My mother is 54 years old, diagnosed with multiple myeloma 1.5 months ago. We found out because of a pathological fracture on the right humerus and unbearable pain there. Her marrow test revealed 40% plasma cells.
She got first cycle of treatment with Velcade, Endoxan [cyclophosphamide], Dexaton [dexamethasone], and Zometa. Doctors have given radiotherapy on the right humerus in the painful area. Initially her serum IgG was 7250. After 1st cycle of treatment (1 month) it is now 1526 (within reference value).
My question is about her fracture at the right humerus. The doctors said that it will probably heal itself with the medication. Orthopedics at the hospital, in the meantime, fixed her arm on a simple immobilizer belt. Another orthopedic said that he believes it will need surgery.
I'm trying to figure out what is right because I fear that if it is not done properly now, this can cause her a great deal of pain later on. Not being able to use her right arm has significantly lowered her quality of life.
What is the right option for the treatment of her fracture. How long should we wait for natural healing? Or will it require surgery? Will her body sustain surgery? She has diabetes.
Any advice will be great help for us.
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Re: Fracture of the right humerus - how best to treat?
A simple followup AP/ Lateral of the Humerus, in 45 days or so, to assess the degree of callous formation at the Fx site, is a reasonable, cheap, non-invasive method.
CT and MRI may show additional items. I'm assuming she is getting regular blood work to monitor such things as sugars, calcium, Sodium, creatinine, etc, as well as her myeloma labs.
Has she had a baseline bone density test and serial calcium measurements ?
In the interim, Gentle Physical Therapy is helpful to avoid "frozen joints' and to stimulate bone growth / callous formation. Having her Diabetes under good control would also be helpful for healing.
The better her overall Health, the better her chances of laying down sufficient Osteoclasts, etc --to form bone at her lesion site.
Good luck.
CT and MRI may show additional items. I'm assuming she is getting regular blood work to monitor such things as sugars, calcium, Sodium, creatinine, etc, as well as her myeloma labs.
Has she had a baseline bone density test and serial calcium measurements ?
In the interim, Gentle Physical Therapy is helpful to avoid "frozen joints' and to stimulate bone growth / callous formation. Having her Diabetes under good control would also be helpful for healing.
The better her overall Health, the better her chances of laying down sufficient Osteoclasts, etc --to form bone at her lesion site.
Good luck.
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Rneb
Re: Fracture of the right humerus - how best to treat?
This is a really tough spot to be in and you and your mother have some tough decisions to make. It seems you have had a fair number of doctors and specialists look at her and have some second opinions.
If you do not get many responses to your inquiry for help with making this decision about how to treat her humerus, it is not because people do not care or are indifferent, but because it is really hard and I feel would be a bit difficult to tell you what to do without being a medical professional and having access to examine your mother's condition and medical records.
My recommendation would be to find the best specialist you can get access to for this problem, who can examine you mother first hand, and go with what they say.
If you do not get many responses to your inquiry for help with making this decision about how to treat her humerus, it is not because people do not care or are indifferent, but because it is really hard and I feel would be a bit difficult to tell you what to do without being a medical professional and having access to examine your mother's condition and medical records.
My recommendation would be to find the best specialist you can get access to for this problem, who can examine you mother first hand, and go with what they say.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Fracture of the right humerus - how best to treat?
I had a pathologic fracture of my left humerus 5 years ago which led to the diagnosis of progression from MGUS to active myeloma. I saw an orthopedist who specializes in upper humeral and shoulder injuries/problems. He is the same one who did shoulder replacement surgery on my right shoulder due to arthritis and suspected myeloma.
Anyway, he did nothing for my fracture other than to recommend limiting the use of my arm according to the level of pain that I was in. The fracture was non-displaced, but extremely painful. He told me to see my oncologist immediately and that, once I started treatment for the myeloma, the pain should come under control. He had me schedule to see him again in 6 weeks to see how my arm was doing. He was pessimistic about the fracture actually healing.
I saw my oncologist and started on Revlimid 15 mg, dex 40 mg and Zometa infusions. Once I started treatment, the pain began to subside in about 1 week. When I saw the orthopedist 6 weeks later there was obvious healing going on in the fracture site. At my 3 month follow-up, the orthopedist told me that he was surprised at how well I healed. He really thought that he would need to put a rod in my arm to stabilize it.
Five years later and the arm is still good. I do get some discomfort in the fracture site when I've lifted something too heavy or am over tired. I didn't have any radiation at the site although, when I saw a radiation oncologist for a different painful area last year, he said that he would have done radiation to the fracture site.
As a physical therapist, I have worked with people with myeloma who have had surgery to place a rod in the humerus and people who have worn a fracture brace for several weeks. I'm the only one that I've met who didn't have any intervention other than to begin treatment for the myeloma. All of us have done about the same in the outcome in that our arms are functional and basically pain free.
As you'll find with myeloma there are no clear cut answers to anything. The more doctors that you see, the more opinions that you will get that you will have to sort through. My personal bias would be to at least have a fracture brace on the arm. The most painful thing for me was when I moved my arm and I could feel the bones in the fracture site moving against one another.
All the best to your mother and for complete healing of her arm,
Nancy in Phila
Anyway, he did nothing for my fracture other than to recommend limiting the use of my arm according to the level of pain that I was in. The fracture was non-displaced, but extremely painful. He told me to see my oncologist immediately and that, once I started treatment for the myeloma, the pain should come under control. He had me schedule to see him again in 6 weeks to see how my arm was doing. He was pessimistic about the fracture actually healing.
I saw my oncologist and started on Revlimid 15 mg, dex 40 mg and Zometa infusions. Once I started treatment, the pain began to subside in about 1 week. When I saw the orthopedist 6 weeks later there was obvious healing going on in the fracture site. At my 3 month follow-up, the orthopedist told me that he was surprised at how well I healed. He really thought that he would need to put a rod in my arm to stabilize it.
Five years later and the arm is still good. I do get some discomfort in the fracture site when I've lifted something too heavy or am over tired. I didn't have any radiation at the site although, when I saw a radiation oncologist for a different painful area last year, he said that he would have done radiation to the fracture site.
As a physical therapist, I have worked with people with myeloma who have had surgery to place a rod in the humerus and people who have worn a fracture brace for several weeks. I'm the only one that I've met who didn't have any intervention other than to begin treatment for the myeloma. All of us have done about the same in the outcome in that our arms are functional and basically pain free.
As you'll find with myeloma there are no clear cut answers to anything. The more doctors that you see, the more opinions that you will get that you will have to sort through. My personal bias would be to at least have a fracture brace on the arm. The most painful thing for me was when I moved my arm and I could feel the bones in the fracture site moving against one another.
All the best to your mother and for complete healing of her arm,
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 of the right humerus - how best to treat?
I was 53 when I was diagnosed. I initially went to the doctor with back pain, which I thought was caused by lifting air conditioners. During the treatment for my back pain, before diagnosed, my left upper arm began hurting also ... to the point of only being able to lift it by holding it up with my other arm. Since the pain I was having in my back and left leg was far worse than my arm at the time, I put off getting it checked.
When I was diagnosed in February of 2012, I found out I also had a pathologic fracture of my left humerus. I also had a few broken ribs (some healed) and several sacral / spinal lesions. I was to get radiation to these areas, but the radiation oncologist wanted the fracture fixed first so the bones would not be too brittle to tolerate hardware.
I now have a plate on my shoulder with a rod that extends down to my elbow. I think this is the best thing I could have done.
Wishing your mom the best in her journey.
When I was diagnosed in February of 2012, I found out I also had a pathologic fracture of my left humerus. I also had a few broken ribs (some healed) and several sacral / spinal lesions. I was to get radiation to these areas, but the radiation oncologist wanted the fracture fixed first so the bones would not be too brittle to tolerate hardware.
I now have a plate on my shoulder with a rod that extends down to my elbow. I think this is the best thing I could have done.
Wishing your mom the best in her journey.
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AnnieCee
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