I have severe diverticulosis.
I was just diagnosed IgG kappa multiple myeloma February 2015 and have finished my 3rd round of VRD [Velcade, Revlimid, dexamethasone] with one more round to go before harvest.
I've had two bouts of diverticulitis already, brought on at least partially from the on-and-off constipation from the meds that I just can't get regulated.
The first bout I got under control on my own in two days without antibiotics. But the current one is worse, probably because of my ANC dropping to 0.49. (the doctor held my Velcade that week), then had to hold Velcade and dex the next week with the infection. Instead I had to get IV antibiotics and now orals.
Just wondering if anyone has any useful insights or perspectives regarding diverticulitis during treatment for multiple myeloma.
I'm facing the transplant decision and wondering how all the really severe states of no immunity coming up will affect this issue and whether this needs to be part of the basis for my decision one way or the other.
Thank you.
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Dealing with diverticulitis
Hi HeddleAndHook,
In case it might help a bit, there have been several previous postings in the forum where people have mentioned cases of diverticulitis. Perhaps some of them will have information that's helpful to you. Just click the link at the beginning of this paragraph, and you'll be taken to a list of the postings. (The link was generated using the forum's Advanced Search function.)
Best of luck to you.
In case it might help a bit, there have been several previous postings in the forum where people have mentioned cases of diverticulitis. Perhaps some of them will have information that's helpful to you. Just click the link at the beginning of this paragraph, and you'll be taken to a list of the postings. (The link was generated using the forum's Advanced Search function.)
Best of luck to you.
Re: Dealing with diverticulitis
I don't know why when I searched diverticulitis that nothing came up.
That said, now that I've read the few posts in your link – it seems that there are very high risks of a complicated diverticulitis infection with myeloma and with SCT. Just what I was afraid of.
And that's why I would like more information about how to handle this and what path to take.
Thank you.
That said, now that I've read the few posts in your link – it seems that there are very high risks of a complicated diverticulitis infection with myeloma and with SCT. Just what I was afraid of.
And that's why I would like more information about how to handle this and what path to take.
Thank you.
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Dealing with diverticulitis
The Revlimid is more likely causing the low white blood cell counts, not the Velcade. Revlimid is also generally more GI toxic. An option might be lowering the dose of Revlimid, or even holding off on it for now (depending on your response to therapy to this point).
Once your GI system is doing better, you might feel more secure with the idea of a transplant. Certainly a transplant is associated with GI side effects, so your concern is well founded, but hopefully with antibiotics, a good regimen to prevent constipation, and close monitoring you will be ok.
Once your GI system is doing better, you might feel more secure with the idea of a transplant. Certainly a transplant is associated with GI side effects, so your concern is well founded, but hopefully with antibiotics, a good regimen to prevent constipation, and close monitoring you will be ok.
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Dr. James Hoffman - Name: James E. Hoffman, M.D.
Beacon Medical Advisor
Re: Dealing with diverticulitis
I'm still searching out information about this issue. I just saw this in a 2005 article from the Annals of Surgery (full text at PubMed):
But since I have diverticuli throughout the colon, the last point about sigmoid resection would not apply, and partial colectomy does not rule out recurrent diverticulitis anyway per other studies.
Thank you, Dr. Hoffman, for your reply, I am now on Neupogen injections 4 x week to keep my ANC up. I also have started my 5th round of induction as my M spike has slowed responding. Plan is ( was) for harvest after the 4th or 5th round.
I'm still looking for some answers or suggestions to best protect my intestines during the upcoming procedures.
I've heard of palifermin (Kepivance) and, despite no difference between it and placebo in one trial, I wonder about its use in my instance. Or something similar / newer?
Many studies have shown a significant correlation between immunosuppression and perforation as well as poor outcomes.[11,31,32] In a review of 209 patients with acute diverticulitis, Tyau and colleagues identified a significantly higher proportion of immunocompromised patients developing perforated diverticulitis (43%) compared with nonimmunocompromised patients (14%).[13] Postoperative morbidity was 65% in the immunocompromised patients versus 24% in immune-competent patients. Mortality was 39% in the immunocompromised compared with 2% in the nonimmunocompromised patients. Therefore, immune system-compromised patients, including elderly patients, may benefit from early sigmoid resection. Strategies to identify patients truly at risk for catastrophic perforation should be developed ..."
But since I have diverticuli throughout the colon, the last point about sigmoid resection would not apply, and partial colectomy does not rule out recurrent diverticulitis anyway per other studies.
Thank you, Dr. Hoffman, for your reply, I am now on Neupogen injections 4 x week to keep my ANC up. I also have started my 5th round of induction as my M spike has slowed responding. Plan is ( was) for harvest after the 4th or 5th round.
I'm still looking for some answers or suggestions to best protect my intestines during the upcoming procedures.
I've heard of palifermin (Kepivance) and, despite no difference between it and placebo in one trial, I wonder about its use in my instance. Or something similar / newer?
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Dealing with diverticulitis
From our experience: Treat the diverticulitis before the stem cell transplant. The melphalan is terrible on your digestive system during transplant to begin with.
My husband had to have his gall bladder out, and he still has bouts of diverticulitis one year later. Never had it before the cancer diagnosis; it seems to be a regular illness now.
Good luck with everything!
My husband had to have his gall bladder out, and he still has bouts of diverticulitis one year later. Never had it before the cancer diagnosis; it seems to be a regular illness now.
Good luck with everything!
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PaulaAndrade - Name: Paula
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 40
Re: Dealing with diverticulitis
What I am worried about is that the melphalan or any of the chemo that blasts the GI tract--will CAUSE diverticulitis after i get the transplant-- and then I'll have to deal with a possible rupture if it cannot be successfully treated.
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Dealing with diverticulitis
The doctors were standing by and watched my husband everyday and were ready for surgery at any moment. High dose antibiotics right after transplant. He was released at exactly 2 weeks post transplant. UNMC was wonderful prepared for anything.
I wouldn't worry. You will be in good hands, as I am sure diverticulitis is common with the high dose chemo. Are you a surgery candidate now?
Take care!!
I wouldn't worry. You will be in good hands, as I am sure diverticulitis is common with the high dose chemo. Are you a surgery candidate now?
Take care!!
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PaulaAndrade - Name: Paula
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 40
Re: Dealing with diverticulitis
I got diverticulitis about 10 years, first starting in 2003 and repeating mostly once a year (sometimes twice in succession). I was used to it and thought it was annoying, but not dangerous. In fact, I didn't know that it was diverticulitis.
Then in 2012 I got it during a trip to Yosemite and it was in a serious state (couldn't defecate). I had the idea to visit a doctor in Cedar City, where I would pass in a few days. In the meantime, I took some hikes (after a few minutes, walking was OK). In two days the problem was completely over; defecation was normal and the pain was gone.
One and a half year later in October 2013, the problem repeated in the same manner as it did in Yosemite, only this time I didn't take the hikes, since I was at my work. The problem now stayed (the walking moved my bowels in such a manner that the problem was handled).
Now it took three weeks and the last one of the three defecation was completely impossible. At the end of the week, I had terrible pains and I vomited almost three liters of an unknown fluid.
Later I learned that I had an obstruction, a perforation, and because of the obstruction in the ileas, the bowel stops functioning then. Because of the stopped bowel, the stomach can't get rid of the acid anymore and that is about two liters a day. That was the vomit. After the vomit, I felt much better, because of the released pressure.
A day later I went to the hospital and they kept me and gave me emergency surgery. A large part of the sigmoid colon was removed (about 15 inch) and a end colostomy was installed. For a week I had still problems with the bowel, but after a week the bowel resumed work and the stomach again was able to hold some food.
After a year the colostomy was reversed, so everything is normal again, except for the missing part of the colon; It makes me more gassy.
My advice is not to underestimate the dangers of diverticulitis. I had an obstruction and a perforation in the colon. The only luck was that the perforation was behind the obstruction, so the bowels were not able to press the feces in the cavity. That would possibly have killed me.
In short, diverticulitis is nothing to play games with. When taking elective surgery, probably the colostomy can be avoided, since the quality of the ends of the intestines is much better than during emergency surgery.
Good luck with whatever you decide.
Then in 2012 I got it during a trip to Yosemite and it was in a serious state (couldn't defecate). I had the idea to visit a doctor in Cedar City, where I would pass in a few days. In the meantime, I took some hikes (after a few minutes, walking was OK). In two days the problem was completely over; defecation was normal and the pain was gone.
One and a half year later in October 2013, the problem repeated in the same manner as it did in Yosemite, only this time I didn't take the hikes, since I was at my work. The problem now stayed (the walking moved my bowels in such a manner that the problem was handled).
Now it took three weeks and the last one of the three defecation was completely impossible. At the end of the week, I had terrible pains and I vomited almost three liters of an unknown fluid.
Later I learned that I had an obstruction, a perforation, and because of the obstruction in the ileas, the bowel stops functioning then. Because of the stopped bowel, the stomach can't get rid of the acid anymore and that is about two liters a day. That was the vomit. After the vomit, I felt much better, because of the released pressure.
A day later I went to the hospital and they kept me and gave me emergency surgery. A large part of the sigmoid colon was removed (about 15 inch) and a end colostomy was installed. For a week I had still problems with the bowel, but after a week the bowel resumed work and the stomach again was able to hold some food.
After a year the colostomy was reversed, so everything is normal again, except for the missing part of the colon; It makes me more gassy.
My advice is not to underestimate the dangers of diverticulitis. I had an obstruction and a perforation in the colon. The only luck was that the perforation was behind the obstruction, so the bowels were not able to press the feces in the cavity. That would possibly have killed me.
In short, diverticulitis is nothing to play games with. When taking elective surgery, probably the colostomy can be avoided, since the quality of the ends of the intestines is much better than during emergency surgery.
Good luck with whatever you decide.
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RPL
9 posts
• Page 1 of 1