DEAR DR. GOTT: I am writing in reference to one of your recent articles. Recently, a gentleman wrote in that he had gone to an ear, nose and throat doctor in reference to a puffy place at the base of his neck. The doctor suggested he need not worry about lymphoma. Subsequently, you recommended that he back off and not worry.

That is the most ludicrous advice I have ever heard! Suggesting that the gentleman was otherwise healthy does not mean a small, enlarged gland could not be the start of lymphoma. My husband was diagnosed in 2000 with Hodgkin's lymphoma due to a small gland enlargement. Thank heavens he didn't read your column beforehand or he would've been dead by now.

DEAR READER: You have raised an important objection to the “wait and see” attitude that most physicians endorse when dealing with swollen lymph glands.

Let's take a minute to review these structures.

Lymph nodes perform two major functions. The first is filtration. Normal lymph nodes act as filters to prevent infectious material from entering the body. Therefore, a strep throat will often lead to swollen lymph glands under the jaw. Infections in the hand usually cause tender swelling of the glands in the armpit. An inflammation in a foot can produce enlarged glands in the groin. These responses are normal reactions to infection. The lymph nodes also participate in the immune system by manufacturing disease-fighting proteins. Under these circumstances, certain viral infections can cause swelling without frank infection.

I was going to write that lymph-gland swelling in patients with mononucleosis is an example of this phenomenon, but I can't prove that the swelling in mono is secondary to the immune response or to the filtration system. For all practical purposes, however, this is how the body reacts to the Epstein-Barr virus. In such cases, the lymph glands and the spleen may be massively enlarged, tender and associated with malaise, fatigue, fever and other manifestations of acute illness.

In contrast to these features, lymphoma usually presents in a different manner: irritated, nontender, hard, fixed, simple or multiple masses that, to most physicians, feel “suspicious.” In such instances, further evaluation is appropriate in the form of a biopsy or excision.

I do not agree with your position that all enlarged lymph glands must be biopsied. This is an expensive and uncomfortable procedure that may not be necessary. Biopsy can always be reconsidered later, if the situation doesn't improve, other lymph glands swell or additional symptoms (especially fatigue and malaise) appear.

Lymphoma is curable using modern anti-cancer strategies. If your husband's diagnosis rested on analysis of a small, single gland, he was just plain lucky. In most cases, doctors are to be applauded for taking an initial conservative stance.

In short, not every swollen lymph gland needs to be removed. Such instances, however, should be monitored closely. Persisting lymph-gland swelling is always a cause for concern.

To give you related information, I am sending you a copy of my Health Report “Viruses and Cancer.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR DR. GOTT: I am a World War II Army veteran. I spent nearly three years in the Pacific. While I was there, I was hospitalized four times with malaria. The first three times my fever went up to 104 F, and in seven to 10 days I was OK and went back to my work. The fourth time, my fever went up to 106 F.

Since that time, I have had diabetes, a heart attack and a small stroke, and my hearing is very bad. Could the high fever have caused any of these sicknesses?

DEAR READER: Malaria is not the cause of your diabetes, coronary artery disease, stroke and deafness.

These conditions, I am sorry to say, are far more likely to be inescapable consequences of the normal aging process. However, you should certainly share your concerns with your family physician or Veterans Administration doctors. In any case, regardless of the cause, the treatment for your health issues is the same.

To give you related information, I am sending you copies of my Health Reports “Living with Diabetes Mellitus,” “Coronary Artery Disease” and “Stroke.” Other readers who would like copies should send a long, self-addressed, stamped envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Doctor Gott is a practicing physician and the author of the new book “Live Longer, Live Better” (Quill Driver Books, www.quilldriverbooks.com; 1-(800)-605-7176

Copyright 2006, Newspaper Enterprise Assn.