My post graduate study continues in my pursuit of the elusive Doctor of Marty degree. I have been studying, doing my clinicals and taking both written and oral exams for a long time now and apparently I still haven’t completed my class work because Marty has decided to add another course.
We have now expanded our lexicon to include words like vertebroplasty, Forteo, bisphosphonates, bone density, T score and of course osteoporosis. For Marty, bone loss is not that surprising given the amount of steroids she has taken, her hysterectomy and thyroid issues, not to mention the little matter of the strokes. The fact she broke her arm a year ago without falling or that she has developed compression fractures in the lumbar part of her spine all point to significant bone degradation, thus we now embark on a new journey of which I know little.
About two months ago Marty started to complain about lower back pain when we moved her or she moved from lying to sitting. She would complain loudly, “Oh, oh, oh, oh,” a sign of real pain in that she does not complain over minor aches. Given the location of the pain and her past bouts with urinary tract infections we immediately went into infection mode. Testing proved there was no infection. Yeah.
The next thought was simple muscle strain. When we move Marty anywhere there is a certain amount of twisting and turning which could easily strain the muscles of the lower back. We did drugs, ice, heat, and rest and after about two weeks we still got, “Oh, oh, oh, oh” when we moved her and her blood pressure was continually elevated, another sign of real pain. A trip to Great and Wise was next.
He immediately brought up the idea of compression fractures but sounded reasonably confident some relief could be provided by a procedure called vertebroplasty. One x-ray, one CAT scan later we were checking into good ol' Providence for a minor procedure of having biopsy needles inserted into Marty’s back so they could inject glue into the compression fracture in the L2 vertebrae of her spine. Think filling a crushed drink can with goo. Oh yeah, a minor procedure is when they do it to someone else, if you do it to me it’s a big damn deal.
Marty had three compression fractures in the lumbar portion of her spine. Those breaks along with the broken arm she suffered a year ago indicate significant bone deterioration. All of her doctors have directed us to an injectable drug call Forteo. Being the internet maven that I am I have read all of the scoop on this drug, in particular the part about bone cancer and other side effects like joint pain, weakness and nausea just to name a few. Making the decision to start using this medicine is not an easy choice. It is just one more in a series of decisions I would prefer to never have to consider.
I lay out the choices to Marty, I tell her what I know, which is at best surface knowledge. I want her to weigh in on this decision. Taking Forteo is not easy. It is expensive, requires daily injections for two years and is complicated to maintain and purchase, and it has the whole caused bone tumors in rats’ thing going for it. It does grow bone though and the hope would be that it would strengthen Marty’s bones so maybe we can avoid another calamitous fracture such as a leg or even a hip.
I really hate deciding this kind of stuff. This is just one part of care giving that particularly sucks. This is where it would be much easier just to move on, not do anything and let the chips fall where they may, but that option pretty well bites. Marty was always the go to person for medical decisions in our family, she led on those hard decisions. My personality really doesn’t fit well guiding this decision process.
Marty tries to help but I know she is ultimately swayed by what I say or don’t say and will always follow my lead. I simply can’t abdicate; it’s not an option in our relationship today. It really falls to me to talk with her doctor’s, whom we trust, to research and read and then weigh the risks versus the rewards.
I am always biased to some sort of purposeful action, in this case the risk of doing nothing is simply not acceptable, we need to deal with the risks of taking the drug, we need to accommodate the expense and the inconvenience of the drug in hopes of forestalling future and even more devastating bone fractures.
So, once again I find myself prowling the bowels and recesses of the internet trying to increase my chances of earning the Doctor of Marty degree. Being the teacher suck up that I am I’m always trying to know more and do more for approval from the grand master Marty. She has high expectations, but she’s really pretty easy, she’ll let you cheat if you kiss her on the cheek.