Orthopedic Surgeon II

I have always had a horror of sitting in a wheelchair -- not an uncommon fear, I suppose. When I was in my late 20s and my sciatic pain was unbearable, my sister once suggested I use a wheelchair to visit the Royal Ontario Museum, and I refused. To be in a wheelchair felt like giving up, entering a new, frightening world, donning a new identity (or non-identity, as many people who use wheelchairs will tell you).

But my two visits to the hospital this week forced me into wheelchairs. I can walk without too much pain for up to a couple of minutes, and then as soon as gravity begins to do its work, I feel like my ribcage is sliding painfully toward my hips. I have to hold my breath to hold it all up, so I start hyperventilating. I began to wonder whether I should acquire my own wheelchair so that I can get around better, but I don't want to rely on it; I want to keep trying to use my body before it wastes away. Besides, the wheelchairs in the hospital are sloped back a bit, which helps me sit somewhat comfortably -- can you get wheelchairs that don't have straight backs without paying a fortune? I am now unable to sit up straight while eating, so I lean back, dropping food all over my bosom.

I spent all day Monday waiting, with a patient, entertaining and very sharp friend, to see the second orthopedic surgeon, whom I'll call Dr. Second. I had seen him years before, and from reading online newsgroups devoted to the problems of those of us who had surgery for scoliosis when the methods were more primitive, I knew he was one of the handful of surgeons in Canada with lots of experience doing what's called revision spine surgery. He's a bit cocky, not particularly warm, but seems to provide straight answers. He agreed that I have a broken vertebra just at the point where my fusion ends, and I was again able to see it very clearly on the CT scan (why the radiologist's report on that scan didn't mention it boggles my mind). Here's a picture that resembles what's happened to my vertebra (minus all the hardware). As I thought, I have junctional kyphosis, which simply means I've developed a hunchback at the spot where my spinal fusion ends. Dr. Second seemed to think surgery would take away my pain; it would involve fusing a couple more vertebrae, and possibly removing the broken one (a procedure called pedicle subtraction osteotomy) and cutting away some of the steel rod. It all sounds very dangerous, yet I know from a family member who also sees him that this doctor is not one to push surgeries he doesn't think are promising. I told Dr. Second that Dr. 12, the orthopedic surgeon whom I saw last week, had made the surgery sound too difficult to make it worthwhile. Without commenting on Dr. 12's expertise, Dr. Second said casually that this is a very common problem, and that he does 20 of these repairs every year. "We're lucky at this hospital," he added. "His hospital doesn't have the budget to do them."

Dr. Second's comments were markedly different from those of Dr. 12, and I'm inclined to trust him; I'd never heard of Dr. 12 before, and he looked so young. Unlike Dr. 12, Dr. Second doesn't think the fracture is the result of cancer in my spine (though, like everyone else, he has no comment on the radiologist's claim that I have cancer in my ribs); like Dr. 12, he does not recommend that my spine be radiated without first having a spinal biopsy to determine whether there's a malignancy. But unlike Dr. 12, he doesn't favour doing the biopsy now. First of all, Dr. 12 made it sound as though the biopsy and the vertebroplasty (cementing the fractures) are separate things; but Dr. Second claims that because the biopsy involves removing bone, they'd have to put cement in regardless. Plus, he thinks cementing the fractures won't necessarily help the pain and it might make later surgery more difficult. He says the kyphoplasty option (propping up the vertebra with a balloon) is a bit of a gimmick. Second, he says that radiating my spine will kill the bone and make later surgery impossible! He wouldn't be able to do a proper fusion or put screws in the bone.

This was a shock. If I do as he suggests, I'll start with chemo for four months; when I've recovered, I'll need major back surgery, which will include a spinal biopsy; if it turns out it's cancer, when I've recovered from the back surgery, then I could have radiation. Which means the bone metastasis treatment would happen many months from now. Should I wait that long? Should I have my armpit radiated before back surgery? (The radiation oncologist had wanted to radiate the armpit, the ribs and the spine all at once.) Does the chemo help kill bone metastases, or is that usually the job of radiation? Should I be treating the back problem first, because it's wrecking my quality of life, or the cancer, which will kill me (seems like a no-brainer, except when you look at the possibility that the two are connected)?

Many more questions. Even as I learn more with each consultation and each Google search, I am aware that my knowledge is still sadly limited, and my opinions may be entirely wrong-headed. I'll be seeing my medical oncologist on March 3 and the radiation oncologist on March 6. Since I have to get the chemo out of the way anyway, there's still time to see a Dr. Third -- there are a couple other spinal surgeons in town who are known for doing these sorts of revisions. Can't hurt.

Pollyanna moments?

• Again, the friend who accompanied me to see the surgeon was a godsend. He kept me engaged and relaxed through a very long day of waiting, and helped me summarize what had been said after the doctor had left the room.
• Yesterday I had a scan of my heart to see whether I can withstand the tough chemo drugs. Another friend accompanied me and later helped me go to the bank and to a restaurant to eat pancakes for Pancake Tuesday. And she took me home and chopped up all the vegetables in my kitchen.
• One of my aunts sent me a shawl that had been my grandmother's. It's now gracing my couch and matches rather well the afghan beside it that was knitted for me by my other grandmother. So I feel like I'm surrounded by the love of those two women, not to mention that of my aunt.
• My brother and his wife took my mom and me to see Jersey Boys on the weekend. Although I didn't think the production was up to snuff (we saw the matinee substitute for Frankie Valli rather than the regular actor, and he's a bit of a stick), and walking to the car was tough, the theatre seat was comfortable (with cushions I brought), and I enjoyed the music. The next day I downloaded some Frankie Valli tunes and played them for my mom, and I actually spent a couple of minutes dancing around the living room. I felt pretty good that day, and managed to do some exercises. Now that I'm feeling worse, I'm not sure if I'm suffering from having done too much exercise, or from not doing enough over the past two busy days....