Husband getting worse fast. No dx yet, but suspected HL or NHL. 2nd opinion time??

	Asked by cyndi713 (Male ) on Sun 13, Apr 2008 09:54am for $6.00:
	My 31 yo husband has been experiencing night sweats for a year now. They started about once a month for six months. In the past six months they have gotten worse over time exponentially. The more time passes, the faster his symptoms worsen. He is now having severe, debilitating night sweats at least every other night, sometimes 2-3 times per night. Also, he stopped working (due to isthmic spondylolisthesis) in December. Despite his decrease in activities/exercise from working in a factory, his weight dropped to 153 after 2 months although his intake remains the same (he is 5'11" and his avg weight is between 165/175). He is also easily fatigued, which is getting worse as the weeks pass. He takes no medication for anything at all, though for about 3 weeks now I have been giving him one-a-day vitamins and B12 (1000mcg) supplements in an attempt to do SOMETHING for him. Also, he has no history of drug use and only socially drinks a few glasses of wine about every other month or so. He had smoked for about 15 years before quitting about 3 weeks ago when this all came to light. During a c-spine MRI 30 Jan 08, a mass measuring 2.3 x 1.3 cm was found just anterior to the left sternocleidomastoid muscle, while a CT scan done 03 Apr 08 showed a "structure" measuring 8 mm, and just superficial to this region "some soft tissue which is somewhat indeterminate in nature", both at the superolateral aspect of the left submandibular gland. Our follow-up visit to the gen surgeon last week was frustrating. He suggested that since it appeared to have reduced in size, wait 3 months and perform another CT scan. He also called our local small-town cancer specialist who suggested he also perform an ECG to rule out endocarditis (although the CT scan showed all thoracic and abdominal organs as completely normal), and a thyroid function test. He has no other symptoms for these two conditions. Last night when he woke up to use the bathroom, he had three night sweats in rapid succession. He had to crawl back into our room, as he didn't even have the strength to call me loud enough to wake me (my bathroom is only about 15 feet away). When I woke and the hall light was reflecting on him, he was so drenched that it looked like someone basted him in baby oil. I had to sponge him down with a wet wash cloth for about 15 minutes before he could gain the strength to get back into bed. He said the three episodes felt as if he was on fire for about a minute or so, then he was immediately drenched with sweat. He is getting much worse very quickly. Do I wait three months or get a second opinion now?
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	Answer by Dr Paul S, MD (oncologist) on Mon 14, Apr 2008 02:22am: Hi and good day. I'm sorry to hear that your husband is in this condition, and I'll do my best to provide you with insights. From what you have written, there is a big chance that your husband is suffering from a condition called non hodgkins lymphoma (NHL). NHL is a malignancy of a certain type of white blood cell that eventually collects on one's lymph nodes and enlarges to form a tumor. This could be the "structures" and masses that were seen on his scans. Another evidence that this can be NHL is the presence of the striking symptoms of night sweats and weight loss. These are called "B" symptoms of NHL and is a reflection of the aggressiveness or increased activity of the disease. In endemic areas, tuberculosis is a close differential diagnosis, since TB can also mimic symptoms of NHL. However, all we have are constellation of symptoms and we need a definitive proof that this is really lymphoma. This can be accomplished through biopsy (core needle, incisional or excisional biopsy). Fine needle biopsy may not give us an accurate diagnosis since a diagnosis of NHL would require a larger tissue sample. A blood test called LDH will also be elevated in NHL cases. If there is something wrong with his blood counts (low hemoglobin or platelets), then a bone marrow analysis is warranted. I suggest that you discuss with your surgeon regarding biopsy of the more accessible mass and the other tests I have mentioned. Discuss also the risks involved in the biopsy procedure and be sure you understand. Future actions will be dictated by the biopsy results that's why it is so important. Unfortunately, no one will give chemotherapy or any treatment for NHL (or any other malignancy for that matter)without a biopsy result. NHL is a curable malignancy. I hope this information helps and I suggest you act quickly. You can bring him to another doctor if you must. Be strong and willful. God bless. Thank you for using our service.  If you are satisfied with the answer or if you want a detailed answer for your question, please make a donation and request for further clarifications.  Our oncologists will provide an elaborate answer for your clarification.   Please make a donation by clicking the button below. You may donate using funds from your PayPal account or Credit Card. Please rate my answer (select the stars below, no need to log in.)
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	Follow up: Clarification / Comment by cyndi713 on Mon 14, Apr 2008 04:44pm: I apologize for not including this sooner, but he has had the labs done including CMP, CRP, CBC, WBC, ESR, LDH, HIV, and Mono. All came back within normal range. My real question here is what type of doctor should I be calling? Other than HL/NHL and everything else he was tested for (he also does not have GERD), is there anything else that can be causing these severe symptoms? Thank you so much for your time!! Clarification / Comment by Dr Paul S, MD on Mon 14, Apr 2008 06:34pm: I can see that your husband already underwent a battery of tests which were all inconclusive. I believe no single doctor will be able to diagnose his condition. Ask your doctor if they can hold a multi-disciplinary conference and discuss your husband's case as a group. Hospitals usually have these type of conferences where they discuss the complex cases. I still believe that a biopsy can give us some answers. Other diagnosis that I can think of are as follows: 1. Diabetes with neuropathy and autonomic dysfunction 2. Tuberculosis or other mycobacterial infections 3. Connective tissue diseases like lupus or rheumatoid arthritis 4. Anxiety disorders Hope this helps. Keep us posted.
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