This case study is about a college student named Annie. She is attending college on a swimming scholarship. Annie has been experiencing multiple odd symptoms. Annie feels that they are all due to being tired and stressed. Annie has a very hectic schedule. She has swim practice, swim meets, and lots of classes to attend which produce lots of papers to write. When Annie’s boyfriend picks her up for spring break, he insists that she see a doctor make sure there is nothing major wrong with her. After several tests were performed, they finally realize that Annie is not suffering from the normal stress and fatigue of college. Annie has a tumor on her thymus gland and has also been diagnosed with myasthenia gravis. Annie has learned a lot about how her neuromuscular junction works. With the removal of the tumor and help from medication, Annie should be able to maintain her college life.
The Beginning
Annie is a young adult that is attending college on a scholarship. She has been a great swimmer her whole life. Annie has always gotten a great swim score until recently. She started to notice herself getting tired a lot more easily lately. This was affecting her swim times. Due to her slower swim times, her team has been starting to lose their swim meets. Annie’s slower swim times are not the only thing that has been noticed differently lately. She has been feeling weaker and constantly fatigued. Her reflexes are slower. Even her fingers and the hands, in general, have been feeling weak and ache. She almost dropped her boyfriend’s keys when he tossed them to her. She has noticed that she gets out of breath when she goes up the stairs and after swimming. Annie has also noticed that her eyes getting blurry and they keep feeling strained. This has been going on for about a month now.
Since Annie is a college student riding a swimmbreathlessnessing scholarship, she is very active. She has lots of papers to write. She has to practice swimming and compete in all the swim meets. Her eyes could be tired and strained due to all the computer work she has been doing. Her fingers could be weak and ache due to all the time typing. Staying up late writing all those papers could make her fatigued. Swim practice and meets could also be contributing to her fatigued. Annie does not seem to be getting enough rest. The body needs a proper amount of sleep to keep things up and running smoothly. Being out of breath could also be contributing to her feeling weak and fatigued. Her reflexes could be slower, and her normal activities could be more taxing if her body is not getting enough oxygen into her system. Loss of oxygen in the system could also be responsible for her slower reason times and great swim score.
There could be multiple reasons for Annie to be o,ut healthy for, breath. Her body could be using the oxygen for other parts of her body to function. Her lung muscles could be weak. Annie could have undiagnosed asthma. According to the article Managing chronic breathlessness in the community three could be lots of reasons that could be causing Annie’s breathlessness. Some of these could be Acute asthma, Pneumothorax, Sub-acute breathlessness, Asthma, Anemia, or Respiratory muscle weakness (Duncan & Ashby, 2018). Those are just a few of the long list of possibilities. The only way to find out for sure would be to see a doctor and get tests done.
The most probable reasonsreason for Annie to feel , she does is that she is just too stressed from school. She stays up all night studying and writing papers. She goes to class and practices swimming all day during the week. On the weekends she has more studying, papers to write and swim meets. I bet she is not eating enough healthy meals. She could easily be just fatigued. Thankfully for Annie, she has a very good boyfriend that is worried about her. Matt (Annie’s boyfriend) has insisted that she see a doctor during their spring break. He feels that something more than student fatigue is wrong with Annie.
Spring Break
Once Annie got to her pareasons reasonrent’s home, she was able to catch up on her sleep. In fact, Annie slept most of the weekend. On Monday her boyfriend drove her to her doctor’s appointment. Annie did not feel that she needed to go. She stated that she felt better after catching up on sleep. Matt decided not to listen to her and still made her go to the doctor. During the exam the doctor asked the basic questions. Annie explained to the doctor that she has been under a lot of stress at school. She felt that this is whawhatwhat through has caused her blurry vision when she is on the computer. She tried blaming the chlorine in the pool for her stinging eyes, double vision, and drooping eye episodes. She explained that the shortness of breath was probably because she wasn’t getting enough sleep. The doctor felt that it was important to err on the safe side and ordered a bunch of tests to be done and referred her to a neurologist.
Annie still could not understand how this could all be connected. She was trying to figure out how if there was a decline in her muscle function it would make her eyes blurry or even give her eye strain. A diagram was drawn for her (see below) to help explain how the mammalian spinal cord worked. It showed her that everything is connected ,applied, to the nervous system. With this diagram Annie started to realize how the muscles in her eyes could be affected. Annie did not realize that there were so many muscles that affect the eyes. She did not realize that the whole body was connected via the central and the periphehaveappliedperipheral appliedal nervous systems. Annie has learned that even if she is hurt in one place, she could feel it somewhere completely different.
With all that learned information Annie still believes that this is all from lack of sleep and stress. She may even consider that she has developed asthma. She felt that if she just had enough sleep then her body would have more oxygen in her system. More oxygen in her system would help her visions and fatigue. She keeps it in the back of her head that there could be something more significantly wrong. Something could be wrong with her muscular system. Possibly even an autoimmune disease. She will just have to wait until the test results come back. Thankfully the doctor put a rush on the orders so she would be able to get the results before the end of spring break.
Muscle Results Are In
Annie decided that she wanted her mother to be with her when she got her results from the neurologist. The neurologist started with the conditioning test. They always start with the good news. Annie’s conditioning test came back good. Nothing is wrong with her nerves. Her conditioning velocity was fine with no nerve fatigue. Annie and her mother were very happy about that. The next test they went over was her EMG (electromyography). The first part of this test was when they stimulated the muscle directly. Those results came back normal. The second part of the test stimulated the nerve to see what the muscle response time was. This test showed that Annie’s muscle responses would decrease quickly when they were appliedhave applied repeated applied t have repeatedto means nerve stimulation. This means that her muscle responses would get tired over time. This worried the doctor. It also frightened Annie and her mother.
With all the new information that Annie has just received she is now starting to reconsider the reasons why she has been so tired lately. Annie is now learning how this could all be possible. Annie has learned how her muscles and nerves communicate through the release of neurotransmitters that then connect with other receptor sites in muscle cells at or around a place called the nerve-muscle junction. In Annie’s situation, her immune system is creating specific antibodies that have applied are that that front of that sent to destroy the neurotransmitter muscle receptors that are called acetylcholine. Her muscle fatigue is the result fro having fewer available receptor sites. As she has learned before it doesn’t matter which part of her body is missing the receptors it will still affect her entire body.
Annie’s doctor supplied her with ,duringlotsduring lots of information. One of the sheets of paper was a flow chart of how the neuromuscular junction works (see chart below). With this flow chart A, Annie can see how dysfunction is created by sustained neural activity. She can also see how each part plays a role in her muscle response decreasing dur the test that repeatedly stimulated her motor nerve. The brain transmits nerve cells and sends them through the brainstem which then sends them through, and forms the spinal cord. Once in the spinal cord, they get form with certain muscles. To something is blocking doing simple tasks such as chewing food or even walking, the upper motor neurons need to tell the lower motor neurons what to do. If something is blocking or continues this or somehow disrupting the signal between the two the muscles can not work properly. If the muscles are not used, over time they will become weak. The muscles themselves could waste away. Twitching uncontrollably has been found to develop while the muscles are wasting away. As the muscles waste away their movements start getting slower and become stiff. A person can also notice their reflexes overactive. If the signal between the upper and lcontinuestheyower nerve cells continue to be disrupted over time a person could lose the ability to have any control over their voluntary movements. After learning all this Annie is very frightened. She feels that this could destroy her life. She is hoping this is not what is going on with her body.
Blood results and diagnosis
While they were discussing Annie’s results and how they, could all be connected, they received the blood work results. During the lab tests, they had given Annie an injection of edrophonium chloride. They do this to test to see if it will make people feel better. Annie had a short time that she did feel better with this injection. This short relief is seen in people that have myasthenia gravis. According to the article Myasthenia gravis, myasthenia gravis is a disease that results in a neuromuscular transmission abnormality (Sumi, 2014). With this disease the muscles get weaker with activity. Once a person rest, the muscles will restore their strength until used again (Sumi, 2014). Annie’s lab tests showed there were a high number of antibodies in her blood. This confused Annie’s mother. She wasn’t sure what antibodies did. The doctor explained that the antibodies help the immune system. They are created when white blood cells run across antigens. As explained by Margaret Polley, antigens can be any foreign substance in the body which that that repeated cthat, that repeated repeatedly causes action against it by the T cells or antibodies (Polley & Cohen, 2014).
As if that wasn’t enough, they have also found a tumor on Annie’s thymus gland. According to Charles Slonecker, the thymus is a central lymphoid organ that is located in the neck, sometimes in the upper thorax of all vertebrates (Slonecker, 2014). The doctor thinks this is good news. He feels that this could be what is causing all the problems. The doctor felt that if the tumor was removed, her symptoms would decrease or make them go away completely. In the future, thymectomy Annie will still need to have treatments to help with the nerves and muscle situation. It will probably need to be modified thoughthroughthymectomy once they get the results from the thyrectomy.
Annie is still confused about where the antibodies will decrease the synaptic function in the neuromuscular junction. The doctor had her pull out the flow sheet again to look at. He explained that the antibodies that are in Annie’s body could decrease the synaptic function at the presynaptic terminal in the neuromuscular junction. There are a few drugs that help with myasthenia gravis feel stronger, one being Neostigmine. With having an acetylcholine drug in her system, it will work with the voltage-voltage-gated, and channels without having malfunctions in the synaptic cleft. It will help get all the signals where they need to be. With Annie going so long without treatment her disease has progressed. Her body has a very small amount of potassium and sodium that gets past the gated channels.
With all the detail from her tests, Annie feels that this may explain her symptoms. She now understands that the harder she swam, the more tired her muscles would get. The more exertion she used the worse she got. She understands that even if she was just using her arms and legs it still would affect her whole body. Annie understands that her tumortheto on her thymus gland could be the reason this disease has increased so rapidly. She is hoping that once it is removed, they can keep her symptoms under control with medication. Annie has learned a lot over her spring break. She has learned how her entire body is connected. She has learned that her body needs the right structure and components in order to work right. She has learned what her thymus gland is for. Annie has also learned about antigens and antibodies. She has learned the flow of the neuromuscular junction and where her medication will help. Annie now understands what myasthenia gravis is and how it affects her body and her life. Annie will go back to college with a better knowledge of how to take care of her body.
