Transcription:
When Back Pain Is Cancer: An Inspirational Story

Joey Wahler (Host): When Nick Vasil's back pain was diagnosed as cancer, he turned to Dr. Daniel Cavanaugh. So, we're discussing this inspirational story. Our guests are Nick Vasil, a spine and cancer patient at University of Maryland Medical System, and Dr. Daniel Cavanaugh, a spine surgeon in Bel Air, affiliated with University of Maryland Medical Center Midtown Campus, university of Maryland Medical Center and UM Upper Chesapeake Health.

This is the Live Greater Podcast series, information for a Healthier You from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Hi there, gentlemen. Thank you both for joining us.

Dr. Daniel Cavanaugh: Thanks for having us, Joey.

Nick Vasil: Thank you very much. Been looking forward to this for a quite some time.

Host: Same here. So first for you, Nick, when did you first notice symptoms? What were they and when did you seek help?

Guest 2: That happened in September, the first pain that I had. I'm very active, so I was chainsawing trees, and all the lifting and bending and everything else, it made sense that I just had some back pain. I've had pain before. So, I was using a heating pad and over-the-counter in September, thinking that's all it really was, is a pulled muscle. Then, everything else transpired after that.

Host: So for you, Dr. Cavanaugh, to get us started on your end, when usually should people see a doctor about back or neck pain? And in this particular case, what was the diagnosis and the recommended course of action?

Guest 1: Sure. That's a difficult question, Joey, because with Nick's story, his history's a little different. He had had a history of cancer, thought to be treated and in remission for quite some time. Obviously, most Americans develop back pain at some point in their life and it's usually self-limited.

When back pain gets to the point where you can't walk, you start having neurological issues, you have loss of bowel and bladder function, these are obviously very concerning symptoms that you should seek immediate medical care. And I believe that Mr. Vasil developed some of these symptoms and I'll let him talk about what he had.

Host: Sure. Nick, you want to fill us in on that?

Guest 2: Yes. Okay. Again, I went through the heating pad. That was not having a desired result. It normally would if I had just a pulled muscle, which I've had many times in my life. So then, I went to see my family doctor, that was late October, and put me on a muscle relaxer, still thinking that was muscle-related, but she also suggested I see someone in orthopedics, which I did, Dr. Roche. And once I visited with him, then it became a lot more evident that I had a more severe issue. He was able to bring up a scan that was done in September, just part of my regular checkups to make sure that nothing else was evident in my body, and he was able to isolate the one area and sent me for an MRI, that was November 1st. So, everything transpired very quickly, but I was starting to lose mobility. As Dr. Cavanaugh has said, once it got to that point and I was not able to be as mobile as I'd been before, then I started seeking professional help.

Host: And the doctor alluded to a cancer history. Can you briefly tell us about that?

Guest 2: Yes. In 2020, I had, a large mass attached to my left kidney. And, again, no symptoms whatsoever other than urinating blood. But I at that time saw a different surgeon because it's relative to other part of my body. And I had that cancer and my kidney removed robotically and was on a drug called Sutent for a year and a half to hopefully eliminate that part of the cancer, which it did. That's why Dr. Cavanaugh said it was in remission. So, yeah, that was actually more scary than this one, because I lost so much weight. The writing is on the wall was happening to my body, but anyway, I was a cancer survivor. I made it through that.

Host: And so back to you, Dr. Cavanaugh, sounds then as though Nick was far less concerned this latest go around than that previous time that he just described. So now, I guess same question again, now that we're filled in on further information. What was the diagnosis and the recommendation going forward from there?

Guest 1: Yeah. So I think, Nick, when he came to me, I think he came through the emergency department mainly because his back pain had become so intractable and severe. And more concerning was his inability to walk. I believe he lost his ability to ambulate. And if I recall, he may have had some loss of bladder function at that point, difficulty urinating.

And when we got the imaging when things kind of rapidly progressed in this situation, he had what appeared to be a cancerous lesion involving his spine. And that cancerous lesion was expanding out of the bone and causing severe compression on his spinal cord, which was the cause of his loss of his ability to walk and loss of bowel and bladder function. Obviously, this is a case where back pain turns into something more than just a sprained muscle.

Host: Wow. And so how common or, as it were, uncommon is that in your experience?

Guest 1: Well, that's a little difficult question to answer because I, as a spine surgeon, at university medical center, I take care of a lot of very complex spinal pathologies. So for me, this is something I see relatively routinely. But for the general population, this is a very uncommon phenomena.

Host: And so what was the recommended course of treatment that you laid out at that point?

Guest 1: Yeah. So given his neurological issues, loss of neurological function in his legs, loss of bowel and bladder function, there's a certain sense of urgency to this. Because with severe spinal cord compression, if that goes unaddressed, those neurological deficits can become permanent. So, we had recommended an urgent surgery to not only stabilize the area in the spine, I believe it was in the T8 level where he had had the cancer invade the spine and fracture it. So, the objective of surgery is not only to stabilize that fracture, but to decompress the spinal cord and remove the cancerous lesion in the spinal cord to give them the best chance to have a successful treatment after that.

Host: And so Nick, something that you thought initially was not this big of a deal suddenly becomes just that. How are you feeling once you got this diagnosis and this plan of attack?

Guest 2: Actually at that point, when I realized that the first MRI showed that it definitely looked like it was cancer and I did have the compression, I was actually relieved that I didn't have to be transported someplace else. I was lucky in that respect to have Dr. Cavanaugh available and willing to do that surgery. Because at one point, they're talking about transporting me to Baltimore campus and who knows who I would've seen and what would've happened to me in the meantime. So relative to what pain and anguish I was going through, things aligned perfectly in my mind, okay? I had the perfect surgeon at the right time with the knowledge of what to do, and that's why I've been so positive about this case, which is, yes, it could have been a lot more detrimental to my over overall health, but everything aligned almost perfectly at the right time.

Host: Well, timing is everything, of course. And this is obviously a great example of that, Dr. Cavanaugh. So at that point, how quickly does your team formulate a specific plan and move forward?

Guest 1: Yeah, I think we were able to get all the imaging we needed, all the medical workup we needed, and have him in the operating room the next morning to do the operation. And this type of operation is a fairly complex surgery. It involves placing screws and rods above and below the fractured bone and then actually shaving away the bone pushing on the spinal cord, and then replacing the entire vertebral body that was involved with cancer with essentially a prosthetic or a metal vertebral body to take its place. So, it's a fairly sizable operation.

Host: And yet you are all ready to go the following day, you say.

Guest 1: Yeah. We know we have a great team here, especially at Upper Chesapeake. Great oncology team, great medical team, great OR staff and allows us to get to these issues fairly rapidly.

Host: And so, Nick, what was your reaction to this immediate springing into action of those that were caring for you, Dr. Cavanaugh and Company? And how did that make you feel to know that you were in such good hands?

Guest 2: Relieved. Absolutely relieved. I figured just a day earlier in a different doctor's hands, you know, arranging an MRI and I needed assistance to walk to that office and actually relieved, realizing that what was necessary is going to be done.

Host: So speaking of what was necessary, doctor, what's your relationship to the Cancer Center team and the other departments at UM Upper Chesapeake Health and University of Maryland Medical Center? And in a nutshell, how would you describe to people how you all work together so well to provide this very crucial care?

Guest 1: Yeah, I think these kind of complex problems definitely require multiple people with multiple different expertise to address this. So, it takes the expertise of an oncologist to do medicinal oncology. It takes the expertise of a radiation oncologist to target things with postoperative radiation. It takes the expertise of a medical team to help with the patient's medical issues and then, my expertise surgically. So, the reality is the relationship with all of these people is excellent. Everyone here is very responsive to a phone call. And it's, honestly, such a pleasure working with my colleagues to address these issues.

Host: We'll get back to you in a moment, Nick. Let me follow up, Dr. Cavanaugh. Obviously, Nick sounds like he had, if there is such a thing, the perfect attitude for a patient. How helpful was that in this case for everyone concerned? And in a case like this, what are some of the questions patients should have for doctors when diagnosed with something that's relatively out of the ordinary?

Guest 1: Yeah. So, that's two questions. So, I'll answer the first. So, Nick's attitude is, among my patients', one of the best that I've ever seen. He's such a positive individual. And I think he's very active and very motivated. And his motivation really plays a huge role in allowing him to recover so well as he's done postoperatively.

And then, the other question, yes, I think that's a great question to bring up with any provider, right? We as medical providers always want to ask patients, you know, we want to counsel patients to the best of our ability. I mean, I think that the general questions should involve, you know, what surgery are you planning? What are the expected outcomes? What are the potential complications that can occur? And how long is it going to take me to get better, right? I think those are all pretty standard questions that I would ask.

Host: Sure. So Nick, what is life like for you now, especially compared to with the condition you were in before this all began?

Guest 2: I'm in great shape. I went back to work, but just part-time. My boss has to understand that what I've done for 42 years with the company, now I require less hours, okay? I've reduced my hours, but I'm able to take care of that. I'm still able to operate around the home. Life is somewhat different. I rely on other hands now to do the heavy lifting, okay? But I think I deserve that because I've been there for everyone else for many, many years. I'm usually the strong person helping other people. In this case, I need help. So, there's nothing wrong with that, you know? And some people get depressed over the fact that this happened to me and why did this happen to me? There is no answer, I think I have no clear answer why that would happen. It's "What am I going to do about it," okay? There was no doubt in my mind that I was going to do what was absolutely necessary and I'm going to continue to do that every day.

Host: And remind us again what you do for a living or were doing.

Guest 2: I am a supervisor of a warehouse. I've worked for the same group of companies now, this is the 42nd year in several cities. I've held a number of different positions. But currently, I'm a supervisor that takes care of warehouse operation.

Host: Well, good for you. Congratulations. Anyone, especially nowadays that can stay with the same company for over four decades, it's something to be said for that right there.

Guest 2: Yeah.

Host: Let me ask each of you one final question before we go. For you, Dr. Cavanaugh, what are some of the advantages you can share with our listeners to being part of such an advanced medical system like that of University of Maryland Medical System?

Guest 1: I think that having the resources of kind of every tool available to you. And I think it's important that, you know, maybe have Nick touch a little bit about what he went through as far as his recovery, because recovery from such an operation like this is fairly extensive, right? We have experts in physical therapy. We have experts in radiation. I think he had to go through some post-operative radiation. We have experts in immunotherapy, right? Specialized cancer treatment. So, there's no information or technology we don't have available to, even if it's not locally at a hospital like Upper Chesapeake, then having it within our system is critical, and we can get patients to the right place to get the right care that they need.

Host: Well, how about that, Nick? What in a nutshell was that recovery like? And in closing, in addition to that, maybe you can tell people what advice you would have for them if they're considering being treated by this same medical team that you were.

Guest 2: Well, I mean, the recovery was at first of course at home, just trying to get strong enough to where I could move around. But some of the radiation was already set in effect. I had 10 radiation of that particular area to make sure that eliminated all the cancer in that cervical area. But through the entire time, I've had both doctors and nurses from the cancer facility as well as the hospital, from Cancer LifeNet reaching out to me many times during the week just asking how I'm doing. And that's a valid question. In other words, how are you doing? You know, I said, "I'm doing great." How could I not be anything else? I have some real positive news. I was in recovery in the hospital, laying on the hospital bed. And I got a message on my phone. It was a message that my daughter was pregnant again, okay? And we're going to have another granddaughter. And everyone in the hospital is excited for me. So, what can be more positive than that, okay? Every person I've heard from, every person I've touched from the hospital, from both wings, has been admirable. The support is out there.

And I think your last question was what can I tell other people, okay? I would go to the exact same extent that I have always done. This was the perfect scenario. I already had an oncologist that I was working with because of my previous cancer. I was lucky enough to have the correct surgeon at the right time. But everyone else from Dr. Cavanaugh's team that reached out to me, saw me every day when I was in the hospital, everybody's been remarkable. It's a great facility for anyone with any concerns or any cancer of whatsoever to go and be treated and be taken care of. I'm living proof today.

Host: Indeed you are. And so, we all have a happy ending. This is certainly an example of that. We appreciate you both sharing this great story. Nick Vasil, congratulations on the new addition to the family and continued great health. Thanks for being with us.

Guest 2: Thank you.

Host: And Dr. Daniel Kavanaugh, thanks again so much for sharing your part of the story and continued great work and success on your end as well.

Guest 1: Of course. Thanks for having me.

Host: And you can find more shows just like this one at umms.org/podcast. Again, umms.org/podcast or go to the University of Maryland Medical System YouTube channel for content there as well. Now, if you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.