Wednesday, April 29, 2009

The Back Story

Ted Baxter's story comes to mind.

You remember Ted? The news anchor on the Mary Tyler Moore Show? "It all started at a little 10,000-watt station in Bakersfield."

So, here, it all starts with a twinge in the left shoulder that leads to the orthopedist.

"Doc," I say, "it hurts when I do this."

In Vaudeville, they'd've said, "Well, don't do that."

Instead—x-rays, cortisone shot, physical therapy, cortisone shot, no results, an MRI.

"An anomaly on the left humerus," says the radiology report. Off to an oncologist for you, young man.

Uh-oh. Did someone say oncology? Cancer?

Is that...? Yes. Yes it is. A trickle of fear limning down the back of my neck and along my spine like the first spring snowmelt seeking its downhill trail.

Blood work, but the spot is too obscurely located to biopsy. Another referral, this time to an oncological orthopedist. (Who ever heard of an oncological orthopedist?) Perhaps he can biopsy it.

Wrong. Too small. Can't get at it. Here's a list of scans to be performed.

  • MRI
  • CAT
  • All-Body PET
  • Bone
  • more anomalies on a rib
  • and, wait a minute, some nodules on the thyroid
Side trip required: endocrinologist.

Add-a-scan: ultrasound-guided thyroid biopsy.

Guess what? You've got hyper-thyroid. Regular doses of Synthroid for you from now on.

But, What about the anomalies? Choices:
  • cut a huge hole in the arm to look at the tiny speck
  • remove a rib to look at tinier specks
  • come back in three months for more scans
No need to call on Solomon for wisdom in these choices.

Three months later. Same scans, same results.
Three months later. Same scans, same results.
Come back in six months, but meanwhile, you're cleared for shoulder surgery.

Oh year. Shoulder surgery. Almost forgot about that.

Six months later. Same scans, same results.

Do it again in six months... "But, wait," says Dr. Onco-Ortho, "what does Dr. Onco say about these blood results? The monocytes are high."

"Haven't seen Dr. Onco since she referred me to you," I reply.

Back to Dr. Onco.

  • The good news: forget any more scans—you've been radiated enough.
  • The bad news: we'll do a general bone marrow biopsy.
  • The good news: the biopsy shows nothing.
  • The bad news: the blood platelet count is down a bit.
That's January, 2009. Nearly 2.5 years since the first orthopedist visit.

March, 2009. Skiing in Minnesota. Beautiful weather. Fantastic spring snow. The usual great and collegial companionship of fellow ski writers. It's Thursday. I ski all morning, eat lunch on the mountaintop, feel tired, go back ot the room for a nap. I wake up with a terrible stomach ache and flu-like symptoms.

Never mind it's just another stomach hassle.

Except that 10 days later it's still going on.

Off to the primary care physician for some antibiotics. "There's some nasty stomach virus going around," says he. "If it's not improved in two days, see the GI guy."

"Hello? GI Guy? I'll see you Friday."

GI Guy: blood work and–guess what?–a CAT Scan! Come back Thursday.

Scan shows nothing. Blood work shows alarmingly declined platelet count. Quick—go see Dr. Onco. She can do blood work on the spot in her office.

Dr. Onco: platelets are 9,000. 10,000 is the "Mendoza Line." Off to the hospital with you.

Five hospital days of IgG infusions (gamma-globulin), prednisone, other drugs, another bone marrow biopsy, low platelet counts. By Monday, the count reaches 12,000.

You may go home, but must report for blood monitoring daily. By Monday, the count reaches 19,000. We're on the road to recovery, right?


Thursday's counts are slightly down and then—wham-o!—a delayed chromosomal report from the marrow biopsy.

You have Myelodysplastic Syndrome.


It's called MDS.