Docvern here. My wife was diagnosed with multiple myeloma after having MGUS for about 6 years. She has been on chemo off and on to the present, starting with Velcade plus dexamethasone and Velcade, cyclophosphamide, and dexamethasone (CyBorD) and then more recently she is using Pomalyst and dexamethasone.
March of 2015 she had a pathological fracture of left humerus with placement of titanium rod. At this time no healing has occurred and several months ago she fell and sustained another fracture of the same arm and that doesn't appear to be healing either.
Her recent bone marrow biopsy showed less then 5 percent plasma cells.
Unfortunately, 3 orthopedic surgeons have not given her any way to repair this and she has pain around the clock, so we are using morphine and Dilaudid (hydromorphone) plus soft cast with a sling.
Does anyone have any suggestions for how we could address the fracture and/or pain?
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Re: Fracture that won't heal, causing constant pain
Hello Doc:
I am not sure at all that I can give a decent answer. However, it might be helpful to "divide" the problem. First, under the guidance of a myeloma specialist, get the multiple myeloma under control. Second, engage an orthopedic specialist on the bone issue.
Good luck to you.
I am not sure at all that I can give a decent answer. However, it might be helpful to "divide" the problem. First, under the guidance of a myeloma specialist, get the multiple myeloma under control. Second, engage an orthopedic specialist on the bone issue.
Good luck to you.
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JPC - Name: JPC
Re: Fracture that won't heal, causing constant pain
Docvern,
Has your wife had platelet-rich plasma (PRP) therapy? While my insurance didn't cover it, I opted to have PRP therapy as part of a surgical procedure to repair a ruptured achilles tendon. My recovery time was very short and I became a real believer in PRP therapy.
You might find this article to be of interest:
Golos, J., et al, "Results of the use of platelet rich plasma in the treatment of delayed union of long bones," Ortopedia Traumatologia Rehabilitacja, July-August 2014 (abstract, full-text PDF)
Has your wife had platelet-rich plasma (PRP) therapy? While my insurance didn't cover it, I opted to have PRP therapy as part of a surgical procedure to repair a ruptured achilles tendon. My recovery time was very short and I became a real believer in PRP therapy.
You might find this article to be of interest:
Golos, J., et al, "Results of the use of platelet rich plasma in the treatment of delayed union of long bones," Ortopedia Traumatologia Rehabilitacja, July-August 2014 (abstract, full-text PDF)
Last edited by Multibilly on Wed Jul 20, 2016 2:14 pm, edited 1 time in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Fracture that won't heal, causing constant pain
Is your wife being treated with a bisphosphonate such Zometa or Aredia? They assist with bone issues.
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Little Monkey - Name: Little Monkey
- Who do you know with myeloma?: Father-stage 1 multiple myeloma
- When were you/they diagnosed?: March/April of 2015
Re: Fracture that won't heal, causing constant pain
Hi,
Has your wife had any radiation to that area?
My husband had a rod placed in his femur 2 weeks ago. We're seeing his orthopedic- oncology surgeon for post-op checkup today. Previously she said he would need radiation after surgery because the myeloma would loosen the hardware if not radiated. We understand that will also help with pain.
Best wishes for you both,
Chris M.
Has your wife had any radiation to that area?
My husband had a rod placed in his femur 2 weeks ago. We're seeing his orthopedic- oncology surgeon for post-op checkup today. Previously she said he would need radiation after surgery because the myeloma would loosen the hardware if not radiated. We understand that will also help with pain.
Best wishes for you both,
Chris M.
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Chris M
Re: Fracture that won't heal, causing constant pain
My husband was diagnosed in March 2016 and had a pathological fracture of the humerus a week later. Ortho decided not to operate and wait and treat with pamidronate (Aredia) while also treating the multiple myeloma with chemo.
I believe that this was a good decision, as we can now see that the bone is starting to fill in and the pain is gone. Will be having the transplant probably in a month from now.
I believe that this was a good decision, as we can now see that the bone is starting to fill in and the pain is gone. Will be having the transplant probably in a month from now.
Re: Fracture that won't heal, causing constant pain
Docvern-
You have been given some good suggestions and good questions about your wife's treatment. I had a pathological fracture of my left humerus which led to me being diagnosed with progression to active myeloma from smoldering myeloma. My orthopedic surgeon didn't recommend surgery, but wanted to see if my arm would heal on its own. He was very pessimistic at the time and was quite surprised that it did heal on its own. At the same time, I started treatment for the myeloma and started Zometa infusions for my bones. I responded quickly to the myeloma treatment and my pain began to decrease. But, your wife is a different person with apparently not well controlled myeloma.
One of the things that none of the others have suggested is going to see an orthopedic oncologist for a consult. The orthopedic practice that I use added one to their group a few years ago, as did the cancer center where I am treated.
If there isn't a specialist listed as an orthopedic oncologist, look for a specialist who treats sarcomas. The most frequently diagnosed sarcoma is osteosarcoma, so the oncologist would be very familiar with bone healing problems in the environment of cancer. I'm not suggesting that your wife has a sarcoma, just saying that this type of specialist would have experience with bone problems. My orthopedic surgeon suggested that I see a sarcoma specialist when my humerus broke.
Another suggestion to all of the others is to look into the use of a bone stimulator to encourage the bone to heal. I don't know if one can be used when there is a rod in place, or not. But, this might be an option. Of course if there is active myeloma in the site of the bone fractures, this wouldn't be possible to use.
Did your wife have radiation to the site of the original and of the second fractures. Any further treatment would probably require radiation to kill any myeloma cells in the area prior to using any of the other modalities. I know that radiation solved my pain problem from a symptomatic lesion in my left leg.
Lots to consider and to research. Hopefully you and your wife will find effective treatment of her humerus and of her myeloma soon.
Nancy in Phila
You have been given some good suggestions and good questions about your wife's treatment. I had a pathological fracture of my left humerus which led to me being diagnosed with progression to active myeloma from smoldering myeloma. My orthopedic surgeon didn't recommend surgery, but wanted to see if my arm would heal on its own. He was very pessimistic at the time and was quite surprised that it did heal on its own. At the same time, I started treatment for the myeloma and started Zometa infusions for my bones. I responded quickly to the myeloma treatment and my pain began to decrease. But, your wife is a different person with apparently not well controlled myeloma.
One of the things that none of the others have suggested is going to see an orthopedic oncologist for a consult. The orthopedic practice that I use added one to their group a few years ago, as did the cancer center where I am treated.
If there isn't a specialist listed as an orthopedic oncologist, look for a specialist who treats sarcomas. The most frequently diagnosed sarcoma is osteosarcoma, so the oncologist would be very familiar with bone healing problems in the environment of cancer. I'm not suggesting that your wife has a sarcoma, just saying that this type of specialist would have experience with bone problems. My orthopedic surgeon suggested that I see a sarcoma specialist when my humerus broke.
Another suggestion to all of the others is to look into the use of a bone stimulator to encourage the bone to heal. I don't know if one can be used when there is a rod in place, or not. But, this might be an option. Of course if there is active myeloma in the site of the bone fractures, this wouldn't be possible to use.
Did your wife have radiation to the site of the original and of the second fractures. Any further treatment would probably require radiation to kill any myeloma cells in the area prior to using any of the other modalities. I know that radiation solved my pain problem from a symptomatic lesion in my left leg.
Lots to consider and to research. Hopefully you and your wife will find effective treatment of her humerus and of her myeloma soon.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Fracture that won't heal, causing constant pain
I am SO grateful to have found this thread. It has given me hope.
Last Thursday, I was told that I relapsed and had three areas of lesions: my hip, my left shoulder and my right femur.
The largest and most painful area is my hip. I went into the medical center today for a biopsy so that a sample of the hip lesion could be sent to NIH for BCMA study, hopefully. After the relatively painless procedure, they told me my hip had a small fracture. This explains the excruciating pain I've been feeling.
I start treatment and radiation soon, but now I know to contact an orthopedic oncologist to work with my team of doctors. Thanks again (especially Nancy)!
Last Thursday, I was told that I relapsed and had three areas of lesions: my hip, my left shoulder and my right femur.
The largest and most painful area is my hip. I went into the medical center today for a biopsy so that a sample of the hip lesion could be sent to NIH for BCMA study, hopefully. After the relatively painless procedure, they told me my hip had a small fracture. This explains the excruciating pain I've been feeling.
I start treatment and radiation soon, but now I know to contact an orthopedic oncologist to work with my team of doctors. Thanks again (especially Nancy)!
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JinMingDao - Name: Kim
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 46
8 posts
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