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Suggest Treatment For Multiple Myeloma And Dermamysotosis

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Posted on Sat, 9 May 2015
Question: Hi I am a Vet and the VA has run a ton of tests due to a very recent diagnosis of Dermamysotosis and it's risk of cancer. Unfortunately, they took 22 vials of blood and did not explain some of them. For example: Urine, Monoclonal Protein at 14.2 High, C Reactive High at 5.8, blood protein was low at 6 has been amended at normal 6.6. Hemacrit is low and I have been severely anemic in the past. I am deeply concerned that no one has shared with me any ideas and I am left to determine these numbers for the last two weeks for myself. They all seem to point to multiple myeloma? Sx that brought me in, a couple years of bone pain, nodules of bone or cartilage lumps under skin on my hands (specifically, the side joints on the inside fingers, the center of my palm, swollen index fingers so sore they feel they will burst) and a swollen hip that is painful to sleep on and hurts to turn in my sleep-all this on top of blotchy red rashes on the back of my neck and hands. One last question if you don't mind, I was also given an HIV 1 RNA Quantitative. The result was <40, but protocol state use for HIV 1 positive only and I (being a Veteran have been tested and always come up negative) Why would they use this test as it clearly states not to use to determine HIV status? The fact that I saw this 'only use with documented HIV 1 pos population was initially daunting, and the patient advocate won't tell me why they used it, they only apologized and said they would make sure it doesn't happen to anyone else. Thank you for your time.
doctor
Answered by Dr. S. Samanta (30 minutes later)
Brief Answer:
You need more work-up!

Detailed Answer:
Hi! thanks for your health query!

From your description, I would summarize that you have monoclonal protein in urine, high CRP, low blood proteins and severe anemia, in addition to the diagnosis of dermatomyositis!

I would say that you are correct as there is strong possibility of multiple myeloma; please follow my suggestions as below if they appear reasonable to you:

1. have a serum protein electrophoresis and immunofixation, complete hemogram, serum calcium level, b2-microglobulin level and x-ray/CT scan of your pelvic/spinal bones

2. please mention the details of the biopsy report that reads 'dermatomyositis' along with ANA titre and also mention if any specific problem with your facial skin, neck region movements etc..

No or hardly any relation to HIV; just forget it! They must have done it due to an error. Good that they apologized for that error. In HIV neg documented people it is not required to go for such test.

Welcome you with feedback!

Regards
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. S. Samanta (9 hours later)
Dr. Samanta,

Thank you for your feedback. The have just recently begun the CT's and MRI's. The other blood work has come in normal, but I will copy and paste here for you to see. I also had pneumonia in 09 (4 different antibiotic before cleared) and double pneumonia in 2011 (a bit more resistant, but cleared). I now get a vaccine every 5 years and take my vit D, as it was low (now normal at 50, but I take 6-8 thousand IU's daily to maintain this level. I recently read a journal article noting Vit D and some kind of exacerbation of Multiple Myeloma. Have you heard of this? One other question regarding the C reactive protein and Monoclonal development, I read another journal article that stated during treatment of Multiple Myeloma the c reactive protein actually enhances proliferation of monoclonal development (non-scientific terms as I am paraphrasing here). If that is the case, what would be the best course of Tx since both of these numbers are high according to my blood work? Again, thank you for your time and consideration. I will post all blood work later today.

I can also cite the journal articles if you like.
doctor
Answered by Dr. S. Samanta (4 hours later)
Brief Answer:
CRP is non-specific ; please don't give much importance!

Detailed Answer:
Hi! CRP is rapidly replacing ESR as a prognostic marker of any kind of inflammation/infection/malignancy and your value is not that much raised; please don't give much importance to it!

Vitamin-D deficiency has a negative impact on Multiple Myeloma. but please don't give much importance to this as they may just co-exist also without any significant effects...


Only immunofixation, protein electrophoresis, imaging and plasma cell percentage in the bone marrow could confirm a diagnosis of multiple myeloma....!

Please share all detailed reports then..

regards,
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
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Dr. S. Samanta

Pathologist and Microbiologist

Practicing since :2004

Answered : 1107 Questions

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Suggest Treatment For Multiple Myeloma And Dermamysotosis

Brief Answer: You need more work-up! Detailed Answer: Hi! thanks for your health query! From your description, I would summarize that you have monoclonal protein in urine, high CRP, low blood proteins and severe anemia, in addition to the diagnosis of dermatomyositis! I would say that you are correct as there is strong possibility of multiple myeloma; please follow my suggestions as below if they appear reasonable to you: 1. have a serum protein electrophoresis and immunofixation, complete hemogram, serum calcium level, b2-microglobulin level and x-ray/CT scan of your pelvic/spinal bones 2. please mention the details of the biopsy report that reads 'dermatomyositis' along with ANA titre and also mention if any specific problem with your facial skin, neck region movements etc.. No or hardly any relation to HIV; just forget it! They must have done it due to an error. Good that they apologized for that error. In HIV neg documented people it is not required to go for such test. Welcome you with feedback! Regards