Select Page

Post-Radiation Patient

Exit forum ID Forum Discussion Post-Radiation Patient

This topic contains 1 reply, has 2 voices, and was last updated by   William Brady, DC October 31, 2017 at 9:11 am.

Viewing 2 posts - 1 through 2 (of 2 total)
  • Author
    Posts
  • #3212

    Danielle Hommer, DC
    Participant

      I have a fit 53 year old (fitness classes 2-3xs/week, walking 2-3x/week) LB disc patient go through treatment successfully from last September-November. I would rate her at a 33% disc/66% adhesion diagnosis – no imaging responded wonderfully both objectively & subjectively to care. We put her on maintenance at the beginning of the year and she held a clean pencil test (Flat only segment to segment) at follow-ups in February, April & then July as she went through chemotherapy for breast cancer Feb-April, a mastectomy in June & then radiation through August.

      She came in late September and reported right glute pain the last 2 weeks – her original complaint. She was in extension from 0-3″; after that treatment she was flat 2-4.25″. We’ve treated 8 times since (started hip lift exercise at visit 4) and she’s up and down with symptoms and QLF. I know load is a factor; she admits to working longer hours the past few weeks but has made a concerted effort to take breaks every 30 minutes. We have tried to implement good mornings over the last few visits as I think strength is an issue at play but is symptomatic in the right L5 region (where her disc injury is) with a dowel only. (I’m translating this as disc irritation and that means we’re not ready for that, is that correct?)

      I have read some resources concerning side effects of radiation & ‘fibrosis’ is one of them although typically in the area of radiation [how far away is too far? I’m sure that’s unfortunately unknown]. Is this a load problem, a healing problem due to radiation or a weakness problem? We’re managing 1 & 3 but I do not have enough experience to answer #2. We’re getting down to the last bit of adhesion & I feel like I’m squeezing the test. She only reports 1-2/10 VAS 25% of the time (end of day mostly) but we had her symptom-free and progressed steadily last round.

      Where do I go next? Take some time off of treatment to focus on strength at-home, really hammer on load, get imaging? I will re-test other LB exams to get those current & report back any outliers.

      #3260

      William Brady, DC
      Participant

        Well done! Great job and great questions.

        Yes, if the exercise is producing symptoms then she is not ready for that. With the good morning you can cut the range in half and try that.

        Having cancer, chemo and existing disc pathology makes for the opposite of a healing environment. I can see why she still has some symptoms. Her diet, load, stress would all need to be managed (not all by you). I would get the MRI to grade the extent of the degeneration and rule out metastasis (you can’t be too careful with cancer patients).

        Don’t forget it’s not our job to “fix” everyone to 100%. It is our job to diagnose and reduce reducible dysfunction. We don’t control the irreducible blocks or many other variables.

        Keep up the great work.

      Viewing 2 posts - 1 through 2 (of 2 total)

      You must be logged in to reply to this topic.