Mark
A.
Mark
A. is a 66-year-old man with a 12-year history of prostate cancer.
He was initially treated with local radiation and chemotherapy
and had an initial positive response. His response was so good
that his oncologist scheduled him for annual follow up visits.
He remained clear of prostate cancer until 4 years ago when
he was diagnosed with metastases to his lumbar and thoracic
spine. Radiation and chemotherapy were once again employed but
with much less response than he had previously experienced.
Over
the last 18 months the lesions have been growing rapidly and
invading his spinal canal. At that time he had severe bone pain
and lower extremity weakness and burning numbness from spinal
cord compression to the point that he could not walk or transfer
from bed to a chair independently, and he had bladder impairment
requiring a catheter. Due to other medical problems he has been
deemed to be a non-surgical candidate by two neurosurgeons despite
his loss of bladder control. He had been told that at the rate
of spread and growth of the lesions he had 4-5 years to live
at most. He was in profound pain and was depressed and hopeless
due to his poor prognosis and quality of life. He was on high
dose narcotics provided by his oncologist, which had lost their
effectiveness at treating the pain and were only successful
in that they kept him sedated while his life ebbed by.
Four
months ago, at his daughter's insistence he consulted Georgia
Pain Physicians, PC. Mr. A. was evaluated and found to have
severe bone pain due to erosion of his T9 vertebral body and
a small compression fracture. In addition, he had severe nerve
damage to his bladder and lower extremities due to spinal cord
compression. Initially a small amount of local anesthetic was
injected into his spine under X-ray guidance, which completely
eliminated his lower extremity pain, and so a temporary catheter
with an external pump infusing local anesthetic was initiated.
This was highly successful at resolving his lower extremity
pain, but did not help his bone pain. A vertebroplasty was then
performed at T9, which relieved his bone pain 90% in 12 hours,
and it has not returned. Two weeks later the temporary pump
was stopped and a permanent pump was implanted. It has now been
two months since the treatments were performed and Mr. A. is
virtually pain free and is off all narcotic medication. He is
alert, has a much-improved quality of life, and is interacting
with his family again. He continues to have bladder dysfunction
but with the initiation of bladder medications he no longer
wears the catheter continually and has been taught to catheterize
himself twice per day. He still has difficulty with ambulation
but is able to transfer to a chair and bathe independently.
At
this point, Mr. A. still only has a life span of 4 years projected,
but since his quality of life has improved so much he is looking
forward to each new day.