In the Beginning

When Don scheduled his routine physical exam in late July of this year, we had no idea how much our lives would change. He was energetic and active, with no symptoms of the disease that would be discovered. Elevated proteins and albumin in his urine caused our PCP to raise a curious eyebrow. Don dismissed her concern, stating that he had been taking protein supplements as a part of his workout routine. The results were the same three weeks later, with no protein supplements to blame. This time, a serum electropheresis was done. This test fractionates the proteins so that abnormal levels may be differentiated. This is a screening test for multiple myeloma, a cancer of the plasma cells in the bone marrow.

Dr. Clark reassured Don that this was a disease more common in the elderly (he is 57) and she has done many screening tests, with no one in her practice having multiple myeloma (MM).
Two days later this test showed the presence of a "M-spike", indicating abnormal levels of plasma cells. Our next stop was a visit to a hematology/oncologist.

We were both in shock. Our oncologist repeated several lab tests and reassured us that 90% of the people referred to him with this had a benign problem called MGUS (monoclonal gammopathy of unknown significance). He told us if we didn't hear from him, everything was OK and we would see him in two weeks. He called back in 90 minutes, stating that Don's ESR was elevated (ESR or sed rate is a measure of how quickly the red cells sink. Inflammation or infection causes cells to become heavy, increasing the sed rate).

At this point, we scheduled a bone marrow biopsy, the definitive diagnostic tool for MM. Don was pretty numb by this point, but expecting the worst. I had been doing a great deal of internet research and was quite alarmed by the information available about this cancer. Three days later, our oncologist gave us the bad news. Don has Multiple Myeloma (type IgA kappa), an "incurable" cancer of the bone marrow. More tests would be ordered, including a 24 hr urine collection and a series of skeletal Xrays. These showed no kidney involvement and no bone lesions. If you are unfamiliar with MM, I have provided a link on the blog with basic information. Believe me, I have learned more about blood cell production in the past few months than I ever cared to!