Saturday, August 18, 2012

Update on Jim

Some of you have asked me how Jim is doing.  I forgot that I'd left you all with a cliffhanger about his medical issues! So here is his update; I will update myself next.

Jim's back saga has continued throughout the summer.  The MRI that he finally had in March showed that he has a significant herniation of the disc between his L-4 and L-5 vertebrae.  While this was not great news, at least we finally had an explanation for the pain.  He got an appointment right away to see a spine doctor, one who is not a surgeon but does other interventions like injections. (He will be Dr. W here)  This doctor felt that Jim's case was too serious for injections alone to help, so he got Jim an appointment with a spine surgeon, looking for the first appointment available.  I went with Jim to the consult and it was the worst medical appointment I've ever been to... and this includes all of my consults where I was given bad news, and the appointment I sat in on of my father's in 1998 when he was diagnosed with stage IV lung cancer and told that he should get his affairs in order.  This was worse.  The surgeon, whom I shall call Dr. X, asked Jim to explain what was going on, and Jim told him, including the worthless ER visit described in my March post.  Dr. X chastised Jim right away, saying "You mustn't blame the people in the ER - that was correct.  You had bladder and bowel function so your case was not emergent.  Pain is not an emergency."  Oh boy... I could feel the hope leaving the room with those words.  He did a brief exam of Jim, and told us that the surgical procedure was a relatively simple one, but then told Jim that he is not a good candidate.  He cited Jim's weight and type 2 diabetes as being "severely complicating" issues.  He told Jim "I'm not saying I won't perform surgery on you" but then proceeded to explain why Jim shouldn't have it.  He told Jim that he needs to be walking, that sometimes these injuries resolve themselves, and that he might just be in pain for a year. Like, oh well...  I asked Dr. X flat out:  if Jim was thinner and did not have type 2, what would his chance of success be?  "oh, 90 to 95%!" said Dr. X.  Ok, so I got it... because it is riskier to operate on someone who is obese and who has diabetes, both conditions being associated with healing issues, well, Dr. X didn't want to chance messing up his statistics.  That told me that even if we decided to go forward with the surgery, that Dr. X would NOT be the surgeon operating.  He asked if we had any questions as he prepared to leave the office and I asked him about giving Jim more pain medication, since he was in such agony.  Dr. X was surprised... "you mean Dr. W didn't write you any prescriptions?"  No, Dr. W thought you would operate, Dr. X.  He told Jim that the amount of Percocet he was taking was too low, so he prescribed a much higher dose, along with a muscle relaxer and another pain medication.  So at least we got that.  *sigh*

So, Jim contacted Dr. W, who said, well, let's try doing injections; however, I think you should have them at the hospital rather than here at our offices, so he referred Jim to a pain clinic at the main campus of Cleveland Clinic.  Jim got in to see Dr. Y, who has a great reputation, that gave us more hope.  His resident did the initial assessment and asked Jim a lot of questions, then Dr. Y came in.  He recommended a series of 3 steroid injections into Jim's back, to be done at monthly intervals.  He explained that it might help enough to help him heal, but even if not it would be worth trying before surgery.  Of course the wheels of bureaucracy turn slowly, so while waiting for approval for the injections, Jim made an appointment with another surgeon, Dr. Z, who knows Jim's brother.  That appointment went much better than the first surgical consult.  Dr. Z did a more thorough examination of Jim, and showed us the areas of concern on Jim's MRI.  Unfortunately, besides the herniation, Jim also has some pre-existing bone spurs and narrowing of the spinal channel, which likely should be addressed surgically at some point anyhow.  Dr. Z recommended that Jim go through the injections first, and then when/if he feels like he is not being helped, to come back to discuss surgery in more detail.  He agreed with Dr. X that Jim has complicating factors but wasn't fazed by them like Dr. X was.  We felt much better after meeting with Dr. Z.

Jim had his first injection in late April.  He was sore for a few days but then began to feel improvement.  He had been lying in bed most of the time before this, so seeing him able to move was wonderful for the girls and me.  We had hope that the next injection, in late May, would really help but it turned out not to be the case.  Jim said that a few minutes into the procedure he started to feel intense pain on the inside of his leg, which he screamed through.  (nice, huh?)  After that, he found that while the initial back pain has indeed gotten much better, he had this new pain spreading across his glutes and in his legs.  If the new pain hadn't been there, he felt that he would be close to pain free.  When Dr. Z's office called to follow up on him a few days after the injection, he told them that he was a lot worse, and so was transferred to Dr. Z's secretary, who told him she would have Dr. Z talk to him ASAP and they would try to get him in to see him as soon as they could.  Dr. Z never did call back.

The third injection was not until late July, because there is a limit to how much steroid a body can take.  At that appointment, Jim told them what his experience was during and after the second injection, and felt like they didn't believe him.  Dr. Z looked at Jim's MRI again and decided that the space was very small where the injection needed to go, and so the pressure of the fluid was likely causing the pain.  OK, but why did he not get this pain after all of the injections?  For that we have no answers.

At this point Jim can schedule another injection, though there doesn't seem to be much use in that.  He did get Dr. Z to write him a prescription for physical therapy, which I think could really benefit him.  If you know Jim, please remind him to call for a PT appointment... if you know Jim you know he's not always his own best advocate.  He was told by Dr. Z's resident that it would also be reasonable to contact the surgeon if he didn't feel the injections were helping at this point.  I'd like to see what physical therapy could do for him first, though if he ends up needing surgery, then so be it.

He's definitely in better shape now than he was prior to the injections - at that point he could barely stand or sit.  Now he gets around, albeit with a cane, and takes rest breaks, but is otherwise pretty active.  If we could just get this new pain to disappear, he'd be back to himself.

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