The vertebroplasty on Satomi’s first 3 vertebrae seems to have worked quite well. For the first time in many months, she can sit up in bed with little pain.
The vertebrae above (T9, T10, T11) and below (L3, L4, L5) the “fixed” bones are now the problem. Just like any load-bearing structure, the spine is designed to distribute the stresses of the body evenly across its length. If any individual point becomes damaged (i.e vertebral compressive fractures), the previously evenly distributed loads become biased onto those weaker points causing further damage. Now that her central vertebrae have been reinforced with the medical cement, the stress concentration on the adjacent vertebrae has increased as well as Satomi’s pain in those areas. (If you are interested in further engineering-speak, take a look at: http://en.wikipedia.org/wiki/Stress_concentration).
We’re scheduled to begin our second vertebroplasty procedure next week. The Pre-Op fluoroscope review is set for Tuesday the 19th to decide if the next work will be done on the upper-adjacent or lower-adjacent vertebrae. Both sets seem equally as painful.
This stress concentration issue is the primary reason doctors recommend that treated vertebrae be next to one another. In all likelihood we’re going to need at least another 2 sessions to address all the seriously damaged bones. We don’t have recent detailed scans on her lower back so we are basing our expectations purely on Satomi’s pain level.
With only a bit of coaxing by me, things are moving fairly quickly on these procedures. Luckily all of our blood work, Cardiac scans, and other tests are recent enough to re-use. Hopefully, things will go smoother this time around. You all better believe that I’ll be triple checking everything beforehand.
As of January 15th, 2010, the Outpatient Physical Therapy department at Healthsouth Tustin Rehab Hospital will close it’s doors and associated staff will be laid off.
Satomi will be officially losing her job.
While the situation does create some short-term financial savings for us, I consider the closure mostly a bad thing for Satomi’s future health.
The layoff will officially end her “Personal Leave”. As I described in my post COBRA Hiccup back on November 3rd, we now qualify for subsidized COBRA. Luckily, the Fed recently extended the subsidy enrollment deadline to February 28th, 2010 (See http://www.dol.gov/ebsa/newsroom/2009/ebsa122109.html). The cost savings is significant but this job is so much more than a paycheck to Satomi.
The job was a great motivator-She so wanted to return to work and make-a-difference in people lives. Just like she had done for the previous 15+ years there. This job was her second home-a deep sense of familiarity, security, and support. Those traits are essential to Satomi’s continued healing and return to normal life. Although she may not vocalize it, I know that the love and friendship will be sorely missed.
So what are we going to do now? To be honest, I have no idea. Satomi has never been lacking of headhunter calls to the house or flyers from countless other hospitals looking for qualified Physical Therapists. The problem is that it is no longer a proper job description for her.
While her mental facilities remain sharp, her physical capabilities are much more limited. She has limited mobility and suffers from fatigue. She is always dizzy to some extent. My point is this: If she were to return as a PT, she would likely be in a worse physical condition than her patient.
A part-time supervisory position would probably be ideal for her initial return. For now Satomi is focusing on healing. We’ll consider options more seriously in a few weeks, after her next Vertebroplasty session.
Dr. Mortimer from the Oncology department came to visit us just before discharge. She happily repeated Dr. Chen’s news about the biopsy returning cancer-free. Her concern was the condition of Satomi’s bones.
She talked of the extent of Satomi’s spinal damage at her young age. Her tone and body language seemed to question the steroids and chemo as the cause.
The doctor again recommended the Zometa (which we already took) but didn’t have a clear recommendation for more chemo.
Since we were still here, Dr. Chen came to visit us with some good news-The biopsy results from Satomi’s spine were returned early. It has now been confirmed that Satomi’s spine is cancer-free.
The vertebral fractures are likely due to the combination of steroids and osteopenia/porosis. Hopefully, we will be discharged in the next hour or two.
Satomi is resting. As predicted, she’s still in pain but says her back definitely feels different. Her word was “stable”. At least to me, it sounded good. She still has spine pain in her thoracic vertebrae so it’s likely that we will need to repeat this process in a few weeks.
I asked her to dance and she gave me a dirty look-but that could easily be her disgust with my sense of humor-Not a reflection of her physical condition.
The on-staff Neurologist examined her and she passed all just tests fine.
Satomi's Cancer Blog 