I had a patient last year initially went to ED with crippling back pain. She
had just entered her 3rd trimester with her 4th child. They found metastatic
breast CA. It had metastasized to her spin e hence the back pain. She had
fetal medicine, Neonatology, Oncology, Internal Medicine, Neurosurgery, Pain
Management on board. They started treatment once she hit the third trimester
and she delivered via c-section at 32 weeks. We saw her on the Oncology floor
until stabilized and she was transferred to labor and delivery for close
monitoring until delivery. She was in hospital for a month and we mostly
focused on functional mobility. We were limited to w/c transfers and
seated/supine exercises because of her pain. We worked closely with pain
management to tone her sessions with her pain meds. We also had to work our
therapy schedules around the times of day when she was hooked up to the fetal
monitors.
You will likely be even more limited due to your patient’s cardiac involvement.
Close monitoring of vitals with activity is essential. Also, keep close watch
on notes from the Fetal Medicine specialists for activity preferences. It’s
possible they may suggest bedrest in which case you’ll be limited to supine
therex.
Ashley Ross
Sent from my iPhone
On May 26, 2021, at 8:12 PM, Allison Brookins <brookina@xxxxxxxx> wrote:
I am reaching out for support/any literature support for a patient with
extremely difficult circumstances.
Patient is a 39 y/o female admitted now for worsening shortness of breath,
cardiac tamponade and persistent malignant pleural effusions. Widely
metastatic/refractory breast cancer (ER/PR+, her-2 neg). Also has DM, type
2. Dx with breast cancer in 2014, underwent chemo in 2014, mastectomy in
2016. Had a pericardial drain placed in 12/2020, pericardial window 1/2021
This patient is at 24w, 3 days gestation with expected date of delivery:
9/12/2021 with her 1st child. Patient wishes to proceed with aggressive care
and her pregnancy.
PT/OT orders received to evaluate and treat.
Patient has Oncology, Maternal/Fetal medicine, Intensivist, Palliative &
Psychiatry disciplines involved medically.
I’m just reaching out to glean any experience/assistance with any listserv
members with ideas/treatment planning ideas so that we support these two
patients to the best of our ability, given the serious nature of the
circumstances. Any reference materials profoundly appreciated.
Thanks in advance,
Allison
.
<image003.png>
Allison Brookins, PT
PT Rehabilitation Specialist
Boise, Elmore, McCall
St. Luke’s Health System
( 208-381-1100, ext 7953001
208-381-2090
(best call reception and voicemail)
+ brookina@xxxxxxxx
"This message is intended for the use of the person or entity to which it is
addressed and may contain information that is confidential or privileged, the
disclosure of which is governed by applicable law. If the reader of this
message is not the intended recipient, you are hereby notified that any
dissemination, distribution, or copying of this information is strictly
prohibited. If you have received this message by error, please notify us
immediately and destroy the related message."
