This talk will cover. Myeloma kidney disease, pain and fatigue: complications of myeloma and side-effects of treatment. Pain.

Transcription

1 This talk will cover Myeloma kidney disease, pain and fatigue: complications of myeloma and side-effects of treatment Shirley Crofts Myeloma Clinical Nurse Specialist University Hospital Southampton NHS Foundation Trust Pain Fatigue Myeloma kidney disease 1

2 Take home messages Pain Most patients emphasise pain and fatigue as the major problems Myeloma kidney disease is a common complication These are effects of myeloma and its treatment but can be tackled Other side-effects and complications will be discussed in the breakout session Causes Symptoms Treatment Peripheral neuropathy Bone damage Neuropathy localised or general Bone severe local pain, fractures Pain-relieving drugs TENS machine/acupuncture Treat bone disease 2

3 Myeloma bone disease Radiotherapy 70 80% of patients have evidence of bone disease at diagnosis Features: Bone pain Lytic lesions Osteoporosis Fractures High blood calcium Treats: Localised bone damage Rapid pain-relief Relieves pressure on spine Side-effects: Nausea, vomiting Diarrhoea Skin reactions Fatigue 3

4 Bisphosphonates the bone strengtheners Anyone receiving myeloma treatment should receive a bisphosphonate whether or not they have myeloma bone disease Monthly IV infusion Zometa (zoledronic acid) Aredia (pamidronate) Daily tablets Bonefos (Sodium clodronate) Loron Surgical interventions Balloon Kyphoplasty Vertebral compression fracture Insertion and inflation of balloon Side-effects are rare Cavity filled with bone cement. Stabilises and restores height 4

5 Peripheral neuropathy - treatment and management Neuropathic pain-relief (e.g. gabapentin, pregabalin) Dose reduction, frequency or route of administration of treatment Report any symptoms as soon as possible Vitamin B and folic acid supplement Gentle massage, heat/cold packs What patients say: It s there all of the time gnawing away It s a daily reminder that I have myeloma I m reluctant to take prescribed pain-killers as they constipate me Report any new or increasing pain A lot can be done to improve things, a referral to a pain specialist may help Take pain-killers regularly, do not wait until pain is overwhelming 5

6 Fatigue Causes Symptoms Treatment Anaemia Disease-related Side-effect of treatment Extreme tiredness Does not improve with rest/sleep Treat anaemia if present Moderate exercise (Improves exercise tolerance/breaks vicious cycle Fatigue Causes: Myeloma treatments Myeloma itself Psychological effects Diet Thyroid function Symptoms: Feeling tired all the time Waking up tired Too tired to think straight 6

7 Coping with fatigue Plan your day Balance activities with rest Delegate tasks to others Prioritise Take gentle exercise good for combating chronic fatigue Well balanced diet A diary may be helpful TELL YOUR DOCTOR OR NURSE how it affects you What patients say: I feel tired all the time I feel like I m walking through treacle I m too tired to think straight I m tired but I ve done nothing all day Report symptoms to your doctor or nurse you don t have to put up with fatigue Don t underestimate the physical and psychological importance of a good diet, plenty of fluids and a gentle exercise regime 7

8 Myeloma kidney disease Myeloma kidney disease Causes Lights chains can block the tubules Dehydration, hypercalcaemia Some drugs can contribute Symptoms Sometimes none Shortness of breath Swelling in ankles/feet Persistent headaches Treatment High-dose steroids Drinking lots of fluids Dialysis (10% of patients) 8

9 Kidney problems - management Can be reversible if managed and controlled early: Treating the myeloma High-dose steroids Reducing calcium levels Keeping well hydrated Careful use of drugs Dialysis may be needed for some patients What patients say: I struggle to drink so much in a day but taking little and often helps It s difficult to know if my kidneys are alright how can I know for sure? Try to drink between 2 and 3 litres of fluid a day most liquids count so drink as much water, squash, juice, decaf tea, milk as you can Patients with myeloma kidney disease can have no symptoms; however, kidney function will be monitored regularly through blood tests 9

10 Other complications and side-effects This talk has covered Opportunity to ask questions during the afternoon breakout session about: Myeloma bone disease including bisphosphonates, radiotherapy, surgical interventions Peripheral neuropathy Anaemia/neutropenia/thrombocytopenia Gastrointestinal disturbances (diarrhoea/constipation) Thrombosis Pain Fatigue Myeloma kidney disease 10

11 Take home messages Most patients emphasise pain and fatigue as the major problems Myeloma kidney disease is a common complication All of these effects of myeloma and its treatment can be tackled Other side-effects and complications will be discussed in the breakout session MUK resources Pain and myeloma Infoguide Fatigue Infoguide Myeloma and the kidney Infoguide Myeloma TV Medical animations (including Myeloma Kidney Disease and Myeloma Bone Disease) Infoline 11