[nalar]

Multiple myeloma diagnosis in someone 93 years old

by nalar on Fri Nov 20, 2015 11:21 pm

My father-in-law (age 93) was just diagnosed this week (November 2015) with multiple myeloma It was a total shock to all of us since he currently has no symptoms, except for some increasing fatigue and bruising. 15% of his white blood cells have an extra copy of chromosome 11. He also has "low blood counts" for both his normal white blood cells and his red cells, but I don't know the exact numbers.

Based on the doc's recommendation, my FIL is starting on Revlimid with a steroid booster, but because of his advanced age, it is unclear how well the therapy will do versus the side affects.

Does anyone have any experience with someone of such advanced age dealing with multiple myeloma? We suspect this condition has been coming on for over a year because of abnormal blood work reports from 14 months ago (which we just found out about). My FIL lives 300 miles away and we are his closest family. He lives alone and has never been very good about understanding medical issues about himself. We suspect the doctor tried to explain his concerns to dad last year, but the discussion went over dad's head.

Dad had a heart rhythm problem 6 months ago that resulted in him getting a pacemaker. Dad has also been somewhat difficult about sharing information on issues like this (he doesn't like to talk about this stuff). It has only been since the heart crisis that we have been able to get access to most of his medical records.

My FIL is still in pretty good physical condition. He was playing tennis up until 2 years ago and is still driving and doing his own yard work. Unfortunately, he appears now to also be in the early stages of dementia, but it is not severe enough to prevent him from passing a formal driving test.

The doctor said that dad's white blood cell count was almost too low to safely start the Revlimid, but the doc was able to give him a booster shot which brought the count up high enough to make the drug acceptably safe.

Because there is so little info about multiple myeloma in the very elderly, the doc said he really has no idea how well (or poorly) dad may do with this disease. Dad did report a couple of days ago that his tail bone hurt (for no reason), but that was the place where they took the bone biopsy from 3 weeks ago. Dad said the biopsy hurt (duh!) but the spot hadn't hurt since until now. Could this be the start of a bone lesion?

I would appreciate any info anyone could provide about their experiences with this disease in the very old. We are like deer in the headlights right now.

[NStewart]

Re: Multiple myeloma diagnosis in someone 93 years old

by NStewart on Sat Nov 21, 2015 2:28 pm

I'm so sorry that your father-in-law has to deal with myeloma at his advanced age and with him so far from family. There has been some research done recently on treatment of the elderly and presented at one of the major cancer conferences, ASH or ASCO, within the last two years that found that Revlimid with dexamethasone is a good combination with good results. I don't know if your father-in-law lives close to a cancer center with a myeloma specialist, but it might be a good idea for him to get a second opinion from one. A specialist would be more likely to be up on the research and successful treatment regimens for the elderly and might also have experience treating elderly patients.

There are some side effects that could be somewhat troublesome for your father-in-law. One is GI problems, such as diarrhea or constipation. Both of these can be managed quite easily, but it is important to be aware of them since these are both common in someone who is of advanced years.

Another is the development of blood clots with the Revlimid. Hopefully, your father-in-law will be told to take an aspirin each day or some other anticoagulant as a preventive measure. Dex­amethasone also can cause people to become agitated or hyperactive with sleeplessness for a day or two, depending on the dose, and then a crash for a day or two. But, the good news is that this regimen is very well tolerated and works well quite quickly.

If possible, encourage your father-in-law to get copies of all of his lab work each time that he sees the oncologist and ask him to send them to you. That way you can keep track of what's going on better. Also, encourage him to sign a form allowing you, or your husband or other family member, to talk with his oncologist so that you have a better idea of how things are progressing.

If he hasn't done so already, it's important to have some legal things in place such as medical power of attorney and advance directives for treatment. If your father-in-law is beginning to show signs of dementia, you want to make sure that these are done soon before he is unable to do them and you have to go through the courts to get things in place.

All the best to your father-in-law managing this latest health problem and responding well and to the rest of the family in helping him to manage it.

Nancy in Phila

[cdnirene]

Re: Multiple myeloma diagnosis in someone 93 years old

by cdnirene on Sat Nov 21, 2015 4:25 pm

To be honest, I hope your father in law seriously considers moving closer to you and your husband. He is going to need some help.