
Ans-3-Endoscopic laser ablation -for those mucoceles and for retention mucous cyst of maxillary sinus,would be needed only if no resolution is achieved with anti-allergic and anti-histaminics and steroidal medicines in appropriate combination and period.
Pain is comparatively less with these advanced endoscopic corrections.


Next appointment-
Any time 24x 7, for any urgent need.
And or/ after 4-6 weeks,after working up on suggestions given on lines, as above, to review and plan further treatment for the health issues remaining at that time.

Dear, I Hope this reply would reduce worries with your health issues and would help you to plan further proper care,with help of doctors there.

Dear, I tried to simplify the complex query of yours,by My brief ups as above.
But still If you want more explanations for few more queries, You are welcome.

Hope this would help you to plan further for this complex health issue of yours.

If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229

Dear, if satisfied, Do close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services.

Good Day!!

Wishing Good Healthy Life in time to come!!

Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Mukund Savaskar

General Surgeon

Practicing since :1978

Answered : 3607 Questions

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Suggest treatment for severe back and shoulder pain

Brief Answer: Lumps under chin and jaw with lump in the gum/ Under Evaluation Detailed Answer: Brief Ans- Lumps under chin and jaw with lump in the gum/ Under Evaluation Mostly from dental chronic infection,with multiple other separate health issues as discussed below Hi,Dear!! Thanks for the query to HCM,but it fails to indicate,which is your priority/ or leading problem,which troubles you the most. Due to no definite demands in the query from you about the troubling health concerns,I reviewed your last question about an hour back and understood that you have unresolved issue of lumps under chin and jaw. My Comments on Multiple health issues- Read and reviewed the query in context to your health issues and My comments on them are as follows- 1-lump in gums at site of tooth extraction?when tooth was removed -Lymph nodes under chin with double chin, with accompanied pains in shoulder, neck,and behind the eyes,which is mostly from chronic infection. 2-Breast Lump-benign-very small with USG call after 6 mths time 3-Pap smear 4-Many symptoms suggestive of chronic infection-like falling hair,no appettite,no libido/ mostly from a -Sinus Cyst, and headaches 5-Lump in low back,5x5 cm-which seems to be benign lipoma , as doctor is not taking any cognizance I may need more details,for exploring further suggestions in your case,if need be,after this reply. Reasoning and solutions on Your Multiple health issues- Dear you seem to have multiple health issues, which need separate and independent attendance for each of the issues one by one. In the given scenario,You seem to have major health concerns from- 1-Chronic Dental problem with post-tooth extraction gum lump. Chronic dental infection,treated over last 6 mths(from Dec,15 to May,16)with 10 courses of antibiotics has caused lot of stress on your body, causing fatigue,no libido,no appetite. With the lump still existing, you need to consult dental surgeon to get rid of any infection at the extracted tooth site. The lumps under chin and jaw, they all seem to be chronically inflamed lymph nodes from the dental infection which caused all these lumps. Don't worry much about these lumps being cancerous/ or malignant, unless proved by a Lymph node biopsy from a Surgeon.This is because the FNAC report of these lumps is -of Reactive lymph nodes,which could caused from non-specific chronic dental infection, in your case. I differ from My colleagues opinion,that it could be cancerous/ or malignant. Just don't worry for it being Cancer/ malignant unless you fix this issue by Lymph node biopsy.Chances of it being malignant are less in view of the non-reactive report of the FNAC.I would wait for the Histopath reports after Lymph node biopsy. -Comments about Other allied problems- 2-Chronic Sinus Cyst-indicates that you seem to suffer from chronic Sinus Infection with repeated history of Upper respiratory tract infection with seasonal changes.This is causing lot of stress leading to chronic/long term exhaustion. Consults with ENT Surgeon would be needed to fix the Sinus Cyst issue, which may need to be surgically dealt with, under ENT guidance. 3-Your thyroid reports seem to be normal and hence not to be worried, for thyroid being a cause of your exhaustion. 4-Your chronic hairfall (? androgenic hair fall(alopecia) from ? PCOS) would need further investigation,for the accompanied ?PCOS(Poly Cystic Ovary Syndrome). I would suggest you to consult Gynecologist and endocrionlogist if needed. Else this hair fall could mostly be due to chronic malnutrition resulting from chronic -6 mths-antibiotic treatment. 5-Chronic antibiotics for chronic dental issues,could cause multiple complaints of fibromyalgia, body pains and exhausting fatigue, and lack of libido etc. This would need consults from Specialist Physician and needs to be attended separately. 6-Continue consulting radiologist and surgeon to resolve benign lump in right breast. 7-Continue following with Gynaecologist for Pap smear abnormality,as you are quite young and need to take care. Key ALERTS to care your major health issues- Good nutrition and rest, under advise of Physician,to correct chronic malnutrition is the basic need for correcting your health issues. Besides this attending to lump issues with -Lymph node biopsy, and other health issues as suggested would resolve your complex health problems which you have. Next appointment- Any time 24x 7, for any urgent need. And or/ after 4-6 weeks,after working up on suggestions on lines as above. Dear, I Hope this reply would reduce worries with your health issues and would help you to plan further proper care,with help of doctors there. Dear, I tried to simplify the complex query of yours,by My brief ups as above. But still If you want more explanations for few more queries, You are welcome. Hope this would help you to plan further for this complex health issue of yours. If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229 Dear, if satisfied, Do close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services. Good Day!! Wishing Good Healthy Life in time to come!! Dr.Savaskar M.N. XXXXXXX Surgical Specialist M.S.Genl-CVTS