On May 2, 2017 I had a fall and spent 20 hours in the emergency room (ER). During that time the doctors found nothing wrong with me. I had an appointment with my neurologist at the VA the following week and he suggested MRIs of my skull and spine. The skull MRI was fine, but the spinal MRI showed spots on my L2 and L5. So they did a bone scan which came up completely clear.
I took copies of the MRIs to my doctor at my health plan, who consulted with a couple of oncologists and a hematologist, who suggested a blood test. I finally got them to give me the results of the blood test tonight:
Test Ref Range & Units Result
IgG 600 - 1,600 mg/dL 1,140
IgA 40 - 375 mg/dL 248
IgM/Plas 30 - 190 mg/dL 775
It looks like the IgM/Plas is way high. I am not due for another test until January. Is this reading something that I should push them on?
Thanks.
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EoinDubh - Name: Michael Black
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 2017
- Age at diagnosis: 72
Re: High IgM - should I ask for quicker follow-up testing?
Hi Michael,
When you said you had a "bone scan", was that actually a true "bone scan" (aka bone scintigraphy) or was it a CT or a PET/CT scan? Scintigraphy is not at all good at picking up the kind of lytic lesions that are caused by myeloma and related diseases.
Secondly, with a relatively high IgM level like yours, I would personally push for some follow up sooner rather than later. I don't know what your choices are for doctors given you say you are going to the VA. But if you can see a myeloma specialist, that would be ideal.
In the meantime, I would also push for some other basic tests, including a a serum electrophoresis, serum immunofixation, and a serum free light chain assay, along with a CBC and comprehensive metabolic panel.
Also, note that monoclonal IgM-related disorders tend to be rather unique. If the serum electrophoresis and serum immunofixation results show that a portion of your IgM is monoclonal (cancerous), then I would suggest that you study this article:
J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)
If no monoclonal IgM is detected via the above tests, then you would start to look for other conditions such as infection, hepatitis, liver disease, etc.
Hope this helps a bit.
When you said you had a "bone scan", was that actually a true "bone scan" (aka bone scintigraphy) or was it a CT or a PET/CT scan? Scintigraphy is not at all good at picking up the kind of lytic lesions that are caused by myeloma and related diseases.
Secondly, with a relatively high IgM level like yours, I would personally push for some follow up sooner rather than later. I don't know what your choices are for doctors given you say you are going to the VA. But if you can see a myeloma specialist, that would be ideal.
In the meantime, I would also push for some other basic tests, including a a serum electrophoresis, serum immunofixation, and a serum free light chain assay, along with a CBC and comprehensive metabolic panel.
Also, note that monoclonal IgM-related disorders tend to be rather unique. If the serum electrophoresis and serum immunofixation results show that a portion of your IgM is monoclonal (cancerous), then I would suggest that you study this article:
J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)
If no monoclonal IgM is detected via the above tests, then you would start to look for other conditions such as infection, hepatitis, liver disease, etc.
Hope this helps a bit.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgM - should I ask for quicker follow-up testing?
Multibilly,
Thanks for the info. I am in 2 healthcare systems: one is the VA and the other is Kaiser. The VA took the original MRIs after the fall on May 2nd. The MRI of the head was fine. The whole body MRI showed two spots on the lumbar spine: L3 and L5. The spot on the L5 is 1.5 millimeters and on the L2 is 12.2 millimeters. The VA then did a bone scan, not sure, but I think it was a CT scan, and found nothing, so they thought that the spots on the MRI were anomalies.
I took copies of all the scans to my GP at Kaiser and he consulted with a couple of oncologists and a hematologist who suggested the blood test which returned the results in my first post above. Their decision was to wait for 6 months and repeat the tests. That would be early January. I emailed him earlier today to ask if the tests could be moved up. If not, I will contact my VA GP to see if they can do it sooner.
This all a bit scary for me as we lost a good friend to multiple myeloma a couple of years ago and it was pretty bad.
Another issue is that my exposure to Agent Orange in Vietnam is somewhat of a factor. I had prostate cancer in 2015 that was diagnosed as early stage 2, but when they did the surgery, it was actually stage 4 and had invaded my bladder. They monitor prostate cancer with a blood test on the PSA level and do not worry unless the level goes above 5.0. The day of the operation, my PSA level was 3.5. Agent Orange seems to mess with standard levels.
Hopefully I can get 1 or more on my doctors to get on with it.
Thanks for the info. I am in 2 healthcare systems: one is the VA and the other is Kaiser. The VA took the original MRIs after the fall on May 2nd. The MRI of the head was fine. The whole body MRI showed two spots on the lumbar spine: L3 and L5. The spot on the L5 is 1.5 millimeters and on the L2 is 12.2 millimeters. The VA then did a bone scan, not sure, but I think it was a CT scan, and found nothing, so they thought that the spots on the MRI were anomalies.
I took copies of all the scans to my GP at Kaiser and he consulted with a couple of oncologists and a hematologist who suggested the blood test which returned the results in my first post above. Their decision was to wait for 6 months and repeat the tests. That would be early January. I emailed him earlier today to ask if the tests could be moved up. If not, I will contact my VA GP to see if they can do it sooner.
This all a bit scary for me as we lost a good friend to multiple myeloma a couple of years ago and it was pretty bad.
Another issue is that my exposure to Agent Orange in Vietnam is somewhat of a factor. I had prostate cancer in 2015 that was diagnosed as early stage 2, but when they did the surgery, it was actually stage 4 and had invaded my bladder. They monitor prostate cancer with a blood test on the PSA level and do not worry unless the level goes above 5.0. The day of the operation, my PSA level was 3.5. Agent Orange seems to mess with standard levels.
Hopefully I can get 1 or more on my doctors to get on with it.
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EoinDubh - Name: Michael Black
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 2017
- Age at diagnosis: 72
Re: High IgM - should I ask for quicker follow-up testing?
Well, it looks like both the VA and Kaiser finally are in agreement. After harvesting some spinal bone marrow and more blood, they now say that it is MGUS. Now they want me to come in annually for another MRI and blood test.
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EoinDubh - Name: Michael Black
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 2017
- Age at diagnosis: 72
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