Hi,
I'm new to the Myeloma Beacon. Last month I had an appointment with my new doctor through my HMO for a regular checkup and to discuss my peripheral neuropathy and spinal arthritis symptoms. I've had the peripheral neuropathy symptoms since around 2005.
Previous explanations were at first, anxiety, then later possibly related to early diabetes. My new doctor did not agree with either explanation, so she ran an SPEP and it came back with an interpretation of M protein in the gamma region, 1%. She emailed me that it was only a slight elevation and nothing to worry about, and that she wanted to repeat the test in 12 months.
I didn't really know much about protein in the blood could mean, other than it usually is not a good thing. So after searching online and talking to a family member who has been a clinical lab scientist for 40+ years, I decided to email my doctor to ask if both an SPEP and S-IEP could be run in 6 months. She agreed to run an SPEP and a U-IEP at 6 months out. All my other labs came back within normal ranges.
I'm a reasonably healthy and active 63 year old, with the main issues being the peripheral neuropathy and the "significant amount of spinal arthritis throughout my spine" and DISH of the thoracic spine.
I was wondering if this seems like a reasonable approach at this point.
I've learned quite a bit by reading other posts on this forum and appreciate the kind support shown by other users. Thank you.
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Re: Plan for additional tests after serum M protein 1% found
Hi TerriLyn,
Welcome to the forum.
In a nut, you have some monoclonal protein registering in your blood. This can only mean that there is some some sort of plasma cell dyscrasia (disorder) going on, although it may only be early stage MGUS.
You said you have a "1%" M-protein level. Do you know your absolute M-protein value (it would likely be expressed in mg/dL or mg/L) and would show up on your SPEP report? Are your hemoglobin, serum creatinine and calcium levels all normal?
You also said that you have peripheral neuropathy coupled with spinal issues.
If you didn't have the above symptoms, it might be OK to wait for follow-up tests. But I just don't see the logic in waiting for more thorough follow-up tests under the circumstances, especially since these are not expensive tests. I would be pushing for the following tests to get a more complete picture and get to a diagnosis sooner rather than later:
1. Serum protein electrophoresis (again)
2. Serum immunofixation
3. Serum free light chain assay
4. Quantitative immunoglobulins (IgG/IgA/IgM)
A 24 hour urine test is also a good idea, but it doesn't really substitute for the above tests.
Running all of the above tests together will tell you more precisely just what is going on and would allow a hematologist to come up with a preliminary diagnosis. Depending on what those test results show, it might then make sense to wait 6-12 months for a follow-up test.
Just my two cents ...
Welcome to the forum.
In a nut, you have some monoclonal protein registering in your blood. This can only mean that there is some some sort of plasma cell dyscrasia (disorder) going on, although it may only be early stage MGUS.
You said you have a "1%" M-protein level. Do you know your absolute M-protein value (it would likely be expressed in mg/dL or mg/L) and would show up on your SPEP report? Are your hemoglobin, serum creatinine and calcium levels all normal?
You also said that you have peripheral neuropathy coupled with spinal issues.
If you didn't have the above symptoms, it might be OK to wait for follow-up tests. But I just don't see the logic in waiting for more thorough follow-up tests under the circumstances, especially since these are not expensive tests. I would be pushing for the following tests to get a more complete picture and get to a diagnosis sooner rather than later:
1. Serum protein electrophoresis (again)
2. Serum immunofixation
3. Serum free light chain assay
4. Quantitative immunoglobulins (IgG/IgA/IgM)
A 24 hour urine test is also a good idea, but it doesn't really substitute for the above tests.
Running all of the above tests together will tell you more precisely just what is going on and would allow a hematologist to come up with a preliminary diagnosis. Depending on what those test results show, it might then make sense to wait 6-12 months for a follow-up test.
Just my two cents ...
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Plan for additional tests after serum M protein 1% found
Thanks for your reply, Multibilly.
Calcium was normal at 9.5 mg/dL; creatinine normal at 0.65 mg/dL, Hgb normal at 13.3 g/dL.
I did not see anything in my records that shows absolute M protein value. I have a protein electrophoresis interpretation, serum that read SPEP abn, Homogeneous Band in Gamma Region, M-protein band, percent 1. The SPEP form shows total protein at 7 g/dL, then all the other breakdowns, Albumin, Alpha-1, Alpha-2, etc., which all appear to be in the normal range.
I have another doctor's appointment in several weeks, so I'll request the additional tests and see what happens. Fingers crosses.
Thank you for your input.
Calcium was normal at 9.5 mg/dL; creatinine normal at 0.65 mg/dL, Hgb normal at 13.3 g/dL.
I did not see anything in my records that shows absolute M protein value. I have a protein electrophoresis interpretation, serum that read SPEP abn, Homogeneous Band in Gamma Region, M-protein band, percent 1. The SPEP form shows total protein at 7 g/dL, then all the other breakdowns, Albumin, Alpha-1, Alpha-2, etc., which all appear to be in the normal range.
I have another doctor's appointment in several weeks, so I'll request the additional tests and see what happens. Fingers crosses.
Thank you for your input.
Re: Plan for additional tests after serum M protein 1% found
Hi TerriLyn,
That's good news about your blood markers. Also, if your M-protein (aka M-spike) is 1% and your total protein is 7 g/dL, that means your M-spike is only about 0.07 g/dL - which is a very tiny M-spike.
The key thing you want to rule out in your next round of tests are some versions of multiple myeloma and related diseases where predominantly the kappa and lambda free light chains are the proteins that get out of whack as opposed to a heavy chain such as your IgG. That's why it will be important to get your serum free light chains measured.
Let us know how things go and good luck.
That's good news about your blood markers. Also, if your M-protein (aka M-spike) is 1% and your total protein is 7 g/dL, that means your M-spike is only about 0.07 g/dL - which is a very tiny M-spike.
The key thing you want to rule out in your next round of tests are some versions of multiple myeloma and related diseases where predominantly the kappa and lambda free light chains are the proteins that get out of whack as opposed to a heavy chain such as your IgG. That's why it will be important to get your serum free light chains measured.
Let us know how things go and good luck.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Plan for additional tests after serum M protein 1% found
Thanks for the info, Multibilly. I'll post back when I have more results.
Re: Plan for additional tests after serum M protein 1% found
Today I emailed my doctor to request that a serum free light chain test and a quantitative immunoglobulins test be done to get a baseline. She emailed back that because my SPEP had an M band < 5, further testing isn't necessary. She said that < 5 percent does not mean much.
Are they basing their protocol on an outdated set of standards?
Thanks.
Are they basing their protocol on an outdated set of standards?
Thanks.
6 posts
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