While each cancer is treated differently, few diagnoses are treated AS DIFFERENTLY as multiple myeloma. As we discussed in episodes 202 & 203, multiple myeloma may be approached with observation, clinical trials, chemotherapy &/or other agents, as well as hematopoietic stem cell transplants (aka BMT).
How multiple myeloma is treated can significantly impact what & how we treat these patients. In today’s episode, I’m presenting two patients with multiple myeloma that I’ve treated. Neither is perfect, in fact, you may have some strong opinions that I welcome hearing – this promotes great discussion & improving our patient care.
Peter was a 60 year old male who presented to the emergency room with unrelenting back pain after injuring his back playing tennis. Imaging revealed punched out lesions in his lumbar spine & blood work eventually confirmed his multiple myeloma diagnosis.
He spent a couple weeks in the hospital, during which he became extremely deconditioned.
He presented to PT 1 week after starting a chemotherapy regimen of revlimid (lenalidomide), dexamethasone, & bortezomib. At evaluation, he demonstrated significant hesitation with movement due to low back pain, difficulty/pain with transfers, & slow gait again due to pain. He also demonstrated some non blanching redness on his low back where his TLSO was rubbing against his skin (through his shirt).
He was scheduled to undergo a hematopoietic stem cell transplant (aka BMT) in 6 months, so it was imperative that we got him as physically ready for HSCT as possible.
Here’s what we worked on:
Complications: DVT in Month 2; substitute PT in Month 2…
Margie was a 78 year old female diagnosed with multiple myeloma 5 years ago. Her disease was very stable, so she was undergoing basically observation. Might have been on some agent, but honestly can’t remember.
She did have a stable lumbar spine pathological fracture, no brace, so abided by spinal precautions.
Most of her impairments were caused by older age, deconditioning due to sedentary lifestyle, & back pain limitations.
Here’s what we worked on:
As you can see from these two patients, treating the person with multiple myeloma can look very different, particularly depending on their disease status & treatment.
So now I want to hear from you: What would you have included in your treatment of these patients? Message me on Instagram and let me know.
Until next time, this is Elise with TheOncoPT. And remember: you are exactly the physical therapist that your patients with cancer need. So let’s get to work.