What Would You Do?
The Case of the Harmful Herbs
Martin has been treated for chronic myelogenous leukemia for the past two years with imatinib. Although he initially responded well, a recent bone marrow aspiration demonstrated an increase in myeloblasts. During a medication review prior to seeing his oncologist, Martin admits that for the past several months he has been using echinacea to strengthen his immune system and St. John’s wort (SJW) to help with feeling depressed about his diagnosis. Despite his worsening disease, he states he feels “better than ever.” What would you do?
The Case of the Painful Port
Louise arrives in your office for her chemotherapy treatment with doxorubicin and paclitaxel. You access her implanted port without difficulty and obtain a brisk blood return. However, when you begin to flush with normal saline, she complains of severe burning.
The Case of the Diminished Desire
Kenneth, a 61-year-old man being treated for prostate cancer, comes to you for his leuprolide acetate injection. After a few minutes of awkward silence, his wife Barbara asks to speak to you in private. She explains that Kenneth no longer has any sexual desire and avoids intimate contact. The problem began with erectile dysfunction.
The Case of the Overlooked Osteoclasts
Judith is a 54-year-old woman with breast cancer. Her regimen over the past two years includes chemotherapy, an aromatase inhibitor, and zoledronic acid infusions. Last week, she called complaining of oral tenderness. After reviewing her chart, the RN concluded that Judith had mild mucositis from the chemotherapy and suggested she rinse frequently with salt water. When you see Judith today, her pain is worse. Upon assessment, she has no evidence of mucositis but has a solitary 7 mm erosion on her gums adjacent to where a molar had been extracted a couple of months ago. The lesion is necrotic and devoid of normal tissue, and the mandible is visible. What would you do?
The Case of Confounded Confusion
Ian, a 68-year-old patient with early-stage small cell lung cancer (SCLC), has become progressively confused throughout the night. His bilirubin and creatinine have been slightly elevated, and he is receiving hydration with 0.45% normal saline. He has also been uncharacteristically belligerent and has vague complaints of nausea. Ian’s physician doubts that the confusion is the result of brain metastasis or hepatorenal insufficiency and orders an electrolyte panel to be drawn. The results indicate a sodium level of 116 mEq/L, and the physician subsequently orders urine sodium and osmolarity tests. What would you do?
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