Neck pain makes swollen lymph node noticeable

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DEAR DR. ROACH: I am a 72-year-old woman in good health, generally. Three months ago, I woke one morning with a very sore neck that I attributed to “sleeping wrong.” As I massaged it, I found a firm lump about 1 cm in size that I assumed was a lymph node, located on the right side of the back of my neck, about 6 cm from my earlobe. I did not have a fever.

Over time, the soreness in my neck faded, but it never completely disappears, waxing and waning in intensity from day to day or hour to hour. The lump never disappears either, and also waxes and wanes in size and degree of tenderness. It’s never seriously painful, and probably never as large as 2 cm. My doctor ordered X-rays that showed age-related degenerative changes, but nothing else. He recommended physical therapy. He seems completely unconcerned with the lump, but I wonder whether it’s safe to ignore it indefinitely. -- A.R.

ANSWER: An enlarged lymph node in the neck rarely turns out to be a serious disease. Lymph nodes are normal structures in the body that can enlarge under certain circumstances, especially infection. Cancer is the big worry for patients and physicians alike. However, it sounds like his being “completely unconcerned” makes you feel like he isn’t taking you seriously.

I doubt the initial neck pain was associated with the lymph node. But it served to get you to notice what was there, and it may have been there for days or even weeks. Although the older you are, the more likely it is to be worrisome, I am reassured by its small size. Cervical (in the neck) lymph nodes normally are up to 1 cm (in fact, in one large study, no person with a lymph node smaller than 1 cm had cancer). Tender nodes are less likely to be cancer.

I would have hoped your GP would have done a thorough exam of all of your lymph nodes, such as in the groin and armpit, as the possible diagnoses are much different for people with multiple areas of enlarged lymph nodes, compared with just one.

A node larger than normal, that is present for more than four weeks, should make a physician consider doing a biopsy. This is done under local anesthetic and without admission to the hospital. Only about 1 percent of people who saw their doctor for enlarged lymph node had a diagnosis of cancer, but sometimes getting the biopsy helps both patient and the physician sleep better at night.

DEAR DR. ROACH: Can you please explain why every winter causes dry, chapped lips for many people? Every winter my lips turn painfully dry and chapped. Lip balms and creams give short, temporary relief, but they need to be applied on a regular basis and certainly are not a cure. Why is it that the lips are prone to being affected as they are, when no other body part seems to be affected in that same way? -- M.G.

ANSWER: Lips are unique in several ways. The thin layer of skin sits on intensely vascularized tissue underneath (that’s why they are red), and it doesn’t have oil glands protecting it from the drying effects of cold, dry air. If your nose is congested, that worsens the situation because of mouth breathing, and once the lips start to get dry, we moisten them with saliva, which actually worsens moisture loss due to the chemical effects of saliva.

You also need to be cautious with lip balms and creams. Many contain phenol, camphor or menthol, all of which can damage the ability of the lips to stay moist.

READERS: The booklet on diverticulitis explains this common disorder and its treatments. Readers can order a copy by writing:

Dr. Roach, Book No. 502, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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