Swollen Lymph Nodes
When swollen lymph nodes in the neck, above the clavicles (collarbone) or in the axilla (armpit) occur there are a few immediate questions we need to answer.
- Is there infection occurring in the body?
- Could lymphoma (a cancer that begins in the immune system lymphocytes) be present or developing?
- Is there cancer spreading from other sites?
A number of factors will help determine the importance of each of these questions.
For example, if a teenager has signs and symptoms of tonsillitis and there lymph nodes are swollen in the neck, we disregard the question of cancer. We know infection is causing the lymph node swelling.
On the other hand, if a 30 year women has swollen lymph nodes above both clavicles and complaining of weight loss and night sweats, we must rule out lymphoma (e.g. Hodgkin or non Hodgkin).
Lastly, if a patient with a history of cancer …say prostate or cervical cancer…develop swollen glands in both axilla, then we should wonder if the cancer has reoccurred and is it metastasizing (traveling to other parts of the body).
The lymph system is comprised of lymph vessels, lymph tissue including lymph nodes and lymph fluid. These components are located throughout the body and are intimate with cardiovascular, pulmonary, digestive, genito-urinary, musculoskeletal and neurological systems. The lymph system also includes the spleen, thymus and bone marrow where blood cells are produced.
The basic job of the lymph system is threefold:
- circulate interstitial fluid (fluid located around and between tissues in the body)
- transports chyle (fatty fluid from the gut) into the circulatory system
- transportation and implementation system for immune function i.e. for fighting infection and disease.
Lymph nodes become enlarged with the increased influx of lymphocytes (white blood cells). The immune response to foreign material also increases the production rate of T and B cells (part of the immune system) withing the lymph node.
Since lymph nodes are spread out in the body, some are palpable and some are not. During infection of the throat for example, lymph node swelling may be felt in the area below the jaw or along the side of the neck.
In other cases, if cancer is suspected… say due to unexplained weight loss or lump in the breast, lymph nodes in that region of the body will be evaluated with palpation or sometimes with a CT scan of the chest and abdominal cavity.
In sum, if you notice swollen glands, question why they are there. Often it is nothing more than a short term infection. But the best route is to notify your physician who will take a history and physical exam and give an appropriate diagnosis and treatment plan.
Physical Therapy salary with or without bonus.
“Which is better: a higher salary without bonus or a lower salary with bonus incentives?”
Which is better: a higher salary without bonus or a lower salary with bonus incentives?
A Physical Therapy student recently asked this question as they were planning their first job. Thought I would throw my two cents in.
For the first 1-2 years, it is important to find a work environment where other PT’s will support your career values and goals. If you want to be a manual therapist then by all means surround yourself with like minded therapists. If you do not know which area to go into, then seek out a hospital with both inpatient and outpatient programs or practice in a department that rotates the therapists through acute rehab, outpatient ortho/sport and inpatient care.
There are hospital systems out there willing to work with most student’s needs and career aspirations. With coaching many hiring managers should sell their company to the top PT students and likewise PT students should sell too… but that’s another topic.
The money often is a secondary issue. If I were to pick between which is better (question above), the higher salary without bonus is better.
In my next post, I will explain why.
Michigan Physical Therapy Schools
| Andrews University |
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| Central Michigan University |
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| Grand Valley State University |
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| Oakland University |
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| University of Michigan – Flint |
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| Wayne State University |
Professional Medical Recruiting
In Late 2009, Northview Medical Group officially became Northview Health Solutions LLC. No big deal. Just a name change and some letters behind it.
Well, there is more to the story.
We have changed a bit of our business focus. We still dabble in essential oil education and promote their use for health sake. And we still try to share our professional medical experience. But we now are striving and metamorphosing to be a new creature – a company that provides professional medical recruiting.
In short, we are head hunters.
But not the run of the mill head hunting. We provide full service professional medical recruiting. I like that word – full service.
It reminds me of the day when my Dad would pull into the gas station for a fill up and a pack of Kools. The attendant would shortly arrive at the drivers window. Dad would say, “Fill’er up and a pack of Kools”. The man promptly moved to the rear of the car unscrewed the gas tank cap, inserted nozzle clicking the lock level and progressed to the front and side windshields to wash and squeegee them – all time knowing when to return to the pump handle to top er off.
He’s back at Dad’s window. “That’ll be ten sixty.” (yep: $10.60). Dad hands him 11 bucks and the attendant clicks out a few coins from his metal coin holder attached to his leather belt. And you should have seen the roll of bills he stuffed in his pocket after adding Dad’s Hamilton and Washington.
So much for memory lane.
What we do and how we do it are important. In the next few posts, I will discuss some specific ways we are using professional medical recruiting to help folks in healthcare.
Working diagnosis: Lupus
A 55 y.o. man presents with the following intermittent symptoms over the past year:
- fatigue
- multiple joint aches
- multiple areas of muscle ache
- facial rash for several months
- one episode of bronchitis with thick white mucus production
- one isolated bout of reddened eyes and some blurred vision
What is your diagnosis?
- ANA is positive at 1:1280
- CRP: normal
- Sed rate: normal
- anti ds DNA antibodies : indeterminate
- anti smith antibodies: pending
Working diagnosis: systemic lupus erythematosus
New drug for stroke prevention
The FDA is considering a new drug -Dabigatran – for the prevention of stroke in atrial fibrillation patients.
Dabigatran inhibits thrombin and is reported to be as safe and effective as warfarin but without the needed blood monitoring.
In Europe, the drug is being used for blood clot prevention in post hip and knee replacement patients.
For more information, see article in New England Journal of Medicine December 6th, 2009.
LUTS and ED
A 45 y.o. male presents with urinary urgency, dribbling and frequency worsening for several months. He also complains of difficulty maintaining an erection.
No fever, no back pain, no dysuria, no history of CAD, no history of prostatitis. No abdominal pain. No diarrhea or constipation.
Physical exam in normal including symmetrical, non boggy, non enlarged prostate.
Urine dip: normal
Assessment:
- Lower urinary tract symptoms (LUTS)
- Erectile dyfunction (ED)
Treatment plan:
- Cardura 2mg one po daily
- PSA
- refer to urologist to test for urinary flow analysis
Follow up:
Urologist report normal urinary flow without residual volume elevation. Confirmed normal prostate exam.
Patient reports he is now assymptomatic and maintaining erections during intercourse.
Campylobacter jejuni
Campylobacter jejuni is a bacteria which can cause infectious diarrhea.
Symptoms may include fever, abdominal pain, vomiting and diarrhea – sometimes bloody.
Occasionally the abdominal pain may mimic appendicitis with right lower quadrant pain. CT may reveal mesenteric addentitis but no appendix inflammation.
Exposure to wild birds or ducks e.g. hunters; travel to developing countries or exposure to contaminated water are important historical findings.
Stool cultures, fecal leukocytes and shiga toxin levels can be obtained.
Treatment includes azithromycin 500 mg for 3 – 5 days and maintaining hydration level. (Fluoroquinolone and Bactrim resistance has been growing.)
Treat flu symptoms with essential oils
Good afternoon,
We’ve all been hearing plenty about the flu going around. Well, last week we actually got it. We did not have it absolutely confirmed that it was H1N1, but we did have the main symptoms — muscles aches and fever.
Although we did have the flu, it really was not that bad — thanks to the oils. In fact, we found them to be very effective in reducing symptoms and getting over the bug quickly.
There are three main ways we used our essential oils: rubbing on the feet, with moist hot packs on the back and chest, and through a diffuser.
Especially effective seemed to be the use of the moist hot packs.
When my husband came down with the bug, he was determined to get over it quickly, so he had me applying Thieves, Eucalyptus Blue, Oregano, Copaiba, and Peppermint several times a day along the spine, followed by about twenty minutes of relaxation with warm, moist heat on the area. This approach had a significant impact on his fever, bringing it down every time we applied it. It worked so well, he was able to shake the fever in just about a day’s time.
This whole experience reminded us that while using essential oils will not make you “bullet-proof” when it comes to sickness, it does equip you with what you need when sickness sets you back.
A mainstay of the oils when it comes to addressing flus of all kinds is Thieves, because of its antiviral and antibacterial properties.
Stay well!
Laura Bostrom
To purchase Thieves, go to Young Living.com Use member #973559
Essential oils at medical assistant conference
The Michigan Medical Assistant Association hosted its Fall conference in Dearborn MI this past weekend.
I had the honor of presenting the topic: An Introduction to Essential Oil Use in Primary Care Medicine.
The talk went well and focussed on:
- defining an essential oil
- how essential oils are produced
- the importance of therapuetic grade essential oils for medicinal use
- indication for lavender, peppermint, eucalyptus and wintergreen essential oils
- two cases studies: one on MRSA and the other IBS
All in all we covered the basics. Information was research supported. And audience acceptance was good – lots of questions.
For more information on the conference lecture/material, I would like to share it with you.
Send me an email.
