Tuesday, June 23, 2009

My First Attempt At A Larger Account

I sent this e-mail to my wife, Huong, on Thursday, June 11, to be forwarded to everyone. It was my attempt at the time to tell the larger story of what had happened to me.

Huong has asked me to write this full account to send out to everyone who might be interested, instead of having to tell the same story over the phone to everyone over and over... So here goes.

On Sunday April 19, I injured by lower back (lumbar region) while working in the garden at the Avondale house. I was on my knees, and rotated to my left to pick up and move to the right a stone that was heavier than I thought. I heard a "crunch" and felt a big twinge. After a brief break, though, I didn't feel any particular debilitating pain, and actually continued to work. Over the next couple of days, the only ongoing pain was felt at the junction where the right hip joins the spine, and again it was nothing that prevented me from more or less normal activities. I left things go like this, but was being very careful not to do any lifting anything with the back -- legs and abdomen muscles only now. At this point, I began to experience abdominal pains, in a band through the lower ribs around to the back. I attributed these to the extra strain I was placing on these muscles, and assumed they would get used to things in time. I did go to the doctor, who ordered lumbar x-rays. These showed nothing untypical for a 53-year-old male: a little degenerative disk disease, some osteoarthritis. Nothing indicating particular injury. She prescribed some PT, which I delayed seeking since we were headed to the beach house for awhile.

At the beach I did a lot of vigorous spring cleanup work. My abdominal pain symptoms got worse, and I began having genuine trouble getting into and out of chairs and bed. Sitting in a chair for more than a half-hour or so was becoming painful. Memorial Day weekend was particularly bad; I think I spent a good portion of the weekend resting in bed. I also experienced an almost complete loss of appetite, and began losing weight rapidly. Returning to Avondale, the doctor gave me muscle relaxants for the abdominal pains, and ordered thoracic x-rays, suspecting problems there. The results showed something that led her to order a bone scan (dye-assisted) for last Friday, to check to for fractures. I began my PT program the same Wednesday. The next day (last Thursday) started out well. The abdominal pains had decreased, and I was able to do some of my PT exercises. Then, in the middle of the afternoon, completely out of the blue, I began to experience waves of terrible muscle spasms. My diaphragm would contract violently, yanking down on the stressed rib muscles, followed eventually by two thunderbolts shooting down both legs all the way to the toes. As these continued, I began to lose strength, feeling, and control of my legs. Just at that point, Huong called to ask me how I was doing, and I told her that I thought (incorrectly) I was having "seizures", and might belong in the hospital. Soon thereafter, our neighbor friend Dr. David Wien and Mai-Anh showed up; he had been alarmed by the term "seizure", which implies unconsciousness. Seeing my symptoms, he called 911, and I was transported by ambulance to the ER at the Christiana Hospital in Wilmington. The ambulance personnel aren't permitted to administer any meds, so they were forced to watch as I spasmed painfully the entire journey. I arrived at the same time as a collection of people who had been involved in a multiple-vehicle accident on nearby I-95, and the scene was barely controlled chaos. I was stuck on a gurney in a hallway with a bunch of drunken injured people. Mai-Anh followed me in and is due great credit for badgering the overwrought ER nurses to take a look at me. Since they could observe my continued uncontrollable spasming, I got a couple of Percosets to tide me over until they could route me into an observation ward containing actual MDs. The resident who first observed me ordered up unlimited IVs of Valium to calm the spasms, and rounded up the supervising MD, who seeing the same symptoms put me on the fast track for an MRI and panoramic spinal x-rays. The MRI requires absolute stillness, and the staff had no Valium, so that caused some further delay to get some more into me, lest I wind up bouncing around the inside of the narrow MRI tunnel. It lasted just long enough, as the spasms resumed just as I was being pulled out.

The results of these tests got me a slot for the rest of the night (it was actually almost dawn Friday by now) in a ward for head and spinal trauma victims. Later in the morning, a resident came around to inform me that my spinal cord was being inflamed by fractured vertebrae. He began adding a steroid to the Valium to reduce the inflammation, and at that point I was becoming much more comfortable. The fractured vertebrae were CAT-scanned for a closer look. Some time later, I was approached by a neurosurgeon -- but accompanied by an oncologist, who informed me that the "fractured" vertebrae were actually being collapsed from within by bone marrow tumors. His tentative diagnosis was multiple myeloma, which is a cancer of the blood plasma cells that are created in the bone marrow. Many other vertebrae are showing surface lesions that would indicate this as well.

Nothing much happened over the weekend. On Monday, bone and marrow were extracted for biopsy, the final results of which are still pending, but the oncologist would claim tremendous surprise if his hypothesis is not borne out by this. Late Tuesday night, I underwent a procedure called "balloon kyphoplasty" to repair the badly-damaged T8 vertebra. I was fully sedated for three hours, during which time a needle was inserted into the vertebra; this inflates a balloon which expands the vertebra to its normal dimensions, and into which a hot cement is injected. This simultaneously destroys the tumor and fills the cavity, leaving the vertebra closely resembling its intended size and shape. This procedure was evidently a complete success; I am getting a little Percoset now and then to ease the pain fallout.

Wednesday, I met with PT, occupational therapy, and radio oncology personnel to scope out the plans for the immediate future. I am able to stand up and walk (very slowly) with aid; my main problem with this right now is gaining forward-backward stability. I can get into and out of a chair (again very slowly). I get my walker today (Thursday). I think they want to get me out of here before the weekend rush begins Friday. The oncologist assures me that a session of ten or so low-energy radiation treatments should kill the remaining small tumors and lesions. All of this can be done on an outpatient basis. We'll need to make some adjustments at home to allow me to resume normal work activities (e.g. I think I will need to switch my office to the first floor, since it will be quite a while before I will be able to take any stairs).

On the whole, there appears to be plenty of room for optimism that I can get through this thing eventually. Obviously, I am going to need a lot of help from a lot of people, which I can hardly hope ever to repay adequately. The many many expressions of love and support I have received from many of you have been, and I am sure will continue to be, a great encouragement to me.

Thanks once again to one and all...


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