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74 year old Dad with myeloma, rib fractures & pneumonia

by Kerry A on Thu Dec 25, 2014 8:47 pm

Hello. I am new to this forum. Just got back from the hospital (yes, on Christmas), and my dad was admitted because he is suffering from a second bout of pneumonia. I am frustrated though, because I am not sure if he has gotten the best care, and my parents (my mother is very much involved with his care) are very stubborn and they do not always listen to me (they're Irish-American, which may help explain that).

My father suffered a hairline fracture in his back about 6 months ago. We did not know at the time why this happened. He thought perhaps he was picking up my toddler daughter too much, or simply that he was getting older. He was treated with Percocet (oxycodone + aceta­min­o­phen / paracetamol), which caused him to feel horribly constipated and gassy. He was not eating as much as he did before, so we all thought that was why he lost so much weight.

Unfortunately, it turns out that he has multiple myeloma, but six months went by before his primary care physician noticed in his blood work during a routine physical that he had markers for the disease.

His back fracture actually healed up (he was wearing a brace and taking it easy), and the same week we found out he had multiple myeloma, in early November, he needed to be rushed to the ER because of problems breathing. He was in the hospital for two weeks, and rehab for one. He started working with an oncologist while in the hospital, who confirmed the primary care doctor's suspicions that he has multiple myeloma. After he completed rehab and was much stronger, he began treatment with Revlimid (chemo drug), a steroid short-term, and monthly infusion.

At this time, he recently completed his three weeks of Revlimid, and one infusion. When he was released from rehab and started this therapy, he was in good spirits, driving, going out, but still weak.

About 10 days ago, he was having difficulty breathing and, upon the advice of his lung doctor, went to the hospital for a CAT scan. He could not walk at this point. The CAT scan revealed at least 10 fractures in his rib cage, but that his lungs were fine. To my surprise, he was not admitted to the hospital, and although I made sure that the oncologist knew about the rib fractures, the only thing suggested to my parents was that my dad use pain medication.

My dad advocated for himself and got the lung doctor to give him an oxygen machine so that he could breathe better. Neither doctor gave him instructions on how to help heal the fractures, and for the last 10 days my dad has been in a lot of pain and barely moving.

About four days ago, he began to have congestion, and progressively was having a harder time breathing. My parents refused to go to the ER on Christmas Eve, because it was Christmas Eve, and I was up all night worrying. (Again, they are very stubborn). When I checked on him at 8:00 this morning, he said he was feeling a little better. A few hours later they made the decision to go to the ER.

I informed his oncologist of this, and the two doctors who saw him today (one a lung doctor, and one a hospitalist) both asked my mom and me about my dad's wishes should he need CPR or a ventilation machine. Of course we need to think of this, as upsetting as it is, but we'd rather focus on the hope he could get better. I feel like they are writing him off. He will be getting antibiotics to clear up the pneumonia, and the hospitalist said he should not receive any more chemo drugs right now because "it could kill him."

I am beside myself, and want to hold on to hope, and also do anything I can to help him get well. I guess I am looking for some hope, or just plain old advice. It is possible that he will beat the pneumonia, but what then? He will still have fractured ribs and multiple myeloma.

Although my dad has had some heart issues (atrial fibrillation and two stents), his vitals remain strong. I do not want to write him off! He beat the pneumonia last time, and was a star at rehab. I realize that the fractured ribs complicates things, and feel pissed that his doctors did not even mention that he was at high risk for pneumonia because of that, and did not give him much advice on how to heal.

By the way, we live in a suburb outside of NYC, and recently I suggested to my dad that he get a "second opinion" from Sloan Kettering in the city. He agreed to this, and when I called them they told me he would have to wait until his first round of treatment was completed. Now that he is the hospital, and they are working on his pneumonia, I don't know if I should or could get Sloan involved some how.

Thank you very much for any advice or encouraging words you can give me. I appreciate anyone who has taken the time to read this, and wish everyone out there with multiple myeloma, or a loved one with multiple myeloma, a very Merry Christmas.

Kerry A

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by cindylouise on Fri Dec 26, 2014 8:05 am

I'm so sorry for what you are going thru, and especially on Christmas.

My husband had rib fractures from a fall this summer. The myeloma was not the direct cause. But the focus was on letting the fractures heal and preventing pneumonia. First issue is to control the pain, and of course the antibiotics. Controlling the pain helps so he can breathe more deeply. This was actually a very big deal. And he used one of those devices you blow into to make the ball rise? (I can never remember the proper name for those).

When he is not in the hospital, look at your father's home environment and how he gets up and down out of bed. We switched my husband to the opposite side of the bed so he could roll towards his good side, and thereby lessen the strain on his ribs when he was getting up out of bed. If you can imagine just sitting straight up from a laying down position, that's what I'm talking about. That one thing alone was causing tremendous pain, and I'm sure was not helping his healing.

Another issue with pneumonia and the elderly is their concept that they should lie in bed so they can rest until they are better. When you are lying down, your lungs compress and it becomes much more difficult to take in deep breaths.

While it is important to be mindful of DNR's and have the proper decisions made, don't let anyone rush your father to his grave. Also, keep in mind that these are typical questions upon admittance to the hospital. They may not mean to imply anything by asking.

And by all means get that second opinion. And also ask more questions about stopping the treatment. Common knowledge here on this forum is treating the disease is generally the first step to getting the secondary issues under control. Non-myeloma specialists don't always understand that it seems.

Merry Christmas, and best wishes. Hope this helped a little.

cindylouise

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by Kerry A on Fri Dec 26, 2014 10:17 am

Hello, CindyLouise,

Thank you so much for your reply. I feel a lot of regret that I didn't assist more with helping my dad to understand what he needed to do to avoid getting pneumonia and helping his rib fractures to heal. Unfortunately, I did not understand it myself, and his doctors were no help at all.

I only recently learned some things that my dad should be doing, like the breathing exercises, and he did use that device you were referring to half-heartedly. He did not want to move around much, and I didn't know he should be moving around. He deteriorated so quickly, and I am so regretful that I didn't know how to assist, and, again, that no medical professional gave him proper advice.

I am going to call Sloan Kettering today and inquire about the second opinion again. Perhaps they can visit him at the hospital. I am also going to call his oncologist and fill him in about what is going on. No one should be giving up on my dad. He is very strong-willed, which is sometimes his downfall, but his spirit is strong, and he shouldn't be ignored.

Thank you again, and best wishes.

Kerry A

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by mikeb on Fri Dec 26, 2014 10:20 am

Hi Kerry A,

Boy, that's sure not the way anyone wants to spend Christmas! I'm sorry you and your family are going through all of this.

I can't speak to the broken ribs or pneumonia (fortunately for me), but I can talk about second opinions and Memorial Sloan Kettering. I am being treated at MSK, after first seeing them for a second opinion back in 2010 when I was diagnosed with smoldering myeloma. I've been in treatment at MSK for symptomatic multiple myeloma since January 2013. I'm currently in maintenance therapy and am doing well.

I highly recommend the myeloma team at MSK. I am sure that I have gotten top-notch care from the folks there. As cindylouise said, it is really important to be treated by a myeloma specialist, if at all possible, because myeloma is such a complex disease. You want someone who sees a lot of myeloma patients and has experience with the range of things that happen with this disease.

Also, there are new research findings coming out all the time now that can affect the patient's treatment protocol. Myeloma specialists will be up on those latest findings.

One other thing I particularly like about the care I've gotten at MSK is that my myeloma doctor calls in other specialists from MSK when they can help me out with secondary issues I might be having. There is very much an integrative approach to dealing with my needs.

Good luck to you and your father. I strongly recommend following up with the folks at MSK to get a second opinion there.

Mike

mikeb
Name: mikeb
Who do you know with myeloma?: self
When were you/they diagnosed?: 2009 (MGUS at that time)
Age at diagnosis: 55

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by cindylouise on Fri Dec 26, 2014 6:33 pm

Kerry,

Don't be so hard on yourself. We tend to expect that medical personnel are going to tell us all we need to know, and often they seem to think we know those same things!

I would first call his oncologist and ask him to refer your dad to MSK. That may get the ball rolling a little more quickly. And I would just be clear that you want to proceed with treatment.

cindylouise

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by Kerry A on Sat Dec 27, 2014 9:00 pm

Thank you for your advice, Mike b and CindyLouise.

I am very disappointed with my dad's oncologist. Firstly, when I saw him yesterday at the hospital because he was making his rounds, he didn't even know who my dad was and was not planning on seeing him, even though I left him a message on Christmas that my dad had to be rushed to the ER. Then, when I mentioned his rib fractures, he claimed to have no knowledge of that even though my parents called his office for a pain patch a week earlier.

He basically washed his hands of the situation because he said he can't help until his pneumonia clears up. I think we need some place like Sloan Kettering where they have a team of specialists and the knowledge and desire to treat secondary issues.

Although I wanted to punch this oncologist in the face, I withheld my anger because we need his cooperation. MSK needs all this documentation from his office and the hospital to review and either accept my dad as a patient or consult with his oncologist.

I already requested paperwork to be faxed over to MSK and will follow up on Monday. I just hope that my dad beats this pneumonia so he will have a chance at recovery.

Kerry A

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by mikeb on Sun Dec 28, 2014 10:30 am

Hi Kerry,

That's pretty depressing that the oncologist had forgotten anything and everything related to your father. Not good.

This is another example of how / why patients need advocates or need to be advocates for themselves. No matter who you're being treated by, or where you're being treated, you need to stay on top of things, or need someone who can do that for you. Your father is fortunate to have you looking out and helping him.

I hope your father turns the corner with the pneumonia and can proceed from there. Good luck, and please keep us posted.

Mike

mikeb
Name: mikeb
Who do you know with myeloma?: self
When were you/they diagnosed?: 2009 (MGUS at that time)
Age at diagnosis: 55

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by Kerry A on Sun Dec 28, 2014 11:15 am

Hi, Mike,

Thank you so much for your support and for confirming my feelings of frustration and, yes, depression about the lack of care my father has gotten.

My parents are pretty "old school" and always put faith in their doctors. When my father started having difficulty breathing like two weeks ago, I kept asking him and my mother questions to ensure that his doctors knew this was going on, and that what he was doing at home – pain killers and oxygen machine to help – was all that he was supposed to be doing to heal the fractures. They kept assuring me that everything was communicated to both doctors (lung and cancer), and that he needed to rest and hope that the fractures heal. I know for a fact that my mother and father communicated with both doctors.

When he was referred to the hospital for a CAT scan because he was having difficulty breathing about two weeks ago, and it was revealed that "his lungs are fine" and that he had over 10 rib fractures, I was baffled that he was not admitted to the hospital.

Recently, I've done a lot of reading online about my father's condition, and am certain that he did not receive the proper care. A younger, healthier person should be hospitalized just for the fact that he/she has over 10 rib fractures! Yet, they sent my father home, and never cautioned him that a major complication of rib fracture is pneumonia. AND my father has a history of pneumonia!

I am beyond disgusted and feel that several of the doctors that my father has come in contact with have just given up on him or simply do not care.

I'm going to be a big "pain in the butt" to all of these doctors moving forward. I am praying every day that my father beats this pneumonia, that Sloan Kettering can help him, and that I will have the chance to say to these horrible doctors that they should never have given up on my father.

Kerry A

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by Kerry A on Thu May 28, 2015 12:09 am

Wow. Rereading my prior posts just now brought tears to my eyes. It is a long, windy road indeed when you or a loved one is dealing with multiple myeloma.

I have been meaning to repost to this forum for a while because it is always nice to share some positive news: my dad beat the pneumonia! After being in the hospital for about 3 weeks, and rehab about 3 or 4 more, he came home.

There was a difference in my dad though. A loss of some of his spirit, I suppose. He emerged from the second bout of pneumonia much weaker, and thinner. My dad was always a broad, big man. To see how emaciated he has become is hard for us to see. That has been one of my father's biggest complaints. Doctors have commented that his weight loss is not typical.

He did receive the second opinion from Sloan Kettering. It was very difficult getting him there. He was transported from rehab while still in a wheelchair. And then there was the exhausting trek to the city. We were there all day – most of the time waiting. It was difficult, but I do think the doctor who saw him was extremely thorough, and expressed the appropriate care and concern. I consulted with her several times over the phone after that, and at one point she apologized to me about how long my father had to wait in the waiting room.

I was hoping my father would choose to go with Sloan, but he felt more comfortable with his local oncologist. The doctor at Sloan confirmed that the treatment was working, according to the "numbers," so my father decided to continue the treatment of Revlimid and monthly infusions.

Fast forward a few months, and my father seemed to be getting stronger. Very slowly, but steady. He left rehab walking, and received some physical therapy at home. We were terrified of him getting pneumonia again, so through the winter months, and the typical rounds of colds popping up in my household with two children (my dad's grandchildren), we had to be very careful not to expose him to their germs. At one point, my daughter had the flu, and we were very lucky that my father did not catch it before we knew how sick she was.

My father began to drive again a few months ago. He travels locally, but I do think that boosted his spirits a bit. He seemed to enjoy his visits with his grandchildren, and sometimes has gone to family parties, friends' houses, and out to dinner. Recently, I started to recognize good ol' dad again. I saw some of his spark coming back.

And then there was another setback. A few days ago, he injured his ribs again. He isn't sure how he did it, but thinks he just sneezed or twisted the wrong way. He has been receiving double the dose of chemo for the last two cycles because his oncologist believed that he was tolerating it well. His hope is to get him into remission. I was feeling very positive that this would happen. Now, I am mostly concerned about how fragile my dad's bones seem to be, and how this is affecting his quality of life.

My dad is in a lot of pain again, and seems to be feeling very negative. He doesn't say much. He seems very uncomfortable in his own skin. All he takes is Tylenol to deal with the pain be­cause the other more potent drugs gave him so many undesirable side effects. He is still driv­ing despite this. He is scheduled to see his oncologist on Friday, and my mother has a list of ques­tions she is going to ask for us. I feel that this recent rib injury should be looked at by another specialist, as his oncologist does not seem to offer much advice on treating the sec­ond­ary issues that accompany multiple myeloma. I cannot imagine that my father wants to go to another doctor.

I do not feel that my father has given up all of his hope, as he recently said that he feels this in­jury will heal like the other ones. I am so fearful that this injury will complicate things, and ter­ri­fied that he will get pneumonia again. I am also feeling discouraged, and that is compounded by the thought of the physical and emotional pain my dad must be in. He is not someone who usually opens up about his feelings. After this recent setback, he said very clearly to a visitor that he does not want to talk about his cancer.

I want to help, but I am not sure how to at this point. Perhaps just keeping the faith, spending time with my parents, and continuing to help with what they will let me help them with.

I pray for happier times in the future for my father.

Kerry A

Re: 74 year old Dad with myeloma, rib fractures & pneumonia

by Nipon Ginko on Fri May 29, 2015 5:35 pm

Hi Kerry,

Thought I would add my 2 cents worth here. I am now 76 years old and have had multiple mye­loma for over 10 years. I have never been told I am in remission but have received no treat­ment since my initial treatment. I do go in every 6 months for blood tests, which so far have been ok, I have had pneumonia once, but it was not to bad. I do get the pneumonia shots on a regular basis.

My spine was where my main problem was centered and left 3 or 4 of my vertebrae fused to­gether. I am also having severe foot problems which I am having problems getting any doc­tors to do anything about. You have my sympathies in regards to the oncologist who was suffer­ing from Rectal Cranial Inversion. I had one like that who not only was not receptive to any out side input, he actually started screaming at me one day when I question the lack of treatment on my feet. I was lining him for a head shot when it came to me that I probably did not have the strength to put him away at that time, and also as I exited the room it came to me that my health insurance could be at risk.

So I went out to make my next appointment. The clerk says: Your appointment with Dr. ???? will be in 3 months. I said, no, it won't; I am requesting a change of doctors. She just gave me a knowing look and says, "I understand"!!

I have other problems, but probably none that would be of any help to you. So good luck with your dad's treatment.

N. G .

Nipon Ginko
Name: Nipon Ginko
Who do you know with myeloma?: ME
When were you/they diagnosed?: 2004
Age at diagnosis: 66


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