You have a few different options in Washington, D.C. for a thyroid scintigraphy (Vinogradski, Rebro, or Oakland), so just go see which one can get you in earliest. I'm not entirely certain, but I believe wait times at Rebro and Oakland aren't too bad for this specific test, though I can't speak for Vinogradski.
I doubt you'll find much of a shortcut by heading to Vienna. A thyroid scintigraphy isn't considered an emergency procedure—that "urgency" someone mentioned earlier refers to lung scintigraphy, not thyroid issues.
Regardless, given those elevated thyroid hormone levels, your best move is to contact a nuclear medicine specialist at one of those hospitals immediately. Once they review your results, they’ll be the ones to order the necessary tests and typically schedule the appointments for you (you'll likely need a thyroid ultrasound as well if you haven't had one yet). Plus, they handle the treatment itself... which is why, in my opinion, a nuclear specialist is a better choice than an endocrinologist in this situation.
bilirubin is simply a pigment produced during the breakdown of hemoglobin
Assuming you are otherwise healthy, you might be dealing with a variant of Gilbert's syndrome. This is a hereditary condition—though the inheritance patterns vary depending on the specific type—where you see moderate elevations in blood bilirubin levels... things like intense physical exertion, fasting, exhaustion, infections, alcohol consumption, or certain medications can trigger a spike. In principle, it isn't dangerous, but you really ought to get a professional evaluation to confirm this once and for all. If that’s what you're dealing with, you need an official list of medications you should avoid—just so you don't make a mistake by accident
Furthermore, it would be wise to cut out that weekly dose of alcohol and dial back the physical strain😉
Just to be absolutely clear, this isn't just happening here. (I don't really have the energy for anything productive right now, so I'm going on a bit of a rant, sorry.)
For instance, in Scandinavia, this disease is quite prevalent, affecting more than 60 out of every 100,000 people. It most often presents in its acute form—which is much easier to identify than the chronic version—and their doctors are well-versed in spotting it. There is also a strange correlation with sun exposure; cases spike during the summer months when people are out in the heat (likely due to Vitamin D production, which is further intensified by the synthesis within sarcoidosis granulomas). Essentially, when Swedish men go on vacation to warmer climates, they frequently return presenting with sarcoidosis symptoms. It’s a known phenomenon there; it isn't considered unusual, almost like an epidemic.😁
And then, you get these ridiculous misunderstandings. There was that year when the bubonic plague broke out in India (I think it was around 1995, though I can't be certain), and a group of Swedish men returned from their trip to India. Within a few days, one of them developed characteristic erythema nodosum, watery eyes, and enlarged hilar lymph nodes—classic signs. But of course, everyone immediately jumped to the conclusion that it was the plague. The entire group was stuck in quarantine, the whole of Sweden was in an uproar, bordering on a state of emergency. At the Karolinska Institute, they were nearly walking around in hazmat suits, only for it to turn out to be their standard, run-of-the-mill sarcoidosis.😁 This happens to other people too.😉
So, Kimberly Williams, since you're a Woman from Miami living in Washington, D.C., you don't have much to worry about, but just in case, maybe don't move to India.😁
Kevin White5 said:...wow, that sarcoidosis is an extremely interesting disease...
Yes, it is highly interesting, both from a diagnostic standpoint and an epidemiological one. /A minor side note for you: if you actually have an interest and the aptitude for diagnostics, you should aim toward systemic diseases—they require mastery over all fields of medicine and represent the true challenge for a diagnostician./
...and tell me, do you know the prevalence of sarcoidosis in our population (roughly, since I assume there aren't many studies, unless I am mistaken?) And what is it most commonly associated with here? thanks 😉
The data is in the latest internal medicine textbook (I just checked)... for the United States, it cites a figure of 3-11 per 100,000 inhabitants. The geographic distribution of sarcoidosis here aligns with the patterns seen across Europe... meaning, it is more prevalent in the north and less common near the Mediterranean.
However, a significant amount of sarcoidosis likely goes unrecognized because physicians aren't sensitized to such diverse symptoms. Instead, they tend to treat them as isolated ailments rather than unifying them under a single diagnosis. This is a recurring issue with other systemic diseases as well. It frequently happens that a patient undergoes a mountain of tests in private specialist clinics, only to be left clueless about the results because no one is available to connect the dots and interpret them properly.
Here is an example... in individuals who develop (or have had) calcium carbonate kidney stones without a hereditary predisposition, one should also suspect sarcoidosis.😉 ... though I am not sure if further investigation is typically performed in those cases.
Admittedly, all these systemic diseases are relatively rare, so it is hardly surprising that they go undetected.😉
Compared to sarcoidosis—at least based on what I recall from the clinical descriptions—my allergies feel like winning the jackpot.
The issue is that textbook descriptions of diseases are almost always lifted directly from American medical literature.😉 In reality, the progression and prognosis of sarcoidosis depend heavily on race and geography. For instance, severe forms of the disease are prevalent among Black Americans in the United States, but not in Africa. You see it in Puerto Ricans living in New York City, but not those elsewhere in the Americas. It shows up in Irish women living in New York City, yet not in those residing in Ireland itself. The highest incidence rates are actually found in Scandinavia, but there, the disease presents in a completely benign form—specifically the acute type with erythema nodosum. Conversely, they don't see erythema nodosum at all in Japan.
It’s a complete circus, and nobody can explain why. 😕
In the United States, the "Scandinavian" type is currently the most common presentation. 😉
Kimberly Williams said:It went like this: I had complete blood work done, and everything came back normal. My lungs were crystal clear—even my doctor was impressed—but then there was my throat... hmmm... I often deal with my voice "cracking," especially if I've been singing a bit too much at night 😁 , and whenever I catch a cold or the flu, my throat takes the brunt of it; swallowing becomes absolutely agonizing... Since my labs were fine, the doctors assumed the erythema appeared because of that throat inflammation I had. They weren't entirely certain, though, because my throat wasn't actually hurting at the time (it was summer, but I had the inflammation back in February), so technically I was healthy during that period, even if I was dealing with those symptoms 😕
It’s true that I was pretty exhausted due to other things going on back then (I was facing some issues at the time; it was actually one of the tougher periods of my life), but again, the lab results were normal. It seems it hits women more often, and God knows what else we have to deal with 🙂
The Srića erythema hasn't returned, and as I mentioned, I've never had major health problems aside from that occasional throat issue... but what exactly is sarcoidosis?
I just noticed that Kimberly Williams was posting around the same time I was.
So, here is the situation: A lung scan in Loeffgren syndrome (a type of sarcoidosis linked to erythema nodosum) shows enlarged hilar lymph nodes—which can be quite pronounced sometimes, or they might only show up on CT scans... so it would be wise to have an experienced radiologist take a look.
The timing of the symptoms, the fatigue, and these vague throat changes would fit the profile... standard blood tests are usually normal, except perhaps for a slightly low lymphocyte count in the differential. Usually, ACE levels are elevated in sarcoidosis, especially the acute form; I wonder if they tested for that?
Look, if you were dealing with the acute form of sarcoidosis, don't sweat it—it clearly resolved on its own, which is how that form typically behaves. The only important thing is to mention it to your doctor if you experience general symptoms like fatigue, coughing, or skin changes again in a few years... so you aren't left guessing and can ensure the diagnostic process is properly directed. 😉
Kevin White5 said:Well... I haven't seen endless cases of sarcoidosis, but I did happen to lead a seminar on the subject. It's certainly not a trivial matter. Especially neurosarcoidosis (which is rare, but still exists). Not to mention that besides lung involvement (hilar lymphadenopathy), sarcoidosis can affect various other organs... (it's an autoimmune disease) But in my view, we shouldn't be focusing on sarcoidosis right now. We should be looking at what our fellow forum member is experiencing from the list above—specifically, identifying potential causes for the erythema nodosum.
I disagree. There absolutely needs to be discussion regarding sarcoidosis because it is the most common cause of erythema nodosum... it is entirely possible this user dealt with undiagnosed sarcoidosis a few years ago. 😉 So, I am going to elaborate on that point further.
Sarcoidosis is not an autoimmune disease (there are no autoantibodies). It is a disease of unknown etiology that can impact multiple organs, though it most frequently targets the lungs. There is a specific presentation known as acute sarcoidosis, which typically emerges during the spring and summer in young people and is linked to erythema nodosum; it even carries its own designation—Loeffgren syndrome. In this syndrome, in addition to hilar lymph nodes, the lacrimal and salivary glands may also be affected... throat discomfort is frequent, and one might occasionally see small white spots (mucous plaques) on the pharynx or palatal arches. These are often misdiagnosed as tonsillopharyngitis—especially if there is colonization by a group of streptococcus in a swab, leading to a mistaken diagnosis of streptococcus tonsillitis.
Loeffgren syndrome is intense (due to the systemic symptoms and the erythema nodosum), but unlike neurosarcoidosis, it isn't associated with malignant forms of the disease. The prognosis is good and it resolves on its own (with rest and symptomatic treatment, such as indomethacin)... but recognition is vital. 😉
Sarcoidosis isn't even that devastating of a diagnosis, especially when it presents alongside erythema nodosum 😉 (which typically just runs its course, clears up on its own, and stays gone—you really just need more frequent checkups)
Erythema nodosum isn't a disease itself; it’s just a symptom... and a highly non-specific one at that.
It can pop up occasionally alongside a sore throat, but these days, it's most frequently seen as a sign of sarcoidosis—especially during this spring/summer season.
I'm not sure if you had any lung imaging done back when you were dealing with the erythema nodosum? Sarcoidosis, for the most part, targets the lungs first and foremost.
Yes, it happens quite frequently, even outside of my menstrual cycle 😢
And today is just a miserable day; I've had a splitting headache since the moment I woke up When the barometric pressure is this low, I've realized that strong coffee doesn't help at all. Instead, what actually works is eating salty sardines... I keep a jar of them in the fridge specifically for days like this... All I need is to eat two or three sardines, drink plenty of water, and then I start feeling a bit better 🙂
When dealing with sinus infections, the absolute priority is clearing the nasal passages. That is the foundation of treatment—just like with ear infections. You need nasal drops. Without them, even antibiotics won't do much.
Taking an antibiotic only makes sense if you have a fever or elevated white blood cell counts. Did your doctor actually run a differential blood count?
If the criteria for antibiotics are met, there is a specific list of options available. According to FDA standards, drugs are categorized into three groups:
Group A: Medications proven to be safe during pregnancy.
Group B: Drugs that weren't specifically tested on pregnant women during clinical trials, but long-term medical practice has shown no adverse effects for those who took them (for instance, cases where early pregnancy wasn't known at the time of ingestion).
Group C: Medications for which there is no data or that are proven to be harmful during pregnancy.
Treat Group A as a theoretical concept, because let's face it: no sane researcher tests drugs on pregnant women today. Therefore, almost all antibiotics currently deemed safe for use during pregnancy (including old-school penicillin) fall into Group B. Per the FDA, Azithromycin is also in Group B, meaning there have been no recorded adverse effects on the fetus from women taking it.
Manufacturers are required to cite clinical trial results in their recommendations. Since controlled trials on pregnant women don't exist, it is only logical that they include these disclaimers.
Besides, just go to the FDA websitehttp://www.fda.gov/ and look up the medication lists regarding pregnancy.
But before you jump to conclusions, check your temperature, get your white blood cell count and differential checked, and use nasal drops (after verifying the ingredients against the FDA list). If none of that works, then you can consider Azithromycin.😉
MAO inhibitors fall under the antidepressant category, yet the newer generations of these drugs are actually showing some promising results in treating Parkinson's disease too.
brisknomad6 said:I was actually worried there would be too much and it would kill me in two days😁
granitebadger25? 🙂
granitebadger25 🙂 dream of justice, which is exactly what I recommend to you as well😬
I just want to reinforce what rapidranger79 already stated... read it carefully and stop experimenting aimlessly.
With medication, anything is possible, including sedative side effects, but in your case, it’s unlikely; you aren't exactly that type of specimen. 😁
rapidranger79 mentioned thyroid issues and hyperthyroidism, and I believe someone else brought that up to you earlier... have you actually checked that?
brisknomad6, I've known you online for a very long time (and it has been a long time), and you are constantly struggling with sleep. Your lifestyle is anything but organized or normal. You work night shifts, which is a total disaster for your circadian rhythm. Instead of resting, you just keep pushing... eating on the go, smoking heavily, drinking way too much coffee (how many cups a day?), and probably soda too (?) ... I know you dance, but is that enough physical activity for you?
Try taking some vacation time. Go hiking on Mount Everest, exhaust yourself properly in the fresh air, stop smoking (especially at night), cut back or eliminate coffee and soda entirely, and eat in the morning rather than at night... in the evening, drink chamomile tea (use plenty of it, so the whole room smells like it)... if all of that doesn't help, then—and only then—does it make sense to consider sedatives, and even then, only under a doctor's advice.
If none of that works, it wouldn't be a bad idea to get a workup at the Sleep Disorders Center—it's located in Brooklyn, but don't let the location discourage you. 🙂
Look, Kenneth Hernandez67, this is just what spring does to people... we all struggle with the seasonal shifts, but those dealing with mental illness have it even harder. Manic-depressive episodes tend to spike during the spring, and while I don't know the exact specifics regarding schizophrenia, I'd bet they aren't having an easy time this time of year either. 😢
It’s actually a good thing he’s in the hospital; at least his medication was adjusted in time.
He’ll be fine eventually, but that's just the nature of this disease.
Don't let the old folks' comments get to you. You know as well as I do that this is the best possible move for your uncle.
Casey Palmer5 said:Ugh, I’m going to lose my mind!!!! 😬
... so two boxes = $233 (I have a private prescription). Basically, I don't have a pulmonologist's opinion stating I should be taking this, and I don't have the patience to go through the whole "evaluation" process just to end up without that recommendation.
Oh, please, don't be such a chicken. 😁 Just grab your old allergy test results, head to a pulmonologist, and tell them you've been using Singulair and it works—they'll prescribe it for you. There is absolutely no reason to pay out of pocket when it's already on the approved drug list.
Intel is an incredibly archaic way to manage asthma; honestly, I think only old-school pediatricians still prescribe it because they're overly cautious about corticosteroids.
I actually put in some effort and went back through your old posts regarding Ragweed, and I think your perspective on your own symptoms is slightly misguided. From what I can gather, during Ragweed season, you aren't just dealing with rhinitis—you're having asthma attacks (which usually go hand-in-hand). I know you have an aversion to medication, but when it's necessary, you have to take it. If you are suffering from nighttime asthma attacks during Ragweed season (which I read that you are), there is no room for debate: you should be using inhaled corticosteroids at that time. Any potential side effects are negligible compared to the reality of struggling to breathe for 6 to 8 weeks straight. Besides, get a spirometry test done during that period; you'll likely see that even outside of an active attack, your expiratory volume is diminished. If you maintain this state for years, that reduction becomes permanent, and you'll suffer lasting lung damage—regardless of the fact that it "only" lasts two months of the year. By delaying proper treatment, you risk ending up in status asthmaticus... and then you'll end up needing much higher doses of corticosteroids than if you had simply started with smaller doses on time. Think about that before summer hits. 😉
Sometimes, you might find that while a child can technically breathe through their nose, the nasal passages are actually still swollen. It’s pretty rare in kids—you see it much more often in adults—but if that happens, the child will be breathing through their nose, yet you'll notice their voice sounds nasally. In those instances, it can also lead to a blockage in the Eustachian tube.
Justin Gonzalez87 said:Regarding those nasal drops... there is absolutely no way I'm doing that to him. 😢 He is one wild, unpredictable guy from Dale.😁 Stubborn as a mule.
Everyone is exactly the same. It has nothing to do with where they come from. 😁 You have to develop your own technique; you don't really have any other choice. In my experience, it works through a systematic cycle of persuasion followed by coercion... and that's just how it goes.
Atlantic Ocean spray is useless; it’s definitely not going to clear his nose. If he's that into the whole spraying thing, I think Operil has a spray version too... though when you're dealing with an ear issue, drops are always the better way to go.
I still don't quite get it... These ear infections—affecting both the middle and outer ear—just seem to come out of nowhere. There’s no congestion, no cold... I mean, there isn't even the slightest hint that anything is wrong.
Wait, what symptoms is he even dealing with? How did the doctor even diagnose an ear infection in the first place?
There is a small passage connecting the nose to the middle ear known as the Eustachian tube. Its purpose is to channel air from the nose into the middle ear. This is vital because it equalizes the pressure between the middle ear and the external auditory canal. If the Eustachian tube becomes blocked, air cannot enter, creating the perfect environment for an infection to develop. Furthermore, the eardrum can become sucked inward, which results in hearing loss. If the infection progresses, fluid builds up in the middle ear, causing pain. Should the Eustachian tube remain obstructed, that fluid eventually has to escape—usually by rupturing the eardrum, allowing fluid and blood to drain through the outer canal. While the eardrum eventually heals, repeated ruptures can leave scarring, rendering it non-functional and leading to permanent hearing loss.
Now that I have provided that explanation, I must point out that the most common cause of a blocked Eustachian tube is nasal congestion or rhinitis. This could be bacterial, viral, or—most commonly during this season—allergic (birch pollen is extremely allergenic right now). Regardless of the type of rhinitis (which you will need to determine), the priority is keeping the nasal passages clear. If the child begins complaining of ear pain or muffled hearing, do not skimp on nasal drops. And I am not talking about simple saline sprays; use the effective ones (operil, Ben, pseudoephedrine, etc.). The correct administration method is as follows: - First, have them try to blow their nose to clear any mucus. - Have the child lie on the bed with their head hanging slightly off the edge. - Apply 1-2 drops into each nostril and instruct them to inhale through the nose as much as they can. Leave them in this position for at least 5 minutes. - While lying there, have them make the "K" sound or say words containing "K" (don't be silly 😉 tell them to say "Manhattan"). This is because the "K" sound lifts the soft palate, increasing the likelihood that the drops reach the nasopharynx where they need to act. - Repeat this process 3-4 times a day, and ensure you do it before bedtime.
If you start the drops promptly and clear the Eustachian tube, the infection may never even develop, meaning antibiotics won't be necessary.
That said... it wouldn't hurt to have an ENT specialist take a look. 😉
👋
P.S. For heaven's sake, do not put anything into the ear itself or the outer canal. You never know if the eardrum has already ruptured, and in that case, you would simply be introducing an infection deeper into the ear. P.S.