Journal entry by Dave Clark

Well the complete 16 week Chemotherapy treatment is now behind me, and this final Cycle 4 thankfully went pretty much as expected in my last journal update.  At least insofar as the treatments themselves are concerned.  But Murphy's Law is always lurking in the background, and so these past few weeks have turned out to be very different than what I had been looking forwards to, when I posted the pevious update in this journal.

Indeed, that very same week I made the past journal entry, when I was on my way to Northshore Oncology for my first Kyprolis infusion of Cycle 4 (on my bike, natch), I experienced an incident when crossing a busy intersection.   I had the green signal and the pedestrian/bike path signal also showed me I was clear to cross.  But just as I was riding into the intersection, a car from my left started up -- the driver was looking at approaching traffic coming the other way, (to his left), saw a gap, and so decided to execute a right turn on red -- and so hit the gas and turned into the intersection to his right -- while still looking to his left.   Well I was just entering the intersection to his right, and he never even looked my way at all.

A instantaneous assessment told me a collision was imminent, and that I would NOT be able to beat the turning car -- so I grabbed the brakes and attempted to turn to my left to pass behind the turning car.   While that started to slow me down, the projected travel path looked like it was gonna lead to my running into the side of that car, so I turned left even harder.   And that jammed the front wheel , which stopped the bike and then led to my executing a neat partial summersault over the handlebars, narrowly missing behind the turning car, and landing on my head and right shoulder on the pavement.

Well my head of course was well protected by my bike helmet, but the brunt of the impact was on that shoulder, which of course had no protection.   OUCH  !!!

Of course the errant car never saw me at all, and just kept on rolling.  While I was in some pain at that point, I also realized I was lying on the pavement in the middle of a busy intersection, so I jumped up and grabbed the bike and quickly backed out of the intersection.  Then dropped the bike and took a couple of minutes to assess my situation. 

No evident damage to the bike -- but could not say the same for David -- was experiencing significant pain in that right shoulder.   Well I recall having dislocated that right shoulder once, about 50 years earlier, and so my first explorations were to attempt some movements of that shoulder joint.   Which seemed to move OK in all the normal directions, and such movements did NOT result in any greater pain.   So clearly no dislocation, and if anything, those exploratory movements appeared to reduce the pain in the shoulder somewhat as well.   And I had used both hands picking up the bike and moving it out of the intersection, so clearly I hadn't compromised motor function significantly.   So after a minute or two I came to a tentative conclusion that all I had was a good strong whack, but was otherwise OK.  While I was wearing shorts and a short-sleeved shirt, I didn't notice (then) any scrapes or pain elsewhere -- just the pain in the right shoulder -- and that appeared to be waning rapidly.

So I stood the bike up, straightened the handlebars, and checked it over carefully.  No significant damage evident -- when I had turned the front wheel hard left, the bike had stopped, and then just simply fell over, while I was executing my "forward exit" summersault.

By that point the pain in my shoulder had faded significantly, so I did some more systematic movements of both arms and shoulders, and while there were some minor twinges in the right shoulder, such movements did not appear to lead to additional pain or discomfort, so I decided I was OK.  And so I got on the bike and resumed my journey -- at that point I was about 4 miles into my trip, and had another 4 miles yet to go.   So off I went.

When I arrived at the medical office complex where Northshore Oncology is located, I saw that I was significantly early for my infusion appointment, and also noticed that there was an "immediate care" facility office right there in the first floor of that building.  And since I'd experienced a couple of twinges in my right shoulder on going over bumps while I was completing the remainer of my ride, I decided I might as well drop in and have them take a look at me.   While I was signing the patient log, I discovered that i was dripping some blood on the page -- evidently had scraped that hand and it was still seeping, but I never even felt it.   So figured it was a good thing to have them clean me up and check me over more carefully.

Once they got me in, they found that one bleeding scrape and a couple of other minor areas of "Road Rash", which would only be minor problems.  But I mentioned the shoulder impact, and we noticed that movement of that shoulder was somewhat uncomfortable.   So they had me take off my shirt.  That was uncomfortable, and I could see the nurse looking back and forth between my two shoulders and then shake her head.   "Looks like you've done something", she says.   So off to X-ray.

To make a long story short, the X-ray showed that the impact had fractured the distal end of my right clavicle (collar bone), which attaches at the top of the shoulder -- right where I landed on it.   So they cleaned me up, and bandaged the couple of scrapes, and then strapped my right shoulder into an "immobilizer", and then after setting up an appointment for the next day with the local orthopedic specialists, they released me so that I could go forwards with my Kyprolis infusion upstairs.  A remarkable experience with this Immediate Care facility -- was in and out in only 40 minutes.  See picture at the bottom of this journal entry, which we took once I eventually got home later.

My most significant wonder about that whole experience is how I was able to complete the second half of my ride, with a fracture in my shoulder, without realizing how severely I'd been injured.  Evidently the bike riding posture and gravity collectively tended to press the fracture together, and some natural hormones tended to numb the injury.  Regardless, after completing the Kyprolis infusion, then I had to call Jean and explain why I needed to have her come over and pick me up, rather than ride my bike home -- riding the bike home was clearly not in the cards.

So my appointment with the Orthopedic specialists the following day brought me a whole raft of bad news.   Yes I had a fracture, and it was going to take several weeks to heal.  But there was a silver lining -- the condition of the fracture and positioning of the bones would not require any surgery to pin it, in order to heal properly.  So during that healing period, I was going to essentially lose the use of my right arm.  No golf.  No kayaking.  No bike riding.  Indeed, I was to continue to keep my right arm strapped in that "Immobilizer", 24/7, for at least a couple of weeks. 

Wunnerful, just what David needed at that point.   Just when my Hemoglobin levels were moving upward, and I was feeling peppier than I'd been all year, and looking forwards to resuming a number of physical activities that I hadn't been able to engage in since the preceding summer -- hard stop on all fronts.  About the only form of "exercise" I would be allowed is walking.  Just great.

But it is what it is, and so enough about that pivotal incident.  The remaining weeks of Chemotherapy treatment Cycle 4 have been very different than what I was anticipating, as least as far as lifestyle and physical activities are concerned.  Hello couch potato-hood.

Anyhow, this past week I have now official graduated from the planned 16 weeks of Chemotherapy, and all the tentative signs are that those treatments have accomplished what they were intended to.  Indeed, over these past 2-3 weeks, my Hemoglobin levels have been higher than they've been since early 2017.

This past week I've made two trips into the City of Chicago, to the University of Chicago Hospital complex, to visit with the stem cell transplant specialists there, and to undergo a whole raft of pre-transplant testing.  Next week we'll do yet more testing, and then also another bone marrow biopsy.  Then finally we'll meet with the transplant specialists one final time to review all of these test results, and make the final Go / No-Go decision on the anticipated transplant procedure and schedule.   That key checkpoint meeting will be in 10 days, on September 18th.

So this journal installment brings me up to date as of today.  I'm still essentially without the use of my right arm, but did acquire a used stationary exercise bike that I've set up in my bedroom, so I can at least get some regular exercise during this period of enforced activity deprivation.  I'll have a 4-week orthopedic follow-up this coming Tuesday, and hoping that they'll allow me to begin some limited use of my right arm coming out of that.  We shall see.

I expect to make my next journal entry following that September 18th "summit" meeting with the stem cell transplant team.  

Then the "real fun" {?!?) will begin ...

Dave Clark

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