Sonia S, a tall, willowy Latina woman with large deep eyes and a beautiful wide smile, came to see me complaining of “bursitis, joint pain, tiredness. Joint pain began in graduate school when I ran into an old boyfriend on vacation.”
She continues, “My foot pain started then, and shortly thereafter my hip pain, and I have had it ever since. Wet weather aggravates it, and when I travel for work on airplanes. First thing in the morning it hurts, then it begins again in the afternoon around 2 or 3 pm.” She is now 30 and the joint pain began when she was 25.
She rarely remembers dreams, none are recurrent. She weeps easily premenstrually but not the rest of the time. Her fears vary, usually worrying about day-to-day issues at work. Others see her as a perfectionist, controlling at times, and as someone who worries too much. She says she gets stressed easily, with her biggest stress work-related (finding work she likes; she currently works as a consultant.) She gets angry when stressed. She also gets angry when things don’t go as she expected them to. She gets jealous when her husband spends a lot of time talking to his old girlfriend, or to her best friend.
She describes herself as a child as being happy, active, and very social. If she had time off from work, she would like to travel, visit a city she has never been to before and go dancing. What she would like to change about herself: would like to be more easy-going while still having energy and excitement.
Her only medication is birth control pills. She gets a mid-cycle vaginal discharge that is clear, thick and sometimes white.
She dislikes beets and says of her diet only, “I could eat more vegetables.” She likes room temperature drinks and sleeps from 10-11 pm to 6-7 am. She gets canker sores in her mouth, and her jaw sometimes cracks.
When I met her, I was struck by how beautiful, smiling, friendly and outgoing this woman was. I asked her first to give me more details of her joint pain: she said when she went out to San Diego and ran into her old boyfriend, her right ankle hurt, then her left knee and hip (possibly from favoring her right ankle, she said); then it spread to the left ankle and right knee and hip. She has been to a physical therapist to strengthen her leg muscles but still lacks range of motion in her ankles. She has been diagnosed with bursitis of the hip and has been to an acupuncturist. Acupuncture left her feeling calmer and more relaxed but did not help her joint pain.
The joints feel worse in damp weather and worse when she first gets up in the morning, then better as she starts to move around, then worse towards the end of her workday because she has been zooming around all day trying to get things done. They are worse when she flies especially when she goes to Europe. She can’t bear sitting still and tries to keep walking up and down the aisles. It’s hard for her when the Fasten Seatbelt sign goes on and she has to sit down, cramped in the small seat. Traveling is also difficult when she has to carry heavy luggage because she gets worn out. Stretching helps, but exercising too much makes the joint pain worse. A hot bath makes it feel better.
Once she seemed comfortable in the interview, I asked her more about what happened in San Diego. She said that she had a boyfriend from the age of 16 to 21 while living here in the Boston area, then she broke up with him. When she was 25 she went to visit a friend in California and by an unbelievable coincidence, this ex-boyfriend turned out to be the roommate of the friend she was visiting. It was an uncomfortable situation, in fact the young man was quite nasty, “agitated and not nice.” He mentioned that he had a gun.
She became convinced that he would come back to Boston, find her and kill her. (Upon questioning, though, she admitted that he had not actually made any threats.) She was so afraid that he would kill her that she moved to an unlisted address, using a PO box for forwarding, and had an unlisted phone number which she gave only to her family and a few close friends. When she got married two years ago, she would not allow her wedding announcement to be published in the paper, because she did not want him to know where she was or what her married name was. Even though this incident happened five years ago and she is now married, they still have an unlisted number.
See “Student Case-Solving Contest Guidelines” for how to enter.