I have just been going to the cancer center and I am confused and my doctor does not explain anything to me.
I was sent to the cancer doctor by my orthopedic doctor because I am a 54 year old male and I have severe osteoporosis and he wanted to find out why I had it. He found signs of multiple myeloma. My recent blood work was flagged all over the place.
Can someone tell me if I should get a second opinion and could someone tell me if I should be concerned.
Lambda Free 209.83
Kappa/Lambda Free Ratio 0.05
Beta2 Microglobulin - Blood H 3.0
IgG L 666
Uric Acid - Serum H 8.2
Bilirubin, Total H 1.10
Protein (Total) - Serum H 8.4
Phosphorous - Serum L 1.9
Creatinine - Serum H 1.4
Chloride - Blood L 99
WBC - Blood 9.0 K/uL
Lymphocytes - Blood 1.4
Mixed H 1.8
Granulocytes / Bands - Blood 5.8
Lymphocyte % L 16
Mixed % H 19.0
Neutrophil % 65.
RBC Count - Blood 5.49
Hgb - Blood 16.8
Hematrocrit 48.7
Platelet Count 222
MCV 89 fL
MCH 30.6
MCHC 34.5
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Re: Doctor found signs of myeloma - help with lab results
What I am seeing is evidence of excess protein, a high lambda free light chain level and a low free light chain ratio.
You did not give your kappa light chain numbers, but with a lambda number of 209.83 and a ratio of 0.05, it had to be about 10.5.
The light chain normal readings are:
Kappa 3.3 - 19.4
Lambda 5.71 - 26.3
K/L ratio 0.26 - 1.65
The lambda reading of almost 210 is the key marker which has caused the ratio to be out of norm. That, coupled with a high protein and creatinine level, along with "osteoporosis", is a strong indication of active multiple myeloma.
I am surprised that a SPEP [serum protein electrophoresis] was not run along with a immunofixation electrophoresis [IFE]. Those would identify the type of multiple myeloma (if you have it) and if you had a measurable M spike.
Ron
You did not give your kappa light chain numbers, but with a lambda number of 209.83 and a ratio of 0.05, it had to be about 10.5.
The light chain normal readings are:
Kappa 3.3 - 19.4
Lambda 5.71 - 26.3
K/L ratio 0.26 - 1.65
The lambda reading of almost 210 is the key marker which has caused the ratio to be out of norm. That, coupled with a high protein and creatinine level, along with "osteoporosis", is a strong indication of active multiple myeloma.
I am surprised that a SPEP [serum protein electrophoresis] was not run along with a immunofixation electrophoresis [IFE]. Those would identify the type of multiple myeloma (if you have it) and if you had a measurable M spike.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Doctor found signs of myeloma - help with lab results
Hi Krogers,
As Ron alluded to, there are a number of tests that need to be run before a definitive diagnosis will be given. Unfortunately for patients waiting for an answer, they often seem to be run sequentially, rather than all at once. Very frustrating!
But to try and answer your second question -- I don't think you need to get a second opinion about whether or not you have myeloma. The tests will tell you that. But if the tests tell you that you do, you may want to think about getting a second opinion about your treatment options.
Good luck!
Lyn
As Ron alluded to, there are a number of tests that need to be run before a definitive diagnosis will be given. Unfortunately for patients waiting for an answer, they often seem to be run sequentially, rather than all at once. Very frustrating!
But to try and answer your second question -- I don't think you need to get a second opinion about whether or not you have myeloma. The tests will tell you that. But if the tests tell you that you do, you may want to think about getting a second opinion about your treatment options.
Good luck!
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Doctor found signs of myeloma - help with lab results
Thank you Ron and Lyn.
You are right, seems to take so long to do the test. I just got a call from my family doctor to give me results of some bloodwork done and the doctor left a voice message that my calcium level was high and to ease off of milk and cheese products. Red flag is that I have never drank milk and have eaten very little cheese recently and not taking any calcium pills and not eating any ice cream either, so curious why the calcium is high now.
I understand about the not getting second opinion by another doctor, but my oncologist just does not communicate and when he comes in the room, he spends about 3 minutes with me and I don't know what questions to ask.
When I went for that blood work, the nurse called me back and said "Do you have your urine sample", and no one ever told me to do one and she said you should have been given a jug to do a 24 hour urine and then she was supposed to do the blood work the next morning when I bring the 24 hour sample back.
So she goes in the back and comes back and said, well, they messed that up, I will go ahead and do the blood work, and she sent me to the room for the doctor to see me for 3 minutes and still no one said here is a jug to do a urine sample.
So I am confused. If they just did the blood work to go through the motions, and when will they decide or figure out I have not done the urine test yet?
You are right, seems to take so long to do the test. I just got a call from my family doctor to give me results of some bloodwork done and the doctor left a voice message that my calcium level was high and to ease off of milk and cheese products. Red flag is that I have never drank milk and have eaten very little cheese recently and not taking any calcium pills and not eating any ice cream either, so curious why the calcium is high now.
I understand about the not getting second opinion by another doctor, but my oncologist just does not communicate and when he comes in the room, he spends about 3 minutes with me and I don't know what questions to ask.
When I went for that blood work, the nurse called me back and said "Do you have your urine sample", and no one ever told me to do one and she said you should have been given a jug to do a 24 hour urine and then she was supposed to do the blood work the next morning when I bring the 24 hour sample back.
So she goes in the back and comes back and said, well, they messed that up, I will go ahead and do the blood work, and she sent me to the room for the doctor to see me for 3 minutes and still no one said here is a jug to do a urine sample.
So I am confused. If they just did the blood work to go through the motions, and when will they decide or figure out I have not done the urine test yet?
Re: Doctor found signs of myeloma - help with lab results
Hi krogers:
You were curious why your calcium levels are high even though your diet is not calcium rich. Having high calcium doesn't mean you have myeloma, but many myeloma patients do have high calcium levels, especially before they start treatment. It is caused by an effect of the myeloma plasma cells on the bones. The abnormal plasma cells cause biochemical changes that increase your body's normal "turnover of the bone." This can cause small lesions (holes) on bones or osteoporosis. Basically the dissolving bone leads to higher calcium levels in the blood.
Part of the process of diagnosing and staging a new myeloma patient is to have a skeletal survey (usually by X-rays but sometimes with a whole body CT scan) to see how your bones are doing. A bone marrow biopsy is also an important step in determining a diagnosis because the pathologist can directly look for abnormal plasma cells.
May I suggest that you start to look for a hematology specialist or preferably a myeloma specialist in your area? It sounds like you are probably seeing a general oncologist, who may not be that familiar with hematologic diseases and malignancies, and that may be why you are not getting very much time or any explanations from this doctor. If you are definitively diagnosed with myeloma, there are a LOT of treatment options, and it is really important to have a physician who knows this particular field very well, and can communicate with you.
You were curious why your calcium levels are high even though your diet is not calcium rich. Having high calcium doesn't mean you have myeloma, but many myeloma patients do have high calcium levels, especially before they start treatment. It is caused by an effect of the myeloma plasma cells on the bones. The abnormal plasma cells cause biochemical changes that increase your body's normal "turnover of the bone." This can cause small lesions (holes) on bones or osteoporosis. Basically the dissolving bone leads to higher calcium levels in the blood.
Part of the process of diagnosing and staging a new myeloma patient is to have a skeletal survey (usually by X-rays but sometimes with a whole body CT scan) to see how your bones are doing. A bone marrow biopsy is also an important step in determining a diagnosis because the pathologist can directly look for abnormal plasma cells.
May I suggest that you start to look for a hematology specialist or preferably a myeloma specialist in your area? It sounds like you are probably seeing a general oncologist, who may not be that familiar with hematologic diseases and malignancies, and that may be why you are not getting very much time or any explanations from this doctor. If you are definitively diagnosed with myeloma, there are a LOT of treatment options, and it is really important to have a physician who knows this particular field very well, and can communicate with you.
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Tough Mom - Who do you know with myeloma?: myself
- When were you/they diagnosed?: January 2013
- Age at diagnosis: 45
Re: Doctor found signs of myeloma - help with lab results
Hello krogers,
I am sorry you are not getting the answers you need or much attention from your current doctor. It seems odd to me that a physician would suggest laying off calcium rich foods without actually seeking the cause of the elevated calcium.
I was diagnosed with MGUS this past spring. I am fortunate in that I did get the correct labs to begin the process of understanding what was going on with me. My oncologist was adequate and did answer my questions, but once we discovered the M-spike, I chose to seek a second opinion from a myeloma specialist.
Ron Harvot wrote:
"The lambda reading of almost 210 is the key marker which has caused the ratio to be out of norm. That, coupled with a high protein and creatinine level, along with "osteoporosis", is a strong indication of active multiple myeloma."
I would add to the above that your elevated calcium levels are also concerning.
Is it possible for you to seek help from a myeloma specialist oncologist? I know sometimes insurance can limit you, but I would be very concerned with your numbers and symptoms.
Be proactive about your health and do not wait. I have a positive view of physicians and facilities, but I do believe that some facilities and physicians are better than others.
All the best.
I am sorry you are not getting the answers you need or much attention from your current doctor. It seems odd to me that a physician would suggest laying off calcium rich foods without actually seeking the cause of the elevated calcium.
I was diagnosed with MGUS this past spring. I am fortunate in that I did get the correct labs to begin the process of understanding what was going on with me. My oncologist was adequate and did answer my questions, but once we discovered the M-spike, I chose to seek a second opinion from a myeloma specialist.
Ron Harvot wrote:
"The lambda reading of almost 210 is the key marker which has caused the ratio to be out of norm. That, coupled with a high protein and creatinine level, along with "osteoporosis", is a strong indication of active multiple myeloma."
I would add to the above that your elevated calcium levels are also concerning.
Is it possible for you to seek help from a myeloma specialist oncologist? I know sometimes insurance can limit you, but I would be very concerned with your numbers and symptoms.
Be proactive about your health and do not wait. I have a positive view of physicians and facilities, but I do believe that some facilities and physicians are better than others.
All the best.
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Doctor found signs of myeloma - help with lab results
I also just pulled my bone density test that was done about a year ago. My lower spine was -4.1, my right hip was -3.8 and my left hip was -2.8. So how does this affect the possibility of multiple myeloma?
Re: Doctor found signs of myeloma - help with lab results
Well, as you said in your first post, you have severe osteoporosis and that would be how they came to that diagnosis. This result for a 54 year old man is very unusual. Once again, what is the cause?
Have you had any luck in pursuing help from a myeloma specialist? Is there anyway we can help you find someone in your area? Has there been any more consults or testing since the last time you posted here? Or are you waiting for an upcoming appointment? Please do let us tell what is currently happening.
All the best.
Have you had any luck in pursuing help from a myeloma specialist? Is there anyway we can help you find someone in your area? Has there been any more consults or testing since the last time you posted here? Or are you waiting for an upcoming appointment? Please do let us tell what is currently happening.
All the best.
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Doctor found signs of myeloma - help with lab results
I believe you need to be referred to a hematologist/oncologist.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
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