Larry’s episode of cardiac tamponade never recurred. In fact, after tapering off the three-month course of prednisone that was prescribed to him, Larry decided that he was ready to move on. He packed his bags and moved to Hawaii, where he worked as a cable guy and life was good—work six days then relax on the beach and take in a little sun. As I learned, Larry defied many of the rules that we spell out to our lupus patients. He just thought that he looked better with a suntan. I guess who doesn’t? But the fun times did not last forever. He began to notice some difficulty walking. He tired very easily. Eventually he had to give up his job because of his troubles. It was time to come home to Boston.
Larry’s Lupus Rears Its Head
This is when I first met Larry. I quickly learned that he was a man with many friends. If I ever needed help with parking ticket citations, Larry assured me that he had people in the “right places who could help make them disappear.” Was I looking for Sox or Bruins tickets? No problem. He had friends working in all the Boston teams’ box offices.
Larry did not look well. He limped around my 60-square-foot clinic office, clutching the furniture for support. His hip X-rays revealed those telltale signs of avascular necrosis (AVN); a tiny sclerotic rim capped each femoral head. My orthopedic colleague Tom Thornhill suggested we consider a new treatment for AVN proposed by Drs. Tom Zizic and David Hungerford of Johns Hopkins University in Baltimore. They and others postulated that increased venous pressures may be contributing to the development of AVN. Their technique involved reaming out a core of femoral bone marrow and cortical bone to reduce the vascular pressure in the femoral head. Years later, I was amazed at how this procedure helped reduce Larry’s pain and allowed him to preserve reasonable function even when his subsequent X-rays demonstrated a loss of cartilage space in both hips.
However, there were other serious problems to contend with. As Larry’s story taught me, with lupus there is no limit to how many things can fall apart at once. Out of the blue, his blood-cell counts dropped—whites, reds, and platelets. His kidneys, which had functioned well until now, were starting to fail. Larry was a short guy, but the excess edema and weight gain from the steroids that we prescribed made him look even squatter. However, Larry still kept his biting sense of humor. I usually could tell when he had arrived at the clinic. He was always at least 30 minutes early, which I found unnerving, because I tended to run at least 30 minutes late … on a good day! The waiting room was Larry’s stage. Within minutes, he would have all the other patients in stitches. His impersonations of the staff were uncanny. Patients didn’t seem to mind if their doctors were running late. In fact, some of them requested that others go ahead so that they could stay to watch Larry’s whole show.
