Several years ago I found a lump in my breast and like most women I was terrified since breast cancer had been diagnosed in the maternal side of my family. I immediately made an appointment to see my gynecologist but prior to the appointment I noticed that my lymph nodes were swollen under my arm and in my neck. Upon further examination of myself, I realized that this breast lump was probably just a lymph node. However, I kept my doctor’s appointment as originally planned.
Even though I was convinced that this lump was a lymph node, my doctor insisted upon performing a needle aspiration in her office. When she could not aspirate any fluid, she agreed with me that I needed to see a surgeon for a biopsy. In addition to this mass, I was also having night sweats. I had been having them for about a year but thought nothing of it. My bedroom was on the second floor and heat rises, you know. That is how I justified not seeing a doctor sooner. If you have not ascertained by now that doctors are horrible patients, just keep reading.
I remember the day of my biopsy like it was yesterday. I remember being slightly groggy in the recovery room but I noticed that my husband and a good friend were by my side. The surgeon entered, held my hand, and told us that the preliminary results revealed what I already thought: it looked like lymphoma, a lymph node type of cancer. Tears streamed down my cheeks. I had a one year old daughter and a new career. How could this be?
Waiting for the official biopsy results was torture. The specimen had to be sent away to have special staining in order to confirm the tissue sample taken during the surgery. I could not eat or sleep as I waited for that dreaded phone call.
About three days later, the surgeon called and revealed that the results were negative for cancer! Hallelujah! He then went on to say that the specimen was read as “non-specific.” That means nothing to doctors. So in my mind, it was not cancer so I moved on to other things.
However, a few months after that I began feeling more tired than before but I simply attributed the fatigue to my job. I then began experiencing joint pain and stiffness, worse in the mornings. I was barely able to comb my daughter’s hair because I could not properly grasp the ponytail holders.
Finally, the light bulb went off in my mind. I checked some labs on myself and put it all together: black female, third decade of life, joint pain, night sweats, swollen lymph nodes, and abnormal labs. I had lupus!
Systemic Lupus Erythematosus is a multisystem autoimmune disorder of connective tissue that is highly variable in its presentation, disease course, and prognosis. Lupus, as it is mostly known, affects primarily women but men are not spared. It usually presents in the second or third decade of life. As in my case, it may take several months or years to diagnose lupus.
Lupus can present with one or more of the following:
Rash on face (looks like a butterfly)
Joint pain
Fatigue or weight loss
Anemia
Low white count
Recurrent miscarriage
Although there are over 11 criteria used in diagnosing lupus, only four positive findings are needed to make the diagnosis per the American College of Rheumatology. Once preliminary labs such as an ANA, complete blood count, and sed rate have been checked, other confirmatory tests are then obtained.
The exact cause of lupus is unclear. It is thought to be a combination of immune system dysfunction, a genetic predisposition, and environmental factors. In lupus, the body produces antibodies that essentially attack it. This then can potentially damage the kidneys, lungs, or skin.
In previous genome studies, chromosome 1 has been linked to lupus in certain populations. It is also known that certain environmental triggers can cause lupus flares in genetically susceptible people. Sun exposure, illnesses, stress, or even certain medications such as procainamide or hydralazine, can potentially provoke a lupus exacerbation.
May is Lupus Awareness month. Lupus occurs more frequently in African Americans, Afro Cubans, Anglo-Asians, and American Hispanics. Currently, there is no cure for lupus but only medications to help manage and prevent flares. Because the manifestations of this disease can be overwhelming, I often recommend that patients join a local support group. This disease can be difficult on the patient as well as their family. For more information, contact the Lupus Foundation at www.lupus.org.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
