Had to diagnose a 15 year old girl with Lymphoma yesterday.

livi · 08-23-2007, 12:55 AM

Two weeks feeling tired and developed an intermittent fever. No focal symptoms at all. I saw her at the clinic. She looked a bit pale but otherwise a happy, cute teenager.

During my examination I noted a slight liver enlargement, but that is fairly common with many viral infections. Ordered a blood screen that came back with an unusual combination of results. Thought it somewhat suspicious and had her do an ultrasound of the abdomen.

Came back with the result that shows multiple, enlarged lymph nodes in the upper abdomen. Together with the absence of infectious signs the tentative diagnose must be Lymphoma. A malignant disease with not always that good a prognosis.

What a blow. One day a happy teenager with the whole life in front of her, seeking help because of a certain feeling of tiredness and fever - next day diagnosed with cancer.

I truly loath this job sometimes..

slodave · slodave's Garage

Cancer is very prominent these days, among young and old. Cancer has been around me my entire life. My mother has had cancer twice. The first time was about 20 years ago and she beat it. She was diagnosed again about 3 years ago, with a non related cancer, She is strong and doing well and kicking its a$$!!!!

My ex-wife has had cancer twice within 3 years and my aunt recently died from it. I hate cancer!!

I hope your patient is able to live as healthy and as happy a life as she can!

Dave

frogger · 08-23-2007, 02:57 AM

Markus, that's very sad, indeed. I'm sure the girl and her family will be glad you discovered this problem and they'll get her started immediately on the treatment. Hopefully, it will be something the girl and her physicians can overcome.

widgeon13 · 08-23-2007, 03:31 AM

Quote:

Originally Posted by frogger

Markus, that's very sad, indeed. I'm sure the girl and her family will be glad you discovered this problem and they'll get her started immediately on the treatment. Hopefully, it will be something the girl and her physicians can overcome.

Couldn't agree more, you did what you are trained to do and you got it at what seems to be the earliest opportunity. It is very sad but at least you have given her the chance to fight cancer and get on with her life.

You had to know there would be days like yesterday but you do it anyway. Bravo!

Tim Walsh · Tim Walsh's Garage

That reminds me of my brother, Mom took him in at 16 to confirm what she thought was mono, and a few hours later we're at Wake Forest Univ. with a diagnosis of Leukemia. It was a rough couple of years, but he's healthy as a horse now.

On the plus side she sounds like an otherwise healthy kid so I'd expect her chances are better than most.

KFC911 · 08-23-2007, 04:13 AM

Quote:

Originally Posted by Tim Walsh

That reminds me of my brother, Mom took him in at 16 to confirm what she thought was mono, and a few hours later we're at Wake Forest Univ. with a diagnosis of Leukemia. It was a rough couple of years, but he's healthy as a horse now.

On the plus side she sounds like an otherwise healthy kid so I'd expect her chances are better than most.

Markus, that must truely suck...that aspect of your profession, good luck! Tim, that's fantastic...that's been some time back huh?

Tim Walsh · Tim Walsh's Garage

Yep, he was in remission by 19-20 and just got accepted to med school at VA. I guess the cancer worked out for the best since I think that's what pushed him to the Phd-Md program there.

svandamme · svandamme's Garage

at least you got right on top of the case, right away

when i had liver problems back in NL, i had to wait 6 months before i managed to get past my house doctor( it's stress, no it's something else, no it's stress, no this ain't normal, ok , i'll run some more blood tests, hey, this is odd, ok , i'll forward you to the internist), past the waiting times for both internist( 3 weeks) and ultrasound (another 3 weeks) and back waiting for the internist to get results(again 2 weeks)

i would think, in cases like this, every month, every week counts

luckily for me, i just had fatty liver

NICKG · 08-23-2007, 05:07 AM

Markus, how does the healthcare system work there? Are they gonna have huge medical bills or is that something that is taken care of by the government? Here it is essentially bankruptcy for most people because the bills are enormous

livi · 08-23-2007, 05:25 AM

Thanks for your encouraging words, guys.

Fortunately, these cases are relatively few and far between for any individual doctor. It is the 'moment of truth', when you have to reveal the grim fact to the family, that is the hardest. No matter what you say and how you put it, the minute they hear the ominous words, they shut down completely. The rest of the session is just a hazy, blurry nightmare..and there you are in front of this devastated, chocked family...with not a single word to say that make any difference.

No, no matter what circumstances or disease, the cost for the patient is basically the same, which is virtually none. Particularly for children, for whom there are no charge what so ever.

Well, the semi-communist regime has to have some advantages, I suppose..

NICKG · 08-23-2007, 05:34 AM

glad to hear that, at least they won't have to have the added worries of how they will pay.

targa911S · 08-23-2007, 06:09 AM

Livi sorry to hear about your grim discovery. I played in a casual band for a while with some doctors. One day I came to rehearsal kinda pissy after a hard day with advertising clients. When the Docs asked what was up I started to explain but stopped myself when I thought ..Hell this is as hard as my day gets, these guys have clients die on them every day. I don't know how ya'll deal with it but some days, like yours, it must be crushing. Hang tough bud.

ckissick · 08-23-2007, 06:55 AM

Of course, here in America, we always talk about the poor government services in Socialist countries, including health care. This does NOT seem to be the case in Sweden because of Doctors like you, Markus. Keep up your heroic work.

ckissick · 08-23-2007, 06:58 AM

Quote:

Originally Posted by targa911S

Livi sorry to hear about your grim discovery. I played in a casual band for a while with some doctors. One day I came to rehearsal kinda pissy after a hard day with advertising clients. When the Docs asked what was up I started to explain but stopped myself when I thought ..Hell this is as hard as my day gets, these guys have clients die on them every day. I don't know how ya'll deal with it but some days, like yours, it must be crushing. Hang tough bud.

Ain't that the truth. My wife used to be a nurse in neonatal ICU. A bad day for me might have been getting rained on during field work. For her, a bad day was when she had a baby die in her arms. After ten years, she couldn't do it anymore.

competentone · 08-23-2007, 07:52 AM

Quote:

Originally Posted by livi

Came back with the result that shows multiple, enlarged lymph nodes in the upper abdomen. Together with the absence of infectious signs the tentative diagnose must be Lymphoma. A malignant disease with not always that good a prognosis...

"Tenative diagnosis" -- I assume there is going to be a biopsy?

It is not a diagnosis until a pathologist looks at the slides. Sometimes the body can show strange symptoms, but the cells don't tell the same story (personal experience 20 years ago).

And even if the biopsy result confirms the initial diagnosis, it is hardly a "death sentence" these days.

(I've been looking at this company from an investment perspective. From my reading, there is some fascinating stuff going on with potential cancer treatments: http://www.medarex.com/Development/ http://www.medarex.com/Development/Pipeline.htm )

KFC911 · 08-23-2007, 07:54 AM

Quote:

Originally Posted by ckissick

Ain't that the truth. My wife used to be a nurse in neonatal ICU. A bad day for me might have been getting rained on during field work....

My ex-g/f was a nurse tending for the elderly, hospice, etc. I've never, EVER had a bad day at work that compares to what she and other good people like Markus must cope with. They have my upmost respect...

CarreraDan · 08-23-2007, 08:20 AM

Those days do suck. About a month ago we had a patient on our floor diagnosed with metastatic sarcoma--not much anyone can do at this point for her. She had just graduated college and it really hit all of us hard on the unit. I will giver her credit that she handled the news very well and they transferred her to a bigger hospital to attempt to shrink some of the tumors. The oncologist said best case was 6 months for her. I honestly don't know what I would do if I was told best case I had 6 months to live. Luckily for us we normally don't have to deal with this kind of stuff on a regular basis.

If you guys every suspect something is wrong with your body please get it checked out and if your doc doesn't want to pursue it find another one that will you just never know.

Aerkuld · Aerkuld's Garage

livi - You did good. Hopefully you caught it and it can turn out well.
A way back I worked with two guys, absolutely fantastic guys. These two had worked at the same company for years, had grown up locally, raced a car together, and had been best friends since childhood.
One of them got diagnosed with non-hodgkins Lymphoma, battled with it for a few years, and just when he appeared to be doing OK, secumbed to the disease. I guess it was shortly after that that I left the company only to get a phone call about a year later from some of my former colleagues to ask if i wanted to attend the service for the other guy that had just passed away from the same thing.
I understood that it was a fairly unusual disease, so to get two guys who had grown up together both have it just seems so strange. Very sad.

pwd72s · 08-23-2007, 09:38 AM

15...it's sad when one so young faces such a serious thing. Livi, I hope all turns out well...

livi · 08-23-2007, 09:49 AM

I really appreciate your posts. Thank you.

Over the years I have come to acknowledge that the single most difficult part in the medical business is communication. There is a vast cleft of language distorting knowledge and experience difference between doctor and patient. We simple do not speak or think the same language. So much that it actually prompted me to right a book on the subject (that surprisingly sells rather well). No matter how skilled a professional, if you can not convey the message to the patient in a way that they truly understand, you might as well be 'cleaning windows' as Van the Man sings.

It is an amazing, strange, sometimes appalling feeling of humbleness spending an hour telling a family that their baby is seriously ill - sometimes with poor prognosis, knowing that this is a milestone moment in their lives and for me it is just another day at work. Next day, next patient. Yes, many times a patients faith dwells in my mind for weeks and months, but I am still just the messenger. For them I am however the person who alerted them and treated them for one of the most important and memorable issues in their life time.

This is why having a humble understanding of the infinite power of how you convey the message is of utmost importance in the medical trade. Typically, it is also the most difficult. Too make matters worse, it is a fact that it is impossible to really know what impression you make on the person in front of you.

Therefore, being faced with the inescapable mission of being the messenger of bad news in this business, feeling almost guilty being all healthy yourself and able to look forward to another great day tomorrow, you do need a sympathetic pat on the shoulder by good caring people.

That is why I posted this here. Completely egocentric. Thanks.