22/05/23 Orthopaedics at Broomfield

 An update on my left thigh / hip and the “benign cyst” identified in recent MRI scans:

I saw an orthopaedics consultant at Broomfield Hospital this morning. He took quite a detailed history, wiggled the hip joint around a bit, and sent me off for a pelvic X-ray. When I got back from that we looked at the images and did a compare & contrast with MRIs and X-rays dating back to the discovery of a big  (myeloma) lytic lesion in my left hip back in 2019. That had a course of radiotherapy which solved the immediate pain and walking problems (two sticks, very slow, very painful).

I have been led to believe from PET scans and other evidence that the lesion had largely or completely “re-modelled” itself so that my hip was for practical purposes back to normal and had been so for a few years.

It seems not. The cyst showing up now is a perfect match for the lesion of 2019 - same place, same size, same shape. There seems to have been no re-modelling. Why it is now being described as a cyst rather than a lesion is a mystery so far unsolved, but probably not important. You can see it on the image (not my pelvis, I found this one online and added the personalised stuff). 

The black area is the cyst, and it’s full of something that is not good hard structural bone. Probably some sort of proto-bony gloop. The base of the cyst lies very close to the top of the socket of the hip joint, and there is obvious potential for a rather nasty fracture there. The entire top surface of that socket should be embedded in good strong weight-bearing bone, but now that is reduced to the bit shown in white. Obviously that’s been enough to keep me going for the last four years, including all the heaving about of heavy boxes etc. that I did during the house move earlier this year, but now I know the weight-bearing area is so small, I can’t help being rather nervous about it. One fall, one ill-judged step off a high kerb, one over-ambitious lift…

So the good news is that it’s not progressing and it’s not giving me significant day-to-day trouble. The bad news is that it might very suddenly get a lot worse, and a repair job on a broken hip there would be difficult partly because there’s not a lot of good solid bone in the area to attach metalwork to, and also because one consequence of the radiotherapy in 2019 might be that it killed off a lot of “good” cells in the area as well as the “bad” ones, meaning that any kind of bone growth, including ideas like bone grafts or packing the cyst with bone chips taken from some other part of my skeleton or with an “artificial bone” matrix to encourage growth of my own bone cells might not work too well.

So it’s a “complicated” situation beyond the scope of Essex Orthopaedics, and I’m being referred to the Royal National Orthopaedic Hospital in Middlesex. You never know where your myeloma ‘journey’ will take you! The experts there will re-assess everything (new CT scan to be done at Broomfield first) and possibly a biopsy to find out exactly what is inside that lesion / cyst. Then they will suggest a way forward, which might include a custom 3-D printed implant. Shades of vet Noel Fitzpatrick and his TV shows – he always said that the real aim of his animal work is to develop the same techniques for people, and here I come….

Perhaps.

We shall see. And the mystery of that left thigh pain – mercifully now only a mere shadow of what it was - remains.

20/05/23 Cyst

 Here's the report from the second MRI:

This is obviously a bit nasty. A roughly egg-size cyst sitting just above the socket of the hip joint which means not only a high risk of a fracture but a difficult repair job afterwards because of not enough good bone to attach a replacement socket to. The good news is that I have a (cancellation) appointment with Orthopaedics at Broomfield 9am Monday morning. The secretary said "He wants to see you straight away". I think I've been walking around on a bit of a time-bomb for quite a while, without knowing a thing about it. Just glad I pushed hard for the right scan to be done and that the new haematologist agreed to push it through quickly. As I understand so far the options will be to put in some strengthening metalwork (but danger of it breaking through into the joint - not good), or packing the cyst with bone chips taken from some other bit of my skeleton, or "artificial bone" which encourages new bone to form. We shall see.

One question is whether the development of this cyst is enough to explain the (referred?) left thigh pain that started all this off. If not, still looking for an explanation of that.

A few other things to write about today, but leaving them for later.

16/05/23 Omelette

 (copied from a Facebook post)

I love the NHS, I really do. Twice this evening my attempt to produce an edible cheese and mushroom omelette was sabotaged by NHS phone calls. I just missed the first one (took too long taking two pans off the heat and turning the rings off), and the second came in just as the omelette was seconds away from perfection...

They've had another MDT meeting to consider the result of the second MRI of my left hip. I have a benign cyst in it, which I knew already after the report of the first MDT meeting about the first MRI. And they're referring it to orthopaedics, which I also knew already. "Any sign of an orthopaedics appointment?", I asked.

"Sorry sir, I don't know anything about that".

In other words, a fair amount of NHS time and effort expended for no obvious benefit at all.

The omelette, by the way, survived the delays surprisingly well.

12/05/23 Nothing new

Still waiting to hear about that MRI and the possible involvement of orthopaedics. The only other thing of note is my CPAP mask. Ever since we moved here (new bed, new pillows) I've found it hard to get a good sleeping position that doesn't push the mask out of place and cause some leaking around the edges. Recently that's got even worse, not least because the velcro on a couple of the straps has got worn so that it starts to slip or even come unstuck altogether, causing me to take the mask off altogether while still barely awake at some point in the early hours. So I rang the CPAP people at Broomfield and they're going to send me a new mask "as soon as some more come in" - next week if lucky. But now it's got worse, because one of the powerful magnets that secure the straps to the body of the mask has come off, so I now can't fasten it on at all. So no mask and no CPAP until I get a new one...

07/05/23 Trying to get back into the habit...

 ...of rather more regular blogging.

Had the MRI of my left hip yesterday afternoon, and therefore missed the Coronation flypast over Chelmsford. I hear that the low cloud meant there wasn't that much to see anyway.

Played boules at Ongar this morning and met a couple of new players who've appeared since the autumn. Played two matches, won both comfortably. It was Market Day in the usual car park so had to use the other car park across the High Street:

Some new arrivals - four electric chargers at the expense of four "normal" parking spaces. And, as with most of these things around here, none of them in use. I know it's a case of which is the horse and which is the cart - do we need more chargers to encourage more electric cars, or does demand from electric cars lead installation of more chargers? - but it seems to me that a lot of them are going in the wrong places. It's the motorways and the major trunk roads where "range anxiety" really kicks in and people don't want to be queuing to get to a charger as well as the time taken to charge up. If you want to encourage electric car numbers (and I'm far from sure that battery electrics offer a real long-term solution), those are the places where I'd put them.

04/05/23 Games afternoon, and palaeontology:

 Miniature boules in the Sky Lounge:

I was umpiring that "match".

and carpet bowls:

and finally, our mysterious collection of fossilised dinosaur eyeballs...

03/05/23 Myeloma news

 At last! At last!!

Copying this from a post I've just put on the Facebook group:

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I had my second 'phone consultation with my NHS consultant about 4pm this afternoon. All bloods ok again apart from a fractionally high FLC ratio, probably a result of the upper respiratory tract infection I was brewing up when the blood was taken. Nothing serious and my temperature never went up. Last time she ordered an MRI on my troublesome and erratic left thigh pain, and I had that done a couple of weeks ago on a cancellation. Results were in, and nothing found in my femur. But "incidental to the main scan" they found some degenerative change in my knee (not too surprising in mid-70s) and a "benign cyst" in my left pelvis. That's where I had the big lytic lesion that led to a pathological fracture and my myeloma diagnosis. It's not in quite the same spot but she thinks it might be connected to the healing / remodelling process for that lesion. Anyway, they've had a Multi-Disciplinary Team meeting, and she wants another MRI of my left hip and to bring Orthopaedics in as it's weight-bearing and they think there's significant risk of a fracture. I can only assume that means they're thinking in terms of some surgical intervention, possibly inserting some titanium reinforcement to go along with the bits of it I already have in my neck.

Three and a half hours later, the 'phone rang. Broomfield Hospital - they have an MRI cancellation, could I come in 10am tomorrow morning? Not at all convenient, as I have other appointments, so I asked when's the next available date? Saturday 6th, 2:10pm. It'll mean missing the back-end of the Coronation, but I can live with that.

NHS delays?? Not a sign of them. So far it's been wonderful, and faster-moving than the private system was. Maybe I'm just lucky, but I'm mightily impressed.

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