Dr. Gott: Neck and node pain, swelling not normal aches

DEAR DR. GOTT: In September 2009, the right side of my neck above the collarbone started to swell. By December, the area from beneath my right ear to my collarbone and into my armpit was swollen. It wasn't painful. It was, as the physician's assistant put it, a diffuse/overall swelling. The lymph nodes were not swollen. A neck CT scan showed a slight ear infection but no problem with the nodes.

The swelling is not edema because it is "more spongy" (per the doctor). When pressed, it does leave an indentation. I also have a tender spot just to the left of the center of my throat on the outside of my neck, near the base. I also have a symptom that comes and goes - a spot in my throat that feels dry and seems as if it is clinging to the tissue around it. My doctor told me that it is scar tissue from having my tonsils out years ago.

He hasn't been able to give me an explanation of what is going on, and after he ran several blood tests, he told me not to worry about it. Now I have several lymph nodes in both armpits and one on the right side of my groin that are painful.

I have to sleep on two pillows now because if I don't, I wake up with a lot of chest pressure and can only describe it as having an elephant on my chest. It takes more effort to breathe during the day if I sleep with only one pillow.

Do you have any thoughts on this? Are there any additional tests that could be done? My doctor says not to worry, but this is not normal for me. I am 50 years old, and this is the first time I have had any symptoms like this.

DEAR READER: I urge you to return to your doctor with your new symptoms. He can then order repeat or more extensive blood work and perhaps a chest X-ray, CT scan or MRI of your neck and chest. If he cannot or will not help you get to the root of your symptoms, request a referral to a specialist. You should start with an otolaryngologist (ear-nose-and-throat specialist) since your throat and neck appear to be where your symptoms first started. He or she can then refer you to other specialists, such as a pulmonologist, if appropriate. You may also want to find another primary care physician such as a general practitioner or an internist.

Painful, swollen glands, especially those associated with neck swelling and chest pressure, are not normal. There are many causes, the most common of which are infections. Mononucleosis, strep throat, ear infections and tooth abscesses are the most likely candidates. Certain STDs (sexually transmitted diseases), tuberculosis (TB), cat scratch fever and toxoplasmosis are possible uncommon causes. Lupus, rheumatoid arthritis (RA), lymphoma, leukemia or any cancer that has spread to the lymph nodes may also be the culprit, but these are, again, uncommon causes. Rarely, certain medications can cause swollen, painful nodes.

You need to undergo further examination and testing. The sooner the cause is found, the sooner you can get appropriate treatment and start back on the road to a normal, healthful life.