“It’s great to see you, Josh,” I began. “I see that you’re still on the etanercept they switched you to in Thomaston. Is that working well enough?”
“Well enough,” he said.
I scratched my cheek, waiting. If he was after narcotics, I was ready to say no, but Josh had other ideas. “I’ve been reading about a big surgery. They break your back in multiple places, put in some rods and screws—well, maybe more than a few rods and screws—and straighten the back. What do you think?”
I knew what Josh was referring to. It was a monster of a surgery. Only specialized centers had spine surgeons with experience enough to break up a bamboo spine and put it back together again. This was much more than corrective surgery for scoliosis. Josh would have to go out of state for the consult. Even then, there was no guarantee that a surgeon would take him on. The risk of infection, bleeding, hardware loosening or even paralysis was very high. If he survived the surgery, he could go through months of rehab and be worse off than he was now.
“You sure you want to start down this road?” I asked.
“Positive.” Josh stood up and found his cane. His eyes locked onto his shoes. “I know where I’ve been. I just want to see where I’m going. That’s not too much to ask, is it?”
I began the paperwork.
Charles Radis, DO, is clinical professor of medicine at the University of New England, College of Osteopathic Medicine and employed part time at Maine Coast Memorial Hospital in Ellsworth, Maine.
References
- Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007 Apr 21;369(9570):1379–1390.
- Moodie R. Palaeopathology. An Introduction to the Study of Ancient Evidences of Disease. Chicago and Urbana: University of Illinois Press; 1973:128.
- Yu D, Kuipers JG. Role of bacteria and HLA-B27 in the pathogenesis of reactive arthritis. Rheum Dis Clin North Am. 2003 Feb;29(1):21–36, v-vi.
- Hammer RE, Maika SD, Richardson JA, et al. Spontaneous inflammatory disease in transgenic rats expressing HLA-B27 and human beta-2m: An animal model of HLA-B27 associated human disorders. Cell. 1990 Nov;63(5):1099–1112.
- Tautog JD, Richardson JA, Croft JT, et al. The germfree state prevents development of gut and joint inflammatory disease in HLA-B27 transgenic rats. J Exp Med. 1994 Dec 1;180(6):2359–2364.
- Ebringer A. Ankylosing spondylitis is caused by Klebsiella. Evidence from immunogenetic, microbiologic, and serologic studies. Rheum Dis Clin North Am. 1992 Feb;18(1):105–121.
- Russell AS, Suarez A. Ankylosing spondylitis is not caused by Klebsiella. Rheum Dis Clin North Am. 1992 Feb;18(1):95–104.
- Ogrendik M. Treatment of ankylosing spondylitis with moxifloxacin. South Med J. 2007 Apr;100(4):366–370.
- Jenks K, Stebbings S, Burton J, et al. Probiotic therapy for the treatment of spondyloarthritis: A randomized controlled trial. J Rheumatol. 2010 Oct;37(10):2118–2125.
