Pamidronate
Finally, it was time for dad to go for appointment with orthopaedic oncologist (nearly 3 weeks after end of 2nd line chemotherapy) to plan for the surgery. This time, as we found out later, we were seen by a more senior specialist.
After looking through the the X-rays taken that morning, he concluded that there was no need for surgery. We were surprised and stated that we were told that the femur was going to fracture any time, based on MRI done previously.
Dad: Oh, but Dr Y said...
(interrupted)
Snr specialist: She's a medical officer and she works for me.
(much later)
Me: Dr P said...
(interrupted)
Snr specialist: He's ranked below me.
Oh, wow. What arrogance. We were confused and just wanted to reconcile the difference. Giving the response "I'm ranked higher" does nothing to address our queries and is condescending.
Fortunately, he called Dr P in and through their exchange, I surmised that the difference in opinion is that he placed more emphasis on the X-ray and the fact that my dad could walk with a walker (but so slowly!) while Dr P placed more emphasis on the level of pain and to need to pre-empt the fracture. This summary was confirmed by Dr Y much later when we bumped into her at the ward.
Dad: "So, he wants to wait for it to fracture then only do surgery?"
Dr Y: "Yes."
Omg. Dad will be in great pain if that happens.
Instead, he recommended pamidronate, an anti-osteoclatic drug, to strengthen the bone. He showed us two X-rays of the pelvic bone of a prostrate cancer patient to illustrate the before and after effect of the drug and the stark improvement was impressive. If it works, then it should alleviate dad's bone pain significantly. He recommended a monthly infusion for 6 months.
He told us that it would take about an hour for infusion and hydration but it turned out to be 4 hours, aside from the 4+ hours wait for the drug. Humph!
Dad stayed overnight because it was the first time he was taking this drug and the ward doctor was worried about serious adverse effects. Dad did wake up 7 times throughout the night, in pain but this was confounded by the fact that he had never been able to sleep on hospital bed, whether in public and private hospital.
There was yet another round of waiting the next day, to be discharged. To our surprise, dad was given appointment to consult orthopaedic at their clinic, instead of the appointment for the 2nd infusion. Maybe there was misunderstanding and/or miscommunication. The ward doctor suggested to us to ask for the specialist to set pre-determined dates for the infusions during that appointment.
After looking through the the X-rays taken that morning, he concluded that there was no need for surgery. We were surprised and stated that we were told that the femur was going to fracture any time, based on MRI done previously.
Dad: Oh, but Dr Y said...
(interrupted)
Snr specialist: She's a medical officer and she works for me.
(much later)
Me: Dr P said...
(interrupted)
Snr specialist: He's ranked below me.
Oh, wow. What arrogance. We were confused and just wanted to reconcile the difference. Giving the response "I'm ranked higher" does nothing to address our queries and is condescending.
Fortunately, he called Dr P in and through their exchange, I surmised that the difference in opinion is that he placed more emphasis on the X-ray and the fact that my dad could walk with a walker (but so slowly!) while Dr P placed more emphasis on the level of pain and to need to pre-empt the fracture. This summary was confirmed by Dr Y much later when we bumped into her at the ward.
Dad: "So, he wants to wait for it to fracture then only do surgery?"
Dr Y: "Yes."
Omg. Dad will be in great pain if that happens.
Instead, he recommended pamidronate, an anti-osteoclatic drug, to strengthen the bone. He showed us two X-rays of the pelvic bone of a prostrate cancer patient to illustrate the before and after effect of the drug and the stark improvement was impressive. If it works, then it should alleviate dad's bone pain significantly. He recommended a monthly infusion for 6 months.
He told us that it would take about an hour for infusion and hydration but it turned out to be 4 hours, aside from the 4+ hours wait for the drug. Humph!
Dad stayed overnight because it was the first time he was taking this drug and the ward doctor was worried about serious adverse effects. Dad did wake up 7 times throughout the night, in pain but this was confounded by the fact that he had never been able to sleep on hospital bed, whether in public and private hospital.
There was yet another round of waiting the next day, to be discharged. To our surprise, dad was given appointment to consult orthopaedic at their clinic, instead of the appointment for the 2nd infusion. Maybe there was misunderstanding and/or miscommunication. The ward doctor suggested to us to ask for the specialist to set pre-determined dates for the infusions during that appointment.
Comments
Yes, it is :(