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.
Patient Case #1: Peter
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:
- Education: HSCT process, importance of skin integrity regarding TLSO
- Therapeutic exercise: light dumbbells & resistance bands for upper extremity & periscapular strengthening with lots of cuing for posture
- Month 2 therapeutic exercise: cleared to begin standing balance & UE resistance training. Tabata format to also target aerobic conditioning. Standing balance exercises progressed slowly again due to pain & sometimes medication interference
- Month 2 patient was also cleared to begin leisurely walking
- In Month 4, we reached a plateau (ceiling effect, due to still being in TLSO & other surgeon restrictions), so discharged with HEP.
- Month 5, patient was all cleared (TLSO & prior activity restrictions), so began core stabilization exercises in neutral spine & then discharged in month 6 for HSCT.
Complications: DVT in Month 2; substitute PT in Month 2…
Patient Case #2: Margie
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:
- Education: importance of spinal precautions & purpose
- Balance: static & dynamic balance exercises to improve safety in order to maintain independence while living in loft apartment
- Therapeutic exercise: upper extremity & lower extremity strengthening exercises with dumbbells & resistance bands as tolerated
More from this episode:
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.
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