Snap, Crackle, Oh Sh**!
It took long enough. It has been fifteen years, since I found out, one of my late developing side effects from radiation and chemo treatments for Hodgkin’s Lymphoma, would result in an increased risk for a particular event, in the case for this post, risk of a bone fracture. Radiation history is actually a double whammy as it impacts the healing of such an injury. For instance, when my chest was cracked open to perform the emergency heart surgery on me (for one of my other late effects), normal heal time for the breast bone I was told, would be about three months. Because of my radiation exposure, I was told to expect six months for my sternum to heal properly, not something my employer wanted to hear for sure.
Some time after my heart surgery, as evaluation after evaluation was performed on various systems of my body to determine late effect concerns, included a DEXA scan, a measurement for bone density and bone loss, one of the potential late side effects from both radiation and chemotherapies. Without getting lost in the weeds, results would diagnose me with osteopenia, simply, the little sister to osteoporosis. Osteopenia is a lowered bone density, where as osteoporosis is a full blown disorder. Osteoporosis is commonly thought of a something only women have to deal with. But just as with breast cancer, especially with late term side effects from treatments, osteo can impact men as well.
An MRI would confirm the effects of osteopenia, with the L1-L5 vertebrae showing facet joint arthritis, a wear-and-tear of those vertebrae, this was a late effect I would be dealing with. The most concerning comments made on the report, was the potential for an increased risk of bone fractures. I do not think of myself as clumsy, and following my heart surgery, and the reduction of my physical activity, especially anything with a risk of injury, was not really a concern to occur imminently.
And then last week…
I was sitting in my chair, reviewing some paperwork for college with one of my daughters, when I dropped my pen on the floor. I leaned over the arm of the chair to reach for the pen. I felt it. I heard it. If you have ever snapped a pencil between your fingers, that is exactly the sound, exactly the feel, that I experienced. I had cracked one of my ribs and instantly leaned back in my seat to relieve what I was hoping was just a cramp, soon realizing it was much more serious than that. One thing was certain, I knew what had just happened. This was not a simple crack like made with the knees when standing, or stretching the back, or cracking the knuckles. This was bad.
As I am prone to do, I process any crisis or trauma rationally. I do not understand how I can do this, I just do. But I reached out to my doctor, and the first concern is whether or not to do an x-ray to confirm it. With the amount of radiation that I was exposed to during my cancer treatments, he is always reluctant to expose me to any more radiation than necessary. To keep things in perspective without getting all nerdy, here is how this plays out for me. My medical history shows that I was exposed to 4,000 grays of ionized radiation in a period of 30 days. The maximum amount per year a person in the industrialized arena (a.k.a. work), is .05 grays per year. So, you can see the shit load of radiation I was exposed to, not just in one year, but covering so many lifetimes of exposure.
There are exceptions as to when I do not question exposure to more rads, and that is the concern that exists for lung cancer, as I have multiple spots on my lungs likely from my treatments. It is urgent that the moment any of these spots gain additional concern, response is quick before too late to do anything, and that requires a CT scan to do it, more radiation.
But in this case, while an x-ray will officially diagnose my rib being cracked, treatment for my rib, will just be care and rest. Therefore, both my doctor and I agreed, additional radiation from an x-ray was of no benefit to an increased shot of radiation. The important thing with this injury, my breathing was not impacted, so I was not worried about any injury to the lung. All I can do in the meantime, is “exercise” my lungs, to keep my rib cage expandable, which I do using a spirometer or singing around the house, anything to expand my lungs.
Of all the trauma my body has gone through, this is clearly one of the most frustrating, because I want to continue my “fitness” routine that I have been doing since my last heart surgery. My arms are fine. My legs are fine. But my rib is saying “hold my beer.” So, still no exercising.
One thing is certain, if I am that fragile now, that the simple act of leaning over something can cause a bone injury, clearly I need to be careful with any kind of fall, as already noted with the vertebrae in my back, my body is already compromised.
Paul's Heart 