I went to see an ENT doctor today (Dr. S - named one of NY Magazine's best doctors) to check out my salivary glands and ask him about the pressure and discomfort I've been having the last couple of weeks. After getting my history, he felt around my face, cheeks, mouth and behind my ears and he didn't see or feel anything abnormal.
He said that I am still well within the normal timeline after RAI to be getting the salivary gland discomfort I am currently having and that there is probably nothing to worry about right now. He said that it could take as long as 6 months to subside (pressure and dryness). He said that the most important thing, over the next few months, is to stay hydrated as much as possible and keep the saliva flowing through my glands either using gum, sucking candies, etc. If you mouth and glands get too dry, than the saliva can get thick ("sludge") and clog up the tiny ducts in the salivary glands. Dr. S said that that was probably the "bump" I was feeling behind my ear - a clogged duct with thick saliva. The ducts behind the ear are the most like to get clogged after a couple of months since they are the farthest from the main saliva duct in the cheek. When I asked about the possibility of having a stone, he said that it is unlikely and that he didn't feel anything abnormal. Also, most stones that occur are in the lower part of the cheek and not behind/below the ear where I thought I felt one.
This was good news for me and I was happy to hear that what I am experiencing is well within the norm. He was a great doctor and I would definitely go to him again.
Tuesday, August 26, 2008
Monday, August 25, 2008
Follow Up Blood Test at Hematologist
Went for my second follow up blood test today at the hematologist's office and my white blood cell count crept up a little bit more, going from 3.3 last week to 3.6 this week (the low end of normal is 4.2). At this point the weekly increments are not as important to me - I'm just excited that the readings keep going in an upward direction. My platelets still look low. If my hematologist doesn't mention anything, I will say something about it after my blood test next week.
I made a follow up blood test appointment for next week - 9/3/08 at 12:30PM.
My pain/pressue on my left side was pretty minimal today. It is still a little difficult to eat drier foods due to less saliva (it is harder to chew the food) and I notice that my mouth gets pretty dry on runs. I will mention these when I go to the ENT doctor tomorrow.
I made a follow up blood test appointment for next week - 9/3/08 at 12:30PM.
My pain/pressue on my left side was pretty minimal today. It is still a little difficult to eat drier foods due to less saliva (it is harder to chew the food) and I notice that my mouth gets pretty dry on runs. I will mention these when I go to the ENT doctor tomorrow.
Sunday, August 24, 2008
Pain Fluctuation
It seems as if the intense pressure and pain of the left side of my face/jaw seems to fluctuate day by day. Yesterday, I was able to eat normally all day long with no pressure, on only minimal pain. While this morning, after my first bite of food, the pain and pressure was back again.
Do something trigger the pressure and/or blockage in the gland? What can I do to prevent it or lessen it?
I will ask the doctor these questions on Tuesday.
Do something trigger the pressure and/or blockage in the gland? What can I do to prevent it or lessen it?
I will ask the doctor these questions on Tuesday.
Friday, August 22, 2008
Made an appointment with an ENT
The pain keeps persisting and I want to get this checked out. I made an appointment with an ENT doctor on Tuesday 8/26 at 1:30PM.
Thursday, August 21, 2008
More Localized Salivary Pain
While the pain and discomfort I had in the past regarding my salivary glands was more general, dull, and covering a larger area of my cheeks and face, now seems to becoming more localized on both sides of my face, especially on the left side. It is at the top of my jawline, directly below my ear. When I massage the area, I can feel a slight bump that doesn't seem to be on the right side of my face. The pain, swelling and discomfort is at its worst during and after eating. I am wondering if a salivary stone has developed. Salivary stones are more common in the submandibular salivary duct, which is exactly where my "bump" seems to be. I have been reading a bunch of thyroid and salivary websites and the more I read them, the more they sound like what I might be experiencing. If this persists for a few more days, I will probably make an appointment with an ENT doctor and get it checked out. Below are a couple blogs/websites I found on this topic:
http://www.steadyhealth.com/Constant_Swollen_Salivary_gland_t86629_st10.html
http://www.privatehealth.co.uk/diseases/ear-nose-throat/salivary-gland-stones/
WIKIPEDIA:
Sialolithiasis refers to the formation of stones in the salivary glands. Stones are most commonly found in the submandibular gland, where stones can obstruct Wharton's duct. It is frequently associated with chronic infection (Staphylococcus aureus, Steptococcus viridans) of the glands, dehydration (phenothiazines), and/or increased local levels of Calcium, but in many cases can arise idiopathically. Pain, when present, usually originates from the floor of the mouth, although in many cases the stones cause only intermittent swelling.
Since mastication (chewing) promotes release of saliva, symptoms tend to increase during meals. A palpable lump or visible swelling in the area of the gland is often noted. Complications include persistent obstruction of the duct, leading to bacterial invasion, overgrowth and infection (sialoadenitis). This can require IV antibiotics such as Nafcillin, and sometimes surgical drainage.
Diagnosis: Usually by characteristic history and physical examination
Treatment: hydration, moist heat, NSAIDs occasionally. Sucking on something sour, such as a lemon, may increase salivation and promote spontaneous expulsion of the stone. Either an ENT or Maxillofacial surgeon may canulate the duct to remove the stone if symptoms persist
Below is an excerpt from a thyroid blogger that seems to explain my feelings pretty well at the moment:
"This just started happening to me. I get it on my right side on the top of the jaw line and just below the ear. It swells up and if I touch even slightly, it feels like it is going to pop. I do notice that if I put a cool, damp wash cloth on it, it helps relieve the pain and pressure. I really do hope they find out hwat this is, because I most certainly don't want to live with this forever. It can't be safe. If anyone who is reading his knows ANYTHING about this, I encourage you to please reply, it could really help"
"I have the same swelling...everyone here seems to have swelling of the submandibular gland or the partoid gland...these are both salivary glands. We have stones, just like kidney stones. They are either in the glands or in the duct (usually they are in the ducts). The glands are in front of our ears (partoid) or beneath our chin(submandibular). They swell with blockage. Partoid stones are worse. There are other glands, but these are the most common affected. The stones block the salva that forms in the glands and does not allow the salva to pass throught the duct to the opening in the mouth. The stones sometimes come out on their own if you suck on sour candy and press on the swollen gland, ENT doctors can take them out via the inside of the mouth if they are close to the opening....otherwise we must undergo a "big" (ENT doc's word, not mine) surgery to cut the neck and take out the gland and duct. This leaves an ugy scar and can result in facial nerve damage. Not good options....lithotripsy is not available in the U.S., but used in other countries to break up the stones. The bad news is that the stones have to come out....they grow in size and will result in infection and ultimate surgery with more complications. I am researching alternatives, but not too much has been found. By the way, a CAT scan shows the location and size of the stones. In a few cases, the stones are opaque and do not show up. In rare cases, these are tumors in us. "
http://www.steadyhealth.com/Constant_Swollen_Salivary_gland_t86629_st10.html
http://www.privatehealth.co.uk/diseases/ear-nose-throat/salivary-gland-stones/
WIKIPEDIA:
Sialolithiasis refers to the formation of stones in the salivary glands. Stones are most commonly found in the submandibular gland, where stones can obstruct Wharton's duct. It is frequently associated with chronic infection (Staphylococcus aureus, Steptococcus viridans) of the glands, dehydration (phenothiazines), and/or increased local levels of Calcium, but in many cases can arise idiopathically. Pain, when present, usually originates from the floor of the mouth, although in many cases the stones cause only intermittent swelling.
Since mastication (chewing) promotes release of saliva, symptoms tend to increase during meals. A palpable lump or visible swelling in the area of the gland is often noted. Complications include persistent obstruction of the duct, leading to bacterial invasion, overgrowth and infection (sialoadenitis). This can require IV antibiotics such as Nafcillin, and sometimes surgical drainage.
Diagnosis: Usually by characteristic history and physical examination
Treatment: hydration, moist heat, NSAIDs occasionally. Sucking on something sour, such as a lemon, may increase salivation and promote spontaneous expulsion of the stone. Either an ENT or Maxillofacial surgeon may canulate the duct to remove the stone if symptoms persist
Below is an excerpt from a thyroid blogger that seems to explain my feelings pretty well at the moment:
"This just started happening to me. I get it on my right side on the top of the jaw line and just below the ear. It swells up and if I touch even slightly, it feels like it is going to pop. I do notice that if I put a cool, damp wash cloth on it, it helps relieve the pain and pressure. I really do hope they find out hwat this is, because I most certainly don't want to live with this forever. It can't be safe. If anyone who is reading his knows ANYTHING about this, I encourage you to please reply, it could really help"
"I have the same swelling...everyone here seems to have swelling of the submandibular gland or the partoid gland...these are both salivary glands. We have stones, just like kidney stones. They are either in the glands or in the duct (usually they are in the ducts). The glands are in front of our ears (partoid) or beneath our chin(submandibular). They swell with blockage. Partoid stones are worse. There are other glands, but these are the most common affected. The stones block the salva that forms in the glands and does not allow the salva to pass throught the duct to the opening in the mouth. The stones sometimes come out on their own if you suck on sour candy and press on the swollen gland, ENT doctors can take them out via the inside of the mouth if they are close to the opening....otherwise we must undergo a "big" (ENT doc's word, not mine) surgery to cut the neck and take out the gland and duct. This leaves an ugy scar and can result in facial nerve damage. Not good options....lithotripsy is not available in the U.S., but used in other countries to break up the stones. The bad news is that the stones have to come out....they grow in size and will result in infection and ultimate surgery with more complications. I am researching alternatives, but not too much has been found. By the way, a CAT scan shows the location and size of the stones. In a few cases, the stones are opaque and do not show up. In rare cases, these are tumors in us. "
Tuesday, August 19, 2008
Parotid/Salivary Gland Pain
After several days/couple weeks with minimal or no pain in my salivary/parotid glands, today brought painful swelling and blockage in the exact same place on both sides of my face. The discomfort is usually next to my ear, and directly below my ear along the top of my jawline. I am able to produce saliva, but if I eat dry foods that pack easily in my mouth, my glands became very sore and painful. I have to pause while eating due to the pain. I have to vigorously massage the glands for a few minute before the tightness goes away and the pain takes longer to subside. This does not happen all of the time, but every few weeks it seems like the pain comes back. I am starting to eat sour candies more to see if that helps. The massage helps to lessen the discomfort once it appears but I am hoping to figure out if there is any way to prevent it. I've been reading many thyroid cancer blogs and the salivary gland blockage and pain seems common, even weeks/months after RAI. While some people have gone to an ENT, it doesn't seem like there is too much you can do. There seems to be surgery available to relieve the blockage but I am not looking to do that. If this discomfort continues, I will mention it to my endo and get her recommendation as to what to do - or I will got to an ENT on my own and get it checked out myself.
Monday, August 18, 2008
White Blood Cell - Test Results
I heard from my hematologist's office this afternoon and got some good news. My white blood cell count is going in the right direction. My total white blood cell count went from 1.8 last week (normal is in the low 4s - I believe 4.2) to 3.3 this week. Although I am not in the normal range yet, I am pretty close. Hopefully, this means that the low count was merely due to a side effect of the radiation.
My neutrophil count went up as well. The normal range begins at 1.8, and my count went from 1.1 last week to 1.9.
I scheduled another blood test for Monday 8/25 at 12:30. If this test is normal, than I probably won't have to go for any additional blood tests.
My neutrophil count went up as well. The normal range begins at 1.8, and my count went from 1.1 last week to 1.9.
I scheduled another blood test for Monday 8/25 at 12:30. If this test is normal, than I probably won't have to go for any additional blood tests.
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