This case involves a middle aged woman who presented to her primary care physician with complaints of pain in her lower back that had persisted for some time. The woman was referred to an orthopedic specialist, who ordered an MRI of her lower back with contrast that showed evidence of a vertebral fracture. The patient then underwent a surgical procedure to stabilize the fracture, and to take a biopsy of the area to rule out any malignancies. Despite the fact that the biopsy was positive for cancerous cells, no further action was taken and the patient was not informed of the findings. A year later, the patient discovered that she was suffering from metastatic bone cancer.
Question(s) For Expert Witness
- 1. How often do you see multiple myeloma?
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2. Is the treatment different for patients caught in an early stage before they need surgery?
Expert Witness Response E-007604
Multiple myeloma is the focus of my clinical practice and research. I see approximately 50 follow-up patients per week and 3 new patients per week, all with multiple myeloma or related conditions. Surgery to stabilize the spine may not be necessary for all patients with myeloma. It is possible that an earlier diagnosis would have allowed earlier initiation of chemotherapy and perhaps local radiation that would have prevented further bony damage and the need for stabilizing surgery. If any other complications occurred in the year after the initial biopsy, those also would have potentially been avoided.
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