First, we met with the orthopedist to go over the MRI results. It turns out he has a handful of fractures along his vertebrae. Words that you never want to hear combined in the same sentence are 'multiple fractures' and 'spine'. The biggie is along what's known as Lumbar 1 (L1). It's the vertebra that is right where the ribs end and the sway of the small of your back begins. He then has several fractures that the x-ray was unable to detect but the MRI picked up along the vertebrae above and below it. And more than slightly disconcerting, he has some old fractures up in the thoracic region of his spine. Since he suffered no blunt force trauma, the question then became what weakened the bones to allow them to be cracked under the grunts of muscular straining. Most likely, the cancer probably played some role in weakening the bones but that probably wouldn't explain that many fractures. We don't have a bone density scan yet but odds are that he has some osteoporosis going on concurrent with the CLL.
Second, we met with the oncologist to go over the final results of the biopsy and bloodwork. While he does not have one of the most aggressive forms of CLL, neither does he have one so indolent that a wait-and-see approach is warranted. He had 2 units of blood to buffer his worsening anemia and the plan moving forward is to have surgery next week to reinforce the bone with some cement which ostensibly will give quick and significant pain relief. He'll then be given 2 to 4 weeks to recover and then he starts down a long road of chemotherapy which will likely last approximately 6 months receiving therapy every 4 weeks for a few days. Somewhere in there, he'll begin treatment with osteoporosis drug(s).
It's been rough on my brother....or, I guess I should say it's been rough on me watching my brother go through the past couple weeks. Since he's been down here staying with my parents moving back and forth from MD Anderson, I've had the opportunity to spend more time with him, mostly as his gym buddy. I have no idea what he's experiencing and I don't even like to imagine it. It's hard to watch someone you care about in pain. He's lost probably 50-60 pounds on what was an already slender frame from the beginning. He missed getting into the clinical trial due to worsening anemia (notice a pattern here?). They gave him 2 units of blood and Plan A is to wait 2 more weeks to see if his anemia stays above the cutoff. They wouldn't give him more than 2 units. It's a long convoluted story and all that I can say is PLEASE GIVE BLOOD on a regular basis if you're able. There's essentially not enough blood so they triage and reserve it for catastrophic cases. Not wanting to miss the cutoff again, my mom took my brother back up to Dallas to get another 2 units up there since it's a different blood supply. You do what you gotta do. He'll be back down here this week to see if he qualifies for the trial. If he doesn't, there's Plan B. From what I can tell, I don't like Plan B. It was recommended by the clinical trial doctor and I was not impressed. Maybe they know something I don't know. As someone who's just a first year med student, I'd like that to be true but.....I guess there'd be a Plan C, too, though I do not know what that is. I'd prefer to stick with Plan A and we'll know that answer by the end of this week.