Susan sat nervously in Dr. Owen’s office. “I hate going to the doctor,” she said to her son. She fidgeted in her chair. “And I feel so silly coming in when I’m not even that sick.”
“It can’t hurt to have him examine you, Mom. Just relax,” replied John.
“Susan Forest?” the nurse asked.
Susan followed the nurse into the small exam room and sat on the crunchy white paper waiting for Dr. Owen. He walked in and shook her hand.
“What brings you here today, Mrs. Forest?”
“I haven’t been feeling well lately. I had a cold for a while that never seemed to completely get better, and I’ve been feeling tired and achy for a while. I’ve also been extremely busy at work and watching my grandchildren, so I think it’s just lack of sleep. But recently I’ve been waking up at night with pain.”
“OK, Mrs. Forest. I’m going to do a history and physical right now. I’ll ask you some questions about your symptoms, your general medical history, and your lifestyle, and then I’ll perform a physical exam to try to determine what is causing your symptoms. How old are you, Mrs. Forest?”
“Sixty-seven,” she replied.
“And how long ago did you begin having symptoms?”
“About three months ago, in February, I caught a cold that I couldn’t seem to get rid of.”
“Are you still producing mucus when you cough or sneeze? Are you blowing your nose a lot?”
“Did you take any over-the-counter medications?”
“Yes, for about two weeks I took an over-the-counter decongestant and pain reliever.”
“So at that point you weren’t really having the cold symptoms anymore?”
“What about fevers? Did you take your temperature?”
“No, but I felt feverish once in a while even after the cold symptoms stopped. I don’t think it was a very high fever, though.”
“And you said you are feeling tired a lot. How much sleep do you usually get each night?”
“About five or six hours every night, which I don’t feel is enough.”
“Why do you think you aren’t getting enough sleep?”
“Well, I work in an accountant’s office, so tax season is our busiest time. In early March I started working about 60 hours per week. Also, my son started working the night shift a little after that, and that’s when I began picking up my grandchildren after their sports practices and watching them until their father gets home.”
“Any shortness of breath after activities?”
“As a matter of fact, yes. I’ve been exercising a lot less than usual because I become out of
breath. Even after just cleaning...”
“Have you been around anyone who was sick with the flu or any other contagious illness?”
“I don’t think so. No one at work or in my family has been sick.”
“Have you had any nausea or diarrhea or stomach upset in general?”
“Have you been urinating more frequently or had blood or pain with urination?”
“You said you’ve been having pain at night? Is this only at night, or do you feel pain upon waking up in the morning?”
“Does the pain wake you from sleep?”
“Is the pain localized in one specific place?”
“No, it’s just general achiness, almost like my bones hurt. Sometimes it’s in my upper legs,
sometimes my back hurts. But I can’t pinpoint it to one location.”
“Do you find that the pain increases with more activity?”
“Have you lost any weight?”
“Do you or any close family members have high blood pressure, diabetes, cancer, or heart disease?”
Susan shook her head. “No. My daughter-in-law died of breast cancer, but none of my blood relatives have had it. My grandmother had diabetes, but no one else who I know of has had anything else you mentioned.”
“Do you smoke or drink alcohol? Are you taking any drugs or prescription medications?”
“No, I don’t smoke or drink. I have a prescription medication for migraine headaches, but only take it when I get a migraine, which is usually about once a month or so. I don’t take any other medicines, and I don’t use any illegal drugs for heaven’s sake.”
“OK. I have to ask these questions just so I can get a clear picture of your overall health.”
Upon physical examination, Dr. Owen noticed that Susan’s spleen, located under the ribs on the left side of the abdomen, was swollen.
“I think that we should run some tests, so I’m going to take a blood sample from you. I am
requesting a CBC (complete blood count) with differential. This will determine your hemoglobin and hematocrit levels, which are proteins present in the blood. It will also give me your platelet count, red blood cell count, and white blood cell count (including the percentage of each type of white blood count). All of these cells are present at specific levels in the blood of healthy individuals but can increase or be reduced when someone is sick. I am also requesting a blood smear—meaning the lab technicians will look at your blood sample under a microscope—and a chest X-ray. I should have the results in a few days. My office will call you to schedule a follow-up appointment as soon as we have the results.”
“Thank you, Dr. Owen. Do you think this is something serious?”
“I can’t really say until I have more information. Let’s wait and see what the results of the blood work tell us.”