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Parotid gland

Q:  First, thank you so much for this blog!

I'm a 35 year old male from Denver, CO. I was quickly diagnosed with Sjogren's
after swelling from a wisdom tooth extraction didn't diminish. My Ear Nose and
Throat Doctor confirmed my Sjogren's with a lip biopsy. Currently, the swelling
is contained to my left parotitis gland. My Rheumatologist has me on 400mg of
Plaquenil (daily) which seems to help with the mild discomfort but, isn't really
helping to reduce the swelling. My Doctor said that it would take about 6 months
for the Plaquenil to start working. However, I have been on the drug for over a
year now. The swelling of the my parotitis gland fluctuates in size daily
(smaller in the morning and larger in the evening) by about 20-30%. The swelling
is roughly the size of an egg.

Other complications due to my Sjogren's are minimal. I'm not currently having
any problems with saliva or tear production. I do feel some joint pain and some
mild fatigue occasionally but, thats about it.

Since my diagnosis, I have tried many things to reduce swelling. But, it seems
like prolonged exercise and fish oil are the only things that help.

Are there any other successful methods for reducing the swelling? Its seems like
there are a lot of options out there, but was wondering if anything was more
effective? I'm willing to try just about anything including lifestyle changes,
alternative medicine i.e, acupuncture, lingering pathogenic factor testing,
detox, anti-inflammatory diet, hidden food allergens, etc.

Unfortunately, I'm in a profession where appearance is very important. So it's
crucial that I reduce the swelling if I'd like to continue working in this
field. I have considered surgery to have the gland removed. But, I'd like to try
and exhaust all other possibilities before I get to that point.

Thank you for your time.

A:  Consider topical anti-inflammatories, such as Aspercream (otc) or Voltaren Gel 1% (script in US). Apply warm compresses to the gland, apply topical anti-inflammatory, gentle massage - usually works best before bed.

Have seen some benefit from Acupuncture with a skilled clinican, anti-inflammatory diets/supplements, short courses of mucolytic agents to increase salivary flow through the gland.

Oral NSAIDs, which you probably have tried, or if your physicians were open to it...a brief course of oral Prednisone. Sometimes 10-20mg/d for 1-2 weeks will work, or the use of higher dose over shorter duration...Medrol dose pack (same as used to treat poison ivy or severe skin rashes.

I have not been involved in a case using low dose, targeted, short course radiation therapy to the gland....but given your Profession...you might discuss this ?option with your astute ENT, who got you diagnosed soooo quickly!

The concern with minimal systemic symptoms and it being only one of the 2 parotid glands...is an early pseudolymphoma assoc with Sjs brewing????? This is difficult to absolutely rule out without biopsy of the tissue. Sometimes an MRI can help. A blood test that is NOT widely used yet, and has not been validated in "clinical practice" for Sjs is the beta2 microglobulin. If this were very high....it could add some suspicion of a "lymphomatous process".

The fact that the gland fluctuates in size, and is not steadily increasing in size argues against a pseudolymphoma and for chronic inflammation/autoimmunity.

Sjogrens Foundation Fact Sheet for massage can be found @ http://www.sjogrens.org/files/brochures/Salivary_Glands_Massage.pdf......or through a patient blog  www.reasonablywell-julia.blogspot.com

drc

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