What Would You Do?
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?
The Case of the Tingling Toes
Harold is a 69-year-old patient receiving oxaliplatin. He tells you that his toes started tingling about a month ago, but the symptoms had gone away. Today he says that the “pins and needles” are constant, and he tripped getting into the car. What would you do?
The Case of the Carboplatin Hypersensitivity Reaction
Gail is a 40-year-old woman receiving her sixth dose of carboplatin. Three minutes into the infusion, she complains of mild itching on her palms. After the nurse briefly pauses the infusion, Gail’s symptoms abate and the infusion is restarted. However, within five minutes, the itching returns, along with complaints of facial flushing, abdominal cramps, and shortness of breath. What would you do?
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