[K_Shash]

Revlimid and muscle / tendon tears

by K_Shash on Thu Nov 09, 2017 1:49 pm

How common is it to tear a muscle or tendon during treatment with Revlimid?

I have been on the Revlimid-only maintenance for over 2 years after about 10 months of the induction therapy with Revlimid, Velcade, and dexamethasone (RVd). I have been an avid golfer (not very good at it, though) for over 10 years. I tore up my upper tendon of the right biceps while taking my first swing of the golf round about a month ago. I felt an acute and severe pain, and I considered quitting the round. However, I was able to play the whole round by just being careful and by keeping my arms straight and parallel and by avoiding any 'whip-like' action. I had felt a little twist in that area from the previous week's round. I had shaken my arm a few times and that seemed to have cured it.

I was due for my annual skeletal x-rays and my oncologist ordered them a little earlier. The x-rays confirmed that there is no fracture of the arm bone. I had been cleared to play golf and con­tinue my exercises because the lesions on my bones apparently were faint and there are no rings. The radiologist's report and my oncologist's reading of the recent X-rays seems to be that there is no appreciable change in my x-rays. However, there is some osteopenia of some of the bones, and I am going in today for a bone density survey to see if I need any Zometa infusions. I hope I can manage with just some oral Zometa, though, if I need the bone strengthening at all. I read the posts about the side effects of Zometa and I would like to avoid the side effects of these drugs as much as possible.

All these various drugs have so many side effects! I just confirmed that the Protonix (pan­toprazole) that I have been taking for my acid reflux can also cause osteopenia, particularly at my age and after 5+ years of use.

I am also studying the posts and articles about the thalidomide versus Revlimid, too. Our health coverage through my wife's employer covers the cost of the Revlimid with a minimal co-pay. I have always considered switching to thalidomide if the cost ever became a concern. I think thalidomide is still prescribed with the Velcade and the dex for the Induction and maintenance therapies in many other countries. But each drug would have its own side effects.

I hope to continue my weekly round of golf, in spite of the lumpy muscle mass, possibly with a KT tape. Any advice or insight into what I've experienced, and the best way to go forward, would be appreciated.

[NStewart]

Re: Revlimid and muscle / tendon tears

by NStewart on Thu Nov 09, 2017 4:58 pm

Steroids can leave the muscles and tendons weak and can lead to tears. I would suggest that you see an orthopedic doctor about the tear that you have and possibly go for physical therapy to strengthen around your shoulder joint. Steroids most commonly affect the muscles around the shoulders and the hips.

Nancy in Phila

[K_Shash]

Re: Revlimid and muscle / tendon tears

by K_Shash on Thu Nov 09, 2017 9:19 pm

I just got an update from my oncologist:

My bone density is "Normal" and he confirmed that I do not need the Zometa, I.V. or oral, at this time.

I am stopping my omeprazole (Prilosec, Losec) (because of the osteopenia, as its known side effect), and I hope that the ranitidine (Zantac) and the cholestyramine will help me keep my acid reflux in check. I had stopped the omeprazole a few years ago and I think I had to resume it during the induction therapy.

Any suggestions about the osteopenia?

[K_Shash]

Re: Revlimid and muscle / tendon tears

by K_Shash on Fri Nov 10, 2017 1:58 pm

Thanks, Nancy.

Yes, my PCP had a phone consult with the orthopedist while I was in his office. The tear is obvious since the bicep is all bunched up in a lump in the middle of the arm, and I opted not to push for a complicated surgery to try and attach the torn tendon (or part thereof) back to the shoulder. I do plan to go for the physical therapy, though.

Fortunately, I have no pain (except for the acute and severe pain I experienced at the moment) in that area, and I have been able to use my arm for the normal lifting and golf swings, etc., in spite of the internal bleeding. All that purple swelling and the color dissipated in about a week after the injury.

My steroid use was limited to the weekly 20 mg dexamethasone for about 10 months of the induction therapy and the "tapering to maintenance", combined. And that was 2 years ago. My oncologist has advised me not to take any steroids to supplement the Revlimid maintenance, presumably to avoid the same kind of side effect you mentioned.

[Mike F]

Re: Revlimid and muscle / tendon tears

by Mike F on Tue Nov 14, 2017 11:34 am

Just for what it's worth, I was on Revlimid and dexamethasone as my induction regimen for about eight months, four and a half years ago. Had the transplant and have been on 10 mg/day Revlimid maintenance ever since. I work out regularly with free weights and various machines and have had no issues with torn tendons or muscles. Plenty of stiffness, but I'm pretty sure that's just me getting older.

[K_Shash]

Re: Revlimid and muscle / tendon tears

by K_Shash on Tue Nov 21, 2017 1:07 pm

Thanks, Mike F.

Keep up with your routine exercises and I hope you would not have any muscle related problems.

I did some more Internet searches came across a few instances of muscle tears, including a partially torn ankle tendon and another article describing the shoulder muscle "catching", which I had about a week before the shoulder muscle tear I experienced during the golf swing.

A couple of other articles mention myeloma as one of the causes of torn rotator cuff and Achilles tendon tear. Apparently, 25% of the myeloma patients (most of them on Revlimid?) experience the shoulder pain in addition to the bone damage many endure due to the myeloma.

I think trying to hit the big golf (and tennis) swings may be a contributing factor in some muscle tear like mine. I am hoping to find specific exercises and stretches that may help avoid such a tear before I get back to my golf. And taking smoother swings would help my golf and the muscles, too. I plan to try that along with the routine exercise and curcumin (which may also help).