History:
Keith is a 67 year old male presenting to you with a diagnosis of Multiple Myeloma who has just been discharged from the acute ward following a Autologous Stem Cell Transplant he received 1 month ago.
He lives at home with his wife and son and is semi-retired, where he works from home part time for himself.
Keith had a challenging admission and became extremely unwell following his stem cell transplant. At one point during his acute admission he required a Nasogatric Tube and supplemental oxygen.
He is now at home and mobilising independently with nil aids, however he reports still feeling very weak.
PMHx:
- Osteoarthritis
- Known lytic lesions at T1 and 2
- Hypertension
- GORD
- Gout
Assessment:
- 6 Minute Walk Test: 340m, nil aid, nil rests, lowest SpO2 98%, BORG RPE Pre 2, Post: 7
- 5 Times Sit to Stand: 20.5secs
- Bicep Curl 10 Repetition Max: 3kg both arms
- Timed up and Go Test: 25.5 secs
Questions:
- What other information do you require of Keith’s situation?
- What other members of the multidisciplinary team would you need to involve?
- Develop a potential exercise program for Keith over the next four weeks. How often would you want him to participate? Will you provide him with any home based instructions?
- What would you monitor Keith for during and after his session?
- What other information do you require of Keith’s situation?
- Is he on any ongoing treatment or have any upcoming treatment plans?
- Pre-morbid mobility and exercise history
- Does he have any associated pain with his known T1-2 Lytic Lesions – what are their size and type
- What other members of the multidisciplinary team may you need to involve?
- Dietitian – likely significant weight loss during acute admission including use of NGT
- Psychologist – possible significant trauma associated with period of being significantly unwell and long hospital admission
- Occupational Therapist for the management of fatigue
- Develop a potential exercise program for Keith over the next four weeks. How often would you want him to participate? Will you provide him with any home based instructions?
- Aim towards 3 x weekly aerobic exercise of 30 mins and 2 x sessions of resistance training – at moderate level of exertion to target Cancer Related Fatigue
- Slowly build towards the goal of 150 mins of exercise per week
- Give him “Being Active When You Have Cancer” info sheet for basic ideas on how to start being more active now that he is home
- What would you monitor Keith for during and after his session?
- During session fatigue and post session fatigue
- HR/SpO2/BP/BORG RPE scale for exertion
- Back pain associated with lytic lesions and adjust exercises accordingly
- Taking regular rest breaks
“I can now stand long enough to cook a meal. Yesterday, my son and I were cleaning out the gutters, and that is something I couldn’t have dreamt of when I started this program.” – Keith
Keith regained much of his energy and was able to join a community health service for ongoing exercise services.
He returned to walking significant distances for exercise and is back on a full diet.
Note: Case studies have been adjusted for educational purposes with the consent of the participants.