Tuesday, July 19, 2016

Debbie update...

Debbie update...  She's now into her 7th week of recovery, and on her 6 week followup the surgeon declared her bone growth “as expected”.  That means, most likely, that the combination of vitamin D3 and calcium supplements she's taking are fixing the symptom of whatever the underlying cause of her osteoporosis is.

Yesterday she had a doctor's appointment (with our GP) to review the latest (third) round of blood test results.  It was all good.  To review, her initial blood tests (with blood drawn while she was still in the hospital) came back with abnormalities in vitamin D, parathyroid activity, liver function, and a couple of other less important (or relevant) issues.  The second round, three weeks ago, came back with everything good except some liver function concerns.  This latest round, with blood drawn this past Friday, came back completely normal.

In addition, the doctor told us that all indications are that the really bad possibilities are not present.  Primarily these are multiple myeloma, osteomalacia, and Paget disease.  In addition, a relatively easily remedied cause is also not present: hyperparathyroidism.  These all have been ruled out by a combination of X-rays and blood work.  She (our GP) is going to have a radiologist review the X-rays to double-check, and they drew more blood yesterday for some more sensitive tests to double-check on the negative results here.  We should know all these results by Friday, but we're expecting them to verify the initial findings.

That means the endocrinologist will be the key to finding out what the underlying cause of her osteoporosis is.  There are many potential causes, some reversible, others not.  In all cases, some combination of calcium supplements, vitamin D3 supplements, exercise, and drugs can improve her bone density.  Exactly how much improvement is uncertain at this point – to some extent it depends on the underlying cause, and to a large extent it depends on her diligence in following the regimen prescribed.  Those calcium supplements are no fun to take, and of course the exercise will be a lot of work.  Until her bone density improves, the doctor has forbidden any high-impact activity (including running), and any activity that carries with it a risk of falling.

You may be wondering, as we have been, why her osteoporosis wasn't detected earlier.  There are two fundamental possibilities here.  The first possibility is that its onset was so fast that it occurred since her most recent injury.  The second is that all of the surgeons (three surgeons on multiple occasions each) she's seen in the past three and a half years just plain missed it, while the current surgeon picked up on it from the initial X-rays.  Debbie last had a bone density test done in 2012, and that came back well into the normal range.  The test she had done a couple weeks ago came back with “moderately severe” osteoporosis.  Some of the underlying causes can be fast acting, so it's possible that no diagnosis was missed anywhere – but it seems more likely to us that one or more of the surgeons missed the call.  If that's the case, Debbie's latest injury might have been avoided...

In addition, yesterday Debbie had a physical therapy evaluation appointment.  She had two main goals for that appointment: getting advice on improving her range of motion in both knees, and getting cleared for hydrotherapy.  I had an additional goal: to get her some element of independence.  Up until yesterday she has been completely dependent on me for even the most basic things (like getting into or out of bed).  I know this has been frustrating for her, and it's also very different than the recovery for her past injuries, where she was fairly independent quite quickly.

The physical therapist did an outstanding job on all of our goals, and most especially on the one of achieving some independence.  When we got home, Debbie was immediately able to do several things she formerly needed my help on completely on her own.  I stood by to make sure she was safe, and I'll continue to do that until she's confident – but I have no doubt that in a day or two she'll be doing it all on her own easily.  Hooray!

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