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Anup Trikannad, M.D., and patient Harshad Inamdar talk over appointment results.
Image by Evan Lewis
Myeloma Center Hospitalists: A Vital Link in Patient Care
| A strength of the University of Arkansas for Medical Sciences (UAMS) Myeloma Center is the variety of strategies utilized to obtain the best outcome for the patient.
The center’s hospitalists are an important part of that process.
Hira Imad Cheema, M.D.
The term “hospitalist” was coined in 1996 to describe physicians who only see patients in a hospital, typically treating a variety of conditions. Myeloma Center hospitalists take that one step further.
“There are general hospitalists and myeloma hospitalists. We provide inpatient care for myeloma patients who may be admitted for chemotherapy or related complications,” said Anup Trikannad, M.D. “We’re a primary care physician while they’re in the hospital, but we’re more specialized for myeloma.”
Myeloma patients are seen by this team even if they’re in the hospital for reasons not necessarily related to their condition.
“If a myeloma patient comes to the emergency room or is in the ICU, we still see them,” said Tanvi Patel, M.D.
Myeloma treatment presents special challenges, and the concept of hospitalists who focus on myeloma patients is a plus.
Manozna Karri, M.D.
“It’s a team effort,” said Hira Imad Cheema, M.D. “We learn every day from the oncologists on how to help take better care of myeloma patients.”
“We have constant discussions with the oncologists, so they are aware of what’s going on with their patients,” added Asis Shrestha, M.D.
Myeloma Center hospitalists conduct the actual stem cell infusion procedures in both inpatient and outpatient settings, and follow these patients till they recover from the side effects.
Syed Naqvi, M.D.
Trikannad said there are various scenarios where a patient could be admitted under the care of the hospitalists.
“A patient may be newly diagnosed with myeloma. They have a workup done and maybe they’re a candidate for a stem cell transplant,” he said. “If it is felt they need to be in the hospital, we take them.”
“We get patients from the Outpatient Clinic to the hospital,” Trikannad continued. “We also take patients from Infusion B who may need to be admitted so we have some continuity of care.”
Cheema said patients greatly benefit from the team’s general medical knowledge.
“Our inpatient and internal medicine training helps,” she said. “We can not only take care of the oncology side, but any other issues a patient may have.”
While the Myeloma Center hospitalists aren’t oncologists, training in that field is a key element in treating myeloma patients at UAMS.
Tanvi Patel, M.D.
“It’s a continuing learning process with myeloma,” said Shrestha. “We have discussions and meetings with the oncologists.”
“We’re always learning,” Cheema said. “Before we start taking care of any of the myeloma patients, we go through training provided by the oncologists.”
Patel notes how understanding myeloma treatment assists in their work with those patients.
“If we know what kind of treatment a patient has received, such as whether they’ve had any recent transplants or what specific type of therapy they’re on, that helps us make decisions on how to treat other issues,” she said.
Asis Shrestha, M.D.
Myeloma patients undergoing immunotherapy or cellular therapy can experience various side effects, including cytopenia, infections or mucositis. A common side effect for myeloma patients is cytokine release syndrome (CRS). The symptoms of CRS can be similar to those of an infection, so it’s important for the hospitalists to know the patient’s treatment regimen.
“If a patient has had an immunotherapy treatment and presents with a fever within a few days, there’s a good chance it’s CRS,” said Shrestha. “If it’s beyond that point, an infection is the more likely cause.”
The hospitalists stress the importance of communicating with the rest of the care team.
“Our communication works very well,” Patel said. “If a myeloma patient is admitted, we inform the oncologist.”
Anup Trikannad, M.D.
“We have weekly meetings about our patients, and the oncologists help direct us,” Trikannad said.
“It’s important to have that contact with the patient’s oncologist so we can inform them of what’s going on while they’re in the hospital,” Cheema said.
“We’re very coordinated, from the social workers, the nursing staff and the oncologists,” Shrestha added. “We want the best for our patients.”
Trikannad expressed the overriding feeling about the team.
“We take accountability for any myeloma patient — they’re ours,” he said.