Friday, August 19, 2016

Debbie update...

Debbie update...  Lots of news on the Debbie recovery front this week – and it's all good!

On Wednesday she had her 12 week followup appointment with her surgeon.  What we were hoping would happen is that she'd get clearance from him to start putting weight on her left knee (the badly injured one).  We got that clearance, and more: he told her to stop using the wheelchair, to start aggressive physical therapy (the main concern there is to get her left knee's flexion back to normal), to stop using her leg braces, and to stop the hydrotherapy (as it's not aggressive enough!).  Her surgeon was surprised (in a positive way) to see how well her repaired tibia plateau had built new bone, especially considering her osteoporosis.  The only concern he raised was her current flexion limitation – but he carefully noted that the worst case is that it's fixable with another surgery.  He referred her to a specific physical therapist who has special equipment that will help her.  For example, he has a treadmill with a harness that will let her put partial weight on her left leg, gradually increasing it as she improves.  Her first appointment for that is next Tuesday.

This morning she had her first followup with her endocrinologist.  We'd only gotten a little feedback on her lab work before this morning.  Today we found out several interesting things, all of which are amenable to treatment:
  • In the human body, vitamin D3 is metabolized into calcitriol, which is the actual chemical that helps the body absorb calcium from food and turn it into bone tissue.  Debbie's blood levels of vitamin D3 are normal, but her calcitriol levels are low.  We don't know why, but it doesn't necessarily matter as one can take calcitriol supplements directly, which Debbie is now doing.  Even if she has to do this permanently, it's easy: a tiny little capsule.
  • She's excreting (in urine) eight times the normal amount of calcium, and there's only places that can come from are diet and bone.  Her endocrinologist basically went “Aha!  Now we know!”, meaning now we know why her bone density dropped so fast. Again, we don't know why this is happening, but it doesn't really matter as it's easily treatable.  She's started taking a diuretic called chlorthalidone which has the additional effect of plugging the calcium “leak” through her kidneys.  The expected result is that calcium excretion returns to normal levels, and her body stops ripping calcium out of her bones and throwing it away.  Assuming this works as plans, she'll likely be taking this drug permanently.
  • We were hoping that she'd be cleared to start using Forteo, a drug that helps rebuild living bone tissue.  That didn't happen, because of the high rate of calcium excretion discussed in the previous bullet.  However, her endocrinologist said that as soon as we know the chlorthalidone is working (likely in 4 weeks), then she is cleared and can start the Forteo.  We're both looking forward to that day!
Debbie also had a chance to discuss her diet (low sodium, high calcium) with her endocrinologist, and the upshot of that is a bunch of ways to make her diet less dreary.  For instance, she can eat as much meat as she wants (so long as it doesn't have added salt), and can on occasion drink one of the Epic beers she so loves.

A good week!

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