53. Goal setting

Mile 50 – Hard going and very tiring up this unexpected hill.

Challenging yet achievable. That’s what a marathon is about for most people who enter. You need a certain level of fitness to consider taking one on, then the training will build your confidence that you can achieve it. After completing a few you might feel confident enough to compete in the next, and to set yourself the goal of a target time.

First of all, I know you will want to see the x-rays. Don’t think I haven’t noticed that the number of views of my blog posts is higher when I have something nasty like a stem cell transplant or a broken leg to report. These first two were taken on the Sunday afternoon when I was admitted to A&E.

The next one was taken a couple of hours into my operation on Tuesday morning, when I was blissfully under anaesthetic.

These are at the end of the operation, when the screws were in place.

Sorry about the quality of some of the images. I’m eternally grateful to the doctors and surgeons for their skill in fixing my broken leg, but, when they took pictures of the x-rays on their computer monitor, they didn’t seem to understand the problems of reflective flare.

I have a copy of the surgeons’ report from Tuesday’s procedure. The operation lasted four hours. I don’t understand most of the jargon but they have done a fantastic job.

They described the “Lateral incision over fracture site. Challenging reduction in view of muscle bulk.” I was especially proud of that and I was able to thank my physio at UCLH when she gave me a call. (Sadly, those Monday morning sessions have finished now, I’ll miss seeing her and the other Myeloma patients.)

A few friends had expected me to have a plaster cast upon which they could write rude comments, but those are a thing of the dim and distant past. I last broke a bone in 1985, again in my right leg, playing football for Haywards Heath College Staff against Ifield Comprehensive, when a collision in our penalty area resulted in me going down with a loud crack. I couldn’t believe it was broken on that occasion, went to the pub after the match, then had a lift home. It wasn’t until 3am when my leg was the size of a watermelon that Sue took me to the hospital. On that occasion I had a plaster cast from the knee down to my toes, along with a knitting needle to help the itching.

And Ifield’s resulting goal was allowed to stand.

At the end of this operation, the team announced that my leg was now fully weight bearing. No supporting structure was needed and while bone traditionally takes six weeks to heal, that doesn’t really matter nowadays. When the swelling has subsided and my muscles can be persuaded to work, I’m ready to go walking again.

As for goal setting, I was in the hospital until Friday, with suitable challenges for each day. Wednesday’s was to climb out of bed and sit in a chair, then Thursday’s to walk with the roller frame to the WC across the corridor.

Having passed those tests with flying colours, on Friday I completed the last two: stairs (up and down) and having a shower. With that, they sent me on my way in the afternoon to make way for the next customer. Since coming home, I have hobbled around the house on my frame and crutches, resting a lot and waiting for the swelling to subside.

—oOo—

So let’s look for the positives. I was out of the house, I met some new people and saw more bare bottoms through hospital gowns than usual (although I’m not sure that last one was a positive). When you are on a trauma ward you realise that the other people have suffered much worse injuries than a paltry broken leg. Some had been in there for weeks. The parents of one youngster in that category told me about the wonderful Ronald McDonald House Charity with a block of apartments just opposite the hospital providing free accommodation and food (not just burgers) for people in their position. Much better than their first few nights spent sleeping on plastic chairs by their son’s bed.

I realise that I need to just focus on this mile to use my marathon analogy. I’ll do the exercises that I have been given and I’m sure I’ll soon be on my feet again. I know I did this successfully not long ago, and this time at least the other three quarters of me are working fine. The main difficulty since coming home has been fatigue: I do find I need to sleep a lot.

As for future goals setting, some of them have been adjusted. Running 5K is obviously set back and the Myeloma UK London to Paris cycle ride is rather in doubt. If I can trip while running with the risk of breaking something, I could easily do similar damage if I take a fall from my bike. I have reconciled myself to maybe going back to lane swimming and the gym again to keep fit.

There will be quite a lot of risk analysis in the future. Perhaps I was just unlucky and I would have suffered a break if I had perfectly healthy bones. Or are the lesions from Myeloma so bad that my bones can break that much more easily? We will discuss this with the consultant next week, in person if I am up to visiting the hospital, otherwise by phone.

—oOo—

I came across an interview with an Assistant Director of Medicine at the University of Texas about research into CAR-NK cells as cellular therapy for the treatment of Multiple Myeloma. NK cells are natural killers, part of everyone’s normal immune system. Another type of immune cell, the T cell, is activated the first time you catch an infection, and takes a while to learn to fight it, but the second time it recognises it and springs into action straight away.

NK cells, on the other hand, recognise an infection straight away the first time around, whether or not they have seen it before.

The CAR bit of the therapy stands for chimeric antigen receptor, the genetic engineering to make the cells target cancer cells. CAR-T treatment is not generally available on the NHS at the moment but there are several trials. It involves harvesting a patient’s cells, genetically adjusting them to target cancer cells, cloning them to make an adequate dose then giving them back to the same patient. It is expensive and takes weeks in the lab.

Unlike T cells, NK cells would not be rejected if taken from one patient and given to another, which is another advantage. When the treatment is perfected, the hope is that it could be administered not just in specialist centres but maybe even at a doctor’s surgery. If you have time, the article is a good read and hints at a positive future.

https://journals.lww.com/oncology-times/fulltext/2024/02000/amping_nk_cells_to_battle_multiple_myeloma___other.3.aspx?fbclid=IwAR14pDOBEfHpLhsVJ2WAOZgeBrTQuMMR41qfGTlQmVROreqHb9mIpQrhwA4

Thanks for reading and take care.