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Can treatment slow ‘smoldering myeloma’?




 

 

DEAR DR. ROACH: I have been diagnosed with multiple myeloma in the smoldering stage, based on a bone marrow biopsy and blood tests. Every three months, my hematologist checks my blood tests and tells me that when I feel bone pain, it will be time to begin chemo. While I am in the smoldering stage, is there anything I can do to prolong the shift to the fullblown stage? I am 79 and otherwise in good health. My only symptoms are some fatigue and lack of energy. — W.K.

ANSWER: Multiple myeloma is a type of cancer of blood cells — the plasma cells, which are responsible for making antibodies. Most, if not all, cases of myeloma have a precursor stage called MGUS, monoclonal gammopathy of uncertain significance. About 3 percent of all people over 50 have MGUS, and about 1 percent of people with MGUS will develop MM per year. “Smoldering” MM is the diagnosis when the bone marrow biopsy shows evidence of MM, but there are no other signs of MM. Signs of MM include myeloma in the bones (on X-ray or CT, called lytic lesions, since they cause holes in the bones), anemia, high calcium, poor kidney function and high viscosity of the blood, which predisposes a person to strokes.

In addition to looking for physical symptoms, your hematologist is searching for any of these findings. In addition, the amount of immunoglobulin in the blood predicts risk for developing overt MM (the higher the immunoglobulin, the higher the risk). A level over 1.5 g/dL puts you at high risk. Although trials are ongoing, there are no generally accepted treatments to prevent progression to MM for people with MGUS or smoldering myeloma.

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DEAR DR. ROACH: I had colon cancer nine years ago and had 12 inches of my colon removed. Quite a few times since then, I have lost control of my bowels, or have had a large movement that I couldn’t stop. Last night, I had one in my sleep. This is the first time that has happened. I take Metamucil, which was recommended by my internist, but it doesn’t seem to work. What kind of doctor should I see to help it? — J.W. ANSWER: Fecal incontinence is a common problem, but one that is so embarrassing for some people that they won’t bring it up with their doctor. It can lead to social isolation, and is the No. 2 cause listed for nursing-home placement. Incontinence has many possible causes and, therefore, many types of treatments.

Your internist is probably right about fiber, as it is very helpful in people with liquid stool, but it can make things worse in people with a stricture, such as from radiation, a common cause of incontinence. If you do try fiber, adjust amount so that you are having one or two soft but formed bowel movements daily.

Other types of treatments depend on the underlying problem. Biofeedback, medications, surgery and nerve stimulation are all treatments that have been useful in some people. A gastroenterologist, the specialist in this area, or your cancer surgeon would be the right person to start with.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour- GoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. ©2016 North America Synd.


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