Some News Might be Good News

Tuesday night I felt a little back pain while in bed, unusual for me.  As it happened, we had already scheduled an MRI at Mayo Clinic for the very next day to look at the nearby vertebrae, numbers T5, T9, and T11, and compare that with MRI images from last October.  Doctor WG called last night to talk about those results: Neither the doctor nor the the radiologist can see any significant damage to the bones of those vertebrae.  That is very good news. However, we still don't know for sure whether the PET scan hot spots are due to increased tumor burden or to inflammation ("flare") caused by my own immune system attacking the tumor cells. We don't get much help from blood tests - IgG and M-spike went up a little from the week before, but light chains didn't. The back pain continues, at level 3 or 4 out of 10, and may actually provide the best guidance.  If it gets worse I can choose to stop this study and go on a proven 3-drug treatment like Revlimid and dexamethasone (DEX) with Kyprolis or Darzalex.  Of those choices, I have only had DEX before - the others would be new to my myeloma. It is quite possible that the pain is not caused by bone damage but by the flare itself, in which case it should decrease as my immune system mops up the remaining myeloma cells. Dr WG believes that the immune system "flare" has reached its peak by now, and should decline from here rather than get worse.   Dr WG also did discuss this whole issu...
Source: Myeloma Hope - Category: Cancer & Oncology Source Type: blogs

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ConclusionThis case demonstrates that sternoclavicular joint arthropathy results in symptoms that can mimic the presenting symptoms of shoulder or cervical spine pathology, such as shoulder and neck pain, necessitating careful diagnosis and management.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
This article is a case report, no outcomes.Lessons:Multifocal extensive spinal TB involving the whole spine is rarely reported in the literature, which presents with atypical presentations and imaging features. It is noticeable that the possibility of TB is considered for any skip lesions involving the spine cautiously. Meanwhile, careful physical examination, trials of anti-TB treatment, and using the whole spine MRI routinely also play an important role in the diagnosis and treatment of this disease. Rationale: Skipped multifocal extensive spinal tuberculosis (TB) involving the whole spine is very rare. So far, only ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
A 50-year-old man was transferred to our hospital with a 3-week history of back pain and a mass on his skull that had been growing slowly for the past 7 months. The mass was smooth, firm, and non-tender. Despite his long hair, it gave him the appearance of having a high domed forehead. Examination was otherwise unremarkable. Laboratory investigations showed renal impairment, hypercalcaemia, anaemia, and immunoparesis. Lambda light chains were detected in the urine and the serum. Magnetic resonance scans of the brain (figure) and spine (appendix) showed soft tissue lesions over the skull and thoracic spine.
Source: LANCET - Category: General Medicine Authors: Tags: Clinical Picture Source Type: research
A 36 year old male presented to the emergency department with severe epigastric pain, nausea, vomiting without hematemesis, diarrhea and anorexia. He presented with respiratory distress, shock and fever at the emergency. He was intubated and shifted to the intensive care unit with the diagnosis of acute pancreatitis with hypercalcemia and an elevated amylase and lipase's well as thrombocytopenia and elevated creatinine. CT scan of abdomen was done which showed lytic bone lesions in the spine and necrosis of the pancrease.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Case Report Source Type: research
Conclusion: This report clearly delineates the diagnosis and treatment of a rare case of synchronous MM and pulmonary adenocarcinoma, as well as depicts a potentially positive outcome for the patient. It also overviews some diagnostic and therapeutic implications for clinicians.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
​​BY SEFAKO PHALA; ​ROBERT STATZ; ANDREW VICTOR; MOHAMMED HASSAN-ALI, MD, MSC; &AHMED RAZIUDDIN, MDA 65-year-old Caucasian man was brought to the ED via ambulance complaining of worsening upper back pain for one week. His primary care physician had recently prescribed him NSAIDs and muscle relaxants, which failed to provide relief. The newest symptoms were numbness and weakness over his left arm and leg. The patient reported no history of trauma to his back nor did he have any chronic illnesses. Physical exam showed paresthesia in the left upper extremity in a dermatomal distribution pattern that suggested f...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Abstract: A 69-year-old man with a history of low back pain for more than 4 months underwent 99mTc-MDP bone scan to determine the cause of the symptoms. In addition to the osseous lesions, significant activity in the stomach wall was noted. However, a subsequent 18F-NaF PET/CT only revealed bone lesion without increased activity in the stomach wall. The cause of the back pain was eventually confirmed due to multiple myeloma.
Source: Clinical Nuclear Medicine - Category: Nuclear Medicine Tags: Interesting Images Source Type: research
For over a week I had to take a little dexamethasone (DEX) now and then to manage a severe pain in my back and lower right abdomen. I don't know for sure why the DEX fixed the pain when Vicodin didn't, but it was magic. DEX is a powerful anti-inflammatory, so my theory is that something was inflamed and pressing on the spinal cord, and the DEX reduced that inflammation. If that's what happened, I don't know why the inflammation showed up, or why it went away. I haven't taken any DEX for three full days now, and I'm glad to be off DEX because it can have serious side effects from long term use. I may nee...
Source: Myeloma Hope - Category: Cancer & Oncology Source Type: blogs
My doctors have now told me that a little DEX to manage the pain is OK on the current medication study. DEX can also have a treatment benefit, in addition to pain relief, and I suspect that the study authors are at least slightly interested in that result too. My daily medication log will now include the DEX, if any, and the dosage. It's working quite well - one 4-mg tab of DEX seems to last at least 30 hours before the pain returns. I've had three tabs so far, with a fourth due today if needed. My main doctor at Mayo would also like me to come there (180 mile round trip) for another scan. In emailed me...
Source: Myeloma Hope - Category: Cancer & Oncology Source Type: blogs
Lots has happened since my last post, and this is a record of those events. I have to write it somewhere. It's interesting to me, part of the journey, but you'll be the judge. It's mostly whining. Background for the reader: Last Wednesday I had an infusion of a study drug and an infusion of Zometa, and also began a week of oral Valtrex in case my back pain might be the prodrome for shingles. By Friday the pain in my back and abdomen was much more pronounced, continuing into Saturday. I posted about that here.Saturday, February 20, 2016: I have a new respect for people who are obliged to tolera...
Source: Myeloma Hope - Category: Cancer & Oncology Tags: DEX dexamethasone kidney pain Source Type: blogs
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