January 3, 2013

REAL fear

"You do NOT know what it's like." I heard this from my brother on occasion. And he was right. I didn't know what it was like to be the one facing death by cancer. But I got one small taste of it recently. And if it's but a fraction of the existential angst he suffered, I shudder at the very nature of it. You see, I have had worsening back pain over the last six months. Big deal. Lots of guys get back pain. But my immediate family is two for two in going to the doctor with back pain and coming out with cancer. There's a saying in medicine that says, "when you hear hoof beats, think horse, not zebra." It means common things are common. Do not go looking for bizarre diagnoses when common ones will suffice. But, as one doctor so aptly told me, what do you do when your family history IS a herd of zebras?

My mom and dad strongly encouraged me to get it looked at. My wife could not bring herself to even contemplate the grim possibility. And I thought, "if there's back pain then that means a metastasis. Frankly, I'd rather not know at that point and live out as many days in blissful ignorance as possible."

But I broke down and got an MRI for various reasons. Some to assuage my family. Some to try to pragmatically solve my pain problem. But mostly to confront in my mind the very real possibility of what may lie there. Anticipating the anxiety associated with claustrophobic spaces, I decided to opt for an Ativan. It wasn't enough. I explained to the MRI tech that I hated small spaces so he was very humane in his treatment of me, talking me through each scan and letting me know the progress. I had one more scan to go, about five minutes, he reassured me, so I took deep breaths, closed my eyes and listened to the hypnotic clicks and clangs of the magnet. The voice of the tech came over the intercom at the end of the last scan, "I need to run an extra scan."

My heart sank immediately. What did he see that necessitated an extra scan? Mass? Tumor? What kind of tumor? My life did not flash before my eyes but I did spend the next five minutes with my thoughts rushing endlessly. What do I tell my son? What will happen to my wife? And my parents? Do I even bother with treatment? What last thing do I want to do before dying? Do I even bother to keep up with my training? How do I keep from experiencing the excruciating physical pain that my brother did? It was the longest five minutes of my life and for that brief moment, I had the smallest of inkling of what my brother must've wrestled with daily. I would not wish it on anyone.

When the tech came in, I asked him flat out why he ran that scan. "Why did you run the extra scan? Were there any mass lesions?"

"No, nothing like that. But how many lumbar vertebrae do you have?" Apparently, I have an extra lumbar vertebra. Normal people have five and I have six. I've never been so relieved or happy to be congenitally abnormal because it meant no tumors. Because of the holidays, I had to wait a good three weeks for the official radiologist report to find out for sure that not only do I have an extra lumbar vertebra, but also an extra thoracic one in addition to only 11 ribs on one side. Either I donated a rib to make Eve, or my parents are brother and sister. Add some degenerative disk disease and I have some very painful and yet happy causes of back pain.


Steve Parker, M.D. said...

FWIW, your experiences like this will make you a better and more empathetic doctor compared to the average. Nevertheless, I'm sorry you had to go through it.

I had a similar scare with oral cancer a year ago. You've seen those patients with half their face resected by the ENT doc? Turns out I was just brushing my teeth too vigorously.

Regardless of imaging studies, most cases of chronic or recurrent back pain respond favorably to flexibility and strengthening exercises. Please share if you find a reasonable regiment.

Write Jerry Pournelle likes The Five Tibetan Rituals. I like Mark Verstegen's Core Performance, but it's very time-consuming. Here's a little more at one of my blogs: http://advancedmediterranean.com/category/low-back-pain/


Isaac van Sligtenhorst said...

Thanks. I'm going to try the Watkins trunk stabilization program that came recommended. And I'm going to reevaluate my weight lifting which is a shame because its such a good stress reliever for me but its possible I'm doing more harm than good.

And not to go woo, but I am trying acupuncture. I've actually had success with treating pain from a different injury so I thought I'd give it a shot. Anything to get off the pain killers.

Isaac van Sligtenhorst said...

And for those ENT cases, we had a lot of delirium to treat on my psych rotation at Mdacc. Anytime you take a 70 year with oral cancer and operate, delirium is usually not far behind. Kind of sad really. If the surgeons would just stop using Ativan for agitation and Benadryl for sleep, it'd probably reduce a lot of the cases.

Abe said...

Being thankful for a lesser diagnosis, I share that with you and am also glad for you. Remembering that is tough when the pain keeps hanging around. Love Dad

Brad Evans said...

glad to hear it Isaac.

be well,