Patients Presenting Concern:
She explained that she had a history of asthma that she used a preventative inhaler for intermittently. She was a little bit tired, but did not report acute fatigue.Initially, this seemed like an easy diagnosis of viral upper respiratory infection with acute asthma exacerbation.
As I proceeded with my physical exam, I noticed enlarged lymph nodes to the cervical chain on her neck that were worse on the left side. As I palpated above her left clavicle I noticed a small mass about 2 inches x 2 inches.
“Have you noticed this bump?” I asked her.
“Yes, it’s been there for a while. My last doctor just wanted to watch it.”
I felt that this was something that should be investigated further. I ordered some blood work that day. The results came back with several abnormalities including a WBC count of 17. I immediately ordered an ultrasound of the mass. The results came back that the mass had unusual properties with concern for cancerous cells or autoimmune disease. In order to obtain a clear diagnosis, I ordered a biopsy. The result was Hodgkin’s Lymphoma.
I immediately called the patient for follow-up. We had a tough conversation about the diagnosis and the likely treatment plan, but also that this is a treatable disease. With teary eyes, she hugged me and thanked me at the end of the appointment. I was overwhelmed by the strength and courage of this young woman, and I felt very teary myself.
I referred her to an excellent oncologist. Over the course of her treatment, I saw her in the office a few times for an inhaler refill or other primary care needs. She remained strong and positive throughout.
Over a year later, I saw her name on my schedule for the day. I was excited to see her and hear how she was doing. She was there with her mother, who wanted to meet me and thank me. My patient was done with treatment and considered fully cured.