Clinical Case #2
Ms. Lang is a 54-year-old single Chinese-American woman who presents for a health maintenance visit. She is employed full-time as an accountant and lives alone. She has a three-year history of NIDDM and has carefully monitored her glucose levels in the past. A year ago you referred her to oncology after a suspicious breast exam. She was found to have a malignancy and underwent chemo, lumpectomy, and radiation. Per her oncologist, post-treatment, she currently has no signs of active disease. Today she reports difficulty sleeping, fatigue, anxiety and concern for "chemo brain." She reports that she has been checking her glucose levels only sporadically, as she often feels forgetful and sometimes feels "too overwhelmed" to manage everything. She has had a consultation with the oncology nutritionist regarding her concerns about appropriate, "cancer-fighting" nutrition. She has attended a breast cancer support group and has read about chemo brain on the internet. She reports that some members of the group, as well as chat-room participants on the net indicate that the "brain fog" does improve over time, although this has not been a universal experience. She has returned to work half-time and is very worried about her ability to concentrate and maintain adequate energy to perform her work, and to steadily increase her hours.
What can you do to assist Ms. Lang with her symptoms and concerns?
Normalize and Educate
It will be helpful to normalize her experiences. She has demonstrated a desire for education and social support and this motivation will serve her well. The same demonstrations and introduction to breathing/releasing and imagery may be offered to Ms. Lang.
Remember to choose your words carefully (click to review "Imagery-Evoking Language" section).
Induction and Guided Imagery
Listen to or review the breathing/induction exercise.
The PDF of the scrip is attached below titled "breathing exercise."
Use of Guided Imagery Beyond This Visit
Ms. Lang may also find it beneficial to use guided imagery on a regular basis.
Listen to "Peaceful Place."
The PDF of the script is attached below titled "peaceful place script."
See the Resource Section for:
1) The PDF of "Tips for Effective Use of Guided Imagery for Health and Well Being" that you may print and give to Ms. Lang, and
2) A list of resources for patients who want to explore guided imagery as a tool for health and well being, including resources specifically for issues such as body image, blood glucose control and recovering from traumatic experiences (also attached below). You may also print and provide this to Ms. Lang.