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Lymph Nodes Etc.
Feb 1, 2006

Hey, it's always good to have a 2nd opinion; I think I'll get one here! I am an extreme hypochondriac; just going to the doctor causes all sorts of problems, 99% of them in my mind, I'm afraid. I've been + for 20 years, <50 for about 8, but I've just now entered the wild and woolly wold of going under 325 CD4. I've always fluctuated back and forth; when I first went under 500 15 years ago they were ready to put me on the available regimens, but I passed. But now that I'm under the "latest ill-wind" limbo bar, I'm back to the doctor again. My first one was 211, but Dr. felt it might be bad lab work, so we re-did. It was 276, so he sent me on my merry way. Now I'm back 6 months later with a 230, though I had a parade of pre-docs come in to say that my percentages were still good, "which is what we want to see" (20% vs. 21%). I thought I was going to escape for another 6 months, but in the end Dr. came in, alluded that I should have known "this day was coming eventually" (which ticked me off), and decided I needed to clear up my HCV for that "inevitable day", since some regiments don't work well with coinfection. I'm not nave or fooling myself about AIDS, but I think everyone's different and we just don't know what my body and my HIV infection will or won't do. Anyway, he wants to put me on Peg-Intron + ribavirin; I tried it earlier, Peg-Intron alone, 4 years ago and relapsed (different doctor). I don't necessarily have a problem with it, since I tolerated it well (the Pen-Intron at least), but I didn't appreciate his rationale, especially after the previous two glowing reviews. Suffice it to say, now my hypochonria is acting up like crazy again; and that's why I'm scouring the internet for lymph information. I was routinely examined and they didn't find anything, but now my right underarm has felt "pouffy" since then. I don't digitally feel anything other than a surface bump that looks like an ingrown pit hair, but nothing "inside the cavity". Sometimes when I push or twist my arm down on the pit it hurts a wee bit, but it simply feels like the surface problem more than anything internal. I also think that possibly, since my muscles are bigger on the right, maybe I'm just rubbing my body with them, where my flabby left arm isn't (and it's seriously flabbier than normal, since I've had surgery on that elbow and don't use it as much as the average person would). But I also have various and sundry other pains, here and there around my body, which do go away with use of the part in question; the armpit doesn't always hurt or feel weird constantly either. I've almost always had "humidity" issues for decades in my groin and armpits; I don't know if that's normal or not. But to bring this long story short, to put my mind at ease (if appropriate), where exactly should I most-optimally be feeling for swollen nodes, and what should they feel like to my digits? My layman's knowledge of it said they were deep up into the pit, but the pouffy feeling is about a half inch lower than the top of the pit, on the torso. I feel absolutely no bumps there, and both pits look unremarkable to my untrained eye (except for the ingrown hair and another pimplish bump above it). The ingrown bump is also blackish, if I might alternately be concerned about that instead (it's also pimple-sized).

Response from Dr. Henry

Lymph nodes are often swollen in HIV infection. For persons with CD4 counts > 200 swollen nodes don't generally have a major impact on the decision to start antiretroviral therapy. Data is steadily accumulating that patients generally do better (decrease in progression to AIDS and death) on antiretroviral therapy once the CD4 count is < 350 consistently. There is individual variation on that general recommendation including the requirement that the patient must be committed to taking the meds once started. Many of the newer HIV regimens are better tolerated and much easier then older regimens so patients have less to worry about in getting started on treatment.KH

PEP side-effect management
ANC count and neupogen

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