All things yin and yang

December 3, 2010

Being diagnosed with sarcoidosis changes physician's perspective on practice of medicine.

Sarcoidosis. It was such an ugly word to bring tears of relief to my wife's and my eyes. The absolute joy of now knowing that I was going to see my 6-, 5-, and 4-year-old children grow up gratifyingly descended on me. I was being given a second chance.

Gradually, the sense of joy and relief gave way to a burning, searing pain in my chest, courtesy of the mediastinal scope that a doctor friend had hammered into my chest that Saturday many years ago. Another physician had reassuringly made his way from the pathology laboratory to my operating room (OR) suite to give me the good news. The differential diagnosis entering the OR that morning in April really only included 3 possibilities: metastatic lung cancer, lymphoma, and sarcoidosis. Given those options, you now understand the joy this weird little disease brought to my life.

My ordeal had started 1 week before. It reads like something from the clinical case section in the New England Journal of Medicine: A 38-year-old white family physician preparing to take a test to obtain added qualifications in sports medicine goes to Dallas, Texas, to attend an intense, weeklong review. Returning home from his first day back in the office, he experiences intense diaphoresis, chills, fevers, fatigue, and myalgias. Suspecting the onset of the flu, he immediately hydrates, takes acetaminophen, and goes to bed early.

The next morning, his symptoms have resolved completely, so he goes back to work. That evening on his return from the office, his symptoms return. He again hydrates, takes acetaminophen, and goes to bed early. Again, in the morning his symptoms have resolved, and he returns to the office to see patients. The cycle recurs for 4 days, his symptoms progressively more severe each successive night.

He finally discusses his symptoms with a colleague, who suggests obtaining blood work. The blood work shows a moderate elevation of his liver enzyme levels. Suspecting a mild case of hepatitis, he repeats the blood work, this time including a hepatitis panel.

He discusses his symptoms with a gastrointestinal (GI) medicine colleague. His symptoms now have progressed to the point that he must miss work for the first time in 10 years of practice.

The results of his hepatitis panel are negative. His GI colleague makes his first house call (for which the family physician is eternally grateful). The idea of obtaining a primary care physician (PCP) for himself never has occurred to the physician-now-patient. A chest x-ray is obtained and shows significant mediastinal swelling and discrete nodules in the peripheral lung fields.

x