Present Condition

A patient entered the clinic with reduced mobility and balance following a diagnosis of Non-Hodgkin’s lymphoma and six sessions of radiotherapy. He was paralysed for 18 months and 3 months ago he was able to mobilise with one walking stick. He received 6 weeks of rehab from the community rehab team, but this was stopped and his mobility has plateaued.

Main Assessment Findings

After the assessment, it seemed the patient’s main problems were poor core stability reducing his mobility and ability to transfer, weakness of his quads and gluts and poor balance. With treatment, I therefore worked on building up the quads through SLR and squats exercises and gluts through bridging, doing simple gym ball exercises – forwards and backwards and lateral weight transfer exercises, bouncing to activate gluts, catching whilst sat on gym ball to improve balance and also catching in standing position.

On his 2nd visit, his balance had improved and he had minimal postural sway and could walk 5m unaided, which was a significant improvement, showing treatment was successful.

Symptoms:
The most common early symptom of NHL is painless swelling in the lymph nodes in one area of the body, such as in the neck, armpit or groin. Some people have other symptoms relating to where the lymphoma is in their body. Symptoms may include:

• A cough, difficulty swallowing or breathlessness (if the lymphoma is in the chest area)
• Indigestion, tummy pain or weight loss (if the lymphoma is in the stomach or bowel).

If the lymphoma has spread to the bone marrow (where blood cells are made), it can reduce the number of blood cells in the body. This can cause:

• Tiredness (too few red blood cells)
• Difficulty fighting infections (too few white blood cells)
• Bruising or bleeding (too few blood-clotting cells, called platelets).
NHL can also cause more general symptoms, including:
• Heavy, drenching sweats at night
• High temperatures that come and go without any
• Obvious cause
• Unexplained weight loss
• Tiredness
• Itching of the skin that doesn’t go away.

Treatment:

Watch and wait
Some types of NHL grow very slowly and may not cause troublesome symptoms for a long time. Because of this, some people don’t need to start treatment straight away. Instead, they see their specialist for regular check-ups and only begin treatment if they develop symptoms.

Chemotherapy
The most common treatment for NHL.

Steroid therapy
May be given with chemotherapy to help the treatment work more effectively.

Monoclonal antibody therapy
Is often given alongside chemotherapy. Sometimes it’s used after chemotherapy treatment has finished. Monoclonal antibodies used to treat NHL target lymphocytes while having little effect on other cells.

Radiotherapy
This is sometimes used after chemotherapy to treat enlarged lymph nodes or an enlarged spleen. If you have indolent NHL affecting just one group of lymph nodes, radiotherapy may be the only treatment that’s needed.

Stem cell transplant
Less commonly used. It’s sometimes used to treat people who have NHL that has come back (recurrence). It may also be used to treat some types of NHL that don’t respond well to standard chemotherapy treatments. It’s an intensive treatment, so it’s usually only suitable for people who are fit enough to cope with the side effects.

Surgery
This is rarely used to treat NHL as most people need a treatment that can work in several areas of their body at once, such as chemotherapy. If the lymphoma is in just one part of the body, it may be treated with an operation. For example, people who have a rare type of lymphoma called splenic marginal zone lymphoma may have an operation to remove their spleen.

Other treatments
Antibiotics are sometimes used to treat a type of indolent NHL called MALT LYMPHOMA.