Paul's Heart

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.

The “Speed Bump”

What does a speed bump do? It slows you down, if you are driving a car that is. I have referred to a couple of my former co-workers as “speed bumps” for similar reasons, because they slowed me down. But another thing that a speed bump does, if you hit it too fast, or if the hump is too steep, it gets your attention in a big way. I just flew right over a “figurative” speed bump. And just like speed bumps I see as I am driving, I knew this one was there as well. And just like other speed bumps, I often do not pay attention to them, and then wish I had done otherwise.

This was the second of two major milestones for me to have reached as a thirty three year cancer survivor of Hodgkin’s Lymphoma, my younger daughter graduating high school. But there was a speed bump approaching, and I had totally forgotten about it. Just like my car bottoming out of an actual physical speed bump, I was going to hit the “figurative” speed bump soon that I referenced earlier. And just like scraping the undercarriage of the car, this speed bump is leaving some marks.

As I did last year when my older daughter graduated, I spend Father’s Day week with my daughters. In full disclosure, this week is not just about having fun, making memories, taking pictures, we also get a lot done that needs to be taken care of until the next time that I see them both again. This year, both of my daughters will be in college, and then… well, they are off on their own lives.

If there is one thing missing from my younger life, it is pictures. I have very few photos of me as a child, and even fewer with either of my parents. Though I do have some memories of my youth, photos would definitely help to jog those memories. I know that, as my daughters often do not recall things we did together in the past. I have made sure they have photos to show them what they have done. A lot of photos.

This week has been no different, other than probably a lot less photos than ten years ago, attributed to “diva” behavior of two late teen/young adults. But I am getting my share of photos and memories. With the graduation photo pictured above, I was pumped for what I had in store for my daughters this week.

And then, an innocent photo, the type taken many times before, grabs my attention, like a speed bump, wrecking my inner core.

For the most part, most people find it hard to believe that I am a thirty year survivor of cancer, or that I have the number of major health issues that I do. I have even had one of my doctors tell me at an office visit, “you look great!”, especially when they know inside, my body is a train wreck.

But this photo shows the obvious, besides the fact, that it is obvious which shirts I must wear to hide what I have been through. This pullover shirt, exposes the major muscle loss that I have developed over the years, from my neck muscles, shoulder muscles, and chest muscles. While I currently consider myself in fairly good shape (all things considered) and my strength well enough, that same conditioning shows what I have lost.

A recent photo shows the results of damage to my neck from high dose radiation. Muscle loss from the back of the neck results in remaining muscles in the front of my neck, pulling my head forward, and eventually drooping down. Before I learned what was happening, I constantly heard co-workers accusing me of being depressed because I was always looking down at the ground when I walked. Turns out, I could not help it. Physical therapy and various neck braces can help to a certain point, but not reverse the damage that is cumulative. The degradation and muscle loss in the neck of many Hodgkin’s survivors often gets nicknamed “pencil neck.” All too often, you can pick us out just by that observation alone.

Honestly, I really don’t pay attention to it. I very rarely walk around without my shirt on, because of the horrific scars on my chest and abdomen which only took one incident to garner too much attention. I have trained myself not to really pay attention to mirrors because I know that in spite of the good shape I believe myself to be in, a side or rear view will show a “chicken wing” like appearance of my shoulders as opposed to a nice, rounded shoulder.

Normally, I do not let this appearance stuff get to me. I know that my more serious issues belong to my heart, my lungs, and many other interior issues. But as I looked at the current photo, I reminded myself, I should have paid more attention to the “speed bump.” The result, I still took a lot of photos, but now I was no longer in them, and the few that did now include me, I examined and focused on my chest and neck area to see if I hid my physical late effects well enough. Seriously, the stuff going on inside of me is supposed to be the difficult things to get through.