My worst episode of salivary gland swelling

When I saw the oral surgeon in September, he said that there seemed to be pus coming out of my salivary glands when he expressed them. This, he said, was due to an infection because of the pooled saliva in my blocked glands. He prescribed me ten days’ worth of apo-clindamycin, to be taken once every eight hours.

I found it extremely difficult to take that medication, as it was causing me two major problems. For one, the antibiotics caused awful heartburn, which forced me to stop taking them after two days. I went back to the doctor’s office, but because I’m allergic to so many antibiotics, I couldn’t change the medication. They prescribed me some Zantac to take along with it, which helped a little.

The other problem I had with the medication was that, for some reason, it made the excretions from my salivary gland more prolific, which means that I was dealing with more blockages. It seemed like while I was on the medication, my glands refused to empty on their own. They were extremely swollen, and I had to constantly stroke or push on them to get them to empty.

In all, I probably took the medication for five days total.

A couple of days before my October appointment, I decided that I really needed to finish my medication, so I started again in earnest. On the second day, I was having lunch at school when I felt the familiar tenderness in the duct of my left submandibular gland. I was annoyed, but I figured that the blockage would leave the duct when it was ready. Before I was finished eating however, I felt the swelling worsening, and decided to go home to try to empty it myself. However, it was pouring outside, so I had to wait a while before I could go home.

Sometimes the blockage gets so bad that it feels like it’s pressing on my airway and my ear canal. I know the ear canal doesn’t make sense considering the location of the submandibular gland… maybe it pushes the parotid gland upwards. I’m not sure, but I certainly feel something.

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A diagram of the major salivary glands and their positions in the head, from patient.info

While I waited for the rain to let up, my throat started to feel like it was getting smaller, and the swelling was getting really bad, really fast. And for the first time, the swelling was actually painful. I was getting worried, so I called my doctor’s office. By this time it was about 4:30. When the receptionist picked up, I explained that I thought I was having an emergency – that I thought a stone was stuck and causing swelling, and that my throat was closing up. After (presumably) checking with the doctor, she told me that he was seeing his last patient for the day, and I would have to come in the following morning. Even though I was scared that my throat was closing.

Disgruntled and worried, I went home and decided to rest until the following day.

I can’t remember much of what happened immediately afterwards. I do remember calling around to see if there were any other oral surgeons that could help me, but everyone had gone home for the day. Maybe I also went to sleep. I remember that in the night, the swelling was really progressing. I called my mom, and she encouraged me to go to the hospital, so I asked my sister to go with me, and we called a cab to take us.

After waiting for a long time, I finally saw a doctor. As I had expected, she couldn’t do anything to help me. She offered me a hydrocortisone shot for the swelling, but as I was convinced that it was a stone, I refused it. I cried a little bit in the lobby while I waited for the cab to take me home. I was tired, I felt awful, and I was frustrated that I had been paying so much money to try to get my illness diagnosed, and while I was having an emergency, no one was able to help me.

On the way home, I started to feel like the stone might be ready to come free. As soon as I got home, I rushed to the mirror. When I lifted my tongue, I saw something small and yellow just barely pushing out of my swollen duct. I tried to push it out, but to no avail. It was extremely painful to do so.

After a while, I gave up, and decided to go back to bed. I was pretty sure that the blockage wouldn’t move without surgery, so I refused to eat or drink anything for the rest of the night, in preparation for the next day. My friend, who is a student at our university’s dental school, offered to come with me to the doctor’s office the following day.

I stayed up for most of the night, as I was too scared that if I fell asleep, my throat would close up and suffocate me. At about 3 a.m., my throat felt really tight. I called 119 for an ambulance, and a very rude operator informed me that I had called the wrong number for an ambulance, and that someone would call me back. I could barely speak, because of how small my airway was. To date, no one has called me back (Welcome to Jamaica!). Frustrated, I called my mom, who I found had been sitting up, waiting to hear back from me.  When my call with her cut off, I tearfully called another friend, who graciously stayed up with me for about an hour. Before he hung up, he suggested that I place a warm compress on my throat. I microwaved a damp hand towel and held it to my neck until it got cold, and then I fell asleep. It seems like during the night, the stone or whatever it was came free, because I woke up about an hour later, and found that awful tasting, salty saliva was slowly seeping into my mouth. It made me nauseous, but I was glad that the stone had come free, because by that time, the swelling was so bad that I was actually choking. When the sun finally came up, I was relieved to have survived the night.

I showered and went to the doctor’s office at about 10:30, where my friend from the dental school was waiting for me. She sat with me and fussed over my swollen face, until it was our turn to go in to the doctor. And it was then that I got the disappointing news, that there was actually no stone in my salivary glands.

I really wanted to cry after that, but my friend comforted me before returning to school. I was extremely tired, so I went home and slept. My swelling went down over the next couple of days, and I was extremely tired.

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This is a picture of mumps, but is not unlike the way I looked that night. My swelling was noticeably worse on the left side, and took a few days to go down completely

That was, by far, the worst episode I’ve had to date. Since then, I continue to have swelling and express white threads. At this point, I’m trying to get an appointment with a GP, so that I can get a referral to a rheumatologist. The next step in my journey is to begin testing for autoimmune diseases. I have a theory about what I might have, but I don’t want to jump to any conclusions just yet.

Hopefully, my next post will be about my visit to the rheumatologist.

Stay strong in the meantime, as I’m trying to do.

Yours,

Maladie

My history with salivary gland blockage

When I really think about it, I realise that my illness might have been gradually progressing for several years.

I’m not really sure when I started getting the itching under my jaw. I hadn’t started university yet, so it was definitely before 2015, but that’s as much as I can say. I didn’t really pay it much attention at the time; I couldn’t even pinpoint what was causing the irritation. It could have been my eczema, or it could have been hirsutism from my recently diagnosed Polycystic Ovarian Syndrome (diagnosed 2011). It was kind of a joke among my family, the way I would dig at my jawline with my index finger. I couldn’t really blame them for laughing – sometimes I would scratch so vigorously that I felt like a dog scratching with its leg.

Sometimes when my allergies acted up, the itching would spread to my nose, throat and ears. When that started happening, I figured it was due to an allergic reaction. I could sometimes calm the irritation with a dose of Piriton. It never completely stopped, though. I’ve been going at it for so long, that I have small rough patches on my neck where I usually scratch.

While my itching remained a mystery for many years, as it got worse, I was able to gradually decipher what was exactly going on.

In September 2017, my allergies suddenly got worse, when I seemed to develop a pollen allergy. I began sneezing almost constantly, and I think the constant stimulation to my salivary glands exacerbated whatever had been causing the itching for all those years. I can’t be sure that the itching got any worse, but I started experiencing near constant swelling under my jaw. At that time, I thought that it was my tonsils that were swollen, and so I was going to the doctor almost every month, getting antihistamines and antibiotics. Obviously, it didn’t really help much. At best, I would feel better while on medication, and then as soon as I came off it, my symptoms would return. At one point, I was actually planning to have my tonsils removed in the summer of this year.

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This is a good example of what my jaw looks like… it looks slightly worse or better depending on how bad the swelling is

The progress of my illness hit a plateau until April or May 2018, when I started noticing new symptoms.

I would notice that when I started scratching, inside my mouth felt swollen and tasted weird. After spending some time pressing on the gland, saliva would gush into my mouth, and gradually the situation would improve. Within a week or two of noticing this new development, I started pulling some white, stringy substance out of my mouth before the saliva gushed out. I can’t explain what I felt, but there was a distinct feeling whenever one of these white threads would present in my mouth. One time, I rushed to the mirror when I felt the sensation, and lifted my tongue. I saw a white thread peeking out of my Wharton’s duct. I grabbed it and pulled it, and it slid out of the duct, with little resistance. I remember feeling extremely grossed out. At that point, I abandoned my allergy theory, and became convinced that my salivary glands had been infested by worms.

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The “openings of the ducts” show the position of the Wharton’s duct – it opens at the base of the frenulum

Around the time that I had come to this conclusion, I found a particularly good doctor at my school’s medical center. He ordered an ultrasound of my neck, which came back completely normal, except for what he described as a node on my lymph nodes. He assured me that it was very likely benign, and due to continuous infection. He assured me that if there were worms in my salivary gland, they would have shown up in the ultrasound; however, by this time, I had collected a number of them in a pill bottle, submerged in rubbing alcohol, and I wasn’t convinced. He didn’t have enough evidence to have me referred to another hospital’s microbiology unit for testing, so I returned home to continue my own research.

By this time I had come across several online forums where people were discussing symptoms similar to my own. I had seen Sjogren’s Syndrome mentioned many times, so I decided to look into that possibility. After searching my symptoms along with the term “Sjogren’s Syndrome” I found a few articles written for the newspaper by a local dentist.

Eventually, I made an appointment to see her. She found my case pretty engaging, and for the first time, I found someone else who was as interested in my gland threads as I was.

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The white threads that have come out of my salivary gland. As shown in the one on the lower left, they’re long and thin; but because they’re so sticky, they fold in on themselves before i can get them into the bottle.

She actually took one of the threads out of the bottle with an instrument like a pair of tweezers to get a closer look at it and take a picture. Unfortunately, because they had been stored in ethanol and not formaldehyde, they would have been broken down too severely to be studied. However, the dentist hypothesised that the threads were probably uncalcified material that was periodically blocking my salivary glands. Through her, I got a referral to an oral surgeon, who had me do an x-ray and a CT scan.

However, like the initial ultrasound, all of the tests came back showing nothing wrong. In fact, the report from my CT scan explicitly stated that everything was normal, including my thyroid gland, my lymph nodes, and my salivary glands and ducts. The only thing of importance that my oral surgeon could show me was diffuse edematous swelling in the tissue around my jaw. He explained that if there was uncalcified matter in my gland, it would show up in an MRI, but because everything appeared normal, he didn’t think it was necessary to prescribe the test. Also, he noted, it was very unlikely for me to have stones in both glands, as both glands were affected.

So now I’m here – waiting to get tested for autoimmune disease to explain my continued swelling.

While I don’t know exactly what is wrong, I do understand now what is happening in my mouth. Some kind of material is coming up into my salivary ducts and blocking them intermittently. Due to the thick, stringy mucus that sometimes comes up, I have hypothesised that it must be especially sticky mucus that has become bound together. I imagine that the long stringy shape is caused by their journey through the duct.

When this matter moves into the duct, saliva backs up and causes swelling. The itching that I’ve been feeling is actually the sensation of the distension of the gland and the duct. While it has almost never been painful, I do sometimes feel a great deal of discomfort when the blockage moves into the narrow ducts. Through scratching – or more recently, stroking the gland – I can force the saliva out until enough pressure builds up in the duct to force out the blockage. Sometimes this can be difficult to do, and the duct becomes swollen and tender due as the obstruction stays put for hours.

Online, there are a number of home remedies for stimulating the duct, but as you will read in my next post, sometimes this might cause more problems than it’s worth. For now, I try to increase my water intake whenever I notice that the gland has been blocked, and that seems to help it to flush more easily.

In my next post, I’ll talk about the worst episode of swelling that I’ve had to date, the catalyst that inspired me to finally start this blog.