Mohr’s Myeloma Musings: Myeloma Hypochondria
Mental health professionals would probably scoff at my self-diagnosis, but by most definitions of the word, I think I have become a hypochondriac.
My general understanding of hypochondria is that it is an unusual or excessive concern about your health; a tendency to fear or imagine that you have illnesses that you do not actually have.
One description of hypochondria states that it persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis, and that there is no illness.
Another source describes hypochondriacs as becoming unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.
Given that this condition first occurred after I was diagnosed with multiple myeloma three and a half years ago, one could label me a myeloma hypochondriac.
In sharing the mental state I am in, particularly in the weeks prior to my regular check-ups, I certainly don't mean to trivialize the serious condition that hypochondria can become and that can often have a debilitating effect on an individual.
I have not always been like this. For most of my life, I was quite the opposite. As a high school and college athlete, I took pride in being able to tell the difference between being hurt or being injured. I drove my parents, who were both nurses, crazy because I often chose to ignore symptoms of a developing illness.
Since my stem cell transplant in June 2014, I have had eight routine check-ups at my medical center. All tests associated with these check-ups have indicated that there is no monoclonal protein present and my free light chain levels and ratio are all in the normal range.
And yet, in the time between those check-ups, I am convinced that the next test results will indicate that the inevitable relapse has occurred.
So why have I gone from being someone who expects the best to someone who expects the worst and is relieved when the best happens?
Could it be due to the fact that, like most of us afflicted with multiple myeloma, my diagnosis was so sudden and unexpected?
What I suspected might be an early onset of arthritis in my hip turned out to be an incurable cancer. It seems that the fear of another surprise of that nature has created a defense mechanism that makes me think that every ailment or condition I experience is a sign of relapse despite continued positive test results over the course of the last 16 months.
Perhaps it is due to the fact that within the last six months I have learned how quickly cancer moves and that it has no respect for our timelines, our schedules, our life plans. In May, my mom passed away six months after being diagnosed with a rare cancer. Within a week of her passing, my nephew, who is just 32 years old, was diagnosed with pancreatic cancer, which is associated with very short survival. A long-time friend who was diagnosed with metastatic malignant melanoma in January is now in hospice care.
As much as anything, I think that this state of hypochondria may be due to the fact that early as well as relatively recent x-ray surveys of my skeleton indicated that, in addition to a large lesion on my left acetabulum, I had small, subtle lesions throughout the sacrum, iliac bones, and proximal right femur, and a small lesion within the L4 vertebral body.
If evidence of the disease was so widespread through my body, I don’t think it is too much of a stretch to fear that any sort of bone pain, aches, or flashes of pain anywhere in my body could signal the development of new lesions.
Of course, these pains could very easily be associated with old injuries and surgeries, getting older, or the side effects of Revlimid (lenalidomide), which I take daily as part of my maintenance therapy. Interestingly, the side effects of Revlimid and symptoms of multiple myeloma are strikingly similar in many ways.
My state of hypochondria has gotten to the point that I sometimes worry that my myeloma has become nonsecretory. This would obviously legitimatize my fears of relapse, despite test results that show otherwise.
Lest I give a false impression that I am physically suffering from multiple myeloma, I need to qualify the above statements. The physical problems I have experienced since my diagnosis have had little impact on my ability to lead a near normal life. After reading of the battles others fight with this disease, I consider myself fortunate that every treatment regimen I have been put through has been highly successful.
However, I doubt that I am the only one with multiple myeloma who deals with this mental state. Maybe others can identify with it and find comfort in knowing that this is completely understandable given the seriousness of the disease we live with.
In a regular check-up prior to undergoing induction therapy, I was detailing for my doctor the physical ailments I was suffering from. As I finished my recitation, I remember saying something to the effect of, “I sound like a hypochondriac.” His response was “Don’t worry, I want to know everything that you are going through physically,” which was as comforting then as it is now as I wrestle with this issue.
So after all is said and done, perhaps a mild case of hypochondria is not only understandable, but desirable and beneficial for anyone diagnosed with multiple myeloma.
Steve Mohr is a multiple myeloma patient and columnist here at The Myeloma Beacon. His column is published once a month. You can view a list of his columns here.
If you are interested in writing a regular column for The Myeloma Beacon, please contact the Beacon team at .
Hi Steve,
I can so relate! I think it is because my diagnoses seemed to come out of the blue, that I now know it is possible to have a serious health issue, even when you feel fine. It happened once, it can happen again. I now expect the unexpected. I don't think I'll ever be the same! But I've learned to live with it and have a happy life in spite of it, so I consider myself blessed and try not to stress about those results too much!
Thanks for you great columns.
Kim
WOW ... here I thought it was just me. I asked my doctor after I finished my two years of maintenance Revlimid what's next. He said you live happily ever after. From his lips to God's ears. Thanks for sharing.
Lisa
I do know exactly what you are talking about! I scrutinize each pain or ache. Is it bone pain or muscle pain, is it myeloma-based or something else, is this beginning of a relapse or nothing at all ... ??? Even after 15 years since diagnosis and 2 stem cell transplants with complete remission, I am still on alert. We know this can become active again at any time.
Still, I try not to be an alarmist - just aware; and I tell the docs of any concerns when I have my rechecks every 4 months. I agree that a mild case of hypochondria is beneficial - keeps us on our toes!
Thanks for your columns - I always enjoy your writing!
Kim, Lisa, Janner - Thank you for your response. Like Lisa, I feared I was alone in going through this change in my outlook on things. Now I know there are at least 4 of us!
Lisa - I love that phrase, "from his mouth to God's ears".
Kim - I think following your approach of "expecting the unexpected" is a great, measured approach to the new reality of the life we now live.
Janner - WOW - a 15 year survivor. You certainly defy all of the statistical data that we read about. 2 stem cell transplants - you are far tougher than I will ever be!
Aloha Steve,
As you have hit upon, I think we all feel this way. I am physically in good shape, but I constantly wonder about this ache or that pain. I have a persistent build up of mucus in my lungs that causes me to cough or clear my throat every hour or so. I am always wondering if this is my cancer or just one of my other frailties.
I find myself so tired of thinking about and discussing my health that I just ignore some of these problems just like the good old days. After all, how many of these issues do we want to have to chase down?
I think the right course for me is to mention them to my doc and ignore them the rest of the time. That way it is up to him to tell me what to worry about. I might miss something, but at least I can think about something else.
Keep on keeping on!
Much Aloha!
Tom
I can so relate! I was diagnosed 3.5 years ago out of the blue. I was going along in remission with zero m spike and a year ago developed an extramedullary plasmacytoma and had became nonsecretory. So I too am a little bit of a hypochondriac, suspicious of every little change or ache. It is good to know I'm not alone.
Hi Steve,
Thanks for another fine column. "Myeloma Hypochondria" is a great topic - something many of us can relate to. I guess I have a mild case of it, wondering a tad whether each new ache is the onset of a new lytic lesion.
However, I think the worst hypochondria period for me was when I had smoldering myeloma for about 3 years. I really did get myself worked into something of a tizzy before each quarterly blood test. I remember driving to the clinic one time and thinking to myself, "Is this one going to be the one that turns out to be a death sentence?"
The bad news about smoldering morphing into symptomatic myeloma did eventually come, but it turned out to be far from a death sentence. Not fun, but I felt like I was on more stable ground when we started actively dealing with it rather than just watching and waiting. That more solid ground has helped me be less fearful about upcoming lab work, and somewhat less fearful about new aches and pains.
I hope your Myeloma Hypochondria continues to be a series of false alarms for a long, long time.
I'm exactly the same ! I was diagnosed almost 4 years ago now with Multiple Myelona and each time I go for my regular check ups, I fear I will get the news I'm no longer in remission. I hold my breath when my doctor reads my results ! I'm not alone as my wife always accompanies me at these check ups and I know she dreads getting the results also.
Super article overall and thanks for highlighting something that is not generally discussed.
Thomas - Like you I find it tiring worrying and talking about my health all the time. I would like to think that that would not be so after living with the disease for over 3 1/2 years now, but such is not case. My doctor has repeatedly told me that he will tell when to worry and be concerned. He is batting a thousand in his advice and treatment prescriptions and my trust in him is complete. Less thinking and more living needs to be my approach.
Diane - I think your situation illustrates exactly why we all experience this: Unexpected diagnosis, unexpected relapse, and an unexpected morph to becoming nonsecretory.
Mike - While I never was in the smoldering stage, I did go through "watch and wait" and I can relate to your sense of relief of finally getting to the point of treating the disease. In reading your forum postings and Thomas's columns, I sense that our experiences and conditions are similar. You two seem to have a better grip on dealing with the fear of the future than I do.
Steve the fear or relapse I think becomes more mentally disturbing than the relapse itself, save knowing what the relapse indicates in terms of survival. I confess although I get all my results to understand how well controlled my myeloma is, I have not focused on relapse during my consultations, but on what 'derangements' to my physiology / metabolosim the disease and treatment throw up together, so I can discuss with 'experts'. I want to keep well while I live!!!
When I relapsed after a year, not being a transplant candidate, I was not in good shape and just wanted to get well. I had developed an infection before second line treatment and was kept in hospital. I wanted to only to know that the next line of treatment was the 'suitable' for me. I found patients who had stem cell transplant just before my chemo started, relapsed and were put on the same treatment. So I was assured.
What we fear is what relapse means. I too lost most of my small immediate family this year, two unexpectedly and suddenly- but not due to cancer. So perhaps I live with this perspective, that the cancer alone will not necessarily be the problem which 'hits' me.
If we take things in our stride, getting our affairs in order, and then LIVE, maybe we need not get so anxious?
Steve,
It is so nice to hear that I am not alone. I too was diagnosed 3 1/2 yrs ago, had my SCT in April 2013 and enjoyed two yrs of remission. But during that time I was constantly waiting for the other shoe to drop. Knowing that it can happen at any moment. I relapsed in June of this year and have been watching the numbers slowly rise. I told my dotor that I didn't know what was worse, the treatment or the anxiety waiting for the treatment.
Neal - Thank you for your kind comments. While the topic is not generally covered, based on the response of those who have posted comments, it seems that it may be somewhat common. Most seem to handle it better that I do!
Edna2 - I think you hit the nail squarely on the head in that it is the fear of relapse and knowing what relapse means in terms of survival that drives this anxiety.
Sandy R - The beauty of The Beacon is that we can learn on a daily basis that we are not alone in the myriad of experiences associated with living with multiple myeloma. I hope whatever treatment you are on reverses the trend of your slowly rising numbers. I admire your reasoned and simple but steady approach of dealing with the unknowns of living with multiple myeloma.
Steve,
Great article as always!
I know I have gone though that also, watching the numbers go up or down depending on if it's serum levels blood counts, etc. It's been a little more then 2 years since my SCT, for me the aches and pains are just about gone, increased physical activity reminds me that I'm not a young man any longer, but still push it some. Listen to your body. There are times I still tire easy, and worry about that, but for the most part I don't think about it. I can play with my grandkids again, chase them, pick them up, without pain.
With the events you have experienced with family and friends makes it more stressful for you, I think it would be for anyone and stress is one thing we don't need a lot of.
Stay positive, talk toyour wife, or someone else just to relieve that feeling. It has worked wonders for me.
Steve
I take each day, one at a time, and this prevents thinking about our disease too much. I have not had a ASCT, but am controlling the myeloma through drugs. My first drug routine was VMP (Velcade, melphalan, prednisone) for one year with weekly Velcade infusions. Then I went almost 2 years before relapse with no drugs and my M protein less than 0.2. Interestingly enough, I felt my best physically toward the end of the two years, that's when my M protein number started to rise again!
I have now been on Revlimid and dex for almost 3 years with my M protein less than 0.5. Same thing happened. When I was feeling my best physically, my M protein is rising again. So my myeloma specialist, who is also a hematologist, and I are discussing the next drug regimen to try. So for me I really only start to think of relapse when I am feeling super good.
However, by taking one day at a time, one realizes not much changes day to day, so you might as well accept that and not worry what may show up in tomorrow's blood tests. One day at a time works for me and my wife, and we have had a tremendously enjoyable life the last 5 years.
Steve,
You hit the nail on the head for sure! I'm always wondering about any little change in me. Is it myeloma-related, age-related, something else, should I tell my doc? I bet everyone is tired of me bringing up my aches or pains. I watch those lab reports for any sign I am relapsing. I feel reluctant at times to discuss things because it seems minor or is probably not related to cancer, but I have learned you can't dismiss anything. My sister kept ignoring a pain in her back, not wanting to complain, but it was a terrible mistake not to tell her doc. My sister is dead now, her pain was a return of her breast cancer. She didn't know this pain could be her cancer returning, she thought she was just a whiner who needed to get in shape. She is gone now. Even knowing this, I still have to fight the urge to keep quiet. Yes, I'm tired of obsessing over this disease, but I guess we need too – we should be our own best advocate.
Keep up the good fight.
Kim
Been there, done that. Still there, still doing it. Excellent column!
Jack - Thanks for the words of advice. I feel positive about the future and will have plenty of time to talk with my wife, as she retires at the end of this month and I will do so December 31st. I jokingly tell her that's when the real stress begins!
Eric - I feel the best I have felt since being diagnosed 3 1/2 years ago. In line with your advice, I think the Good Book says something to the effect of letting tomorrow worry about itself.
Kim - As your sister's story illustrates, probably the only thing worse than obsessing over what may or may not be of importance with our condition is ignoring signs or changes. In addition, I sense that my doctor, who I feel I have a great relationship with, would rip me a new one if I didn't share concerns with him and that silence resulted in a worsening of my condition.
April - I love your comments. Short, sweet, but an accurate description of our reality!
Steve and all the rest of us, we are no hypochondriacs. We are just forced into a very intimate relationship with our bodies. We have to after diagnosis, treatments, transplants, side effects and collateral damage. Our bodies are a mess. Three years post diagnosis and 2.5 years post ASCT it is still hard to find a new balance. Every time something new is popping up. I too wonder - is it side effects, collateral damage, relapse or what else is going on here?
At this moment my joints are triggering. I have a trigger thumb and the same thing occurred until now 3 times in my spine. My numbers are good, only monoclonal bands present. I really don't want to bring this joint snapping under attention of my oncologists. I am getting tired of more tests, more damage to put on the list of damaged bones, lungs, kidneys and heart.
We are no hypochondriacs, there is nothing wrong in between our ears. It really is a physical issue. I even went to a shrink because one of my oncologist thought I was turning into a depressed hypochondriac. My numbers were good so I had to focus on celebrating life and not talk about dying or multiple myeloma.
The psychologist told me that I was doing perfectly normal according to my situation and that her life would be a lot easier if everybody was like me. I asked her to tell this to my oncologist.
Thank you Steve and all others for sharing. At least we know what it is to row this multiple myeloma boat. In rough or in quiet waters, it is not easy at all.
Steve: Thank you for this article! I got tired and annoyed with myself for calling the nurses every time I felt "funny". So I got out the notebook I use for questions for the doctor and started adding my symptoms with the date and amount of time it lasted and what I did for it (Advil, Tylenol, oxy, etc.). And then I TRY not to worry.
Christel - I think I would agree that we are not technically hypochondriacs, which can be a serious mental disorder. I appreciate your comments that clarify this and you probably do a better job than I did in trying to convey my message of the challenges we face in the constant changes our bodies go through. I like your phrase "rowing the myeloma boat."
Macy - That is a great idea of logging your concerns. I can't tell you how many times I have walked out of my appointments and kicked myself for forgetting to ask a question of my doctor.
Hi, Steve.
You absolutely hit the nail on the head for me, right down to thinking I'd become a nonsecretor! I keep thinking that I must be driving my husband and my doctors crazy. Now I realize that doctors are used to this and reporting all my symptoms is a good thing. My husband's response is to "talk to the doctor," which is good advice.
Olga
Steve, as usual great article! I would swear that you have been inside my head, extracted my experience, and articulated my mental state. That being said, I would point out that you missed one recent development in my story that adds to an implied component of your message.
I was diagnosed in December of 2012 with IgG, kappa, del(17p), 88% affected plasma cells (no, that's not a typo), multiple meyloma. I was at death's door. No one expected me to survive the first round of treatment, but I did. Auto SCT in June of 2013. Achieved CR. Maintenance with Velcade and dex (VD) for about 12 months.
I went off all treatments for about 8 months thereafter. My numbers were good: IgG within normal range; light chains and ratios normal; M-protein either non-detectable or less than 0.13 g/dL; CBC normal. The only numbers that were off were my IgA and IgM, both of which were below normal but since I was diagnosed with IgG, this just was not considered a problem.
Sometime last winter I started feeling really depleted. Coincidentally, I had developed a small lump around my mid-thoracic region. No pain. I was repeatedly told that these symptoms were not related to my multiple myeloma. If they were, my lab work would reflect it, and it didn't.
Then one day I twisted just slightly and developed a severe pain in that mid-thoracic area. Long story short, I got an MRI which showed active myeloma cells creating holes in my vertebrae. Despite the fact that my Labs indicated no active myeloma, there it was happily munching away on my bones.
I did 10 radiation treatments for the affected area and am again on VD maintenance treatments. Here's the rub. I had "known" for at least 6 months that the myeloma was again active, but since my Labs and my doctors indicated otherwise, I chose to ignore that knowing.
Steve, your analogy to hypochondria reminded me of the old adage that a conspiracy theory is only a conspiracy theory if it's untrue. Going forward, my doctors and I have agreed that I am the best barometer for what's going on in my body. Hence, I now embrace that inner hypochondriac!
Aloha
Daniel
Olga - There are very few days in the last 3 1/2 years that my wife hasn't had to listen to a myeloma concern / complaint / question of my mine. She is a far more patient person than I am.
Daniel - Despite the heterogeneous nature of multiple myeloma, it seems that many of our experiences are so similar. If ever there was a story to give us hope and confidence in the current treatment regimens, it is yours.
Steve,
Many thanks for this column. You said it for me and a lot of others, I see. "Ever vigilant" could be a good motto for those of us with multiple myeloma and our doctors and health care teams.
Steve and Daniel: Unlike you, I did not find Daniel's comment at all hopeful and confidence producing (although I am really glad for Daniel that all ended well). Rather, I found it scary and in keeping with others' advice that we must be constantly vigilant and should not worry so much about being thought of as hypochondriacs. Like you and others, I was never a hypochondriac (and I still do not think I am one). Until I was diagnosed with MGUS --and that was really a fortuitous finding-- I barely saw a doctor. Now I think it would be negligence not to be on the alert about every ache and pain, given the problems that can arise from our lingering cancer cells even if we are in complete response, and the various medications we take to fight them. I am convinced that it is easier to deal with an incipient problem than a full-blown one.
I recently complained to my oncologist and specialist about an intermittent rib pain I have had for about a year and a hip pain that developed about two months ago after I did some jogging. Both told me that all was well because all my numbers show no detectible myeloma, that if I did have a plasmacytoma my blood tests would certainly raise alarms. I felt much relieved and accepted what I was told as a scientific truth. Now comes Daniel, describes his situation, and appears to be casting genuine doubt as to this "scientific truth." What are we to think? Was Daniel's situation an anomaly and the general truth is that our blood tests would give us plenty of warning about the presence of a plasmacytoma? Perhaps this issue would be better raised as a separate matter in the forum? I cannot believe that I am alone in wondering. masha
Christel Sanders via Steve
Try taking magnesium citrate and potassium citrate supplements to get rid of the trigger finger "cramping". I found supplementing these minerals is necessary, and cramping disappears. Check with your doctor if you are in doubt and get blood tests to see what your electrolyte mineral levels are. You will be surprised.
Sylvia - "Ever vigilant" is excellent advice!
Mrozdav - What I found hopeful and confidence building in Daniel's situation is the fact that he was, in his own words, at "deaths door" and there seemed little hope for survival, and yet through treatment, was able to achieve CR. The questions you ask about his relapse are insightful and ones that legitimately should give as all cause for concern. I guess the real issue is to be leery of so called scientific truths when our bodies are telling us otherwise. Thanks for your comments!
Steve,
I have been handling my own hypochondria and multiple myeloma quite well until this weekend when my girlfriend came down with a nasty cough. I'm concerned for her - not me. Definitely an awakening sensation - nobody gets out of this world alive. Enjoy to the max.
Eric via Steve
Thank you for the advice Eric. I am taking already magnesium and bananas. I will ask to test my electrolyte minerals this Wednesday when I have my check up. Thanks again.
Steve,
Thank you for a great article. Today I just said to my husband that lately I have been worried about this disease coming back. I received an autologous stem cell transplant after getting a diagnosis for lambda light chain mm in June of 2014. After rounds of Velcade, Cytoxan, and Dex, I received the transplant Dec 31, 2014. I am now in remission. I know I am clean but, can't help worrying about when it will return. Every bone pain I think is that mm returning. Geez, last year I was more at peace than I am now in remission. It may be because when they first diagnosed me with smoldering they said very low chance of getting it. Then all of a sudden it came full force out of the blue. That is why I am so edgy about it returning. Your article made me realize that these are normal feelings. I read it at a great time.
Thank you,
Steve, You are, in no way, a hypochondriac.
I am a 17 (2 months shy of 18) year survivor and before every test result reveal, I am constantly assessing my possible response to good or bad outcomes and thinking of and evaluating every ache and pain.
I think every cancer patient goes through this "hypochondria" as a self defense mechanism so we won't be blindsided as we were with the original diagnosis.
As to muscle spasms, etc., even with a balanced diet and normal blood levels, I was given quinine sulfate when the cramps became so bad my body just could not relax. (If I moved a finger, all my muscles would seize.) However, once Lyrica came on the market, my doctors were forbidden to prescribe quinine (unless the patient has malaria) but on their suggestion, I started drinking tonic water. Muscle spasms now only occur when I sit in one position too long. It makes a great popsicle mixed with oj, or I drink 4-6 oz. straight, since I'm not much of a drinker.
God's blessings on all of us.
I'm still at the MGUS stage after removal of a plasmacytoma on my spine last April. I had to undergo spinal fusion (T3 - T10) to repair the damage. Five months of PT followed. I just finished my third 3-month check-up with blood, imaging and urine work. While I am seeing some progression in my numbers toward smoldering multiple myeloma, it still is too early according to my oncologist for any direct treatment. So along with the worry and anxiety related to my hypochondria (What is that pain in my leg? or Why am I losing my appetite?), I am frustrated by the fact that this "thing" is in me and we can't do anything about it, at least right now. It's a little unnerving on most days, downright frightening on others.
Lani - Like you, I worry far more now than when I was first diagnosed. I didn't know what I didn't know then, so the saying "ignorance is bliss" probably explains that.
BeckyS - if there is one thing that has come about for me as a result of my column is that this seems to be a normal state of mind for most who have multiple myeloma. I agree that it is probably a defense mechanism against being blindsided again.
Jack Mc - I can relate exactly to how you feel about "this thing in me". I went through a watch and wait period and actually felt relieved when it was decided to begin treatment. After going through radiation treatments, induction therapy, an autologous stem cell transplant, and now maintenance therapy, I now know why my doctor waited to begin treatment. For me, the medicine/treatment has been worse than the disease. Having said that, I am truly thankful that every treatment regimen has been successful in improving my myeloma condition.
I told my doctor I am sometimes confused between vigilance and hypochondria. I was misdiagnosed for 4-5 years being treated for Meniere's disease-like symptoms. The fatigue gradually worsened. My physical activity came to crawl plus I gained 40 pounds from the multitudes of steroids. I also developed cataracts from the steroids. When I wasn't taking steroids, I felt like I had the flu. I also had an unusual low-grade but persistent sinusitis. My medical records are 2000 pages. Ultimately, myeloma was diagnosed. Had stem cell transplant 8 years ago. My hearing came back while I was doing chemo and dexamethasone. Three years later my hearing problems came back and was recently diagnosed with autoimmune disease of inner ear. I am also taking IgG IV every 3 weeks. Some traces of M protein showed up 2 years after transplant but not enough to justify retreatment.
Like you, I am blessed to be alive. I also have questioned my mental integrity. However, we have a disease that not only cracks bones but sucks the life out of us slowly. Stem cell transplant is a hell of an achievement. The transplant restored my life, but I am not the same person physically before myeloma. All this is confusing and conflicting with the age factor. I was 54 when I had my transplant. I am now 61 with memory problems and arthritis. Is my decline from aging? Cancer? The chemo itself? Along with our decline ,somewhere our self esteem, our self worth, and how we are perceived by others may be questioned. I remember how low I felt while I was misdiagnosed because I could not perform my job or even maintain concentration. I had no stamina. Once diagnosed, there was hope in getting better.
I know my friends probably think I am a little weird or overly concerned with my health. It use to bother me. However, we have a disease that requires vigilance to stay alive. I have good days and bad days, but right now life is still worth living.
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