BR's world just shrank a bit

I was upstairs in a teleconference for work, when I heard a whole lot of commotion and yelling from down stairs. BR was down there with some friends making dinner, so at first I just assumed they were having a good time and "getting happy." In the second wave of shouts, I could make out my name and a sense of urgency. I stuck my head out the office door to see what was going on. "Bobrobert has fallen off the porch! Get down here quick!" A choice expletive and a quick good-bye to the conference, and I was flying down the stairs.

BR was laying on the sidewalk at the foot of the porch stairs, his iBOT on its side and partially on top of him, sounding the all too familiar "red alarm." I powered off the chair, and tried to lift it out of the way, but it was good and wedged on the railing. So I turned my focus to BR.

"Are you OK?"

"Yes." He sounded a little shaken up.

"Did you hit your head?"

"No, sir." Whew. I felt around his scalp just to make sure.

There was no blood and only a few noticeable scrapes on his elbow. At this point, I wanted to ask, "How did this happen?" but realized there would be plenty of time to play Monday morning quarterback later.

Given BR's recent osteoporosis diagnosis, we were all a bit concerned that he may have broken some bones. Without moving him too much, we got him comfortable on the sidewalk with a blanket and the wheelchair cushion for his head, then called the hospice after-hours nurse for help. He took our information, then advised us to call 911, because BR would likely require x-rays in the ER. While a neighbor called, I had Jordan gather all his medication, and I grabbed his DNR. The ambulance arrived and soon he was on a stretcher and on his way to the hospital.

BR hates the ER. His medications give him intense dry mouth, and he's never seen without a bottle of water. So it irks him to no end that from the moment the EMTs arrive until he's seen by the ER doctor, he's not allowed a drop of water. But that doesn't stop him from asking, begging, and pleading. All told, he was without water for a little over an hour, and very happy when he was finally given some.

The doctor ordered some x-rays and a Dilaudid injection. We just laughed, as previous experience with Dilaudid has shown it to have absolutely zero effect on BR. He got Demerol instead.

They took the x-rays, which didn't show any fractures. The doctor wanted to order a CAT scan, but we decided against it. All told, we were in the ER for three hours and left with peace of mind that his bones were still intact.

But things won't be the same. The front porch was BR's place to be social with the neighbors -- one of the few daily social opportunities he has apart from Jordan and myself. He will now require supervision when on the porch. An extra set of eyes to make sure this type of thing doesn't happen again. A little less independence.

Push it up! Push it up! WAAAAY UP!

The pain doctor saw BR this afternoon. He didn't seem worried that BR has not yet responded to the Prialt, telling us that they start with a "center of the bell curve" dose. This means that at this does, about 50% of the people get relief. He then increased the dose from 2 micrograms/day to 9 micrograms/day, saying that BR should definitely notice a difference in pain level by dinner time, but will also likely to have some mild side effects.

He also commented on BR's sacral insufficiency fracture, and repeated the Which doctor's recommendation of sacralplasty. When I said it wasn't considered medically necessary by the insurance company, he was surprised, and offered to make a case on our behalf. Sweet!

Mama, Aunt, Fosamax, Prialt

BR's mama and aunt have once again made the trek from Louisiana to visit, comfort, and generally raise our spirits. We couldn't be more pleased to have them here. We'll be eating turkey gumbo (yum!) for lunch, and then BR and I will take them out for a steak dinner.

The results came back from BR's bone density test. He has osteoporosis. The GP recommends starting Fosamax, but I have some reservations. Certainly strong bones are a cornerstone of his quality of life, as is evidenced from the recent fracture. But from what I've read about Fosamax, it is yet another drug that may or may not help. I've developed a strong distaste for drugs that instead of curing a condition, only lessen the symptoms. Nobody seems to be asking why BR is losing bone mass -- just take a pill for the rest of your life, and maybe you won't get another fracture.

We are going to pass on Fosamax for now. With the Prialt trial next week, it isn't a good idea to add another medication to the mix. That said, I really don't like the thought of BR's bones breaking down. I need to read up on how to care for someone with osteoporosis who is also wheelchair bound.

BR reenacts a scene from Sixteen Candles

The doctor has put BR on high dosage vitamin D for two months after blood work showed he was about a quart low. He also had a bone density test this morning.

Bed rest seems to have helped the fracture pain some, but he still seems to be fighting an infection, as his skin is on fire.

Sacral Bleu!

I was in a work call when I got the text message.

Dr. called. Will call back in 10. Please come down.

BR wasn't sure which doctor had called. When the phone rang, it was the Which doctor. The MRI showed a sacral insufficiency fracture (SIF), which would explain the new hip pain. These fractures usually occur in older women with osteoporosis. <Insert "BR gets all the lady problems" joke here.>

The doctor offered a couple options: bed rest or sacroplasty. The latter is a new procedure, and he is only one of two doctors that perform it here in town. He did warn us that the insurance company will likely consider the procedure experimental, and hinted at finance options should we decide to proceed without insurance approval.

From our insurance company:

Percutaneous sacroplasty is considered investigational and not medically necessary for all indications.

[...]

Standard treatment for SIF includes bed rest, limited weight-bearing activities, oral analgesics, and sacral corsets. Improvement of symptoms may take as long as 12 months.

The Which doctor says that even after the fracture heals, the pain may persist, requiring sacroplasty anyway. Other sources say that 90% of patients get better with bed rest and limited weight-bearing activities.

For now, I think we'll go the bed rest route, and look into treating BR's osteopenia, which was diagnosed a few years back, even before the MS. If the pain doesn't improve over the next few weeks, sacroplasty can still be performed.