I know you're (mostly) not doctors, but . . .

Parent Cafe
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<p>So, I finally saw my doctor today, and it’s definitely a very swollen lymph node. I declined the option to have a biopsy done right away since she said it wasn’t essential, and told her I’d prefer to wait a while. Meanwhile, I need to schedule a mammogram (it’s been a couple of years – I was otherwise occupied last year, medically speaking!), and my doctor also wants me to see a dermatologist on the chance that some skin irritation she noticed on my elbows and upper arms might having something to do with it, and that treating that might make a difference. </p>

<p>If it gets worse, of course, I’m supposed to call her.</p>

<p>By the way, I used to really, really hate those full-body inspections that a lot of dermatologists do the first time you see them, but at least that’s one thing I don’t have to worry about anymore. No more embarrassing explanations required, thank God.</p>

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<p>So, the dermatologist thought that there’s basically zero chance that whatever relatively mild eczema she saw on my arms and elbows has anything to do with the swollen lymph node. Next step, a mammogram. I can’t help feeling anxious whenever I think about what could be causing this, so I do my best to avoid thinking about it. Someone I know (not that well) sent me a lengthy email that apparently contained lots of details about her experience with lymphoma, which started with a swollen lymph node under one arm just like mine. Fortunately, she’s been OK for 10 years. But I confess that I stopped reading after the first sentence; I just couldn’t deal with it, and there’s really no reason I should have to at this point. All reading it would accomplish is increase my anxiety. Kind of like looking things up on Google! I can’t even figure out why she thought I’d want to read it.</p>

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<p>My D & S have a lot of intermittent problems with swollen lymphn nodes over the past ten years. I’d not worry if I were you–it is NOT uncommon for folks to have these symptoms occur from time to time. My kids have pretty sensitive systems and generally when their lymph nodes get swollen, they’re getting a bit run down and take that as a hint to slow down and take it easy. </p>

<p>Please don’t work yourself up and take the mammogram to reassure yourself that all is well. My kiddos have not had any biopsies of their lymph nodes to date.</p>

<p>Sorry, you received unsolicitted too much detail about an irrelevant medical condition that is NOT something you needed to read about or deal with. Please let it go as bad spam. She probably feels the need to broadcast her great knowledge for whatever reason. Just consider it another bad infomorcial, direct to your email box!</p>

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<p>Because she’s worried about you and wants you to look into it right away, even if it doesn’t feel good to think about it? </p>

<p>You know, IF it were something serious, the most rational thing is to respond quickly. Get the biospy! </p>

<p>Plus the stress, however you bury it, is going to eat at you and the sooner you put your mind at ease the better you will feel (and it will put your mind at ease- I’ve had more than my share of similar stuff, including swollen lymph node and numerous ‘growths’, and all turned out nothing to worry about). But boy was I on cloud nine after the results were in. </p>

<p>Please keep us posted!</p>

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<p>I am suprised that someone would say something like that especially someone who has already had cancer and how much fear that inspires. I am a breast cancer survivor and you dont know the countless stories that have ended with the demise of said person and you just want to scream.
donna it is good to be aware and check out the lump, but try to keep it there one step at a time. many times these things are some quirky benign condition. You have been through a lot with some major complications so it is hard not to worry. let us know how you are.</p>

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<p>Ugh!!! Someone suggested lymphoma?? No need to put the cart before the horse, particularly when you don’t know whether there IS a cart OR a horse. Goodness.</p>

<p>One thing at a time…!</p>

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<p>After your mammogram I’d go ahead and schedule that biopsy. Chances are that it’s nothing, but at least then you’ll know for sure. And if it’s not nothing, you can get started treating it. But otherwise you’ll just drive yourself nuts wondering, “What if?”</p>

<p>My D had a mysterious lump just under her skin about the size of a pea on her side near her ribs when she was around 8. It didn’t go away so we went to the doctor, they figured it was a lymph note that had snared an infection from a small cut she’d had. It went away on its own in a few weeks.</p>

<p>OTOH, my FIL had lymphoma, they found it when he had an MRI for a potentially torn rotator cuff. The MRI showed the mass under the armpit, although he didn’t feel it. Once they found it, he realized he had been feeling kind of “run down” for several months, felt like he’d had a series of mild viruses that he just couldn’t shake. His lymphoma is one of the more common ones, and its 80% curable (or at least non-recurring after treatment). He went thru treatments 3 years ago and it hasn’t come back yet. MY POINT IS: If you’re not having any other symptoms (mild fevers, night sweats, general malaise) it’s probably something much more harmless.</p>

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<p>aibarr - I think it was “lipoma”, not “lymphoma” that was mentioned here by someone.</p>

<p>Donna, make sure that you schedule your mammogram early in the day, so the radiologist can review the “pictures” on the spot and perform an ultrasound exam during the same appointment, if needed. Otherwise, if you leave the office before knowing the results of your mammo, you might get a form letter in the mail asking you to schedule a followup appointment to examine “an anomaly”. The pain of waiting for this next appointment can be debilitating, even though they tell you that chances of you having something malignant are below slim. Hang in there! I’m keeping fingers crossed for you.</p>

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<p>I’ll just throw in that even if something does show up on the mammogram that needs to be biopsied, the chances are very high (~80%) that it will be benign. </p>

<p>I agree with others’ advice to schedule the biopsy of the underarm lump after you have the mammogram. There is no point in continuing to worry if the lump is harmless, and if it is something serious, treatment should be started as soon as possible.</p>

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<p>Donna - you need to see a general surgeon to evaluate this lump ASAP. I would not wait for a mammogram and I would not waste any more time with a primary care doc.</p>

<p>A negative mammogram is meaningless as mammograms aren’t 100% sensitive for breast cancer. And the specificity of a mammogram is even worse. </p>

<p>It has been there for over 2 weeks now and hasn’t gotten smaller, correct? Get thee to a general surgeon without delay.</p>

<p>Have you been biten or scratched by a cat on your arm by any chance? Cat scratch disease is a real illness and can be the cause of a painful swollen axillary mass but lots of docs fail to think of it because it is uncommon.</p>

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<p>I thought that it made sense to do the mammogram first because if something else is found that needs to be biopsied, the two sites could be biopsied at the same time. It shouldn’t take long to get a mammogram scheduled.</p>

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<p>“I thought that it made sense to do the mammogram first because if something else is found that needs to be biopsied, the two sites could be biopsied at the same time.”</p>

<p>First, the OP has concluded this is a lymph node and it could be but there is breast tissue in the axilla, so until some imaging is done or she is seen by a general surgeon, I would call this a solitary axillary mass. </p>

<p>Second, a solitary axillary mass doesn’t have to be excised to be biopsied and a fine needle aspirate can be done right in a surgeon’s office. But before a biopsy of any kind is done, I would think an ultrasound would be done to determine if the mass is cystic or solid. So step one here is an ultrasound of the axillary mass and step two is fine needle aspirate of the mass if the ultrasound indicates one is needed. A negative fine needle aspirate is non-diagnostic, though, so further tissue biopsies could be warranted if the FNA came back negative. </p>

<p>The axilla is filled with nerves that control your arm/hand and major blood vessels so operating there, even to do an excisional biopsy, is a big deal - a much bigger deal than an excisional breast biopsy. You would stick a needle in the mass first to see if anything comes back from cytology before you would take someone to the OR for an excisional biopsy of an axillary mass. I am not even sure if an excisional biopsy would be done if the FNA came back non-diagnostic. Perhaps an ultrasound guided core needle biopsy would be done in that case. </p>

<p>She should still schedule the mammogram and get it of course because even if an FNA is done the surgeon will still want the mammogram. However, if she does go to a general surgeon and he/she thinks this is an infectious process, she may not even need an FNA. But, if the primary care doc and the derm thought this mass were due to a bacterial infection, why weren’t any antibiotics prescribed? Maybe they were and she didn’t tell us that.</p>

<p>Bottom line - general surgeons are the experts in managing axillary masses so I would go directly to a general surgeon at this point particularly since she has been to her primary care doc and a derm and neither one ordered an ultrasound of the mass or prescribed antibiotics. I am not saying a mammogram is not needed, too, it is but an U/S should be done on the axillary mass, too unless someone has good reason to think this is infectious. And if they do think it is infectious, why are they ordering mammograms and not prescribing antibiotics? </p>

<p>Let the general surgeon evaluate the axillary mass - that is their area of expertise.</p>

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<p>Thanks so much, everyone.</p>

<p>Atacom, my doctor didn’t say that she thought the reason for the swollen lymph node is an infection; she said only that an infection is one possible cause for something like this.</p>

<p>I have a mammogram scheduled for this Saturday, the earliest appointment I could get. </p>

<p>This is probably a dumb question, but even though I started having mammograms when I was 50, and have had several in the five years since then, I simply don’t remember if my armpit has been part of the imaging that’s done. Although, whether or not it’s been part of it in the past, I assume it will be this time, since my doctor mentions the issue on the mammogram prescription.</p>

<p>After that’s done, I’m kind of confused about what happens next given the different advice people have been giving, and the intermediate steps that Atacom just mentioned, none of which I know anything about. I tried leaving a message for my doctor (before reading Atacom’s last post) to tell her I’d like to get at least a referral for a biopsy before I even receive the mammogram results, so I can get a headstart on scheduling something, because I’m simply too anxious to wait around indefinitely just to see if it gets better (assuming the mammogram doesn’t show anything). But she’s away on vacation right now, until sometime next week. I spoke to someone in referrals and asked if a doctor covering for her could get in touch with me to talk about the situation, so maybe I’ll hear from someone later. If not, I suppose it can wait until my doctor is back, even though I admit that it would make me feel better to talk to someone this week. I had no idea that a biopsy in that location is such a big deal; I’ve had biopsies in a number of locations in the past (most recently a vaginal biopsy last year), and they were all pretty much nothing.</p>

<p>One thing I have to decide is whether to say anything at all about any of this to my son, once he gets home from Vienna on Sunday, before all the tests are done and I know exactly what the story is. My instinct is to protect him from worry and not to say anything. Which would be easy enough to do if he were still going to be away for a while, but he’ll be home for almost a month, until after the New Year. I’m not always so great at hiding anxiety in person. And we do have a close relationship, and are pretty good at sensing each other’s emotional state. If he asks me if anything’s wrong, I’ll be reluctant to lie. Although even if I did say anything, I would be as reassuring as possible that there’s really only a very small chance that anything is seriously wrong.</p>

<p>When I was in my last year of college (I was 20, the same age that J. is now), my mother had to have a breast biopsy, and didn’t say anything to me until after she got the results. I remember being somewhat upset that she hadn’t told me so that I could have tried to be supportive, but I did understand that she wanted to protect me. (Fortunately, the results were negative, although she was dead within a few months anyway because of the car accident we were in.)</p>

<p>So, I’m curious as to what other parents would do in my position.</p>

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<p>I don’t keep any medical issues from my kids so as to protect them, and want open communication so they can learn from what I may be going through…</p>

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<p>I guess I should add that my instinct to protect him from worrying about me unnecessarily is especially strong given what he went through during the summer of last year when I was so sick in that hospital up in Montreal and he was pretty close to convinced that I was going to die. (As some of you may recall.) I’ll never forget how frightened he was.</p>

<p>Then again, I don’t want to lie to him, at least not directly.</p>

<p>PS: OK, I think I understand a little better now what Atacom was saying; I didn’t realize that there’s more than one kind of lymph node biopsy and that they aren’t all such a big deal. I think. (I said I was a little confused!) <a href=“http://www.webmd.com/cancer/lymph-node-biopsy[/url]”>What Are Lymph Node Biopsies?;

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<p>Donna, Given that your son is going to be with you, and he is sensitive to your moods, I don’t think there’s much hope of hiding this from him. If you don’t tell him what is going on, he will be uneasy and imagining much worse situation. Let’s hope that you can get this resolved quickly!</p>

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<p>I agree with the above–I don’t try to hide things from my kiddos. I tell them the truth as best I know it & reassure them that the docs have all been pretty reassuring that it’s not a big issue.</p>

<p>Kids generally worry MUCH more when they sense we’re hiding or trying to protect them from something. When I was diagnosed with a very significant health problem, my folks tried to “help” by telling my kids that I was very ill & might die soon (mom was very worried & serious–fortunately she was very wrong). Even more fortunately, my kids didn’t believe them because I appeared so healthy and they were correct. They knew I’d tell them if there was something to worry about, but I regret not trying to tell them & my folks more so there wouldn’t be the tension of her telling them something that didn’t jive with what they intuitively sensed.</p>

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<p>“This is probably a dumb question, but even though I started having mammograms when I was 50, and have had several in the five years since then, I simply don’t remember if my armpit has been part of the imaging that’s done. Although, whether or not it’s been part of it in the past, I assume it will be this time, since my doctor mentions the issue on the mammogram prescription.”</p>

<p>It is not a dumb question. The typical screening mammogram (meaning one that is ordered as routine screening, not because of any symptoms or lumps) uses 2 views - cranio-caudal and mediolateral oblique. The latter images the axillary portion of the breast (which is called the tail of spence).</p>

<p>Now if there is something felt in the axilla, you are performing a diagnostic mammogram and you can order an additional view, called an axillary view, to get a better image of the tail of spence.</p>

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<p>“I had no idea that a biopsy in that location is such a big deal”</p>

<p>Just to be clear, it is the EXCISIONAL biopsy that is a big deal. That is when the lymph node or mass is removed in its entirety and sent off for pathological examination. As I said before, I don’t even know if something like that would be done.</p>

<p>Other types of biopsies are available that are not as invasive as an excisional biopsy - a fine needle aspirate (FNA), which does not obtain tissue for the pathologist, just cells and has limitations. And a core needle biopsy, which obtains a plug of tissue for the pathologist to examine.</p>

<p>Of course whether or not a biopsy is even needed is up to the general surgeon. He/she may think no biopsy is necessary, but a general surgeon should be consulted to evaluate your axilla and decided what is needed.</p>

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<p>Donna - the reason I think you should get in to see a general surgeon is because of the following statements you made:</p>

<p>“I’m embarrassed to say how long ago I first noticed it, but let’s just say it’s been a while. There have been periods of time when it seemed to disappear (which I take as a positive sign, obviously), but then it returns.”</p>

<p>Whether or not it truly disappeared and then came back, I don’t know and I am worried that your fears allowed you to convince yourself that the lump went away when it didn’t and so has been there for longer than the 2 weeks you have been posting about it.</p>

<p>“So, I finally saw my doctor today, and it’s definitely a very swollen lymph node. I declined the option to have a biopsy done right away since she said it wasn’t essential, and told her I’d prefer to wait a while.”</p>

<p>This statement, too. It sounds like a biopsy right away was offered and you declined presumably because the primary care doctor said it wasn’t essential (then why was it offered?). I would let a general surgeon decide whether or not a biopsy is necessary.</p>