Night Sweats or just a hot night?

I remember learning about the "B symptoms" of lymphoma and cancer during medical school. You hear it time and time again, "If you suspect cancer or it is on your list of differentials, you must ask about night sweats, weight loss, fever and reduced appetite."

Sure, that makes sense right? Not exactly. Details that were seemingly so objective as a physician now have me guessing many nights of the week as I wake with sweat perspiring from my neck and my hair feeling as if I have just gone for a run. It isn't as easy as it sounds to decipher nights sweats from a hot night between the sheets for cancer patients despite education and awareness.

"Do you find yourself waking at night, drenched in sweat?" I used to ask my patients. I would frequently be looked at with I stunned look. I would continue, "do your sheets feel soaking wet, waking you up overnight?" Most people could answer that - "No." Its not a common complaint and even those of us with lymphoma find it hard to understand. Even now, I am still lost as a patient experiencing this distressing and most unusual symptom.

Over the past few weeks, I have been woken at night to find myself sweating. Sweating to the point, it actually does wake me. But, this happens in hot weather night? Its been a hot summer giving way to warm autumn nights. I mean, I am not soaking my sheets, I'm not drenched in sweat from head to toe. Thats what I was taught about night sweats. They were supposed to be so profoundly obvious I would know. Even my boyfriend continues to tell me "Its been really warm at night for me too! Last night I was sweating." I think he is still stuck in denial as I progress symptomatically, but we are working on it.

What else does a doctor do when uncertain about something but perform a literature search. I went searching "Do others with lymphoma experience night sweats just in their head and neck?" It turns out, sure they do. When I mention the above to my family physician, unsure if what I am experiencing can be interpreted as 'night sweats' she looks at me with the same look my patients used to express in almost confusion; though hers is more of an emphasis on "these symptoms CANNOT be due to the temperature at night."

Yet again, I have been forced to learn another important lesson. Not everything we are taught is gospel in medical school. Night sweats aren't what I was taught them to be. For me, they are confined (for now) to my head and neck, to the areas most actively involved with lymph node activity. For me, they aren't drenching, or leading me to change my sheets but obvious in their course. Increasing in frequency, I now smile, almost surprised when I wake in the morning and my boyfriend can ask "Any sweats" with me replying "No!"

So, next time I ask one of my patients about night sweats, I think instead I will ask "Do you ever wake up perspiring like you have exerted yourself, or performed heavy manual labour? Not necessarily involving your entire body, but perhaps just your back, your shoulders, head or neck?" If they look at me confused, I think I can rule out the night sweats from the other side.

#nightsweats #drenching #lymphoma #cancer