I felt pain

Monday, November 24, 2008

The least favorable feeling in the world, and the one I get so often is seeing somebody agonising in pain, yet what you could do is just stare at him as helplessly as a baby.

I stumbled across a patient who presented with lower back pain that persisted for 4 months today in the clinic itself. He was in his twenties and apparently what came to my mind was muscle strain as there was no history of fall or trauma. He was pale, the face was obviously lacking of intensity and brightness. One of his hand was on his back, telling the doctor about the wrenching pain that diminished his quality of life. He complained of weakness and numbness and pain radiating down on both of his legs.

"Could it be a PID ( Prolapse Intervertebral Disc) since the patient presented with sciatica" I whispered.

To have a closer look at him, Dr Kama ordered him to take off his shirt.

"What can you see Calvin, this is an interesting one"

" Scoliosis, but he is only 28, no history of trauma or fall, no mechanical stress exerted along the spine either.Scoliosis?"

The whole thing is like a puzzle, waiting for me to put all the pieces together so that I can at least figure out what is wrong with him. I was indeed puzzled. Scoliosis is a medical condition where the spine is curved from side to side, forming an S shape.

What causes the spine to curve? Did he lift up heavy things?

I recall that scoliosis is usually associated with loss of density of the vertebrae, sometimes found in osteoporotic patients in which the micro architecture of the bone is impaired.

"Don't tell me he has osteoporosis at the age of 28" I laughed, not knowing what is coming ahead of me.

"If there is no history of fall and trauma, the only thing that I can think of is actually infiltration" uttered Dr Kama.

"Infiltration? You mean malignancies? Cancer?" I said dubiously.

"I'm afraid so" said the doctor while laying his hands on the patient's spine.

In medicine, doctors are the detectives. We observe, we make our hypothesis and then we rule in or rule out the possible causes. Every decision is dealt with professionalism, a wrong move and you put the patient's well being at stake.

I scrutinised his body, looking for any abnormalities. What I found was that his shoulders are uneven, probably due to the fact that he has to compensate for his posture to keep himself balanced with the curved spine.

He was skinny, pale as a corpse, and the muscles above his cheek bone as well as the first dorsal interossei was wasted. I compared it with my hand. It was obvious.

It all fits.Vertebral compression occur either due to mineral loss of the bone in osteoporosis, or due to vertebral destruction in benign or malignant tumors. He smokes, and it all points to lung cancer. The curved spine impinged on his lumbar nerve roots causing him immense pain, forcing him to stop working. Every step he takes hurt, every move, everything he does causes emotional distress.

I am pretty sure It was lung cancer. He was scheduled for an X-ray and is supposed to come back tomorrow. At this point, I somehow felt his pain. Watching him take every step at one time, groaning in pain hurts me. I know NSAID ( Non Steroidal Anti-Inflammatory Drugs ) and simple analgesics would not have any therapeutic effects on this kind of pain. When you cannot do anything but to wait. It hurts.

He walked out of the door, looking at his back and his abnormal posture, I prayed. Yes, I prayed.


yingxuan said...

i'm having headache all the while... the doctor just don't allow me to x-ray... i dunno what to do... i guess is some kind of tumor... lol
i used to place hp under my pillow for years...

yingxuan said...

gosh... i think i told you before right? my blood pressure & glucose is just fine....

Yong Chuan said...

Dun scare yourself, its nothing serious.If you have cancer you would be loosing weight right now instead of gaining weight. Wont be having difficulties implementing ur diet plans afterall =)


yingxuan said...

you non-stop saying me fat all the time... indeed i am... all my clothings couldn't fit my size anymore... but i'm still doubt if i have cancer...

Winni3 said...

ooo...if having cancer will lose weight not increase weight one..well..in my case, i used to get headache before rains come.means i can predict and prepare weather reports loll.feel relieve to hear tat nothing's wrong with my head =P

Yong Chuan said...

Girls, do not get overly paranoid =) Its nothing. As I've mentioned, I have just finished my first year, and the information given here does not constitudes to a valid, accurate medical advice/diagnosis.

Its nothing I suppose =) As fit as a fiddle I suppose =)

Yong Chuan said...

Hey Deepdamn :

In general, lumbar compression fracture can be caused by:

1)Osteoporosis which is associated with low level of estrogen in menopausal women.
2)Nutritional deficiency
4)Infections (Osteomyelitis)

The most common malignancy-related factor in the spine that can cause a fracture is metastasis. This includes cancer of the prostate, kidneys,breasts and lungs.

Bone metastases occur when cancer cells gain access to the blood stream, reach the bone, and then begin to multiply and grow new blood vessels to obtain oxygen and food-which in turn causes the cancer cells to grow more and spread.

Cancer cells can spread to the bone and cause 2 kinds of lesion
-osteolytic and osteoblastic
In this case we shall talk about osteolytic lesions.
Osteolytic lesions are destructive, increasing bone loss and decreasing bone strenght by replacing normal bone cells with abnormal immature cells that could not carry out the functions of hte normal cells. This causes the bone to looses its structural integrity.This type of lesion is associated with bone fracture because a weakened bone could not withstand the body weight and the pull of gravity causing it to crack.

Any injury/pathology that changes the shape of the lumbar spine invariably changes the posture of the spine and increases/decreases the lumbar curvature. Consequently this affects the other curves of the thoracic and cervical spine in a negative manner as the body attempts to maintain an upright posture to maintain balance

This is why the patient presents with a scoliosis at the lumbar segment and abonormal posture especially the shoulders.

Hope this helps =)Do look up if you have any doubts because I might be wrong since I added a lil of my opinion.

2)Journal of Bone and Joint Surgery