Posts by Nicholas Myers

silvergardener17 said:Could a kind, expert soul please explain this to me:

Glucose is fine, bilirubin is fine, AST and ALP are fine, but ALT is 50 (ref. range 10-36) and GGT is 37 (ref. range 9-35).

I had atypical hepatitis as a child, and my liver has been perfectly fine ever since. Why this now? It isn't alcohol, nor am I overloading on greasy food.

Many thanks 🙂

The ALT values are off, but only slightly. A crucial factor is whether you are taking any medications—and by that, I mean oral contraceptives, over-the-counter pain relievers like ibuprofen, or other supplements. That alone can cause a mild elevation in liver enzymes (aside from "excessive eating or drinking").

Furthermore, are you experiencing any symptoms? For instance, discomfort, heaviness, or pain in the abdominal area, specifically under the right rib cage, or any other issues? And what prompted the blood work in the first place? Are your lipid levels (cholesterol, triglycerides) within range?

I don't believe there is reason to panic just yet. Consult your physician; they will likely want to re-check these levels in a few weeks.

mellowviper24 said:...
CRP hasn't been checked. Do you think there's any need for it?

Someone already pointed this out, but it bears repeating: we treat the patient, not the lab results.

I don't see much point in ordering a CRP or repeating a CBC right now. Your previous white blood cell counts could easily be interpreted as "borderline" rather than "abnormal." Ultimately, the call should be made by your primary care physician based on a full clinical picture—physical exam, history, and your actual symptoms.

It's also worth mentioning (something I missed in my last post) that stress—whether emotional or physical—can shift blood counts and lead to results like these.

mellowviper24 said:...No, since we're discussing anemia, may I ask one more thing: even though the results show improvement, I’m still feeling heart palpitations during physical exertion (for instance, just going to the lab today set my heart racing). Is that normal, and when can I expect the anemia symptoms to subside?...

Anemia symptoms will fade once the condition is corrected and your hemoglobin and blood counts normalize. Typically, this happens within one to two months, though sometimes it takes longer. Given your current hemoglobin levels, heart palpitations and fatigue during exertion are expected. However, the racing heart you felt just walking to the lab might not be strictly physiological; psychological factors—anxiety, uncertainty regarding the results, or worry about treatment efficacy—can certainly amplify those sensations.

Be patient and try to relax. Everything suggests the anemia is resolving, so the symptoms should dissipate soon. Stick to your prescribed treatment and follow your doctor's guidance. 👍

mellowviper24 said:...
What’s bothering me is the drop in lymphocytes: last time they were at 41%, now they’ve fallen to 16%, while neutrophils have climbed from 46% to 72%.
Can anyone help me estimate why the lymphocytes dropped and the neutrophils rose, and what this means in my case?

Just so you know, I’m an asthmatic. I haven't used my Seretide inhaler for the last few months, but I've been back on it for two weeks now, which is also when I started taking iron. I don't know if that matters, but I wanted to provide all the details.😉

Thanks in advance. 🙂

To properly interpret blood work, one really needs to know the total white blood cell count. That is vital. However, I will attempt to answer without it. Looking at these results, the lymphocyte percentage is only slightly low (the lower limit is typically 20%), whereas the neutrophil count is right at the upper threshold. Essentially, the neutrophil proportion has increased at the expense of the lymphocytes.

Using Seretide—which involves an inhaled corticosteroid—is unlikely to be the culprit here. At standard asthma doses, absorption is minimal, meaning very little steroid actually enters the bloodstream. Usually, it's oral or injectable corticosteroids that cause significant shifts in blood counts.

It seems more likely that this reflects an infection; the labs might just be catching the onset of something minor.
If we knew the total leukocyte count and whether a CRP test was performed—and what that value was—the answer could be much more precise.

There is no reason to panic. Avoid spiraling down internet rabbit holes; it only increases anxiety. These deviations in your levels (regarding the lymphocyte and neutrophil percentages) are quite discrete and shouldn't worry you. The websites listing severe diseases associated with high neutrophils and low lymphocytes aren't referring to minor fluctuations like yours.

As for the iron-deficiency anemia, it is encouraging to see the hemoglobin levels improving. Be patient; treatment is a marathon, often lasting several months. To track progress, you'll continue monitoring your blood work, including those neutrophils and lymphocytes. I expect their levels will return fully within the normal range. 👍

Regards. 😉

I assume this was part of a screening process for voluntary blood donation.

The standard screening tests used for Hepatitis C can produce false positives. Essentially, the results might suggest you have antibodies—which would indicate prior contact with the virus—when you actually don't. It’s also worth noting how risk profiles play into this. For individuals in low-risk categories, the frequency of these false positives tends to be higher than for those in high-risk groups.

Because of this margin for error, any positive initial result triggers mandatory follow-up testing. If those secondary, more specific tests come back negative, you’re in the clear; it means there is no infection.

There is no reason to panic here. Just follow your doctor's lead.

My thanks to Jacob Foster11 for the incredibly quick response and for stepping up to help out everyone here. 🙏

Best regards. 🙏

I’m looking for some guidance from the moderation team regarding a quick technicality. 😕

I uploaded an animated avatar, and initially, everything seemed fine. However, I later spotted a note from Jacob Foster11 stating: "Please ensure avatars stay within the permitted limits (50x50px; 9.8KB)." 😲>

Here is the catch: my file is 9.846 KB. It technically exceeds the 9.8 KB limit by a tiny margin, even though the dimensions are exactly 50x50 px as required. While the avatar worked perfectly for a few moments, I decided to pull it down until I can confirm whether using it puts me at risk of any penalties. 🤷>

Thanks in advance for the help.

Best regards. 👋>

Amy Cox76 said:My CRP is at 30.4, while the standard range tops out at 5.0.

My doctor sent me to the lab this morning, but they don't open back up until Monday afternoon to review the results and start my treatment.
Do I need to head to the ER immediately? My other blood work results are all within the normal range.

Symptoms:
Two weeks ago: stuffy nose, coughing up yellow-green phlegm.
Current status: general fatigue, occasional chills, and a heavy, dry cough.

As a physician—and I don't mean to make a habit of emphasizing my profession on this forum, though I feel it’s warranted here—I need to issue a warning regarding the following: A CRP level of 30.4 mg/L isn't an automatic green light for antibiotics. It’s just a number on a page, not a diagnosis in itself. Basically, if your CRP lands anywhere between 10 and 50 mg/L, you're looking at a mild to moderate elevation. It’s a bit of a gray area—you could be dealing with a viral infection, a bacterial one, or just various other underlying issues and biological processes. It isn't a smoking gun on its own.

To put it simply: a single CRP reading of 30.4 mg/L isn't enough to determine if you're dealing with a viral infection, a bacterial one, or something else entirely. It doesn't tell us whether antibiotics are necessary or not.

I can't say whether she'll be prescribed antibiotics or not. I haven't examined her, so there's no way for me to make that call. It will definitely be necessary to monitor the overall condition, undergo a thorough follow-up exam, and, naturally, check the blood count and biochemical parameters again.

To address the person who started this thread: should you head to the ER? It depends entirely on how you’re actually feeling right now. If you're asking whether a CRP level of 30.4 mg/L alone warrants an emergency room visit just to get an antibiotic prescribed, the answer is: No. However, if your general condition starts taking a sudden turn for the worse and you judge that you need immediate medical attention, then yes—by all means, contact emergency services.

Greetings. 😉

Here it is—the very first patient I saw in dermatology during my medical school rotations had this exact diagnosis.

A few things to keep in mind: Pityriasis typically lasts about 4 to 6 weeks on average, though it can stretch to 3 or even 4 months in rare cases (some medical texts even suggest it can linger for 6 months or longer). However, if the skin lesions haven't cleared up after that 3-month mark, there is legitimate reason to suspect we might be looking at something else entirely. There are several conditions that mimic Pityriasis rosea quite closely. 🧐

I’m not sure when your last dermatology appointment was, but I’d strongly recommend seeking a second opinion. Be sure to tell them exactly how long these symptoms have been persisting. That duration should be enough reason for them to run more extensive tests to confirm the diagnosis and rule out other possibilities. In my view, you need to ask the dermatologist to be definitive: is this truly Pityriasis rosea? And if it is, what on earth is making it so stubborn? 🙂

In the meantime, watch your habits. Avoid wearing unwashed clothes or anything straight from a store without laundering it first. If you pull something out of the back of your closet that hasn't been worn in a while, wash it again—make sure it's thoroughly rinsed of detergent and ironed. When you sweat, dry your skin immediately to prevent further irritation. Try to limit soap and gel usage, avoid frequent showers, and skip the baths if possible. Stick to water where you can. Don't use abrasive towels, don't scrub your skin, and stick to neutral creams and lotions. I assume you've heard all of this already, yet the condition continues to plague you regardless. 🙂

So, the only real advice I have is this: see a dermatologist. Again and again. 🧐

fadedmarlin402 said:The reality is that a sudden draft can essentially shock your immune system, leaving your body wide open to various infections. It’s important to clarify one thing here: a draft doesn't actually cause inflammation itself, but it certainly creates the perfect environment for it to take hold. And let’s get one thing straight—it isn't true that mainstream medicine or science ignores this connection. They acknowledge it; they just can't fully explain the mechanics behind it yet.

Just stumbled upon this thread. As a physician, I find the whole topic incredibly intriguing.

It seems even among my colleagues, there is no consensus on whether drafts actually play a role in the development of illness. People constantly point to a sudden gust of cold air as the primary culprit behind the common cold, yet the medical community remains divided on its actual significance.

As a young physician, my plate is more than full with other priorities, which leaves little room to keep up with the latest research papers in this field. That said, allow me to offer a few observations of my own on the matter.

I hear the same complaints in my clinic all too often. It’s always some variation of this: "Doctor, my daughter has another sore throat; I told her to stop drinking ice water straight from the fridge, but she just won't listen!" Or, "My son ended up with pneumonia because he walked home from practice while he was still sweaty and the weather turned cold." Then there's the one who ends up in the hospital with meningitis and blames her husband, claiming she warned him to roll up the windows during the drive because a draft is bad for her health. And of course, the classic: "Doctor, I always get a bladder infection whenever I walk barefoot on cold concrete."

I remember back in med school, the faculty was pretty split on how much damage drafts actually do. During clinical rotations, I’d often stand right in the path of an open window—mostly because I personally find the airflow refreshing—while some of my colleagues would practically lose their minds, demanding we shut every door and window in the building just to avoid catching something.

To kick off this discussion, I’m throwing in two quotes regarding how drafts might influence the common cold and middle ear infections.

So, regarding the common cold—that viral inflammation of the nasal mucosa that occasionally hits the throat—I just pulled an old infectious disease textbook off my shelf. It’s a 2006 edition I was given as a gift. In the section dedicated to the "common cold," specifically under "epidemiology," there is this one sentence: "Despite prevailing beliefs and observations, THERE IS NO CONCLUSIVE EVIDENCE THAT COLD TEMPERATURES, DRAFTS, FATIGUE, SLEEP DEPRIVATION, OR SIMILAR CONDITIONS ARE LINKED TO AN INCREASED FREQUENCY OR SEVERITY OF THE ILLNESS." This refers specifically to the cold itself.

Regarding middle ear infections, I stumbled upon an article by a certain medical doctor from the Mayo Clinic. To quote him: "Middle ear infections aren't caused by cold ears or drafts. Wearing a beanie when you don't actually need one won't lower your chances of getting sick; instead, focus on your nasal passages—that’s where the secret to healthy ears lies." Here is the link to the article on ear infections: The link provided leads to an article discussing childhood nutrition and healthy eating habits. It covers essential topics like balanced diets, the importance of vitamins, and how parents can encourage better food choices in their kids. Essentially, it’s a guide for maintaining long-term wellness starting from a young age.

I suspect the truth lies somewhere in the middle. A draft isn't the primary culprit for most illnesses people blame it for, though constant exposure to harsh, moving air certainly won't help. Take styes, for example. It’s well-documented that they crop up more frequently when you're dealing with dry, circulating air currents. It speeds up the clogging of the oil glands in your eyelids, which creates the perfect environment for an infection to take hold. I've dealt with that myself on more than one occasion.

I’ve been thinking about this quite a bit lately. I actually found myself debating the topic with some colleagues the other day—it just popped into our heads. We were wondering if anyone could actually quantify the role of a draft in getting sick. Essentially, how much "power" does a sudden chill really have when it comes to creating the perfect environment for an infection to take hold?

Bottom line: I’m with you, fadedmarlin402. Consider me a fan—I follow your posts closely and hope to eventually match even a fraction of your expertise and experience. That said, I think people tend to overstate things. They assign "blame" or "power" to certain factors far more heavily than they actually deserve.

As a physician, I’ve received some incredibly positive feedback from my patients regarding their concerns over child behavior and developmental milestones. They specifically pointed toward the work being done at the Kennedy Krieger Institute. What strikes me about their model is the multidisciplinary approach—children aren't just seen by one person, but by a coordinated team of specialists ranging from psychologists and speech therapists to doctors and developmental experts. They deliver their findings as a unified front. I believe there have even been several segments on national news programs covering the Institute's methodology.

I should clarify that I have zero financial stake or ulterior motives here; please don't mistake this for a pitch or an advertisement. I am simply passing along what parents have shared with me during our consultations. Honestly, until recently, I wasn't even aware a facility like this existed. I managed to find their website: http://centar.testiranje.net/naslovna so if anyone finds it useful...

It could just be a minor salivary gland issue. It’s visible right there on the inner lining of the lower lip.

Take a look at this (it shows a photo and a quick breakdown of the condition): http://www.dentistry.bham.ac.uk/ecou...e.asp?pid=1637

That said, you really should check in with a doctor or a dentist to get a definitive answer. 🤷

Robert Doyle4 said:I ended up in the ER this past Thursday, and my blood work is as follows:
...
My diagnosis is St. febrilis, edema in both ankles, polyarthralgia, and thrombocytopenia; I've been advised to see an immunologist immediately.

Thanks for the help!

Unfortunately, I don't have enough experience to weigh in on your case or your suspicion of an autoimmune disorder—which seems likely given the referral to an immunologist.

If anyone else on this forum decides to comment, I’d suggest you post the full report. There are significant gaps here. For instance, you mention thrombocytopenia (low platelet count) in your diagnosis, yet there isn't a single mention of platelets in the lab results you provided. Furthermore, while some values you listed fall outside the reference range, others are perfectly normal. Just because something is bolded on a lab sheet doesn't automatically mean it's pathological.

It would also be helpful to describe your symptoms in a few sentences—what actually led you to the ER in the first place? Lab numbers alone don't tell the whole story.

Even then, don't be surprised if people mostly just echo the advice to see the specialist. Immunology is a complex field; reaching a definitive diagnosis often requires a long battery of tests, and sometimes patients have to wait quite a while for the clinical picture to fully crystallize.

To find some peace of mind in the meantime, talk to your primary care physician. Gather all your records, present them clearly, and discuss your symptoms. Your doctor might need a day or two to review the literature or reflect on the data. They know your medical history best and can offer much more meaningful guidance than a stranger on an internet forum. At the very least, they can provide direction while you wait for your appointment with the immunologist.

I wish I could be of more assistance. Best of luck to you. 👍

Taylor Smith3 said:Hi.

I had my blood drawn yesterday to check my iron levels, which I’ve been supplementing for three months now. The iron looks fine, but there’s something new and strange on the report. My non-segmented granulocytes are elevated (0.04), and the morphological changes mention toxic granules and some atypical lymphocytes. Can anyone tell me what this means? I did a little digging online, and it mentioned this can happen during inflammation, and I actually woke up today with a sore throat. Could that be it? :hypochondriac:

Based on what you've described, there's a possibility this could be the onset of infectious mononucleosis. That initial stage can often present with findings like yours: the gradual appearance of atypical lymphocytes and, occasionally, an increased proportion of non-segmented neutrophilic granulocytes (though, honestly, a value of 0.04 or 4% represents only a very slight elevation). And then, of course, there's the sore throat—though in that case, one would typically expect other symptoms to follow.

That said, atypical lymphocytes can show up in various other conditions too. It might be a different viral infection, or perhaps something else entirely. Finding atypical lymphocytes isn't a specific diagnostic marker; you can't pin down a diagnosis based on that alone. Without a physical exam, it's impossible to say for sure what's going on. 🤷

Because of all that, you should touch base with your primary care physician. 😉

Jamie Johnson6 said:I’m not looking for medical advice on this forum, but since I have a two-and-a-half-month-old baby at home, I simply don't have the bandwidth to get anywhere—not even to see Dr. Gin. 🙄Well, Sam went ahead and got some private blood work done, and looking at the results, things are definitely outside the normal range. I’m staring at this data and honestly, I don't have a clue what I'm looking at.

Neutrophil granulocytes are low at 33% (normal range 55-75).
My lymphocyte counts are up—both the percentage and the absolute count. Not entirely sure what that implies.
My average red blood cell volume is low. My hemoglobin levels are also down—I’m assuming this is linked to blood loss.
The average platelet volume is running high.

My thyroid was acting up, but that much I already know.

Here you go!🙂

Based on what you’ve shared, I can only say this: a low neutrophil count paired with an elevated lymphocyte count is often seen during viral infections, but that is certainly not the only possibility. There are other factors at play here. That said, I can't provide any real insight into your specific situation because you haven't mentioned your symptoms, nor have you provided the full lab report. Without knowing the total leukocyte count or the specific lymphocyte numbers, we're essentially working in the dark. 🤷

Low erythrocyte volume paired with low hemoglobin levels points toward microcytic anemia. This can certainly be triggered by the blood loss you mentioned, though you haven't specified the nature or timing of that bleeding. One shouldn't overlook the fact that breastfeeding—which I assume you are doing—can also lead to anemia due to the body's increased demand for iron. Anemia needs to be corrected once the underlying cause is identified, and naturally, that's something you won't figure out through an online forum. 😢

Regarding platelet volume, there isn't a specific value provided to indicate how "high" we're talking about. Furthermore, the actual platelet count is missing—and without that number, commenting on the volume alone is like trying to judge the speed of a car without knowing if it's even running.

With all that considered, you've also got the thyroid running wild—something you'll need to rein in if you haven't already.

Take this response as you would a reading from a crystal ball—it’s little more than guesswork. There simply isn't enough data here to build a reliable conclusion.

Given all of this, my advice is simple: find the time and go consult your primary care physician. 😉

Jessica Davis66 said:What does the abbreviation "distr. erythrocyte" mean?

I assume this refers to the distribution of erythrocytes by volume, typically denoted as RDW. Put simply, it’s a value that tells us whether the red blood cells in the bloodstream are roughly uniform in size, or if there is significant variation between them. It's a key metric when diagnosing, monitoring, or treating conditions that impact red blood cells, such as anemia.

Tyler Booth5 said:Honestly, there are moments when I feel like I might just claw my own skin off, or maybe just scream at the top of my lungs—or better yet, lash out at whoever happens to be standing too close to me. I’ve been slathering on various creams, but it feels like a total waste of time. It’s like nothing works. At this point, I’m starting to wonder if even bothering with a doctor is worth the effort. :S :S

First, you have to pin down what’s actually triggering the itch. That’s rarely a quick or easy fix.

The first step is checking for any visible changes on the skin—assuming you haven't already irritated it by scratching. If the skin looks perfectly normal, you have to look at other culprits: extreme dryness or psychological factors, like high stress or anxiety disorders.

If it’s just dry skin, I agree with the previous suggestion; a Johnson & Johnson lotion could help. Switching to oil-based body washes might also assist.

General relief can come from cold showers, cold compresses, or specialized anti-itch creams containing menthol, camphor, or phenol. Over-the-counter antihistamines, such as Belline, can also provide some relief.

However, keep in mind that itching can stem from internal issues too—organ dysfunction involving the liver, kidneys, or thyroid, or even conditions like anemia or hyperuricemia.

On the flip side, if there are actual physical changes to the skin, a whole spectrum of dermatological conditions enters the conversation.

And then there are allergies, particularly to specific foods or medications...

The bottom line: if these steps don't work, if the itching persists, worsens, or if you notice skin changes, go see a doctor. Period. Itching can often be a symptom of something much more significant.

Lisa Hernandez80 said:I had my blood drawn last week, and the only thing off is my MCHC. It’s actually keeping me awake at night... if anyone could help me make sense of this. I'm 18 and quite underweight for my height (BMI 15.8).

WBC 11
erythrocyte 4.90
hemoglobin 140
hematocrit 0.39
MCV 80
MCH 28.6
MCHC 358
platelets 191
leukocytes 5.9
CBC
seg. 0.49
non-seg.
eosinophil 0.02
basophil 0.00
lymphocyte 0.39
monocyte 0.10
prothrombin time 94.0
INR 1.0
GLUCOSE 4.8
bilirubin total 20
AST 26
ALT 15
GGT 13
ALP 68
Cholesterol 4.2

Thanks in advance

Looking at your blood work, everything appears to be within the standard reference ranges, with the sole exception being a slightly elevated MCHC.

MCHC measures the average concentration of hemoglobin (the oxygen-carrying molecule) within a red blood cell. Generally speaking, MCV, MCH, and MCHC are collectively referred to as red blood cell indices. These parameters define specific characteristics of your erythrocytes. When evaluating them, you have to look at them alongside your actual red blood cell count and hemoglobin levels.

Since both your red blood cell count and hemoglobin levels are normal, and your MCHC is only marginally high, I don't believe there is any clinical significance here. In my personal view, there is no reason to lose sleep over it.

The rest of your results are also within normal limits.

What stands out, however, is your extremely low BMI, which indicates significant undernutrition. Based on your previous inquiry from July 19, 2010—where you mentioned bone density concerns, using Ensure shakes, and being sent for specific tests by a specialist—it seems you are already under medical supervision. I certainly hope so. Your densitometry results suggested osteopenia, or reduced bone density, which is a common consequence of malnutrition. If bone density continues to decline, it can progress to osteoporosis. Whatever the underlying cause of your weight loss may be, it needs to be managed aggressively under consistent medical care.

Stay determined and follow your doctors' guidance.
Best regards, 😉

Jason Thompson said:...After intense headaches, followed by agonizing shoulder pain, I’ve ended up in the ER three times and have had my blood drawn three times already.
No fever, though swallowing was a struggle for two or three days because my left tonsil was burning.
...
The specialist (an infectious disease expert) gave the diagnosis after reviewing my labs during the exam.

-infectious mononucleosis

What I really want to know is why I've been feeling like I'm dying from shoulder pain for a week now.
Has anyone dealt with mono before? Can it actually cause shoulder pain this severe?

The specialist prescribed: Ibuprofen, a small dose of corticosteroids (for 2-3 days), one capsule of Ulazol, and Sumamed 500 (for 3 days).

Folks, I'm sleeping in a chair because I can't lie down without the shoulder pain hitting me.

I forgot to mention that my right shoulder blade shifted out of place. It hurt first, then once the pain subsided, it popped out. Now my left shoulder blade and shoulder are killing me.
I haven't done any physical labor or strained myself at all.

I wouldn't dream of telling you exactly what's happening with your case, but if you don't mind, I have a few observations regarding what you've shared:

1.) The lab results you mentioned—specifically values like LDH, AST, and ALT—can certainly align with a diagnosis of infectious mononucleosis. However, a crucial metric, the white blood cell count (WBC) and the differential, isn't listed here. Either you overlooked it, or... frankly, it seems odd that those weren't performed, or that they were normal despite an infectious mono diagnosis.;

2.) Regarding symptoms, most fit the diagnosis: headaches, general malaise, sore throat... What doesn't fit is the issue with your shoulder blades—this sensation of them "shifting"—which doesn't seem linked to mono. Also, you didn't mention swollen lymph nodes, which is a major indicator!;

3.) In the typical treatment protocol for infectious mononucleosis, the antibiotic choice seems off. While antibiotics are occasionally used in rarer cases involving secondary bacterial infections, choosing Sumamed specifically is unusual. My infectious disease textbook notes that this class of antibiotics should generally be avoided in mono patients; if antibiotics are necessary, other classes are typically preferred.

4.) If that shoulder pain persists, the smartest move is to follow up immediately with your primary care physician. After an exam, they can decide if you need a referral to an orthopedist, a physiatrist, an immunologist, or another specialist to figure this out. The ER isn't the place for a comprehensive workup on this specific issue. It should also be an unwritten rule to check in with your family doctor after an ER visit. I assume you saw your doctor to get those prescriptions, so is it possible they didn't react to the situation, or perhaps you didn't mention the shoulder and blade issues to them?!

Honestly, there seem to be several missing pieces to this puzzle.

I hope you seek help from your primary doctor as soon as possible, if you haven't already.

Best regards and wishing you the best.👍

In medical terms, what you’re describing is nasal regurgitation—essentially, swallowed contents traveling back up through the nose.

There are plenty of different reasons why this happens. Without a proper exam, pinpointing the exact cause is impossible.

I think your doctor made the right call by referring you to an ENT specialist. They’ll likely check to see if there’s a structural issue, such as a malformed or short soft palate. If the palate can't seal off the nasal passage properly during swallowing, food ends up where it doesn't belong. They'll also examine the oral and nasal parts of your throat. Is it possible you had some kind of surgery in that area recently? That could be a factor.

If the ENT doesn't find anything, the next logical step would be seeing a neurologist. Certain neurological issues can weaken the soft palate, preventing it from closing off the nasal cavity. There are many possibilities there, but I wouldn't get ahead of myself just yet. Let's wait for the ENT's findings first.

Hopefully, this offers some clarity.

Best regards and hang in there! 👍

I suspect you’ve already answered your own question here.🙂

The logic is straightforward: since the infraorbital nerve is a terminal branch of the maxillary nerve—which itself stems from the trigeminal nerve—we are looking at trigeminal neuralgia, specifically involving the second branch. It’s essentially a suspicion that needs clinical confirmation.

If memory serves, there is a dedicated subforum for neuralgia. You might find more detailed information there.

In short: the condition is defined by sudden, intense, yet brief bursts of pain within the trigeminal nerve's distribution. In your case, that covers the cheek area—roughly the middle third of the face, just below the eyes. The pain is often severe enough to cause facial grimacing.

There are two primary classifications: idiopathic and symptomatic.

Idiopathic means the underlying cause remains unknown. Pain is typically triggered by touching specific points on the face; things like eating, washing up, shaving, blowing your nose, temperature shifts, or even yawning. This type usually responds well to anticonvulsants. Surgery is a secondary option if medication fails.

Symptomatic—as the name implies—means the neuralgia is a symptom of another issue, such as a blood vessel pressing against the nerve, a tumor, or perhaps MS. In these instances, surgical intervention is often the standard approach.

Finally, to reach a definitive diagnosis, doctors have to rule out other culprits like dental issues, sinus infections, or ear problems. That’s why you were referred to a maxillofacial surgeon.

Hopefully, this provides some clarity.
Best of luck.👋