Orthopedic Surgeon I

First, you notice that cops look like they're 12 years old; then the emergency-room physician looks like he's 12 years old; now I'm at the age where even specialists look 12 (of course, I've also passed the milestone that I'm older than the prime minister). The orthopedic surgeon I saw this week was very nice and very young-looking. He spent plenty of time with me, and I think he read the four pages of notes I provided. (Yes, I'm obsessive, but I'm also a fan of the concept of narrative medicine, pioneered by Rita Charon, which holds that doctors and patients are also just human beings with stories to tell, and that the better we are at telling, eliciting and listening to stories, the better our diagnoses will be and the quicker we'll arrive at them. I'm a writer, so I sometimes write down my story for the doctors, though I'm aware that the "story" he or she will pick up is not limited to the content of my written notes, or my oral medical history; they probably pick up that I'm a controlling, detail-strangled fuss-budget! Anyway, there's a great long piece in The New York Times about narrative medicine here.)

So, Dr. 12 can't say for sure whether the compression fracture is caused by cancer or something else, but he recommends a spinal biopsy (which my oncologist had seemed to dismiss as too painful -- gaahhh!). However, he has to consult with a radiologist to get an opinion on whether they can even get into my metal-encased spine to do a biopsy. The bad news is that surgery to fix my back, in his view, would be a major, day-long, dangerous and painful procedure without a great chance of decreasing my pain. My spine might be too soft to hold screws, etc. The good news is that, no matter what is causing the fracture, if the radiologist thinks the area is accessible, he could go in at the same time as the biopsy (I think) under local anesthetic and insert cement into the cracks (vertebroplasty), and maybe even use a balloon to restore the height of the vertebra, a technique called kyphoplasty (which, when I look at this link, seems not to be recommended for people with scoliosis like me, so go figure).

These procedures are meant to take away pain, are supposedly "minimally invasive," but of course have a small chance of causing infection, paralysis, lung embolisms, yadda-yadda.

(Questions that dog me: Why did my oncologist not more closely monitor my bones after I started taking an anti-cancer drug known to cause osteoporosis? Why was I not given extra bone-strengthening drugs? But the reports I've read suggest that Arimidex may cause bone thinning only in people who already have thin bones to start with, and in 2003 I was told I had the hips of a 20-year-old. That would seem to indicate that the compression fracture is, indeed, caused by cancer. Still, while last summer's bone-density test said my hips were fine, too, Dr. 12 told me that you can have perfectly solid hip bones and still get osteoporosis in your spine. And of course, they never test my spine's density because there's metal there!)

What does it matter whether the spinal fractures are caused by cancer or by something else? Of course it would be a relief to think that the cancer metastasis has not gone that far yet. But the other problem is: in addition to chemo, should I have radiation to my spine? Apparently, it can be quite successful at eliminating pain, but it would be crazy to submit to all that radiation (and the risk to my heart and lungs, plus the side effects) if it won't help.

Meanwhile, Dr. 12 says he'll let me know what his radiologist says early next week, and suggests I should go ahead with the chemo. The biopsy/vertebroplasty would take a few weeks to set up, and he seems to think I could undergo the procedure while having chemo. What my oncologist will say to that, I won't know until I see her on March 3. I am not feeling very well as it is -- can't seem to shake the tail end of a cold I got 10 days ago, my stomach is sore and sick, I keep sprouting new pains here and there, I have chills and sweats that seem different from my normal hot flashes -- just stress? Once the chemo starts, God knows how much worse I'll feel.

As for the fact that I now can't walk, stand up or sit up for more than a few minutes without being overwhelmed by the pain and pressure now centred in my left shoulder blade, Dr. 12 agrees that the underarm surgery has probably made that worse. He suggested that taking lots of codeine is better than lying around all day getting no exercise. But I don't find the codeine really helps that much. Anyway, he tried putting my arm up in a sling, which didn't help. Then one of the orthopedics staff put a simple figure-eight brace around my shoulders, which did make me feel a little better, but not for long.

So...on Monday I see a second orthopedic surgeon for another opinion, a guy I've seen before who has a great reputation but is a little arrogant. We'll see how he responds to my "narrative."