Gary,

You, of all people, have no reason to feel embarrassed. Your wealth of information and your willingness to help others, have had such a positive impact on the members of this forum. I remember thinking when I first joined this forum, that nobody could know this much and spend so much time on this website and still have time to eat and sleep.

Somehow, you do it and we all continue to benefit from your expertise.

Thank you.

Jerry

I think that my tonsils must just be naturally enlarged then because I've always been able to see them just by opening my mouth and looking in the mirror. My ENT appointment is just two days away so I hope that he can shed some light on what is going on with my neck. I got so frustrated with my GP because he was only lightly feeling my neck to check for the swollen lymph nodes but there's more that I can feel than just that if I press a little harder. And I don't think that it's normal because it is currently only on the right side of my neck. I'm beginning to think I made a really huge mistake- back in like November of last year I was bored and had my head resting on my hands and I could feel this little flappy thing to the right of my windpipe. It was very small, so I ignored it and now that's where one of my lymph nodes are swollen. =(

I have one more quick question and then I'll quit ranting until my ENT appointment tomorrow: If this does happen to be something bad and has spread to the lymph nodes on both sides of my neck, shouldn't I be in some form of pain right now? There are two lymph nodes, one on each side of my neck, that are swollen and hard, and both have been there for over a month now. Is it a good sign that I haven't had any other symptoms at all except for swollen nodes?

In general, painless nodes are a bad sign. Cervical metastasis of oral cancers are a not good, and if you have fixated hard, painless nodes in your neck, I believe that you should ask him to FNB those nodes while you are right there in the office. One of the real dangers of oral cancers in general is that in its early stages it is mostly painless. I was a stage four patient when diagnosed, and I had no oral discomfort though I had a lesion on my right tonsil as big as a nickel. I went to the ENT after a node on my neck became enlarged and was painless and hard. If you have an infection draining into the cervical nodes from a tooth abscess, or an ear infection, those nodes hurt like hell. I could flick mine with my finger and didn't feel a thing. I wish that more doctors would realize that when a patient presents with painless swollen nodes the WRONG thing to do is get out the Rx pad and write a prescription for antibiotics. THE FIRST DIFFERENTIAL DIAGNOSIS FOR AN ENLARGED PAINLESS NECK NODE IS ORAL CANCER. That is what they should be eliminating from their list of possibilities FIRST. Too many people's diagnosis have been unnecessarily delayed while they gave patients antibiotics for a perceived, undetermined source infection. Infections produce painful nodes. Too many doctors who do not do a good job of differential diagnosis, do the lazy easy thing, Write an Rx for antibiotics when they are not even sure what is going on.

For those (like myself) who struggle with medical terms) Here are 2 pertinent definitions:

Differentiation: In cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated tumor cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated or poorly differentiated tumor cells, which lack the structure and function of normal cells and grow uncontrollably.
(source NCI cancer definitions) Bear in mind that the above definition would a resultant part of the differential diagnosis. Even though both of these terms have similar roots, they have very different meanings in a medical context.

Differential Diagnosis: In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patient's symptoms.

Before a medical condition can be treated, it must be identified. The physician begins by observing the patient's symptoms, examining the patient, and often taking the patient's personal and family history. Then the physician lists the most likely causes. The physician asks questions and performs tests to eliminate possibilities until he or she is satisfied that the single most likely cause has been identified.

Once a working diagnosis is reached, the physician prescribes a therapy. If the patient's condition does not improve, the diagnosis must be reassessed.

The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by Emil Kraepelin. It is more systematic than the old-fashioned method of diagnosis by gestalt (impression).

The term differential diagnosis also refers to medical information specially organized to aid in diagnosis, particularly a list of the most common causes of a given symptom, annotated with advice on how to narrow down the list. For example, this differential diagnosis of sclerotic bone lesions lists nine common causes, including infection, trauma, and drugs.

Example
The patient presents with symptoms A and B. The physician creates a list of diseases that include symptoms A and B. There are three diseases that feature both symptoms:

Disease 1: A, B, C
Disease 2: A, B, C, D
Disease 3: A, B, E
The physician can test for the presence of symptom C. This would either support 1 and 2 or support 3. If the client tested positive for C, a test for D could be used to differentiate between disease 1 and 2. If the client tested negative for C, a test for E would confirm the diagnosis of disease 3.

In modern medicine, physicians typically decide to perform tests based on weighing the likelihood of a positive result against the severity of the disease if it were to remain undiagnosed. For example, if an 18 year old with no personal or family history of heart disease complains of chest pain, the physician is much less likely to be concerned that a heart attack occurred than if the patient were 65 years old.

(source Wikipedia)

My ENT did not seem worried at all when I went to the appointment. He said that the enlarged lymph node was only 5 mm and even though it is slightly hard, it's mobile. So he prescribed a 5-day treatment of Ketex because he thinks that perhaps the last antibiotics weren't strong enough or my infection developed a resistance to it. My mother shared with him my fears of oral cancer (and other cancers in general) and he did feel around a lot for other swollen nodes, plus down my throat and everywhere around in my mouth (from what I looked up on the web, I think that was an oral cancer exam). He says he really doesn't think it's cancer, especially since I have acne and that might also be causing the swollen node (for which he prescribed a cream). I also had a 100.4 fever when I went, plus the previous CBCs also indicated an infection. So I do feel a little bit better, but I'll be going back in 2 months and if the nodes are still swollen, then he may request a biopsy (he said at this point it was too small to even get a tissue sample using FNA).

Amanda,
some conditions like peritonsillar abcess (PTA) can take months of antibiotics to cure. It just doen't feel like cancer to me but you are wise to get a definitive diagnosis. Cancer typically will not produce a fever or elevated WBC. The treatment can, but generally not the disease. I had bloodtests done as part of my differential diagnosis and my numbers were perfect. I also had no lymph node involvement at all. 5mm is pretty small, they can't detect regions of interest smaller then 2mm with scanning devices.

Umm, just for my own peace of mind, if this does turn out to be something other than an infection, is a two-month wait going to significantly alter my health?

Oh, and I forgot to mention before, the nurse practitioner that was checking for other swollen nodes said that she did find a bunch of "shotty nodes." Aren't these typically in response to an infection?

I love nurse practioners - they are so much more accessible than doctors but would I trust them over someone with 12 years of formal medical school training - not. But if you have been delegated to an NP then you probably have less to worry about. To answer your other question. Most of us are "followed" on 6-8 week intervals the first year, spacing out in successive years. My head & neck surgeon informs me that 2 months is enough time to deal with any issues, but consider that this time table is for post treatment patients.

With long term antibiotic therapy for a difficult to control infection, it may take 2 months to ascertain whether it's making a difference.

I do have to add a caution here for OTHERS reading this thread that we typically recommend that if you don't respond in 2 weeks to antibiotics then you need to see a specialist like an ENT or a head & neck surgeon (sorry if this is confusing to you Amanda).

That's alright. I did actually see the ENT, but the NP saw me before he did. And the antibiotics he prescribed were only a 5-day supply. So now I'm getting very depressed. It seems like no one will take this seriously because I'm only 19.