having constant fatigue
CASE STUDY FOR CHAPTER 6
HER STORY Sandra is a sophomore at Bay State University. About a year ago, she began having constant fatigue. She would nap during her breaks between classes but still felt tired. She figured that her busy schedule was wearing her out. She was taking five classes, holding down a work-study job, and playing on the school tennis team. She then developed a persistent itchiness over her entire body 3 months after the exhaustion began, and she often woke up sweating at night.
Shortly afterward, Sandra noticed a small lump on her neck. She took to wearing turtleneck sweaters because she was self-conscious about the lump. When the itch wouldn’t go away, she stopped pursuing a potential relationship for fear that her new boyfriend would find it strange.
More concerned with the itch and the lump on her neck than her exhaustion, Sandra first went to see a dermatologist. The dermatologist thought that Sandra had an infection, so she prescribed antibiotics and a topical corticosteroid. When the itch failed to resolve, Sandra visited a nurse at the student health clinic. He was very concerned about a second lump that had developed on her neck and immediately referred her to the oncology department at the university hospital.
THE EVALUATION Sandra was very upset at being sent to an oncologist and brought her roommate along for support. I explained to them both that I was going to perform an examination and run some lab tests so that we could find out what was making Sandra sick and help her get better. I ordered a full spectrum of blood tests and a CT scan of her chest, abdomen, and pelvis. I explained that I might also need to request a biopsy of the lump on her neck.
THE DIAGNOSIS My suspicions were confirmed when Sandra’s blood tests came back positive. She was shocked when I explained that she had Stage IIA Hodgkin’s lymphoma. She had never imagined that her itchiness and the lump on her neck might be symptoms of cancer.
THE TREATMENT I treated Sandra with four cycles of chemotherapy. This was followed by a course of radiation. Her cancer reacted to these treatments well. If she remains cancer free for 2 years, she will be considered to be in remission. Her hair did fall out due to the chemo treatments, and she was disappointed not to be able to participate in athletic activities with her friends. Her family and friends provided a support network that helped her get through this difficult period well.
CASE CLOSED Twelve months after the chemotherapy, Sandra is finally able to return to her precancer life. She is back in class and has slowly begun to exercise again. Next fall, she hopes to rejoin the tennis team. Her hair has come back in full and curly, and she reports a renewed high level of self-confidence.
Discussion Questions 1. What is Hodgkin’s lymphoma?
2. Why were the antibiotics not effective in controlling Sandra’s condition?
3. What is a corticosteroid drug, which is prescribed by the dermatologist for the itchiness?
4. Part of the examination of Sandra was to determine whether her cancer had metastasized. What does metastasize mean?
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