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Can it still be still multiple myeloma?

by jop on Tue Mar 24, 2015 1:49 pm

I am 36 years from India. I am fed up with my symptoms for many months. I have below lab results from various tests.

All results points to normal. Can it be still myeloma? Or something else?

My Symptoms:

  • Foamy urine for almost 6 months (foam is very much white in color)
  • Gum bleeding while brushing (blood spots)
  • When I apply pressure on the skin, it becomes reddish for few seconds
  • Few reddish skin lesions
  • Mild pain in the middle of the chest in certain positions but not always.
  • Frequent sinus infections. I don't take antibiotics for it. It goes away on its own (My nose has a deviated septum, so I am susceptible to sinus infection from childhood. Either one nostril is always blocked. Doctors suggested me operation for the deviated septum.)
  • Slight weakness for several months
  • Numbness in my hand fingers while sleeping
Family History

Grandfather died of blood cancer. My mother told me that he died of blood cancer. He had kidney problems and bone problems. Was that myeloma?. Not sure. Mother doesn't know.

CBC - all values normal
Kidney profile - all values normal
Liver profile - all values normal
Chest x ray - normal
Abdominal ultra sound Scan - normal
Routine Urine Analysis - normal

Calcium: 9.1 mg/dl ref: 8-10.5
Total protein: 7.8 g/dl ref: 6- 8.2
Albumin: 4.6 ref: 3.5-5.2
Calculated Globulin: 3.2 ref:1.8-3.4
A/G ratio : 1.4 ref: 1.1- 1.8

SPEP:

No monoclonal protein
Total protein -7.6 g/dl
Globulin -3.30
Albumin - 4.3
alpha1: .3 g/dl ref: 0.2-0.4
alpha2: .6 g/dl ref: 0.46-1.38
Beta: 0.8 g/dl ref: 0.3 - 0.89
Gamma: 1.6 g/dl ref: 0.74 - 1.74
Ratio: 1.3 ref:1.5 - 2.5 (out of range)
- Is the ratio an issue? I thought since no abnormal protein, I can ignore this low ratio.

Serum Immunofixation: No monoclonal protein

Serum free light chain: Kappa, lambda and ratio are with in range

Bence Jones test on spot urine: No Bence Jones found

Thanks for reading

jop

Re: Can it still be still multiple myeloma?

by Nancy Shamanna on Tue Mar 24, 2015 2:09 pm

Hi Jop,

I am not a doctor, but looking at your blood tests, all in normal ranges except for the kappa/lambda ratio being lower than normal range, it doesn't look like myeloma to me.

Could it be MGUS or smoldering multiple myeloma? I am not sure about that.

Are you seeing a specialist in internal medicine or a hematologist about these results?

Nancy Shamanna
Name: Nancy Shamanna
Who do you know with myeloma?: Self and others too
When were you/they diagnosed?: July 2009

Re: Can it still be still multiple myeloma?

by Multibilly on Tue Mar 24, 2015 2:56 pm

Hey Nancy,

I hope you are doing well.

The 1.3 ratio in the SPEP is likely the albumin / globulin (A/G) ratio based on the SPEP results, not the kappa / lamdda ratio. That's an easy mistake to make.

Jop,

In any case, I echo what Nancy says. At face value, it doesn't appear to be multiple myeloma, which is good news. I'm not a doc, but a low A/G ratio could possibly indicate:

http://effectivediagnosis.org/albuminglobulin-ratio/

- Autoimmune diseases (where the body starts attacking its own organs)

- Cirrhosis of the liver (Inflammation and scar tissue in the liver)
- 
Kidney disease

But also keep in mind that the A/G ratio reported on your other test is in range and more accurate than the SPEP test results. So, the A/G ratio on the SPEP may be misleading.

Like Nancy suggested, a hematologist or internist might be able to help you out.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Smoldering, Nov, 2012

Re: Can it still be still multiple myeloma?

by Nancy Shamanna on Tue Mar 24, 2015 7:12 pm

Hi MB,

I stand corrected, and the ratio was not to do with the kappa / lambda, since this was the SPEP testing, not serum free light chain testing. Sorry about that!

I actually had not heard of the A/G ratio before this week, so it's something new to learn about.

Hope you can find out why you are having these health problems, Jop.

Nancy Shamanna
Name: Nancy Shamanna
Who do you know with myeloma?: Self and others too
When were you/they diagnosed?: July 2009

Re: Can it still be still multiple myeloma?

by jop on Tue Mar 24, 2015 9:53 pm

Thanks Nancy and Multibilly for the responses.

Nancy - It is the albumin / globulin ratio, not the kappa / lambda.

I am consulting a general practitioner now. He had already seen the A/G ratio on the first test, which is in range. And he is satisfied with the result.

Doctor is yet to see the result of SPEP, IFX and SFLC. I will be consulting him in coming week.

Regarding foamy urine. I have already consulted 2 urologists. Since all lab tests are coming up normal, both are asking me to ignore that :evil: . I really don't want to ignore that symptom.

jop

Re: Can it still be still multiple myeloma?

by mikeb on Wed Mar 25, 2015 11:11 am

Hi Jop,

I'm no doctor either, but I think Multibilly and Nancy are correct that you probably do not have multiple myeloma, fortunately.

You mentioned that one of your doctors suggested sinus surgery for your deviated septum. I had some of the same sinus problems that you mentioned and had sinus surgery in 1999. The surgery ultimately helped me a whole lot. So I recommend that you look into that for your own situation. It won't take care of all the symptoms you described, obviously, but it could be a big help with the sinus-related problems you're having.

Best wishes,
Mike

mikeb
Name: mikeb
Who do you know with myeloma?: self
When were you/they diagnosed?: 2009 (MGUS at that time)
Age at diagnosis: 55


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