She did a quick search of the medical literature, and sure enough, there it was. This was one anemia she had never heard of. This email sent DeGeorge to the internet as well. I wonder if some of the abnormal readings could be related to this, he wrote. He followed the links to a few articles in runners’ magazines and found an even more precise diagnosis - foot-strike anemia. Almost by accident, he found a disorder that he had never heard of but that seemed to fit exactly: runner’s anemia. He entered his abnormal test results, tried various combinations, added his long-distance running and then followed what seemed the most interesting path forward. Using those skills, he searched for information using the most specific terms possible. He works in the tech industry and does a lot of internet research for his job. Confronted with information that seemed important but that he didn’t understand, the patient did what we all tend to do - doctors and patients alike. Once again, his blood count was a little low. That night the patient went online and checked the results of his new blood tests. On his way home, he stopped by the lab to have the repeat tests done. He gave the patient a choice: He could stick a needle into the lymph node right then and the lab would tell them if there were any abnormal cells present, or they could just wait, and if it was still palpable in another four weeks, they could do the biopsy then. He also agreed that it was probably left over from some subtle inflammation, probably related to the sore in his mouth. Two weeks later, the patient went to see the E.N.T., who agreed with DeGeorge that the little bulge was a lymph node - actually, using ultrasound, he identified two enlarged nodes. If the node went back to normal before the appointment - it often took weeks to get in to see subspecialists - he could cancel. And she would refer him to an ear, nose and throat doctor (E.N.T.). Still, she would get blood tests just to make sure there was nothing else going on.
It often takes more than four weeks for these nodes to recede. She told him that the lymph node was probably a response to the sore he had in his mouth. It was easily moved around - that was normal - and not at all tender. DeGeorge was surprised at how firm this one felt. But even enlarged, they usually have a soft texture.
Most of the time, lymph nodes are too small to feel, but when fighting off an infection, they can grow. It was almost a centimeter long and felt a little rubbery. When DeGeorge examined the patient, she easily located the nodule he was worrying about. The man told her he’d had a little sore on the inside of his mouth, but it was gone now. Any sores on your face or in your mouth? the doctor asked. He thought it was probably a swollen lymph node, but it had been there for a while, he said, and he was a little worried about it. Over all, he felt well, except for this small bump he found under his chin. Now he was training for the Chicago Marathon and, after that, a 100-kilometer race. He told her that he recently had run his first ultramarathon - 50 kilometers, or just over 31 miles. A couple of years ago, he took up long-distance running, and now he was logging 30 to 40 miles most weeks. He was a healthy guy and always fun to talk to. Katharine DeGeorge, a family-medicine doctor in a small practice just outside Charlottesville, Va., greeted her patient warmly. It was probably nothing - but he wanted to hear it from a professional. He was due for his yearly physical, so he made an appointment to see his doctor. Years ago, a friend had found a lump near her collarbone and ended up dying of cancer. The soreness had gone away, but still, the lump made him nervous. When he first saw it, while shaving maybe a couple of weeks earlier, it was a little tender. His fingers quickly found the small double-lobed bulge. Lowering his razor, he lifted his chin to see if the lima-bean-size lump was still visible on the right side of his neck, just under his jawbone. The 40-year-old man stared into the mirror.
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