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Having spent over 50 years of work providing healthcare for cancer patients, I suddenly found myself on the receiving end of cancer treatment. Unexpected cancer had thrust me into emergency surgery. It required some immediate skilled surgical and nurse expertise to treat and return me to the road to recovery.
It all happened so quickly. I had previously weathered prostate cancer treatment by robotic surgery. With negligible results of the PSA test, my surgeon had proclaimed me as cured. Now, there was another cancer to beat!
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Lyn Oliver AM PhD
Spinal Surgery
Most people get arthritic back or spinal pains from old injuries and skeletal ageing. I have had those sorts of pains for years. However, the pain became more severe and persistently occurred across my shoulders. The muscles frequently had severe spasms for reasons I could not work out.
Then the pain and ‘pins and needles’ started to run down my arm. I tried to fix it with two weeks of physiotherapy, but it kept getting more severe. By that time, I was taking panadol-rapid four-hourly to keep the pain at bay.
Click on the figures to enlarge:
I consulted my G.P. doctor for medical advice. She immediately requested urgent CT and MRI scans.
The reports from the CT and MRI scans of my neck and shoulder region were alarming. I had a tumour which had eroded 40% of the sixth cervical vertebral body. The tumour was pushing into my spinal cord (Figure 1 and 2).
My doctor urgently contacted me and arranged for me to be immediately admitted to general hospital casualty. After the orthopaedic doctors saw the image scans, they immediately fitted a neck brace and admitted me to the ward for surgery. The orthopaedic spine surgery specialist visited me that evening and explained that the tumour had badly damaged cervical-6. He advised that I was in immediate danger of becoming a paraplegic. Given the emergency, he wanted to operate the next morning.
There were two operations spaced one week apart. During the first operation, the surgeon operated anteriorly through my neck to remove the tumour and the rest of the cervical-6 main body. A titanium mesh containing some of my bone graft was then inserted to replace the missing vertebral body.
Figure 4 shows an MRI of the neck region after the first operation. Removing the tumour left a void of 3cm deep and 5cm long that was filled with the bone graft material.
In the second operation when I had recovered from the first, the surgeon operated posteriorly to attach screws and a plate to cervicals-5 and 7. The procedure removed the tumour affected vertebra-6 and ‘fused’ the remaining spine to the adjacent vertebrae.
Each operation was longer than two hours long and, because of the high anaesthetic drug quantities used, I remained in intensive care for almost two days after each operation. Dedicated nurses continually monitored my heart and temperature and injected, via cannular, anti-bacterial drugs to guard against infection (Figure 5.).
It took quite a while to recover from the anaesthetic drugs. There were times for a week after surgery when I experienced some convincing hallucinations. But the nursing care was wonderful during that torrid period.
While I recovered from the first operation, there was much to do. The orthopaedic physicians had sent my tumour sample to pathology for a detailed examination. They also referred me to the haematologists to examine my blood as well. Between all the doctor consultations, it was explained that the cancer was either multiple myeloma or solitary plasmacytoma. The former was bad news and the latter was better news!
Describing the two probables in laymen’s terms:
– multiple myeloma is a blood, bone-seeking malignant disease that can spread to any part of the skeletal bone structure.
– Solitary plasmacytoma is also a blood malignant disease but remains in a single bone site.
By this time, I was becoming a hot subject at clinical specialist meetings (known as multidisciplinary meetings) where my case was examined. The team ordered a whole host of imaging examinations and laboratory tests such as:
– A whole body CT scan (for detecting bone metastases);
– A whole-body MRI scan (for identifying any soft tissue malignancies);
– A whole-body PET scan (a drug labelled with radioactivity was injected and the body scanned to detect any tumour sites);
– Hematology bone marrow samples were taken from my hip bone to examine the blood cells.
The health cost for all the surgery, the staff, and these tests were significant.
There were no bone or tissue metastases detected from the radiological or nuclear medicine body scans. The Haematologist also reported that the cell type and count in the bone marrow blood were within the levels expected in normal studies. All the pathology results for the venous blood samples were normal too.
On the basis of these results, the orthopaedic surgeon and haematology clinical specialist agreed that the cervical-6 tumour was plasmacytoma and was unlikely to have spread to any other part of the body.
But research information for this type of cancer is scanty and I did receive a warning from the doctors that I would need to receive on-going haematology checks to ensure that this single site plasmacytoma was not a precursor to an occurrence of a future more aggressive multiple myeloma.
The orthopaedic discharge notes when I left hospital said:
– Impression: New diagnosis of ‘Solitary Plasmacytoma’.
– It does not meet the criteria for a diagnosis of ‘Multiple Myeloma‘.
– Based on current findings, it does not require systemic treatment, i.e. does not require chemotherapy.
– Need to arrange a follow-up with the radiation oncologist for consideration of localised radiotherapy to the cervical-6 region.
I cannot speak too highly about the medical treatment and care I received before, during and after orthopaedic spinal surgery,
The skills, professional support and interdisciplinary cooperation I received from the surgeons, medical specialists, nurses and support allied staff were outstanding. It needed a centre-of-excellence hospital and I, thankfully, received it (Figure 5.).
And thank goodness for the availability of such wonderful imaging technology, pathology and modern laboratory techniques that Australian Health offers. Where would we be without it?
The final ‘solitary plasmacytoma’ diagnosis is a good result. It might mean more treatment and more inconvenience. But the new radiation therapy technology provides an excellent prognosis.
How do I know that? I provided the medical physics services for over 20 years in this hospital’s radiotherapy department before my retirement in 2010. Radiation therapy saves the lives of thousands of Australian cancer patients each year. I plan to be one of them!
Look for my next website article:
Lyn Oliver AM PhD
Please Note: This is a patient viewpoint with some scientific and technically based information. It is not intended to provide medical advice and is for information only. If you have any health problems or questions related to your health, then please consult your doctor.
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