+2, +3

Yesterday was given over to a side issue. For a few weeks, I had been bothered by pain in my right leg that kept me from sleeping for extended periods. We mentioned that to our nurses at some point, and they scheduled a neurological consult.

So I got to walk on toes and heels and push against resistance in any number of directions, and it seems that my right leg had some obvious deficits. No need to get into all the details, but as I understand it: 1) some of the pain might come from incomplete healing of my 2007 knee repair (it was a hamstring graft and maybe the hamstring didn't heal right; 2) some nerve is pinched (details on which, where, and why presumably to follow); and 3) a neuroma in my right foot, just for fun.

This was all followed by a highly enjoyable session of having a resident stick electrified needles in various nerves in my leg (up to the sacrum) and inscrutably mapping the electrical signals being transmitted. He assured me that they all learn on each other, so he knew what it felt like, which was a small comfort.

If any of this is going to get fixed, it's going to wait until after all the fun and games are over, but it has a delicate relationship to my current situation. For a few days post-melphalan leg pain wasn't a problem because I had been given a fair dose of dexamethasone, to counter inflammation from the chemo, and that had been more than up to the task of making me forget about the leg pain. When the dex wore off, the pain came back, and my previous "solution" (tylenol PM) is forbidden by the transplant people because they don't want me using any medication that will mask a fever, which could be an indication that I need to be hospitalized for neutropenia. Ibuprofen, and other NSAIDS, are out because of the fever issue and their potential to damage kidneys. So that leaves opioids. I have a prescription for oxycodone, but I have been reluctant to start on it, not from fear of addiction, but because I have been seriously constipated, and my few brief encounters with oxycodone had ended with me choosing pain over constipation.

Meanwhile we had received a wide spectrum of advice from nurses, NPs, residents, and attendings. As a rule, the more senior the personnel, the more reluctant they were to advise stool softeners or laxative, on the theory that in a few days everything was going to be plenty loose. We ended up with stool softeners and, ultimately, a laxative. The good news is that it worked, and now that the constipation is under control, I may have some options for keeping the leg pain under wraps for a while.

So I got a good night's sleep. When I woke up, I had the first bout of wanting-to-throw-up that I've experienced thus far. It didn't amount to anything, but it's maybe a sign of things to come.