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T.M. is a 61-year-old man with a medical history significant for type 2 diabetes mellitus, rheumatoid arthritis, hypothyroidism, and hyperlipidemia. For these, he had been prescribed (via physicians other than the authors) levothyroxine, metformin, glyburide, and fenofibrate. Regarding the diagnosis of follicular lymphoma, T.M. first presented to his primary care provider in April 2004 complaining of enlarged bilateral cervical and inguinal lymph nodes. Shortly before he noticed the lymph nodes, T.M. had experienced a period of profound situational stress followed by a case of Bell palsy. In June 2004, after an initial workup, histological examination of an excised left cervical node revealed follicular lymphoma, grade 1/3 with focal areas of grade 2/3, bcl-2 positive. T.M. was promptly referred to medical oncology by his primary physician, and a chemotherapeutic regimen was prescribed. Fearing the side effects, T.M. declined treatment. The medical oncologist offered no other therapeutic options except for observation. T.M. remained symptomatic with noticeably enlarging lymph nodes. On November 28, 2005, 17 months after the initial medical presentation and 15 months after diagnosis, T.M. presented to the Integrative Medical Center of New Mexico (medical office authors B.M.B. and A.J.B.). There, T.M. revealed a chief complaint of multiple large and enlarging cervical and inguinal lymph nodes. Physical examination revealed the greatest dimension of the largest cervical node (left side) at approximately 7.62 cm and that of the left inguinal region at approximately 12.7 cm. The latter node was particularly symptomatic and painful. The positron emission tomography (PET)/ computed tomography (CT) imaging from December 13, 2005, read as follows:
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Berkson et al. (2007) studied this question.
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