Monday, 12 December 2016

Monash doctors give back life

Monash Health patient Grace Day
Until July this year, Grace Day had never had a sick day in her life.  The 85-year-old swam 3km three times a week and regularly won gold medals in her age group at Masters swimming competitions.

It came as a total shock when Grace was diagnosed with stage 4 lung cancer.  A non-smoker and teetotaller, Grace’s cancer was caused by passive smoking—she had worked at Australia Post her entire life surrounded by colleagues who smoked.
After several months of chemotherapy at Monash Health, Grace’s lung cancer was contained and stabilised, however, as is often the case for many cancer patients, the cancer spread into her bones.

“I’d been mowing the lawns, doing all the gardening and housework, and then out of the blue I had intense and sudden pain in my back,” said Grace.  “Until then I’d had absolutely no pain at all.”

Grace said the pain was so severe she couldn’t walk or see properly.
“I couldn’t put two sentences together because of the pain,” said Grace.

Dr William, Dr Yoong and
A/Prof Chandra at McCulloch House
Due to the severity of her pain, oncologist Dr Peter Briggs referred Grace to McCulloch House, the specialist inpatient unit of the Supportive and Palliative Care service of Monash Health. However, less severe symptoms may have led Grace to the OncoPain clinic, also run by the palliative care service. 

“Monash Health provides a unique cancer pain clinic, not available at other
health services,” said palliative care physician Dr Leeroy William.

“Moreover, patients with cancer pain can also rapidly access procedures to reduce pain though a recently developed multidisciplinary clinical collaboration.”  

The multidisciplinary team includes the palliative care physicians, interventional radiologists and neurosurgeons.

“We aim to get patients into palliative care as early as possible—not because they’re dying but rather to manage their pain and prevent them having treatment breaks,” said Dr William.

Dr William said that evidence shows patients who start palliative care earlier have a significantly improved quality of life and also live longer.

In order to best manage her pain, Grace was referred to Associate Professor Ronil Chandra, an interventional neuroradiologist with expertise in the minimally invasive procedures of vertebroplasty and kyphoplasty.

“When I heard about Grace, the back pain from her fractures was so severe that it was causing her to become virtually bed-bound,” said Associate Professor Chandra.

“I organised further imaging and reviewed Grace at McCulloch House, which confirmed that her fractures were amenable to treatment by kyphoplasty.”

“Kyphoplasty is an interventional radiological procedure where we navigate a small needle through the skin of the back under x-ray guidance directly into the bone, inflate a balloon to create a small space and inject medical cement to stabilise the fracture which reduces the pain.”

New evidence shows that patients with severe pain from a recent spinal fracture have significantly less pain after vertebroplasty or kyphoplasty.  

Associate Professor Chandra said the procedure takes under an hour to perform and is generally done under conscious sedation.

“Until the procedure, I couldn’t stand, I couldn’t walk, and the pain just stopped me dead in my tracks,” said Grace. 

“Immediately after the operation, I felt no pain—for the first time in two months I had no pain and I could walk straight away.”

“What Associate Professor Chandra did is unbelievable—he gave me back my legs and also my life.   I can drive again, and am living independently and doing everything I used to.”

“I’m so grateful to all the staff at Monash Health and I just want to tell everybody what a positive and wonderful experience I’ve had at Dandenong Hospital, Moorabbin Hospital and Monash Medical Centre.  McCulloch House was just the icing on the cake,” said Grace.

Grace plans to be back in the pool early in the New Year.

A Monash University case report highlighting the benefits of sacroplasty (another type of vertebroplasty) for cancer pain, was published last week in Pain Practice.  The lead author is palliative care physician Dr Jaclyn Yoong, in collaboration with Associate Professor Ronil Chandra, Dr Leeroy William, Associate Professor Michael Franco, Associate Professor Tony Goldschlager, Dr Fiona Runacres and Associate Professor Peter Poon.

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