Wednesday, 2 May 2012

Medicine is funny, bodies are strange.... aka I know nothing

I took myself to the doctor today, had been putting it off for a while, but now I had a weird mouth pain. It had been there a few days, under my tongue, on one side. I'd decided it had something to do with a salivary gland (there's not really anything else under the tongue that's likely to cause pain, I thought), either a stone, or it had got infected.

I hadn’t found anything under my tongue, and neither could the doctor. He proded my neck a bit, which was surprisingly painful, and concluded I had a swollen lymph node, which could be causing the under-tongue pain. I hadn't noticed it, and still can't really feel it now if I palpate my neck - don't come to me with your swollen lymph nodes, people. I may not notice them.

Just as he was about to move on from the mouth/tongue/neck, he had a quick glance at my throat, just to check. "Aha! That's what it is!" he proclaimed - he might as well have shouted "BINGO!" He had found an aphthous ulcer (a common mouth ulcer) on the corner-roof of my mouth. He seemed very impressed at how big it was, and told me to go and have a look in the mirror when I got home. I duly obeyed, and he was right - it's big, white, and very obvious. It looks like something out of a medical textbook, near the uvula (dangly bit in the middle) and very obvious.

But here's the bit I find weird: it doesn't feel anything like a mouth ulcer. I've had plenty in my time. And they've all been really, really sore and very easy to locate; the pain lets you know precisely where they are. I'm given to understand that that's what mouth ulcers feel like for everyone, no?

Not this one. It's not really sore at all, not in the way that I could point a finger at it, rather that I can only wave a hand around the left part of my face and neck and say "it hurts in this general direction", yet clearly it's the same disease process and tissue breakdown. This isn't to say it's not painful, it's just differently painful. Though it got more painful after I'd seen it and knew what it was, silly brain!

So I'm really intrigued as to why the difference, and wonder whether the back of the mouth has some kind of different nerve innervation. I wish I knew more than that.

But at least I've learnt: don't make assumptions about one's own health problems, don't jump to conclusions, and aphthous ulcers do not always present with a typical history. For medics out there - if you have a patient presenting with a vague neck or mouth pain, check the back of their mouth and their throat. Even if the pain doesn't sound like it's coming from there.

Learning point - I need to improve my neck palpation and ability to detect swollen lymph nodes.

Overall, a productive learning experience!

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