Many people, including me, believe that canines have extra sensory perception. Well, on Saturday May 28, 2022 at approximately 2 PM Cleo, our 6 year old Doberman, got off her sofa, walked over to Pam and laid her head in her lap, Cleo then licked her hand and walked back to her sofa. A few minutes later Pam took her last breath – she died from complications of multiple myeloma.
Bruce’s Forward: Pam was diagnosed with Multiple Myeloma on March 4, 2022. I believe however, there is strong evidence that shows Pam’s struggle with multiple myeloma actually started in 2018-2019 and that several key elements were missed or over looked by her doctors. This cancer was able to grow uncontrollably in her body for several years. Pam had been reporting back pain, weakness and fatigue to the her doctors for since early 2019. Even though Pam had her blood tested and weight recorded at every single appointment, I don’t think they were ever carefully looked at by her doctors. How could they ignore a 40 pound weight loss in 18 months. To try and get some clarity I pulled Pam’s lab results from her G.P. doctor going back to 2018. Below I have listed just a few of the important results that could have explained some of the symptoms Pam had been experiencing. Both the declining RBC and HGB could have contributed to feeling tired and weak and the abnormal Albumin, Globulin and A/G Ratio could be a signal for kidney problems.
| Blood REsULTS | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| RBC (4.2 – 10.8) | 4.36 | 4.25 | 4.02 | 3.48 | 1.16 |
| HGB (12.0 – 16.0) | 14.5 | 14 | 13.8 | 11.9 | 4.1 |
| ALBUMIN (3.2 – 4.7) | 4.4 | 4.5 | 4.8 | 5.1 | 5.3 |
| GLOBULIN (1.9 – 4.7) | 1.8 | 2.1 | 1.7 | 2 | N/A |
| A/G RATIO (1.2 – 2.5) | 2.4 | 2.1 | 2.8 | 2.6 | N/A |
There’s no way to know for sure how or why these elements were overlooked. I do believe however, that if Pam had been a man and the symptoms had persisted for 2 years the doctors wouldn’t have diagnosed osteoporosis and would have kept looking for answers.
Pam’s Story – By the fall of 2021 Pam had already seen two neurological specialist because of some fractured vertebrae which happened in June 2019. She was diagnosed as having osteoporosis and told she wasn’t a surgical candidate because of her fragile bones. Within a month of getting this diagnosis Pam started taken Prolia – it was an injection given every 6 months to strength her bones. I believe she had completed 4 treatments by the fall of 2021. Over the next two years Pam’s pain level kept rising and her pain medications kept getting stronger. Pam had multiple MRI over that time period which showed either more fractures or existing fractures getting worse. We were told that the best course of action was going to be time to heal and for the Prolia to start working. Physical therapy and gentle exercise to build muscle around the bones was also prescribed. Pam did all of things, she even went back to water aerobics for a short period but health kept declining and her pain kept rising.
Fast forward 18 months and totally frustrated with the 2 specialist she had seen. We starting looking for other options. Some of our friends had mentioned how good this other neurological specialist from Piedmont was – so we made an appointment. The earliest appointment we could get was on December 13, 2021. Even though the appointment was two and half months away we were excited about this new doctor.
Encouraged by the prospect of new eyes and possibly a new treatment plan, I thought a week in St Marys over Thanksgiving would be good for Pam. The weather would be warmer and terrain flatter for gentle walks. Pam wasn’t thrilled with the idea but, I finally convinced her we should go. I rented a house right in the middle of town – close enough so we could walk the streets and to all of the restaurants. When we got there Pam’s pain level was pretty high. She didn’t want walk and pretty much stayed in the house except when we went to Robin and Andrea’s for Thanksgiving dinner. I admit I was a little frustrated and mad because it didn’t seem like Pam was even trying to help herself. Based on what all her doctors were saying – I thought she had to work through her pain to get stronger – boy was I wrong.
Our appointment on December 13 with the new neurologist was pretty uneventful – she got all of Pam’s vitals (weight 89 pounds now), she put her hand on Pam’s knee and asked her to raise her leg, ordered and MRI and that was it. Pam had her MRI on January 3, 2022 but wasn’t able to get a follow-up appointment until March 1. Now, it was the first week of February 2022 and I was getting very concerned and almost frantic about Pam’s rapid decline in health. I couldn’t get her to eat, walk or do almost anything and her pain level still kept rising. I remember one afternoon I was sitting in my car in the Kroger parking trying to think of options. That’s when I decide to go back to square one and called our general practitioner – I insist on an appointment as soon as possible. Pam was pretty mad at me for going behind her back to make this appointment. I think Pam felt this doctor wanted to blame some of Pam’s symptoms on depression and wanted Pam to take anti-depression med – of which she did not want to take.
We had our appointment with Pam’s G.P. on February the 11th. Pam’s weight at this appointment, fully clothed, was 89 pounds – down from her 2020 weight of 122 pounds. The doctor ordered a CT scan to see if there were any blockages that could be causing the weight loss. On February 18th Pam got the CT scan and the report showed;
Severe diffuse osteopenia with multifocal lytic changes for an infiltrative type process such as multiple myeloma or metastatic disease. Recommend correlation with peripheral smear.
We got this news of Friday afternoon on February 26. The G.P. wanted Pam to come in to the office first thing Monday morning February 28th to have a blood test. Then on Tuesday morning on March 1, the same day as our neurology follow-up appointment, we got the results from the blood test that showed a very high M-Spike of 0.2. Within just a couple of hours of getting the results, the folks at the G.P.’s office had Pam an appointment with an oncologist for Friday March 4th. I’m not sure why, but I decided to keep the neurology appointment Pam had for that afternoon. Pam was having trouble walking by now and was is almost constant pain – we had to use one of the provided wheelchairs to get her from the parking lot to the office. The wait for the doctor was several hours long and Pam was miserable and in pain the whole time. When the doctor did come in with the MRI report and was about to go into treatment options I interrupted and showed her the CT scan and blood results. She took a step backwards and looked stunned. I hope she was thinking; how in the world did I miss this. She also said, the oncologist was now in control.
At our first appointment the oncologist was very positive and said there could be several reasons for an M-spike and not all of them pointed to cancer. This is when I asked her if she had seen the CT scan, of which she had not. I brought my copy with me and gave it to her – her facial expression changed drastically and she quickly ordered a complete Myeloma blood panel and a 24 hour urine sample we had to collect over the weekend.
Part of Pam’s blood work that was collected at the office on Friday was analyzed on the premises. By the time we had gotten home the physician’s assistant was calling to tell me that Pam’s red blood count was extremely low (1.4) and they had scheduled an emergency blood transfusion for Pam. The next day, on Saturday, I got Pam to Piedmont Hospital at 8AM and by the time they cross typed her blood and she received 2 bags intravenously we were able to leave at 4:30 PM – one of many long days to come. I was told I could drop the urine sample off at the office by myself on Tuesday. When I got to the office with the sample I wanted a quick word with the P.A. Because even after the blood transfusion I felt Pam had gotten worse over the weekend and I wanted to let the doctor know. When the P.A. came out, she first asked if Pam was with me. When I told her Pam was at home she asked if I could go get her and bring her in right away – I drove home to get Pam. Pam didn’t have an appointment but they saw her immediately. The rest of Pam’s labs had come back and they weren’t good, so the oncologist wanted to do a bone biopsy right away. The hardest part of the biopsy for Pam, was getting flat on her stomach. The curvature in spine was so bad that it was extremely painfully for her to be flat on her back or stomach. Getting the bone marrow was also tricky for the doctor because the base of Pam’s spine was all mush and there wasn’t any place to hold on to. By the time the oncologist was finished with the biopsy she was very certain it was myeloma and didn’t want to waste time waiting for the biopsy report. She scheduled Pam’s first chemo treatment for the next day on Wednesday.
There had been a lot of break throughs in treating myeloma and we were hopeful for some good results. The oncologist had a predicament because the preferred drug for combating myeloma is Revlimid but this drug is hard on the kidneys and Pam was in kidney failure. To try and get Pam’s kidney function back and her calcium level down the oncologist ordered many liters of IV fluids.
The results from Pam’s Myeloma blood panel taken on March 4, 2022 were not good. I’ve listed a few key results to show the severity.
- BMG – the protein made by malignant cells (normal 0.1 – 2.6) – Pam’s was 30.5
- Kappa Light Chains (normal 3.3 – 19.4) – Pam’s – 11,059
- Red Blood Count (normal 4.2 – 5.4) – Pam’s was 1.16
- HGB (normal 12.0 – 16.0) – Pam’s was 4.1
- BUN – for kidney damage (normal 9.0 – 23.0) – Pam’s was 41, she was in kidney failure.
Pam was now receiving some kind of treatment at least three times a week and each treatment required an IV and blood work. Both of Pam’s arm were black and blue and looked like a pin cushion. I asked about getting Pam a port so they wouldn’t have to keep sticking her arm for the IVs and was told that her hemoglobin count was too low for a surgeon to consider this procedure. There were many long days and sleepless nights in March and April but two bright spots was on March 23 when Robin and Andrea came up to visit and help. They went grocery shopping, cooked all day, packaged and labeled everything with cooking instructions and frozen the meals. Then, at the end of April Greta flew in and Robin and Andrea drove back up – it was nice having the extra help and company.
At the end of April and the beginning of May is when things got confusing for me and I started to question the oncologist – and here’s why. The oncologist was pleased with the treatments and Pam’s steady improvements of her labs. But, something was wrong because while her labs may have been improving Pam was getting worse by the day. It seemed like that didn’t matter to the doctor. She would breeze into the room with the latest report, rattle of some numbers she was happy with, glace at Pam and walk out. Things at home were getting bad enough I couldn’t leave Pam’s alone. For a while, I relied on my neighbors to watch Pam while I went to the drug or grocery store. At one of our late April oncology appointments, I asked about getting a palliative care referral and was immediately turn down by the doctor – the doctor wanted home health instead. We got home health and I contracted with Home Instead to have a person come for 4 hours twice a week. Mattie was our person from Home Instead and she was great. Mattie helped Pam with her exercises, washed the sheets and made Pam’s bed. She also did some light cleaning. But, it broke my heart when ever I left, because within 10 minutes of leaving Pam would text me asking if I was almost home.
During our oncology appointment on Wednesday May 4th, I again voiced my concern to the doctor about how bad Pam was getting. I even told her I was very close to taking Pam directly to the hospital. The oncologist told me there was no need for that – and I could call them anytime. The very next day Thursday May 5th we were at Piedmont hospital getting another blood transfusion when one of the nurses pulled me aside to ask me why Pam wasn’t admitted in the hospital.
On Friday May 6, not know what I should do, I consulted with 2 close friends for advise. One friend suggested I call the doctor and try to get her to admit Pam to the hospital. The other friend suggested I take straight to the ER so she would be under the care of a hospitalist and not the oncologist. On Friday morning at 10AM with the help of neighbors we loaded Pam in the car and went straight to the Piedmont emergency room. We spent probably 4 hours in the emergency room before they admitted Pam and she got to her room. When Pam did get to her room, the nurse putting her gown on noticed Pam’s extruding belly and took an ultrasound – then they drained 2700CC from her bladder. Pam spent a week in the hospital and was discharged on Friday May 13th with her catheter. During her stay at the hospital she was was visited by an oncologist from a different oncology group. Even though Pam wasn’t admitted because of her myeloma, this doctor took the time to see her. It was late in the evening when he came by and I had just left. He got my phone number and called me so we could talk. I gave him a brief history of Pam’s journey and we schedule an appointment at his office for Friday May 20. At this appointment Pam weighted in at 68 pounds and was unable to walk. This doctor was so incredibly kind and gentle but also straight forward. He calmly pointed out that Pam was too weak to undergo any more tests and/or treatments. He suggested calling a hospice professional team to help control her pain and get her stronger – we agreed. By the time we got home that afternoon we had already received a call from the hospice team and a hospital bed was being delivered.
Robin and Andrea got back here, I think, on Sunday May 22. Andrea’s school was just out and Robin took time off. By Monday afternoon Pam was declining fast, so we got Greta on a redeye flight out of Denver and she got home Tuesday morning. On Wednesday morning Pam wanted to go onto our screened in porch. We got Pam into her wheel chair and on to the screen porch so she could hear the birds, see her gardens and feel the warm sun. She then wanted to go back to her bed. Shortly after she became comatose and unresponsive.
Conclusion: I could not have done any of this without a magnitude of help. I would first like to thank Laura, Lewis and the whole staff at Athens Art and Frame. You took care of the business and gave me the time off to tend to Pam – Thank you! Next, would be Gene for getting hand rails put on our steps for Pam to use and for spending the time to get my auto gate opener working – Thank-you! Then comes Brown, Steve and Andy who, in one day, helped me build a wheel chair, so I could get Pam to her appointment on Friday – Thank you!. Then would be Alice, Mary, Kathy, Judy, Debbie and Andy all neighbors who helped with Pam’s care and offered valuable insight and information – Thank you!. Finally, would be my sister, a retired nurse, who took all my calls, everyday since this journey started – Thank you!
A sincere apology to all of our friends who were caught of guard by Pam’s sudden death. There was too much to do, and too little time to do to reach out to everyone – for that I’m sorry.