Philip Smith Phil Smith, Fort Mill

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Phil starts his story by saying that his warrantee ran out on his 80th birthday, June 17th. 


We had family photos and a party on Friday evening.  Phil woke up on Saturday morning, June 18,  not feeling well, resulting in the cancellation of the celebratory birthday brunch and the scheduling of a trip to the urgent care center instead.   He  got some short-term relief from that visit but proceeded with his scheduled consultation June 22 at the pain center in Rock Hill for his increasing low back pain.  On July 1, he had an MRI of his back at the referral of the pain center,  While awaiting the results of the MRI and a plan for treating the back pain, he began experiencing severe neck pain as well.  He sought treatment for that from his primary care physician on July 5.   The pain center scheduled an epidural for the back pain on July 13 which gave him great relief in that area.  However, the neck pain was unrelieved and continued to increase.  At the recommendation of the pain center physician, he sought relief through massage, muscle relaxants, steroids, and chiropractic care.  On July 20, the chiropractor took an x-ray of the neck and saw a spot that he advised Phil to talk to his physician about.  Phil had an appointment for a physical on August 5th and had appointments scheduled with the pain center in the interim,  so he decided to wait until his physical to address the x-ray.   On August 4, he received trigger point injections at the pain center for the neck pain but did not experience any significant relief.  At the physical on August 5, Phil's physician reviewed the x-ray in comparison to an x-ray taken in the spring of 2015.  The physician did not like the look of the new x-ray and ordered a chest and liver CT scan to be performed the next week.  It was at this point that a potential cancer diagnosis was mentioned for the first time.  His pain, especially the neck pain, was increasing daily and the strong then stronger pain medications were hardly touching it.  Phil had the CT scan on Wednesday  August 10 and went back to the physician's office to discuss the results on Thursday.  The scan showed a large mass in Phil's right lung, other spots in his liver and lymph nodes.  We proceeded directly to the pulmonologist's office for a consultation and to schedule a biopsy. although cancer appeared to be a foregone conclusion at this point.   The biopsy was scheduled for Monday August 15.   Over the weekend, Phil's pain increased to almost intolerable levels.  He made it through to the biopsy but was ready to seek pain relief through any means necessary by Monday evening.    We consulted with his physician about having him admitted to the hospital for pain management.  Not wanting to go through the ordeal of being admitted through the ER, we waited until Tuesday morning August 16 when he could be admitted through his physician's office.  He was admitted to CMC Main mid-morning August 17 and he was greatly relieved to have IV morphine started.  Oncology and radiology consultation took place while he was hospitalized.   He had a PET scan and an MRI which showed metastases in his brain and in the muscles of his upper back, which we presume were the source of his pain and the new symptom of nausea and vomiting that had recently shown up.  During the hospital stay, we made the decision to have Hospice care manage Phil's ongoing symptoms and treatment.  Phil was released on Friday August 20 and the Hospice intake nurse came on Saturday.  We decided, on the recommendation of the health care team, to pursue palliative radiation to help manage Phil's pain.  Radiation treatments were scheduled Monday through Friday for two weeks beginning August 23.  We saw an almost immediate improvement with the radiation therapy.  Within the first week, his need for breakthrough pain medications was almost eliminated although each trip to the radiation center grew more exhausting.