Oncology (General Cancer)/Boil inside nostrile

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QUESTION: Hi,
I am sorry to bother you but I couldn't find any other category that had an expert available to answer my questions. On Friday my husband started complaining of a pimple inside his left nostril which was very sore. Meh took and needle and popped it. The bump pusses out a bunch if white and yellow junk. He said it felt a little better. On Saturday the pain was way worse, his whole nostril was swollen, the pain radiated to his cheek and upper teeth. I think he pushed on it again and it oozed more pus out. I told him to apply some bacterium cream I had to he sore and to leave it alone. Also on Friday night he started to complain that his jaw also
On the same side was very tender and sore. Sunday his pain was very unbearable but he was to stubborn to go to the immediate care. Today he said his nose fells a little better but the pain in his jaw is worse. Below his jaw is very tender. I am assuming that the lump inside his nose started as a ingrown hair which became infected by him pushing on it. I assume the pain in his jaw is a swollen lymph node reacting to the infection. My main questions is  now that the pain and swelling in his nose is starting to feel better why is the area under his jaw line more tender and sore? Would a this sore area in his jaw be a lymph node reacting to the infection inside his nostril? Is it normally for the lymph node to be sore and tender now that the pain inside the nostril is starting to get better? He does have an appointment with his doctor on Thursday for his annual physical so I think he is holding off and wanting to go in on Thursday. I have read things that these boils can become a serious infection and go to the brain is that very likely? He is using the antibiotic cream on it a few times a day and also he is taking some doxycilian antibiotic that he had left over until he can see his doctor in Thursday.

ANSWER: He clearly needs an antibiotic, and I'm pretty sure doxycycline is not the right one.  It sounds like the infection is spreading.  I would use a drug like amoxicillin or cephalocin.  The antibiotic creme is probably not helping.  Sometimes hot packs will help move things along.  Hope your doctor helps.  

---------- FOLLOW-UP ----------

QUESTION: Hi,
Thanks for answering. He did visit the ENT yesterday and his nose was actually healed up pretty well. So I guess between the antibiotics and the cream that worked. His lymph node is no longer tender and the doctor said he couldn't feel any swelling. He has a rather large neck so sometimes I think it's hard to feel them. To his ENT his nodes appeared back to normal. He is seeing a new ENT now. I actually had a following up with mine and went ahead and gave him my appointment since he takes over a month to get into. He is one of the best in Wichita. He examined his nose and looked up into his sinus cavity with a long metal scope . I don't think he performed the scope that goes down the back of his throat. My husband has had chronic sinus infections for some time now. His old ENT would just look up his nose, say everything was straight and send him on his way with nasal steriod spray . He also had a rather large swelling in his other nostrile which I assume was the inferior turbinate. He said due to the cold dry weather it was swelled and bleeding.

My husband has sleep apnea, he was diagnosed by a sleep study over a year ago. Like I said he has a rather large neck size and his uncles, dad and grandpa all suffer from it. He is on a C-pap machine. The sleep Spector said it was obstructive but no one has ever done a CT to see what was actually causing the obstruction. Even when he lost over 50 lbs when he laid flat on his back he would snore horribly.

The ENT is going to order a CT scan. My question is will he only scan the sinus area or will the scan be of his while head and neck?  While they are scanning him they may as well scan his throat area to see if they can figure out what exactly is causing his obstruction. What I have read online days if the soft tissue of the palate or base of the tongue are larger than normal they can cause the obstruction. It's funny because the sleep doctor said that they can perform surgery but his is so bad that surgery wouldn't help. I am not sure how he exactly bows how bad his obstruction is when they have never performed a CT that or scopes his throat that I know if, unless this was done durning the Sleep study and he doesn't recall it.

My other question is my husband asked the ent to look at the patches on his tongue. He also agreeded with the other doctors that this is a case if geographic tongue and the spots didn't have to technically migrate to other areas of the tongue they can stay in one area. That being said my husband asked him of he could do any type if scan to see if there was possibly something going on that the other biopsy may have missed in a round about way he was asking him if a CT scan would pick up cancer in the tongue. He told him no that that wasn't possible to see in a scan if anything was going on. I am not sure if he was confused by what my husband was asking or what. I have looked online and it shows pics of CT scans of cancer in the tongue, mainly the base of the tongue. So is this technically true that a CT cannt make out cancer inside the tongue? Also of they do do a sinus CT or a head and neck CT will this include the tongue? Will they be able to see if there is anything going on like a mass?

Sorry this is so long of a post but I just wanted to give you some background info.

Answer
The ct scan ordered by the ENT might include the neck -- you have to specify what you want to scan when you order one.  If he's going to have a "CT anyway, get the neck.  As for your other question, the operations for sleep apnea include removing tissue from the back of the throat (like the uvula) all the way to putting a hole in the neck (tracheotomy).  people who are obese and have short necks sometimes don't profit from these procedures as well.  Much sleep apnea is due to tissues in the throat which aren't as rigid as they should be.  All this being said, a CT scan of the throat would be useful to decide what is going on.  As for the question about cancer, you can't prove cancer with a CT scan.  You might find something suspicious, but you always need a biopsy.  If there is no mass, there probably isn't cancer.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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