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Sarcoidosis

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LIVING WITH SARCOIDOSIS
Stacy Kilgore
Nur/427
Sharnee Moore

Sarcoidosis is the growth of tiny collections of inflammatory cells in different parts of body most commonly the lungs, lymph nodes, eyes and skin. It is believed sarcoidosis is the result of the body's immune system response to an unknown substance, most likely something inhaled from the air. There is no cure for sarcoidosis. Sarcoidosis often goes away on its own. However, signs and symptoms of sarcoidosis may last for years and often leads to organ damage. The exact cause of sarcoidosis is unknown. Some people appear to have a genetic link to developing the disease, which can be triggered by exposure to certain bacteria, viruses, dust or chemicals. Research is still trying to identify the genes and predisposing substances associated with sarcoidosis. Many factors may play a role in triggering the disease. I interviewed a current patient with this disease process and viewed a video titled Living with Sarcoidosis on the National Heart, Lung and Blood Institute website.
Signs and symptoms of sarcoidosis vary, depending on which organs are affected. Sarcoidosis sometimes develops gradually and produces symptoms that last for years. Other times, symptoms appear suddenly and then disappear just as quickly. Many people with sarcoidosis have no symptoms, so the disease may be discovered only when you have a chest X-ray for another reason. For many people, sarcoidosis begins with these signs and symptoms: fatigue, fever, swollen lymph nodes, and weight loss. Almost everyone who has sarcoidosis eventually experiences lung problems, which may include: persistent dry cough, shortness of breath, wheezing and chest pain. During my personal interview the patient was coughing and displaying shortness of breath symptoms that prompted her to seek treatment. When she received a chest x-ray it was discovered that she had granuloma’s in her lungs. She stated that she had been seeking treatment for the cough for weeks.
As much as twenty five percent of people who have sarcoidosis develop skin problems, which may include: a rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch, disfiguring skin sores may occur on your nose, cheeks and ears, areas of skin may get darker or lighter in color and growths just under the skin may develop, particularly around scars or tattoos. The patient I interviewed stated she had skin problems on her face. Her physician had treated this issue with corticosteroids. All the areas had presently resolved. She expressed that these areas had caused her some body image disturbance.
This interviewee stated she had experienced blurred vision and severe sensitivity to light. She also stated that she was diagnosed in 1989 and she had to have eye exams every six months since that time due to frequent changes to her eyes. Sarcoidosis can affect the eyes without causing any symptoms, so it's important to have your eyes checked. Rarely, sarcoidosis also can cause cataracts and glaucoma. When eye symptoms do occur, they may include: blurred vision, eye pain, severe redness and sensitivity to light.
Although sarcoidosis is not always serious, it can cause long-term damage to your organs. During the interview the patient stated that she had obtained a significant amount of information from the internet as nurses were not very familiar with this disease process. She stated that over the years nurses have become more familiar but she does often have to provide information to the nurses often. In both the interview with my patient and the video Living with Sarcoidosis, the patients expressed how they were often treated for other illnesses based on the symptoms. Both of these instances expressed how difficult it was to diagnose this disease. Sarcoidosis can be difficult to diagnose because the disease produces few signs and symptoms in its early stages. When symptoms do occur, they vary by organ system affected and can mimic those of other disorders. Your doctor will likely start with a physical exam, including a close examination for any skin lesions you have. He or she will also listen carefully to your heart and lungs and check your lymph nodes for swelling. Your doctor may also be interested in seeing any previous chest X-rays, to check for signs of early sarcoidosis that may have been overlooked.
Because of the misdiagnosing my patient stated how straining it became financially while she was sick and no one seemed to know what the problem was. The diagnostic tests ordered did help clarify the process but were very financially challenging. Diagnostic tests can help exclude other disorders and determine what body systems may be affected by sarcoidosis. X-ray, to check for evidence of lung damage or enlarged lymph nodes in your chest. Some people are diagnosed with the condition after chest X-rays taken for other reasons. CT scan, if complications are suspected. PET or MRI, if sarcoidosis seems to be affecting your heart or central nervous system. Blood tests, to assess your overall health and how well your kidneys and liver are functioning. Lung function tests, to measure lung volume and how much oxygen your lungs deliver to your blood. Eye exams to check for vision problems that may be caused by sarcoidosis. Many of the treatments associated with this process required life changes that are permanent. It was a learning experience for my patient. She had to change careers as a result of this process. She was a certified nurse assistant and could no longer work in this capacity. The video displayed a patient who was formerly a nurse. She also was not able to perform because of the organ involvement.
Even though sarcoidosis primarily resolves itself in two years, most people's lives are forever changed as a result of this disease. Participation in a sarcoidosis support group may enhance coping mechanisms. Living with sarcoidosis may cause fear, anxiety, depression, and stress. Express how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicine or other treatments that can improve your quality of life. Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Ongoing care is important, even if you don't take medicine for your sarcoidosis. New symptoms can occur at any time. Also, the disease can slowly worsen without notice. Routinely visit your physician depending on the severity of your symptoms, which organs are affected, which treatments you're using, and whether you have any side effects from treatment. Despite your symptoms, you should see your doctor for ongoing care. Take all of your medicines as your doctor prescribes.
Both the patient interviewed for this paper and the patient in the video express motivation for learning as much about the management of this disease process in order to maintain a life standard. To my patient it is important to her that she is aware of the current research and treatments so she can continue to live a healthy life. This patient is very concerned that she not regress to the state of health she was in prior to her diagnosis. Continuous teaching and providing evidence based practice changes to this patient is pivotal.

1. Ferri FF. Ferri's Clinical Advisor 2013:5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-08373-7..00002-9&isbn=978-0-323-08373-7&about=true&uniqId=343863096-23. Accessed Oct. 31, 2012. 2. Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/191371208-2/0/1492/0.html#. Accessed Oct. 31, 2012. 3. Baughman RP, et al. A concise review of pulmonary sarcoidosis. American Journal of Respiratory and Clinical Care Medicine. 2011;183:573. 4. AskMayoExpert. What is the treatment for sarcoidosis? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012. 5. AskMayoExpert. Is sarcoidosis considered an urgent situation? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012. 6. AskMayoExpert. What are the clinical symptoms of sarcoidosis? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012. 7. O'Regan A, et al. Sarcoidosis. Annals of Internal Medicine. 2012;156:ICT5:1. 8. AskMayoExpert. If sarcoidosis is suspected, should the patient be referred to a pulmonologist? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012. 9. Morgenthau AS, et al. Recent advances in sarcoidosis. Chest. 2011;139:174. 10. AskMayoExpert. What clinical tests should be performed when sarcoidosis is suspected? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012. 11. AskMayoExpert. What are the considerations for treatment of sarcoidosis symptoms? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012. 12. National Institutes of Health Department of Health and Human Services USA.gov . Living with Sarcoidosis. 13. Neurosarcoidosis Information Page (National Institute of Neurological Disorders and Stroke) 14. Sarcoidosis (MedlinePlus) 15. Sommers, Marilyn Sawyer. Diseases and Disorders A Nursing A Therapeutics Manual. 4th Ed. 2011.

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