I have had MGUS for a year and a half. In May 2014, my light chain proteins had risen, and the doctor had me back for testing in three months. In the meantime, I had a kidney biopsy which showed no kidney involvement. The next 3-month interval came on August 8th. My creatinine level had jumped from 1.0 in May to 3.5. All other blood work was normal. I went to the hospital for I.V. dexamethasone and daily blood work. While in the hospital, they did a full skeletal x-ray survey, and I had NO bone lesions.
At my follow-up appointment with the oncologist, he had the light chain protein test back, and the numbers had gone to the moon - I started with 800, 1000, 1200, then it was 5000. That explained the creatinine spike - kidney involvement.
My official diagnosis is light chain deposition disease (LCDD), not multiple myeloma, because I HAVE kidney involvement, but I DON'T have Anemia, elevated Calcium levels, or Bone lesions (yet I hope) My calcium levels have been normal all along.
I was put on the RVD [Revlimid, Velcade, dexamethasone] chemo plan, and I will be completing the first round in two days.
O.K., so this morning I'm cleaning the bathtub, slip, and bump my chest. I heard a not-very-loud snap and blinked. It did NOT hurt, but I pushed & prodded around to see if it would. Nope. Now, 12 hours later, it still only feels a little tender when I touch it, but no real pain. Evidently, I did SOMETHING to a rib, but I've never heard of a painless broken rib.
I didn't go the the E.R, because even if it is a broken rib, they wouldn't really do anything except tell me to go home & rest.
My thinking: I had no bone lesions a month ago, had normal calcium levels a week ago, and a month of chemotherapy. Is it possible for lesions to come about that fast?
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Re: Can myeloma-related bone lesions develop really fast?
If you are in the USA, I can see your hesitancy to go the ER over the weekend (due to the cost and potentially dealing with a doctor who doesn't understand LCDD). But I would contact the hematologist/oncologist's office that diagnosed you with LCDD to get their take come Monday.
Just my two cents.
Just my two cents.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can myeloma-related bone lesions develop really fast?
I agree with MultiBilly that you should let your oncoloigst know about the incident to your chest. You may have inadvertently done a self manipulation of a rib joint with the bump. This wouldn't hurt, but could be tender to the touch. In any case, contacting your oncologist is a good idea.
Do you have an emergency number that you can contact when the oncologist's office is closed? I've called that number instead of going directly to the ER and have received direction from the oncologist on call that has saved me a lot of worry in the middle of the night or on a weekend.
Nancy in Phila
Do you have an emergency number that you can contact when the oncologist's office is closed? I've called that number instead of going directly to the ER and have received direction from the oncologist on call that has saved me a lot of worry in the middle of the night or on a weekend.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Can myeloma-related bone lesions develop really fast?
I also would not worry too much about contacting or notifying you oncologist first before going to the ER. The oncologist is not likely to be the one to guide diagnosis or the treatment to repair the bone anyway, unless radiation is needed to treat bone lesions which can come later.
In my experience going to the ER, I tell them and they see in my medical record that I have myeloma, and they will contact my oncologist anyway to consult on my case doctor-to-doctor even if I have already contacted my oncologist first. A doctor is not going to trust the information a patient tells them their doctor said, at least if it is really important, as the information could easily be lost in translation or altered to the patient's point of view going through a patient. They will want to get if first hand from the oncologist.
The ER doctors should be able to do the examination and order the imaging to determine just what damage was done, assess how serious it is, start treatment if needed, then send those results to you oncologist and, ideally, I feel your primary care doctor should be informed as well.
Even though for most people with a broken rib, the ER will just assess the damage and send you home to rest with a work release note, if needed. But you are not most people. It took me a while to get the mindset myself that I am no longer most people and I need to think different about these things now.
With myeloma, I feel if you do have a broken rib, it is really important to verify that is the case and look for a bone lesion as a possible cause, and if you are breaking ribs with myeloma, an important question that needs to be determined is what is the state of the rest of you skeleton at this point in time. Is it just this one rib, or are there lots of other potential fragile bones ready to snap?
I would think the ER on their own, or at the direction of your oncologist, will do a whole body skeletal survey to answer these questions before just sending you home -- something they would not do for the normal person with a broken rib unless they suspected bone disease may exist.
In my experience going to the ER, I tell them and they see in my medical record that I have myeloma, and they will contact my oncologist anyway to consult on my case doctor-to-doctor even if I have already contacted my oncologist first. A doctor is not going to trust the information a patient tells them their doctor said, at least if it is really important, as the information could easily be lost in translation or altered to the patient's point of view going through a patient. They will want to get if first hand from the oncologist.
The ER doctors should be able to do the examination and order the imaging to determine just what damage was done, assess how serious it is, start treatment if needed, then send those results to you oncologist and, ideally, I feel your primary care doctor should be informed as well.
Even though for most people with a broken rib, the ER will just assess the damage and send you home to rest with a work release note, if needed. But you are not most people. It took me a while to get the mindset myself that I am no longer most people and I need to think different about these things now.
With myeloma, I feel if you do have a broken rib, it is really important to verify that is the case and look for a bone lesion as a possible cause, and if you are breaking ribs with myeloma, an important question that needs to be determined is what is the state of the rest of you skeleton at this point in time. Is it just this one rib, or are there lots of other potential fragile bones ready to snap?
I would think the ER on their own, or at the direction of your oncologist, will do a whole body skeletal survey to answer these questions before just sending you home -- something they would not do for the normal person with a broken rib unless they suspected bone disease may exist.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Can myeloma-related bone lesions develop really fast?
While I agree with the follow up part, I would like to hear more about how quickly a lesion can form. My husband had a single lesion to his rib that came back within three months of 28 sessions of radiation. He has no other lesions on the PET scan or recent skeletal x-rays. He recently had the rib removed as it fractured twice (looks like he was attacked by a shark).
He is currently on Revlimid-Velcade-dexamethasone. This was started on Tuesday. I find myself worrying every time he is out doing things that he will have another injury. His rib broke with him just turning and looking behind him while backing the truck up.
Does anyone know how quickly these lesions can form?
He is currently on Revlimid-Velcade-dexamethasone. This was started on Tuesday. I find myself worrying every time he is out doing things that he will have another injury. His rib broke with him just turning and looking behind him while backing the truck up.
Does anyone know how quickly these lesions can form?
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Jmiller - Name: Harleygirl
- Who do you know with myeloma?: My husband
- When were you/they diagnosed?: January 2014
- Age at diagnosis: 57
Re: Can myeloma-related bone lesions develop really fast?
JimsKayak: Did you ever go for xrays to see if your rib was damaged?
All - I too am interested in hearing personal stories or studies that show how quickly a bone lesion can form.
I'm MGUS, clearly stable, yet I noticed a tender "dent" on the top of my head maybe a month ago. I really have no reason to believe it's not benign, but it made me curious as to how these develop.
It seems from reading posts on the Myeloma Beacon that many patients suddenly notice a bone lesion through a fracture, often while doing some very common movement that should not otherwise cause any injury.
All - I too am interested in hearing personal stories or studies that show how quickly a bone lesion can form.
I'm MGUS, clearly stable, yet I noticed a tender "dent" on the top of my head maybe a month ago. I really have no reason to believe it's not benign, but it made me curious as to how these develop.
It seems from reading posts on the Myeloma Beacon that many patients suddenly notice a bone lesion through a fracture, often while doing some very common movement that should not otherwise cause any injury.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Can myeloma-related bone lesions develop really fast?
Toni:
According to Drs. Howard, Fine, and Howard ... the dent in your head means you are definitely "A numbskull".
Nyuuk, Yuuk.
A nurse pulled that joke on me when I had surgery ... on my skull. It provided some needed levity, given the situation.
I would think that osteoclasts (bone termites) can do their thing in as little as 6 weeks, albeit that seems a little quick. However, bone density, degree of disease, etc are all factors.
According to Drs. Howard, Fine, and Howard ... the dent in your head means you are definitely "A numbskull".
Nyuuk, Yuuk.
A nurse pulled that joke on me when I had surgery ... on my skull. It provided some needed levity, given the situation.
I would think that osteoclasts (bone termites) can do their thing in as little as 6 weeks, albeit that seems a little quick. However, bone density, degree of disease, etc are all factors.
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Rneb
Re: Can myeloma-related bone lesions develop really fast?
Rneb - yes, I was going to end my post with a joke about being a bone head, but sometimes my humor doesn't go over very well in written form. Well, probably in verbal form too, but I digress.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Can myeloma-related bone lesions develop really fast?
I think this thread brings up a few important points.
Myeloma lesions can certainly grow rapidly at times. Any new bone pain that is severe or gets progressively worse should be evaluated. Admittedly, this is less urgent when it comes to rib pain than it would be with back pain (where occasionally myeloma tumors can compress the spinal cord). However, attention is still important.
It is also true that easy fractures can occur without overt lesions. Myeloma can weaken the bones globally and make them more susceptible to fracture with minor trauma. In a significant minority of myeloma patients with bone disease, the bone abnormality is osteopenia / osteoporosis without overt lytic lesions. This renders patients susceptible to fractures despite the absence of lesions on normal skeletal survey.
A final point ... "Light chain deposition disease" (LCDD) is not simply myeloma affecting exclusively the kidneys. Myeloma can injure the kidneys in more than one way, but LCDD is a very specific pathologic diagnosis (made by pathologists on review of a kidney biopsy). It is treated with similar medications, but is its own clinical entity with its own associated complications (related to deposition in other organs). Bone fractures are less common with it, etc.
Hope this helps, and hope that all turns out ok.
Myeloma lesions can certainly grow rapidly at times. Any new bone pain that is severe or gets progressively worse should be evaluated. Admittedly, this is less urgent when it comes to rib pain than it would be with back pain (where occasionally myeloma tumors can compress the spinal cord). However, attention is still important.
It is also true that easy fractures can occur without overt lesions. Myeloma can weaken the bones globally and make them more susceptible to fracture with minor trauma. In a significant minority of myeloma patients with bone disease, the bone abnormality is osteopenia / osteoporosis without overt lytic lesions. This renders patients susceptible to fractures despite the absence of lesions on normal skeletal survey.
A final point ... "Light chain deposition disease" (LCDD) is not simply myeloma affecting exclusively the kidneys. Myeloma can injure the kidneys in more than one way, but LCDD is a very specific pathologic diagnosis (made by pathologists on review of a kidney biopsy). It is treated with similar medications, but is its own clinical entity with its own associated complications (related to deposition in other organs). Bone fractures are less common with it, etc.
Hope this helps, and hope that all turns out ok.
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Dr. James Hoffman - Name: James E. Hoffman, M.D.
Beacon Medical Advisor
Re: Can myeloma-related bone lesions develop really fast?
Thank you Dr. Hoffman and everyone else for all the informative responses.
I actually could have gone to the ER, because the hospital and cancer center are affiliated and share a database.
As mentioned in my original post, I did have a full skeletal survey 5 weeks ago, and it was clear. This really doesn't hurt much at all, I almost doubt that it is a broken rib. It's almost "better" already.
I do have a "hotline" to a nurse at the cancer center, which I called, so that my oncologist will have the message when I see him tomorrow.
After fretting and stressing about "what it is" and "what can it mean", I decided to make observations, and report them to the people who have the knowledge to interpret them. I could drive myself crazy trying to self-diagnose in a lack of information.
I actually could have gone to the ER, because the hospital and cancer center are affiliated and share a database.
As mentioned in my original post, I did have a full skeletal survey 5 weeks ago, and it was clear. This really doesn't hurt much at all, I almost doubt that it is a broken rib. It's almost "better" already.
I do have a "hotline" to a nurse at the cancer center, which I called, so that my oncologist will have the message when I see him tomorrow.
After fretting and stressing about "what it is" and "what can it mean", I decided to make observations, and report them to the people who have the knowledge to interpret them. I could drive myself crazy trying to self-diagnose in a lack of information.
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