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Does this look like myeloma?

by yomaxx on Fri May 08, 2015 3:04 pm

Hi everyone! I'm a 37-year old male who was recently married this past September. My wife and I went on our honeymoon in September and returned October 1. I haven't been feeling well for about a year and a half. Fatigue, joint pain, just generally not feeling well. I went to my primary, he ran bloods and said you look good and your bloods look good.

A few months went by, and I started noticing what appeared to be bone pain. Mainly arms and shoulders. I went back to my primary who now labeled me a hypochondriac I'm sure. He did basic cbc and a few other tests that all came back fine, except elevated calcium and para­thyroid slightly high. He sends me to a endocrinologist who runs a bunch of tests to rule out hyper­parathyroidism. All tests come back fine.

I go on a diet prior to my honeymoon and that makes me feel so so. I return from my honey­moon in October. Come November, I immediately notice that my health is getting worse as far as bone pain, fatigue, knees going numb, hands and feet tingling, teeth chattering, and the list goes on. Bone pain was so bad I took myself to the ER in December and in January; both times I was cleared and told I was fine.

Fast forward to 2 weeks ago. My wife works in a hospital and suggested I see a neurologist for all my complaints. I see him, and he runs a slew of blood tests; 16 vials to be exact :D He also orders a brain and spin MRI. He calls me this past Wednesday evening at home and says my MRI came back fine and in my spine on the right side I have a herniated disc. He then begins to tell me that my immunoelectrophoresis came back what he labeled "trivially" high. IgM serum was 277 with range being 48-271.

He proceeds to tell me that I should follow up with a hematologist. Here is my concern: I ended up swinging by the doctor's office to pick up my blood results. I like to always have copies for my record.

Upon looking at my results, I see he ran what is called a "Freelite Serum" test. He didn't discuss the results with me over the phone, and I'm still waiting on his call. Here are the numbers.

Free Kappa Serum is 19.9 Range being 3.3 - 19.4 so that's high.
Free Lambda Serum is 11.2 Range being 5.7 - 26.3 so that is fine.
Free Kappa/Lambda Ratio is 1.78 Range being 0.26 - 1.65 so that is high.

So of course I'm concerned, and I start googling everything under the sun. And that is how I stumbled across the Myeloma Beacon.

Everything I have read when I google abnormal freelite comes back to myeloma over and over. What scares me even more is I have extreme bone pain in my ribs, chest, and back bones since November. I have an appointment with a hematologist this coming Wednesday.

I would like to hear some options / facts from some of the experienced people here. I have to be honest with you and say I was hysterical crying in the shower this morning. Not sure if I'm jump­ing the gun here, but I feel this may be serious.

Thanks in advance, Mike.

yomaxx

Re: Does this look like myeloma?

by yomaxx on Sat May 09, 2015 9:33 am

Anyone?

yomaxx

Re: Does this look like myeloma?

by Multibilly on Sat May 09, 2015 9:57 am

Yomaxx,

You really need to look at an immunofixation (IFE) test to see if any of your excess proteins (IgM and kappa free light chain) are monoclonal or not. This would be indicated as a notation in the the IFE report

There is a also a test called a serum protein electrophoresis (SPEP) that measures the amount of monoclonal immunoglobulins in your blood. If you do have the SPEP results already, you should look for something that says M-spike, abnormal protein band, paraprotein, Mprotein, etc in that report.

I don't know if your doc ran these tests, but your hematologist will likely run these tests.

All your numbers are just barely outside the normal range, so they could easily be explained by lab error or other conditions such as inflammation. Also, it is rare to have a monoclonal gam­mop­athy that involves the IgM immuoglobulin, whether it be multiple myeloma or a condition called Waldenstrom's macroglobunemia.

I realize it is tough to wait for results, but I would try not to freak out and simply wait till you have some more definitive guidance from a hematologist before jumping to any conclusions and knock­ing yourself out on Google. Wednesday will be here before you know it.

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

Re: Does this look like myeloma?

by yomaxx on Sat May 09, 2015 1:10 pm

First and foremost, thank you very much for your reply Multibilly!

My neurologist did run the Immunofixation Serum. It noted,

"No monoclonal proteins detected"

He also tested the Protein Electrophoresis Serum. Is this the (SPEP) that you mentioned?

It noted,

"Faint band visible with overall polyclonal pattern in the gamma region. This may represent an inflammatory or acute phase response, but a developing plasma cell disorder cannot be excluded. Serum and urine immunofixation may be useful, if clinically indicated."

The main reason I am highly concerned is the EXTREME bone pain! I drive a truck in New York City and everyday I have to shift positions while I'm driving because the bone pain is so extreme. It's the bones in my ribs, chest, and back. The only way I can describe is it feels as if there is a vice grip on my back and ribs and it's constantly being tightened around me.

Also, another concern is that Advil (ibuprofen), Aleve (naproxen), and other pills have no affect on the pain. If it was more of a inflammatory thing, I assume these anti inflammatory pills would have some affect and help relieve the pain a bit. Unfortunately, they don't.

Also, I'm not sure if this has any significance, but I had blood drawn a day after I finished a one week dose of amoxicillin for a bad cold. Not sure if that would hinder test results.

yomaxx

Re: Does this look like myeloma?

by Multibilly on Sat May 09, 2015 1:35 pm

Well, I am sure you will mention all this to the hematologist next Wednesday. You may want to discuss getting a bone marrow biopsy when you see your doctor. There is a form of multiple myeloma that is "nonsecretory", where none of the telltale markers show up on in one's blood or urine (or they just barely register) and one needs to confirm this via a bone marrow biopsy.

But I'm not sure what to make of all this given that you have bone bone pain, but your MRI also came back clean. Waldenström macroglobulinemia doesn't usually present with the kind of lytic lesions that can accompany multiple myeloma, but it can cause bone pain and it can be detected by an MRI. So, I'm kind of baffled by all this. Others on the forum may have some better insights.

In any case, I'm not a doc. A good hematologist will be best suited to make the next call on where to go from here.

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

Re: Does this look like myeloma?

by yomaxx on Sat May 09, 2015 1:58 pm

The MRI was only of my brain and spine. I should have been more clear.

The bone pain has me baffled as well. I had a chest x-ray last month when I was sick with a cold. The only reason I even had one done was because my wife was sick as well, although she had pneumonia and our doctor suggested I get a x-ray to make sure I didn't have pneu­monia as well.

You would think if something was going on with my bones in my chest and ribs, the x-ray would have shown something. I'm stumped, guess I'll have to wait and see what the hematologist thinks.

Thanks again!

yomaxx

Re: Does this look like myeloma?

by Multibilly on Sat May 09, 2015 2:41 pm

Do you know what you serum calcium level is? This would show up on your comprehensive metabolic panel. If it is elevated, that might also provide a clue if there is bone damage that is occurring.

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

Re: Does this look like myeloma?

by yomaxx on Sat May 09, 2015 4:48 pm

My calcium on this last test is 9.8

On my two previous ER visits when my complaint was bone pain, my level was 10.6 and 10.8, which the doctors said were fine. I then heard different things from a friend of mine who is a nutritionist. He said anything in the 10's is not normal.

yomaxx

Re: Does this look like myeloma?

by bond007 on Sat May 09, 2015 8:36 pm

A calcium level without knowing the serum albumin level has no real value, as the total calcium level will fluctuate with the albumin level and it is the free ionized calcium that is active.

Just ask your doctor for the albumin level when considering the calcium level.

bond007

Re: Does this look like myeloma?

by yomaxx on Sun May 10, 2015 10:51 am

Hey Bond, the albumin on my CBC is 4.7, with the normal range being 3.5 - 5.0.

yomaxx

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