I have flu-like symptoms, but all my lab tests are normal. Why?

Hi,

Welcome to icliniq.com.

I had a detailed look at the USG (ultrasonography) scan report you sent (attachments removed to protect the patient's identity). There is absolutely nothing that you need to worry about. The symptoms you are facing are mainly due to inflammation in the submandibular glands on both sides. Whitecoat over the tongue with or without ulcers can again be due to nutritional deficiency or sometimes what we call geographical tongue and usually disappears on its own without any issues. I suggest you follow the treatment given below:

1) Tablet Clindamycin 600 mg, one tablet in the morning and evening after food for one week.

2) Tablet Pan-D (Pantoprazole sodium and Domperidone), one tablet in the morning 30 minutes before food for the next ten days.

3) Tablet Absolute 3G (Omega-3 fatty acids) one tablet in the evening after food for one month.

4) Saltwater gargling eight to ten times a day for one month.

5) Avoid consumption of oily, spicy, sour, and cold food or beverage items. Maintain a healthy diet.

6) Tess ointment (Triamcinolone) to be applied over the tongue and kept for ten minutes before and after food.

7) Maxtra gargles (Benzydamine) without diluting (you can use 5 ml), to be done at least five to six times a day. The swelling might take around four to six weeks for it to subside. There is absolutely nothing that you need to worry about.

I hope this was helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

As mentioned earlier, the problem that you facing is due to acid reflux and this requires long-term precautionary measures to be followed as medications have very little or no role to play. Please do not keep getting your viral markers done as this has nothing to do with EBV (Epstein Barr virus), HIV (human immunodeficiency virus), or HCV (Hepatitis C virus), etc. All that you need to do is strictly follow all the instructions given earlier, failing which there will be no improvement to any extent. As previously mentioned using long-term PPI (proton pump inhibitors) and multivitamins will only reduce the problem to a very small extent. I would also want you to undergo an upper GI (gastrointestinal) endoscopy to get an H.pylori (Helicobacter pylori) infection ruled out as that also could be one possibility for the long-term problem that you facing. Do let us know regarding the reports, we will get back to you as soon as possible.

Thank you.

Hello,

Welcome back to icliniq.com.

Thanks for reverting back. The picture (attachment removed to protect the patient's identity) you have sent is inadequate to diagnose oral thrush. Oral thrush involves your oropharynx, the details of which are unavailable in the picture you have sent. However, the picture you have sent looks absolutely normal. Do let us know regarding any further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

Thank you for reverting back to us. I have a detailed picture (attachment removed to protect the patient's identity) that you have sent. I do not see any feature of oral thrush in the picture you have sent. There is absolutely nothing that you need to worry about. Submental and submandibular lymph nodes can minorly increase in size but do not necessarily indicate sexually transmitted disease. Even other inflammatory conditions as simple as nutritional deficiencies or minor ulcerations can create such lymph nodes. I would advise you to not get unnecessary further serological tests done here. Do let us know if there is anything more that you need to know.

Thank you.

Hello,

Welcome back to icliniq.com.

All these problems in the throat could be due to acid reflux. The most common reason for having this irritation in the throat with a feeling of a lump or something obstructing while swallowing saliva can definitely be a feature of chronic silent GERD with LPR (gastroesophageal reflux with laryngopharyngeal reflux). Even though you might be asymptomatic or never had gastric issues in between, the inflammation in the throat often exists in the hidden form and can resurface when adequate care is not taken. Why does hidden acid reflux become so problematic? As you know the stomach usually has cells that release hydrochloric acid and thus keep the gastric environment acidic in nature. Your entire mucosal lining from the mouth throat and food pipe (esophagus) is not meant to handle anything acidic. Of the three structures, the throat is the most sensitive due to its rich nerve supply. If in a given situation, your mouth, throat, or food pipe chronically comes in contact with acidic contents, an inflammation starts which the body initially takes care of, but once this compensation wears out, you start developing symptoms that you have mentioned. Please try to follow the advice mentioned below

1. Maintain a strict diet, eating on time.

2. Avoid spicy oily and cold food or drinks.

3. Keep a gap of two hours between meals and going to bed.

4. Do not overeat, rather keep your stomach half empty and have regular intermittent light food like fresh-cut fruits in between major meals.

5. Saltwater gargling 8 to 10 times a day for 15 days.

6. Avoid alcohol and smoking as it can potentiate reflux.

7. Try to maintain a left lateral position while sleeping to reduce the chance of reflux.

Treatment plan:

Tablet Pan D 40 mg (or its equivalent) once in the morning before breakfast for one month.

Syrup Mucaine gel (or it is equivalent) one teaspoon three times a day 20 minutes before meals for one month.

Make sure you follow the precautionary measures as much as possible as mere medications would not fetch long-term relief. Please understand that this typically takes four to six weeks for things to normalize and for symptoms to subside and chiefly depends on how much you have been able to follow the precautions mentioned above as 80 percent of the treatment lies there. There is absolutely nothing that you need to worry about as this is a treatable entity and things will be fine. I hope I have answered your query in detail. If there is anything more you need to know or enquire about, please do let us know and we will get back.

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, this is absolutely the reason for the problem that you are facing. You will require proper treatment with medications and lifestyle changes and you need to consult a gastro surgeon as well. If the hernia continues to give trouble to you and your symptoms do not resolve, you will require fundoplication surgery done laparoscopically. The problem is not due to any sexually transmitted disease. Kindly refrain from getting unnecessary serology done. For now, you need to follow all instructions given and remain on a follow-up for every three months.

Thank you.

Hello,

Welcome back to icliniq.com.

I suggest you undergo a CECT (contrast-enhanced computed tomography) of the neck and oral cavity for a detailed assessment of the same.

Thank you.