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This question was answered on Fri 19, Jun 2009 08:05am by Dr. Monica, MD

High lymph count with flu symptoms and swollen lymph nodes, possible lymphoma or leukemia or normal?


    
Asked by aprilg (Female; 29; Postural Orthostatic Tachycardia Syndrome, fibromyalgia ; Relevant drugs:ambiem, protonix, just started fludrocortisone ) on Thu 18, Jun 2009 01:18pm
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In July 2008 I found a lump left side of chest between the collar bone and breast. I was sent for to breast ultrasound which both came back with the same result that the lump couldn’t be determined because it was not the breast area. Soon after my message therapist found a lump back of my neck left side I went to the doctors who said if it doesn’t hurt then don’t worry. I am on the hunt for a family doctor that can track my health. Because we are military I never see the same provider in doing so I requested all my records and noticed that my RBC is elevated but my lymph count is high. On an average my blood is drawn every 3-6 months and has increased each time. My white blood count is normal though. I do have flu symptoms, weakness, a couple night sweats, I have a constant sore and horse sore throat all this is new for past two months. Overall my health has seriously declined since April. 3 weeks ago I was diagnosed with Postural Orthostatic Tachycardia Syndrome because my blood pressure drops and my heart rate spikes so severely when I stand but the cause of the sudden change is un known. I have also been told I have fibromyalgia but am seeing a rheumatologist for the first time the 29th to see if that’s true. I need to know if any of this sounds like cancer or enough to worry about to pursue getting the answers. Is it possible to have cancer without having a high white blood count and if so what type? Here are some of my blood results. In know I have not had an infection for over a year and my TSH is prefect Feb 08 RDW 15. (11.5-14.5), Lymph 49.4 (14.5-47.7), WBC 7.6 (3.4-10.2) July 08 RBC 5.93 (4.1-5.8), wbc 9.5 (3.4-10.2), RDW 14.8 (11.5-14.5), Lymph 4.3 (0.9-2.9) bun/cr 23(6-20) Oct 08 RBC 5.1 (4.0-5.2), wbc 8.0 (3.5-10.6), lymph 48.4 (22.0-44.0) lymph absolute 3.9(1.1-3.4) Jan 09 RBC 5.8 (4.1-5.8) WBC 7.8 (3.4-10.2) RDW 14.6 (11.5-14.5) lymph 3.4 (0.9-2.9),Bun/cr 23 (6-20) May 09 5.24 (4.0-5.20), WBC 7.0 (3.5-10.6), Lymph 48.1 (22.0-44.0) RDW normal, bun normal
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Answer by Dr. Monica, MD  on Fri 19, Jun 2009 08:05am:

Hi, Your symptoms need further investigation. You need to see an internist for a thorough physical examination and additional diagnostic workup. For the chest and neck lump an FNAC or a biopsy may be helpful for the diagnosis. Since your WBC counts are normal, the possibility of leukemia is unlikely. Lymphomas can present with fever, night sweats, loss of weight, enlarged lymph nodes etc, besides other symptoms. Further diagnostic evaluation would probably include FNAC/biopsy of the lump/s, chest x-ray, CT scans of chest & abdomen, bone marrow biopsy etc. A recent sudden onset of postural hypotension and tachycardia needs to be evaluated further to ascertain the cause. An EKG would be helpful and you may want to consult a cardiologist. On what basis have you been told that you are likely to have fibromyalgia? This condition is characterised by generalized pain in muscles and bones including a painful response to gentle touch. Other symptoms include severe fatigue, sleep disturbances etc. However there are no clear diagnostic criteria and other diseases which could be causing the symptoms have to be ruled out before the condition is labelled as Fibromyalgia. All the Best and God Bless!

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Comment by aprilg on Fri 19, Jun 2009 08:47am: I have seen a cardiologist, that is who diagnosed the POTS condition. I had a stress test, EKG, 24 hr halter and a tilt table. The tilt table and halter gave him the POTS diagnose but it happened fast one day my heart rate and blood pressure was ok and the next it wasn’t. The fibromyalgia was diagnosed because I have a sleeping disorder, where I get stuck in stage 2 and I have very bad pain in my muscles, some in the joints. It does not hurt to touch though. I feel strongly that I do not have fibromyalgia, that I was stuck with that label and now do not get the care I need. Every visit and every symptom is blown off as fibromyalgia. Yesterday I left off also the fact that my body itches to the point I am breaking the skin open at night without realizing it with no visible rash and another weird symptom I am noticing is that I seem lately to have a constant feeling like I have goose bumps in the back of my head, not sure if that means anything or not. I just haven’t experienced that till a couple weeks ago. Could this be related to anything?
Comment by Dr. Monica, MD on Fri 19, Jun 2009 12:26pm: Hi, When did the pain in your muscles and joints start? Since when do you have this sleeping disorder? Was it the same time as the other symptoms in April? It may be a good idea to consult an internist/oncologist since itching may also be associated with lymphoma. A biopsy from the chest/neck lump may be warranted at this point. Goose bumps may be related to the hypotension or may be a non speciic symptom. All the best!
Comment by aprilg on Fri 19, Jun 2009 12:48pm: The muscle and joint pain has been going on for 2 years but was more mild till the past 6 months and the sleeping disorder has been since 2003. I had a EEG that showed that. You have been awsome at answering my questions. Thank you
Comment by aprilg on Fri 19, Jun 2009 01:09pm: I have one more question. I had Epstein Barr in 2004 and had a stomach biopsy October 2008 where they found h-pylori along with wheat sensitivity (not celiac).
Comment by aprilg on Fri 19, Jun 2009 02:09pm: is it true that those two increase your chances of having lymphoma?
Comment by Dr. Monica, MD on Sat 20, Jun 2009 04:18am: Hi, Thank you for your feedback. Probably the combination of a sleep disorder and musculoskeletal pains has led to the diagnosis of Fibromyalgia in your case. The sleep disorder appears to have started much earlier that the pains. It is difficult to say if they may be related to Fibromyalgia. Other causes of musculoskeletal pain like inflammatory arthritis and autoimmune diseases need to be ruled out. Since you have an appointment with the rheumatologist in a few days, you can discuss this with him/her. Epstein-Barr Virus infections are associated with an increased risk of lymphomas. H. Pylori infections are associated with an increased incidence of stomach lymphomas. Have you received treatment for the H. Pylori? Wheat/Gluten sensitivity is an autoimmune condition where the person is intolerant to wheat, rye, barley, oats etc. Have you eliminated these from your diet? Some of the symptoms of wheat intolerance include bloating, diarrhea, skin rashes, itching, fatigue, joint pains, general feeling of being unwell, depression, headache, insomnia etc. Some of your symptoms might be explained by the wheat intolerance too. All the best!
Comment by aprilg on Sat 20, Jun 2009 09:54am: I was treated for H-Pylori in October with some serious antibiotics. It was a pack that I took twice a day for a few weeks. I will be re tested one year from being treated for it. I also follow a strict gluten free diet and have since october 2008. I buy all my bread and pasta from a local gluten free bakery but mostly eat only fresh meat and veggies and never eat boxed or frozen meals unless they are gluten free. Do you think the wheat allergy could cause the two lumps? Thank you again.
Comment by Dr. Monica, MD on Sun 21, Jun 2009 12:27am: Hi, The lumps need to be investigated with an FNAC or a biopsy before any conclusions can be made regarding their nature. Are the lumps increasing in size or have they remained the same since that last one year? Your symptoms have not abated even after you started a gluten free diet so probably other causes need to be considered. All the best!

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