Billy Bob's Wild Ride: Fiftysix-

Wednesday, July 16, 2014

Fiftysix-

56... Fiddlesticks!

56. What a number. Let me explain...On the evening of December 9th, 2007, Notbillybob (Bobby) kissed his wife goodnight, rolls over to his left side, and plopped down in the bed to go sleep. There was an audible CRACK-ing noise. He jumped up out of bed, screaming-I BROKE MY RIB-I BROKE MY RIB-I BROKE MY RIB!!! Early the next morning they went to the ER , and got and x ray. Nothing. Impression,negative. No broken bone. 10 days passed. The pain was much worse. It's the Friday before Christmas, his primary care doctor says "sometimes a broken bone won't show up until it starts to knit...she sends them to a different ER at a different hospital. The report comes in just as her staff is closing up for the holidays. Bingooo. Broken rib. Positive X ray. Miserable Christmas dinner, but OH so glad that there was now proof he wasn't making it up.
There is nothing worse that complaining to a doctor that you have a pain, and they cannot find a reason. They write in your chart "idiopathic" which is Greek for "unknown". The *other doctors see that and immediately they think Munchhausen!

*ER doctors

After the rib healed, Not billybob thought the matter was over... until it broke again.
And again.     A n d . . .a g a i n.
Over and over, this rib would break, and worse and worse the pain would get. Some years it would break up to 4 times. Bedridden for a week, then better and better till the next time. You can look down through the posts to see this.
Then one day Notbillybob went to the "U"   (Colorado University Hospital) October 2010 for a routine screen for liver cancer .
One of them there Cat scans. One of these every 6 months had become routine. This blog has little radiological symbols all over the place as a result. I think it's because Notbillybob thinks that the Radiology department is his home away from home. Heh heh. Anyhow, this screening report was alarming. Possible small liver tumor, AND a slowly enlarging lytic lesion on the
7th anteriolateral rib (means 7th front-side rib) which was the one which kept on breaking over and over. It was a bone tumor- growing bigger and bigger. Lytic means "destructive". They sent Notbillybob to the Rocky Mountain Cancer Center for a follow up. The doctors there ordered every test in the book. A bone scan. A barium swallow. Chest x ray survey.
Ya da ya da ya da ya da.
November 2012 rolls around and another Cat scan. The
thing has just gotten HUGE.

By now, 5 separate doctors have refused to either do
a biopsy or surgically remove it. Notbillybob wasn't in any shoot-fired hurry to go
the the operating table anyway. Liver doctor had said surgery for cirrhosis patient is extra risky. Risk from anesthesia to the liver, risk of bleeding, etc.

Another Cat scan this past April showed that the lesion is now a huge TUMOR, and has broken through the bone.It's very close to his heart. It cannot stay, because it might be malignant.

The differential diagnoses are almost all carcinomas. (Differential diagnosis is a fancy way of saying "It could be ___") The doctor cannot say for sure, because even though the usual blood markers do not indicate a cancerous presence, the only way to know for sure is a biopsy on the whole thing. Looks like a chicken leg.. or a lightbulb. Notbillybob and Sharon named the thing "Lester Diamond. From the movie "Casino". The surgeon wanted it out ASAP. But Notbillybob wanted to wait till later in the summer. Tuesday July 22nd is the day.
Now for the kicker. Starting a year and a half ago, Notbillybob's platelet count
has been going down. A little at first, then more and more. Supposed to be 150 at
the lowest. Was 151 for years years. Now, it's going down.145... More. 100, 97, 78, 69, 67, he developed a low platelet rash called petichia. Little tiny hemorrages in the skin.

Last week, got some bloodwork done. uh oh.
Bad news. platelet count-----56. Really?
56. (it means 56 thousand). Better if it were 156 thousand. Much much better. But I guess we'll take the fiddysixx and run with it.
Tommorrow morning at 9:00 am Notbillybob goes in for the pre-op.
See you at the "U".

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Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)