CIRCUMVALLATE PAPILLAE

 A few days ago I noticed some bumps on the back left side of my tongue.  They are painful when I eat.  I used my finger to feel how big they were as they can not be seen.  They are located where my tongue touches the back of my throat.

Back when I was going through cancer treatment I had some bumps break out on my tongue that were noticable.  My ENT said they were called Papillae.

Typically, small bumps (also known as papillae) cover the surface of the back part of your tongue. Between the papillae are your taste buds that help you taste foods. Usually, these papillae are pretty unnoticeable. But sometimes, they become enlarged and can cause you pain.

It's not always clear why this happens, but it may be related to stress, hormones, or particular foods. Although they can be uncomfortable, papillae bumps aren't serious and usually clear up without treatment and within a few days.  A dry mouth can also contribute to swelling of your papillae.

Other potential causes of bumps on the tongue include: Human papillomavirus (HPV): This is a viral infection that is spread by skin-to-skin contact. It causes warts and may affect the genitals, mouth, or throat. Canker sores: These are painful, red sores that can occur anywhere in the mouth.

While uncommon, bumps on the back of the tongue can be a sign of oral or tongue cancer. These wart-like bumps — or squamous cell papillomas — can look white or red and may be benign. Only a doctor can diagnose an unusual bump as cancerous.

If you notice them for more than 2-4 weeks or if they are growing, you should seek medical attention.

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WARFARIN BLOOD CHECK NUMBER 3

 Had appointment with the Cardiac Clinic to have my blood checked.  My number was 3.5 which is too high.  Was told to take only half of my warfarin pill tonight.  They explained that I was to eat as usual, not to overdo greens, and they would control the medication accordingly.  

I left and went grocery shopping for veggies.

WARFARIN BLOOD CHECK NUMBER 2

 Had my second visit with my Warfarin Team at the Cardiac Clinic today.  I will have to go every week for a finger stick to check my blood levels for the blood thinner I'm taking for A-Fib.  My number last week was a baseline number of 1.0.  Today's level was 2.5 - right where it is supposed to be.  I need to keep it at 2.0-3.0.  After 3 months I will be able to bring the testing machine home and check it myself and call it in to the clinic.  

There are so many foods that I can not eat due to the high vitamin K content which hinders the blood thinner from doing its job.  So no leafy greens which is full of vitamin K.  The total amount of vitamin K I can have in a day is 80 micrograms.    A cup of spinach contains 988 micrograms.   A cup of boiled cabbage contains 163 micrograms.   A cup of brocoli contains 220 micrograms.   I'm having a hard time finding the right foods to eat.  I'm not a meat eater so need to get some protein from mainly fish and seafood.

This blood thinner is the second one I have tried and not having any reactions to it.  The first one made me very dizzy and unstable.  Haven't had an irregular heartbeat in 3 days.  Haven't felt this good for the last 3 months.  I hope this lasts.

CARDIOLOGIST APPOINTMENT 2-14-23

 Had appointment with Cardiologist this morning.  Had an EKG which he said was OK.

Went over the incident with the CAT scan ordered by my ENT and how the premeds caused me to go into A-fib.  Told him I will not take any contrast or pre meds/steroids again.  

Informed him that I am still having A-fib episodes daily.  He changed my heart meds from Digoxin to Diltiazem.  He also put me back on the blood thinner Warfarin which he had originally prescribed for me. Have to attend classes at the clinic for a few weeks to learn how to use the blood thinner and equipment to monitor.

He explained that I should not worry about having a Cardiac PET scan with radioisotope as it is not a contrast.  I agreed to have one.  He said to schedule it when I am ready.

He said that if none of these things work he would order treatment of atrial fibrillation using intravenous infusion of certain meds which I would have to be in the hospital for this procedure.

Wants to see me back in 6 weeks.

FAMILY DOCTOR VISIT

Had appointment with my GP today. Informed him of the kidney pain I've had for the last 2 weeks since the CAT scan ordered by my ENT doctor with contrast and pre meds but no infusions.  I asked for a urinalysis and x-ray which he ordered.  Results showed no blood in urine ruling out kidney stone.  X-ray showed no stones in kidneys.  Now I'm really concerned that there is severe damage to my right kidney as the pain will not go away.  I believe it is damage from not having an infusion prior to the CAT scan.

My GP referred me to a Urologist but warned me that he will want to do a CAT scan with contrast.  If I refuse he may want to do a Cystoscope. Not happy about that.  

I asked if he could give me something for the kidney pain and he agreed to give me some Hydrocodone.  Warned me not to take it at the same time as the Xanax which I take to stop the A-fib attacks.

Informed him that my fasting blood sugar this morning was 177.  He said we may have to up the Metformin but did not order a stronger dose. 

Told him I am tired all the time and stay in bed all day.  Also have a little nausea which I attribute to the kidney problem.

Showed him a print out of the results of my CAT scan of my head and neck taken 2 weeks ago.  We went over the results.  He did not examine my lump on the left side of my neck.  I told him that I feel it is a recurrence of the cancer I had 5 years ago.  It's at the same place and is accompanied by an earache just like before.

Informed him about the heart doctor's order for a cardiac CAT scan several weeks ago.  Cardiologist ordered three hours of infusion to protect my kidneys.  I am allergic to the contrast so need to take pre meds prior to scan.  Could not complete the scan as I had the wrong premeds.   Sent me home and took me off blood thinner till the issue with the lump in my neck is resolved.  I see him next week to decide how to proceed with my heart condition.

Ended my session with the GP by me telling him that I feel that I am dying.  He said no you're not dying.  I said it feels that way.

 

ENT FOLLOWUP ON RECENT CAT SCAN

Had followup appointment with my ENT doctor today to go over the results of my recent CAT scan of my head and neck. It turns out that I misunderstood the results of the lump on my left side of my neck.  The results show a 5 mm stone within the right submandibular salivary gland not the left.  ENT told me that I've had that stone since he first diagnosed me 5 years ago and not to worry about it. 

They don't know what the marble size lump is on my left side of my neck in a lymph node.  It shows no tumor/cancer on the CAT scan.  That could be that it is still too small to show on the scan.  

Info found on my research:

Due to the physical limitations, however, the minimum lesion size that can be measured with CT is about 3 mm.  

Normal CT images showed high false-positive rates of incorrect interpretation 28.2% of the time.  CT scans often miss soft tissue injuries and other abnormalities.

It's important to note that some cancers may be overlooked on a CT scan. Lesions may be missed for a variety of reasons, including location and human error. Still, CT is more sensitive than a simple X-ray. A CT scan can find lesions as small as 2-3 mm.

My ENT said that if it grows to return to his office for further testing.  In my mind there is still a possibility that it a recurrance of the cancer in its pre stage.  Symptoms are the same as 5 years ago with ear ache and tenderness on the lymph node.  Remember... I've been here before.

He referred me to Orthopedic Dr. Chris Cenac for treatment of the spinal stenosis.

He wants to just wait and see what happens to the atrophic thyroid.  I am already taking thyroid meds for that.   

I explained to him about the reaction I had to the pre meds I had to take prior to the CAT scan of my head and neck.  The steriod pill was one of the pills in the pre meds that threw me into A-fib.  I called the clinic and spoke to the nurse and she said to drink lots of water to flush the kidneys out.  I took some Xanax which stopped the A-fib.  I should have had an infusion prior to the scan which would have protected my kidneys.

My kidney functioning gfr number went from 39 to 37.  Normal is above 60. 

I told him that I will no longer approve a CAT scan with contrast or take any premeds ever again. 

CAT SCAN 1-19-2023 RESULTS

Had blood work and then CAT scan yesterday at TGMC.   Got results today.

FINDINGS OF CAT SCAN OF HEAD AND NECK - 1-19-2023

1.  Atrophic submandibular glands and stable 5 mm stone within the right submandibular (salivary) duct.

     - Stress can result in salivary gland hypo-function, which will             reduce salivary flow.

     - Salivary stones and tumors can be smaller than a marble or                 larger.  Most aren't cancerous, but if left untreated can develop           into cancer.

2.  Degenerative changes in the cervical spine, especially C6-7, where there is moderate to severe spinal stenosis.

     - If left untreated, spinal stenosis can result in permanent damage         to the spinal cord. This could cause bowel and bladder                         incontinence as well as paralysis.

    - When the spinal cord gets injured at C6-C7, pain, weakness,             or paralysis may occur in one or more parts of the body below         the injured level. Reduction of bowel, bladder, and/or breathing         functions may occur in some cases. Typically, nonsurgical                   treatments are tried first to control the symptoms of C6-C7                 injuries.

3.  1 cm nodule right lobe of the thyroid, decreased in size. Remainder of the thyroid somewhat atrophic.

     - Thyroid atrophy is the end result of either severe thyroid                     damage or total loss of pituitary stimulation.  The possible                 causes are: (1) irradiation (2) atrophic auto-immune thyroiditis.

So I was wrong about this lump being a cancer recurrence.  However, there are some things to be concerned about in these results.  Notice how the words "stress" and "radiation" keep popping up as causes.  

I am relieved that the cancer has not returned.