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UAB Medicine Helps school teacher return to the job she loves

Rochelle Stewart, a teacher with the Walker County Schools Head Start Program at Sumiton Middle School, was diagnosed with multiple myeloma in late 2014. Like many patients with a myeloma that  specifically attacks bone tissue and bone marrow, during the early stages of the disease Stewart believed her symptoms derived from other causes. Her treatment journey ultimately led to UAB’s Comprehensive Cancer Center. Thanks to a successful stem cell transplant and subsequent chemotherapy at UAB, Stewart was approved to return to teaching this past fall.

Stewart was already experiencing sciatic nerve pain when she had a minor fall from a bicycle in the summer of 2014. After that accident her pain became severe and chronic, but she attributed her condition to both the injury and some physical stress at work.

“I thought maybe I was trying to do too much that summer,” Stewart says. “I was moving all our materials to a new building. My doctors said I was not lifting objects properly. I just assumed my pain and inability to function sometimes were a result of the bike accident and the stress, mental and physical, of the move to a new school. It just made sense. I think anybody would make those assumptions. Once it got to the point where my legs, hips, and back just felt like they were on fire, I began to have days when my body would seize up. I was told that those muscle spasms were due to the sciatic nerve condition.”

Stewart says her determination to continue working was good for her mood but terrible for her condition. She began to rely more and more on her assistant, Kimla Greene, at the school.

“There were so many things I once handled myself that I had to turn over to others,” Stewart says.  “It was very fast. First I was using a cane, and I went from that to using a walker, and then finally my coworkers were rolling me through the halls in a wheelchair. During Thanksgiving of 2014 my mother and I laughed about both of us being in wheelchairs. I suppose I was still in good spirits over the holiday, because I assumed that my back pain would be resolved if I just took it easy for a while. When I returned to the school after Thanksgiving to decorate for Christmas, I had a fall and broke my femur. I couldn’t get off the floor without help. That’s when one of the teachers told me, ‘this is something other than just back pain.’”

Again, Stewart remained convinced that a few days of rest would resolve the matter, but the following Monday she woke unable to stand. Even at that stage she was insisting to family that her main worry was about “getting Christmas ready for the school kids. However, once she arrived at the ER that morning, Stewart learned that she had something else to worry about. Imaging revealed lesions and along her pelvic girdle, finger, kneecap, and spine.

“I didn’t believe it,” Stewart recalls. “I told the surgeon who was going to perform the procedure on my femur that as soon as that was done I could get back to school. I was thinking of the kids, of course, because I wanted all our Christmas events to be prepared for them. Even if I was in a wheel chair I could direct my assistants. My doctor said, ‘Miss Stewart, I love your dedication, but we can’t send you back to that school.’ It finally registered what he was telling me.”

After Stewart had extensive surgeries to remove lesions from her knee, back, and femur, she was referred to UAB for treatment of multiple myeloma.  She underwent a bone marrow transplant in December and began a regimen of chemotherapy the next month. As multiple myeloma develops in the bone marrow, certain bone marrow plasma cells that help fight infection begin behaving in a way that leads to multiple tumors within the bone marrow space. The affected space weakens with time, resulting in destruction of the bones of the spine, pelvic bones, ribs, and areas of the shoulders and hips.

Racquel Innis-Shelton, MD, with UAB Department of Hematology/Oncology, notes that it’s not unusual that Stewart was surprised by the diagnosis.

“Patients have variable degrees of reported pain as the cancer develops,” Innis-Shelton says. “Many patients will explain it away, thinking perhaps they’ve lifted something the wrong way, or any number of reasons based on some injury. More commonly than not, it is the pain that continues to worsen, or a sudden unexplained bone fracture, that prompts further investigation into the cause of their condition. Rochelle’s multiple fractures raised suspicions, and unfortunately this ended up being a cancer that arose from the bone marrow itself. She had multiple severe pathologic fractures, which left her with poor hope of ever being able to walk again.”

Innis-Shelton says the first step is treating any immediate or impending fractures to stabilize and reinforce bone structure..

“More than 70 percent of patients with multiple myeloma will have some degree of bone destruction, depending on the genes that have been affected in forming the diseases,” she says. “If the bones are not at risk of impending fracture then the next immediate step is to treat the underlying problem. The goal in treating myeloma is to keep control of the disease by a combination of chemotherapy and biologic agents that eliminate cancer cells from the bone marrow. There are now more than 30 different combinations of chemotherapy that are effective in the management of myeloma when it first appears and when it relapses, which is often the case.”  

Stewart recalls her initial experience at UAB as a long series of imaging, tests, and  then physical therapy at Southern Orthopedics in Jasper, AL, which meant she couldn’t see the kids and their families during Christmas. “My prognosis was very serious,” Stewart says. “I was informed of the bone marrow transplant procedure, but they also insisted that I need to take care of me before I could began taking care of the school kids again. I was at UAB in early December and was discharged on Christmas Eve. I began chemotherapy in January 2015.”

After receiving what she calls the worst news she ever had, Stewart began to see improvement in her condition. But she recalls that what most improved her mood was interaction with her care team and other patients at UAB.

“My experience at UAB has been exceptional,” she says. “Dr. Shelton and Dr. Lucia Costa were very instrumental in my treatment and recovery.  They kept me well informed every step of the way. I couldn’t have made it through without them.  The nurses in the bone marrow unit were exceptional as well. I think because I had such confidence in my doctors and all the staff here, I was able to be helpful to some other patients and pass along that positive mood We got to know each other like we were growing up to together. I would visit with others who were struggling with cancer and I would tell them ‘This does not define you. You are much bigger than this disease you are fighting.’ But it was these phenomenal nurses and doctors who made me brave. From the day I arrived I’ve been treated like I was their number one case. That’s every unit, every doctor.”

Stewart’s cancer was in remission in late 2015 after she finished her last chemo treatment.. Along with the good news about her treatment progress, she received the news she most hoped for all along. Stewart was released to return to teaching for fall of 2016.

“The doctors offered to retire me when all this began,” Stewart says. “I had certainly thought about that during treatment. But I love teaching. I think I always knew I would get back to my kids if I had the chance and if I was healing properly. So I’m back now. This will be my 23rd year.”