Cowgirl Up!!! ... Does Horse Poop Cause Cancer??

Friday, February 26, 2016

Insidious Awful Worthless Germs

Seriously unbelievable! I am having the hardest time feeling better. Is it my WBCs that are not able to fight my fight for me? Is it something more insidious, deeper in my core that is really SICK sick. Sick beyond the "normal" sick? Sure, I've been sick since I've had Myeloma, but I can't recall the awfulness I feel this time. I've always recovered faster. This bug is sucking the life out of me. Taking forever to leave. I'm going to name it "THE CHRONIC FEVER FATIGUE FOREVER FLU"!

You know how in movies and books you're taken back to that incipient moment of what happened. That retrospective explanation that solves the why. I just want to know Who breathed on me, Touched me, Contaminated me! When did I pick this monster up? I wish with all my wishes, that I could look through the magical back in time telescope and see where I picked this thing up. I'm so darn careful about cross contamination, it just baffles me I could get this sick.

It started with the typical achiness of a fever and just continued to get worse from there. But it wasn't a horrible sinus or respiratory bug. It's manifested in a super high fever for days. Yes days and days and days and days of fever. Finally yes I've gotten better. I'm no longer stuck at 103, 102, 101. I don't ache as much. But I have this weird malaise. Just blah. Just no energy. No helium. Just achy all over. I find myself wanting to take my evil best friend Dexamethasone, just to see if that would make me feel better. Temporarily pump me up. Maybe this is the mystery? Maybe going off Dex has slowed my immune system to sluggish blah? I have my monthly oncology appointment on Monday, so I will ask.

In the meantime, I drag. I drag myself to do everything I try to do. I don't have the fire I used to. What is wrong with me. One day slips into another. I feel downright yucky. I feel no purpose. Just trying to get from one day to the next, to hopefully feel better the next. I can't get comfortable in my own skin. If Jim wasn't so sick too, I would think this was psychological. Yes we are slowly a little better each day. Just a little, not much, just a little bit each day. His settled more in his chest then me. He's on antibiotics, I'm not. Thankfully our chest xrays showed NO pneumonia. I am grateful. Very grateful! But I still feel awful. No pep. No motivation. One day falls into another. I question my life. My purpose. My reason here. Not feeling well makes one feel so awful. In so many ways.
I used to have so many events, goals, plans, challenges, etc to look forward to each day. Something to achieve daily and make me feel accomplished. That some-thing important that moves you forward. Some-thing that makes your body and mind feel good, productive, pleasant, happy, positive. You feel that good-tired feeling at the end of the day of doing some-thing that mattered. That, wow I can't wait to sit and relax feeling because your body "earned it" feeling. That delicious accomplished tired feeling, after you've lived a normal day, and you look forward to the next day's adventures and challenges. Not me, not now.

"Normal" people plan things. Normal people plan because they know they can do their plan. Plans are meant to be accomplished. I was planning to plan little things for my chemo break days. Little things. Drive my Bug. Groom a Horse. Take a walk in Nature. Go to lunch with friends. Maybe even try to visit my office one day. I was hoping we could begin to do a few things. Not much, just a few small fun things here and there. Now, I don't even feel like planning. What's the point. I don't feel well. Even if I plan, my body won't let me participate. I don't want to go anywhere. I can't get comfortable. My body hurts. No point in planning...

My days seem so meaningless now. Just existing. Just trying to get to something that makes me feel ok. Walk outside. No, it doesn't feel good like it used to. Pet the doggies. No, that's an effort. Pet the horses. No, that's an effort too. Sounds hurt my ears. Things give me headaches. Water, not refreshing. Juice, doesn't taste good. Toast, makes me feel stuffed. Soup, yuk, not satisfying. Nothing appeals or satisfies. I try to go outside and sit in the sun. It stings. The neighbor's gardener is blowing incessantly. It hurts my head. Makes my chest feel heavy. I feel sabotaged. I long for that sense of luxuriating on a lounge chair, feeling the sun's rays permeate my being, regenerating my battery. No, it doesn't feel good today, the day before or before. My skin hurts. My body feels restless. Achy. Discontent in any position. I take my temperature. Some days it's 99+. Some days 98+. Haven't seen a normal 98.6 since Feb 14. I know I am better. It's not in the 100's. I'm grateful for that.

This is not me. Not having the energy to do. I'm the eternal optimist. I'm supposed to be seeing the glass always half full. I've been thinking about all this, each day for weeks. I've been sick for 2 weeks now. What is my life now. What is my purpose. What is this getting up, to then get to the couch. To try and accomplish a few necessary chores saps me. To then flop back on the couch. That doesn't even feel good. My hindquarters are sore from sitting. From sleeping. NO I AM NOT DEPRESSED. This is physical. My body is not allowing me to feel good. I am so tired. I have a weird ache all over. I don't have an appetite, but I force myself to eat and drink. It doesn't refresh me. It doesn't make me feel good. It weights me down.

I feel terrible writing like this. There are so many suffering on such a larger scale than me. All over the world. There's so much sickness and suffering. Humans and animals. Cancer patients are dying every day. I follow a lot of myeloma discussion groups online. There's a lot of myeloma suffering out there. Myeloma is so insidious, so vicious. Treatments have stopped working suddenly for so many. Some have little hope. Treatments too invasive and organ-devastating, devour lives. Options have run out. I've been really sick, but at least my chemo treatments are having an impact, keeping my myeloma numbers stable. Years ago, like so many in the myeloma world, Pat Killingsworth was my first go to guy when I was diagnosed. He recently lost his battle. I, like everyone else, overwhelmed and shocked. Devastated he's gone. He blogged for us everyday. Sharing his life, his story, his treatments, his journey. Just devastated to read what happened to him. If you have myeloma, you know Pat. If you don't, please get to know him. His legacy will live on forever. What an amazing, insightful, intelligent man. Such a deep loss. The myeloma community has lost a "giant" and I am whining here about my fever flu awfulness. I am still here. He and so many others are not.

I'm sad I feel so awful. Sad for me, sad for others. I try so many things to make myself feel better. I compel myself. The weather has been spectacular here. That generally picks me up, invigorates me. My family, my animals usually invigorate me. Spring has come early. Beautiful fresh green everywhere, new colors of 2016. I want to feel good! But everything feels like a painful chore. I cancel plans made weeks ago. We just don't feel well. It's insidious. I don't understand why I am sick all the time. Cancer sick. Chemo sick. Flu sick. Sick of being sick.

But I push forward. I know moving helps. I go outside. I try to do some horse chores. I'm exhausted. I hurt. I feel like I'm going to pass out. I walk in my tack room. I'm sad. I waited too long. My life is passing me by. I'm not feeling sorry for myself. I'm a realist. My body failed me. I don't have the helium to do what I've dreamed of, waited too long for. The reality of being sick for over 6 years hits me. 6 years, more than 6 years, I've been sick. I haven't felt good for over 6 years. Tomorrow's another day I tell myself. I will get better. This is temporary. It has to be... It just has to be...

 My happy place ~
So many beautiful memories and miles

Can it really be? I've had this saddle for 35 years. 
So many happy miles. Dusty now, from lack of use...

It's a beautiful day outside. It can't be possible that I can feel bad much longer. It just can't. Monday starts chemo again. I missed 2 treatments this month due to being sick. I wonder how that has affected my status. My IgA was up last labs. Did I mention that? My IgA was up more than 100 points. I need to take monthly blood tests. I can't stand the idea of going over to the lab. So much sickness everywhere at all the clinics and hospitals. Sickness everywhere. I hate germs. I hate sickness. I don't have patience for it. What is their purpose. I hate suffering. I don't understand everyone's suffering. There's too much sickness suffering in the world... Sickness is suffocating. Ok, Enough...

Ok, so I will end with a couple funny stories. There's always that fine line between tragedy and humor, at least in my life. Last week, at the beginning of being so sick, Alissa was here helping us out. At some point she realized a pigeon had fallen down our chimney. We have a lot of pigeons Jim feeds regularly, so they often roost on the roof, but we've never had one visit us inside. I think the pigeon fell down the chimney late afternoon, so we decided to leave it there over night, hoping it might flutter back up by morning. I felt so sick, but I knew I had to help the poor guy. As sick as I felt, it was funny. It made us laugh. The irony of a pigeon falling down our chimney, especially when we felt so awful was just funny. I didn't need one more challenge. But it was funny. A wild pigeon randomly roosting (by mistake) in our fireplace. I'm not sure how in my feverish state I managed to gently grab the pigeon without much fuss, and hold on to him, but I did, and released him outside before I collapsed from laughing and physical exhaustion. 

A few days after the pigeon incident, Jim accidentally let one of the rescued baby sparrows out. For those that don't remember I rescued and raised a single female baby sparrow in 2013 and then in 2014, three more newborn babies fell from the nest. Not my intention to have a household of sparrows, but I didn't have a choice. Anyway, "First Birdie" gets to fly around our house periodically, as she goes right back in her cage. The "Triplets" are another story. They remain in their huge aviary, happy but way too "busy". Well Jim accidentally let one of the females out the other day, and she's not "trained" to fly back into her cage like "First Birdie". Long story short, while Jim and I are feeling feverish and awful, we're trying all kinds of gymnastics to catch the little birdie. She stays close by us and her buddies, but we can't get her back in the aviary without letting the others out. Can you imagine the comedy. First the pigeon in the fireplace last week, now a sparrow lose in the house. Fortunately, she finally flew into our food pantry late in the evening and I secured her there, trying to figure out how I was going to actually capture her and get her back in the aviary. Looking back, as awful as I felt, it was pretty hilarious. I'm climbing around the pantry, Jim finally slipping a step stool ladder in there for me as "girl birdie" flits here and there, swooping in my face, taunting me that I can't catch her. She finally exhausted herself and I managed to catch her behind the condiments and return her squawking and pecking to her aviary. Truly, my life is that fine line of comedy and tragedy. And that's only 2 recent examples our crazy adventures in Myelomaville.

First Birdie trying to cheer me up ~
What a lovely view of me... NOT :( but Birdie's very cute here!

Live happy, live well, and make a difference somewhere, somehow, with someone or something as often as you can! 

Sunday, February 21, 2016

Sick, so Sick. Big Fever. Stupid Immune System Fail

So if being sick from all my cancer related stuff isn't enough stupid body, you have to allow awful germs in to invade!

I've been sooooooooooooooooooooooooooooooooooooo sick since late Monday Feb 15. I started to feel lousy in the morning. Just weird achiness. But I had my prescheduled, every few month appointment with my SCT specialist, so I pushed aside my symptoms and went. I just thought it was treatment related aches, fatigue, headache, etc. I NEVER dreamed I was getting sick!

I registered a 98.9 temp there. Nothing to cause much notice. (I did take note tho, since I "normally" run normal or bit below.) "Relatively good" appointment with wonderful staff. I'll update on my details next post.
I began to feel rotten while driving home. Worse when we got home and when doing all our usual evening animal chores. I still didn't think I could be getting sick! Not me!

THEN it HIT! It really HIT! You know when a fever is real and it's invading. Moving in. Taking Over. You just feel so awful. Your body just aches all over, and there's little relief. You hurt from the inside out, and the outside in.You can't function. Nothing helps. Nothing relieves. You start begging for relief. Bargaining with the "germ g*ds". Promising all kinds of things, if the pain can just GO AWAY.

I didn't realize how doomed I was. But I hoped for the best, took some Jr strength Tylenol, and pretended I'd be fine in the morning. I got worse. And worse. Each day, each night. It got worse. I sent a message to my oncology office. They called. I couldn't even answer the phone. I was soooooooooooooo sick. I should have gone to ER, Urgent Care. But I barely made it from my bed to the bathroom to the couch, etc. I kept popping Jr strength Tylenol and Advil to take the edge off the fever. When it wore off, I'd take my temp. 102, 103+.  I hadn't felt this awful since.... I don't know... maybe my out of remission bug in 2013? Hawaii hotel disaster 2012? SCT fevers 2010? Just awful. Just fever awful. I couldn't eat. Hydrating was a huge effort.

Mon, Tues, Wed, Thurs, sick sick sick sick. Fever sick. Not much else. A cough here and there, but not an awful cough. Just an awful fever. I should have gone to be checked, everyone says. But I couldn't. I couldn't function, communicate, do much of anything. I haven't felt this awfulness in years... Jim gets sick too. We're messed up. What a great life. The weather is stunningly beautiful outside and where am I? I can't believe what has happened to me on so many levels.

Friday my fever finally broke a bit and came down between 102-100.
Saturday down more to 100-99. Starting to think I'll make it.
Sunday, today, down to 98.9. I finally called the "Nurse Advice Hotline". They couldn't believe what I've endured this week. It was "highly" recommended I go in and be checked.
We're going in now...

Live happy, live well, and make a difference somewhere, somehow, with someone or something as often as you can!

Saturday, February 6, 2016

Results, Adventures, Challenges, Grateful

Hello February!

So every time I finish writing a blog, I think Ok, that sums it up, I sure won't have much to say when it comes time for the next on the "6's" date to post! Well, I'm wrong on that! So much seems to happen between my 6's. Since my last post, I've found out the results to my January 4, 2016 Bone Marrow Biopsy (see below). I've had several occasions/invitations to share my myeloma story (one big event I'm keeping secret for now :) ... And more and more, (sadly) I am FORCED to recognize and accept how my cancer treatments and medical status has completely changed my life, and how my situation is preventing me from "functioning" anywhere near how I used to. So I made a phone call..

Saddle up. Here we go with my updates.

February brings the start of a new college semester. "Normally" I would have been involved in so many college related events and activities my head would be spinning. But nope, not now. I haven't set foot on campus since late October 2015. This is really huge for me and it's so weird for me trying to accept this "not going into my office" any time soon, or (maybe) ever again concept. Ouch! That's hard to write. Being a college counselor has been my whole life, beyond my kids and family life. The reality of my cancer side effects and weekly IV chemo treatments push me to accept my "forever" status. I see why those diagnosed with cancer eventually must opt for disability or retirement. I've fought this concept for 6 years. It's such a challenging concept for me, but a concept I must now consider... Ouch.
So I made a phone call...

Life's forks in everyone's road fascinates me. Always has. The choices, decisions, outcomes and adventures are never ending for any of us. Ever. Often exciting and rewarding. Or sadly tragic and too challenging. I used to present this to my students and classes: "If we were all in group therapy together and asked to write down our "issues" on a piece of paper, fold it up, toss it into a basket, then swirl the basket around, then we'd all have the choice to pick a random "issue" out, or pick out our own... Which Would You Pick?!" 
I pose this question to people regarding my cancer situation, as they just can't wrap their mind around living with an incurable cancer diagnosis. So I ask them to reflect on their own life's challenges, or those of others they know. Would they trade issues? Keep their own? Would I trade cancer for their life challenges? It's all so relative and truly, it's all in what we get used to and learn to adapt to. I've had a really hard time accepting my cancer diagnosis and status. I still think it will "magically" change.

Yes, I am always thinking about what has happened to me and why, and how come, and no fair, and shheesshh can I give "it" back. But if given the "choice, would I "trade" my circumstances for another's tragedy? Would you? Could you handle mine, and me, yours? Crazy how we can "get used" to our tragedies and challenges, and "learn" to adapt, cope, accept and move forward. Strange how I am overwhelmed by other's medical situations, but mine, yep it's mine, so one foot in front of the other, every hour, every day, every month. Pushing forward always. Being the optimist I have always been, I forever seek the positive in the negative, always looking for the "silver lining", for "the good" in "the bad".  So I can't help but be humored at the many "good" things and interesting "adventures" that have come out my diagnosis and treatments... Case in point:

As you know from my previous posts, Kyprolis is currently my "elixir" and best friend, gobbling up myeloma and giving me renewed hope for additional longevity. Through a special family friend, I was introduced to PR staff at Amgen. They kindly were interested in hearing my myeloma story and I was of course happy to share and give my endless thanks. My cancer journey IS fascinating. NOT because it's MY story, but because of WHAT so "randomly" happened to an otherwise healthy body, and how all my excellent medical care and treatments SAVED A LIFE! As awful and deadly as myeloma is, cancer is mysterious and fascinating. Why it happens, how it happens, where it happens, to whom it happens. So what a wonderful opportunity it was to be invited to share how much I appreciate all the brilliant medical pharmaceutical researchers, scientists, developers, as well as the entire Amgen staff that helped create and produce the life saving "potion" that is currently saving my life, and battling myeloma back!

I only had a tiny window of opportunity in terms of WHEN I could "safely" get on the freeway for the drive out there, and it happened to be a beautiful day for a drive. I felt so fortunate to be able to do what I was doing on so many different levels! Here I am, 6 years into my myeloma diagnosis, having been through initial chemo treatments, a Stem Cell Transplant, remission with maintenance meds for a few years, and now, after becoming "refractory" to Revlimid, Kyprolis is successfully eating up myeloma, and extending my life! Seriously, how lucky am I! So of course I want to share my story far and wide, to help anyone that could benefit from hearing about my journey, and to thank those that have had a part in saving my life!

We look like college students here, right?! Girl Power!!! Well actually there were several men in the meeting, but they had to dash off quickly for another meeting and missed this great photo-op! THANK YOU TO EVERYONE that took interest in my story and cared as you did to hear what I had to say about how Amgen's Kyprolis is currently saving my life! I had a wonderful time seeing where my best friend Kyprolis was developed and briefly getting to know all of you, and share how YOUR careers are saving my life. Thank you for caring about my story!

So that brings me to my current stats. Yes, I know... feel free to tell me "you told me so" over and over. How I should have ditched Revlimid sooner and been braver sooner, and switched chemos sooner. Ok ok, I've learned my lesson well. I should have taken my escalating IgA and M Protein more seriously, sooner. But as I've said before, I'm not the bravest cowgirl on this trailride of life. For real, side effects are yucky and scary. Often the "known bad" is preferable to the "unknown" possible good, even when that's not the smartest choice. And make no mistake, I still have very yucky side effects. Unpredictable, sudden, where'd that come from GI stuff, neuropathy, weird swelling, disabling fatigue, tingling, dizziness, headaches, breathlessness, disabling exhaustion, etc etc etc, all which keep me home-bound for most of the week.

My Kyprolis infusions are Mondays and Tuesdays, 3 weeks in a row. I then "crash" on Wednesdays and Thursdays. Begin to feel a little bit better on Fridays, little bit better Saturdays and ok on Sundays. Then It Starts All Over Again, to Infinity. So yes my numbers are better, and I am eternally grateful, but my quality of life hasn't changed. I'm still the "limited cancer patient" I've been for over 6 years now. Not complaining. Just stating facts. Ok, here's my numbers:

WBC's = 2.7 (low= why I feel so fatigued, immune compromised) 
4 - 11 = normal range
RBC = 3.7 (low = weak, fatigued, dizzy, oxygen challenged) 
4.20 - 5.40 = normal range
M-Protein = I'm "abnormal", but not a quantifiable number 
normal/remission = Zero
IgA = 432! Whoa!
70 - 400 = normal range
ANC = 1.7 (was a bit higher previous tests)
1.8 - 7.7 = normal range
Platelets = 159 
130 - 400 = normal range

Hello Myeloma! Did you notice... Kyprolis is WINNING! :)

And for the finale... my most recent Bone Marrow Biopsy #6:
#6 of course for 2016 for cancer year #6- The Results Are: 2-10% cancerous plasma cells.

WhooHoo! Take that stupid myeloma! Get out of my cells, get out of my life, just die off and let me live. You're probably wondering how I can be "happy" with those results? Results that show I am still quite cancerous? Remember, myeloma is incurable, and I will always have cancer. It's the degree of, that matters here.
To give perspective, I was 60-70% cancer at diagnosis December 2009.  
10% after initial 6 months of treatment.  
0 after Stem Cell Transplant summer 2010.
15% September 2013 when I came out of Remission. 

So even though I am still "cancerous", and I will have active cancer floating through my blood forever, I'll take these currents numbers.

And so..... periodically, I'm able to infuse mental helium into my exhausted spirit and body, and get out of my house for something other than the chemo lab and doctor appointments. 

After my "good news" and while still on steroids,
I treated myself to some PROTEIN! 
Bit me back later, but fun at the time! 

My sweet friend and avid supporter Susan and I
having a long awaited lunch date Tea Party.
Thank you Susan for "hating" my bad numbers
and celebrating my good numbers.
I wound up dizzy and with a crazy headache, but we had a lovely time
catching up and celebrating life.
Thank you for all your support and caring Susan!

No I didn't eat all this. Myeloma won't let me! 
Food always seems to look so good, 
better on the plate than in the tummy for me. 

I always feel I should be doing so much more than I do
but I just can't, my body won't let me...

 My daughter chauffeur at chemo with me 

Daughter and Son!!!!

Having "fun" at my Kyprolis infusion 
with the options on my new phone! 

 Stopped to get pet supplies on the way home from chemo
and this guy called out to me to rescue him! 
I just love betta fish, but haven't "allowed" myself 
any additional chores.
But I'm such a softie when it comes to animals
so home he came with me :)


Life marches forward. Monday Tuesday, Monday Tuesday, Monday Tuesday.
Blood tests every week to make sure I am strong enough for the Kyprolis infusions. So far, so good. I'm proud of my organs for being able to withstand all these intense chemical treatments. I try to hydrate all the time, eat well most of the time, and I am forever grateful for all the amazing medical care I have received and continue to receive. I truly live my life one day at a time, one chemo appointment at a time. Blood test to blood test. Breathing in monthly results to monthly results. My life status, prognosis, strength to move forward, and whether myeloma is, or I am winning, always revealed through my monthly blood work. I move forward with hope and optimism, still not believing my circumstances. Walking the walk as a lifetime cancer patient. This is my life.

Live happy, live well, and make a difference somewhere, somehow, with someone or something as often as you can!

My Story... How my MM was diagnosed

October/November/December 2009...

Most of my life I was VERY presumptuous about being healthy, taking my (mostly) GOOD health for granted...
I was committed to annual check-ups for all of us, and so late October 2009, my daughter and I went for our annual and very routine physicals.

Surprise, surprise... my routine blood tests revealed extreme Anemia, significant White and Red Cell issues, low Platelets, and a variety of other CBC red flags! I was (stupidly) not worried when my GP doc left repeated phone messages to contact him, and when we did speak, I (stupidly) requested postponement of his referral appointment to the Hematology Dept until the end of the Fall academic term.

Arriving for my first appointment Dec 14, 2009, I was confronted with the check-in sign that read: "Hematology/Oncology"... What? Nooooo! not me... I must be in the WRONG place! And so my diagnosis journey began with vials and vials of blood drawn "stat", urgent Dr consultations, a surprise and painful Bone Marrow Biopsy, a full body Skeletal Scan, more blood tests stat, and then on 12.30.2009... THE revealing meeting... the "huh-what" moment ... the confirmation diagnosis that I, Julie, have CANCER!!!

Happy New Year to me, I just learned a new vocabulary word:
Multiple Myeloma!!! MM, Multiple Mye-what-loma!!!

January - June 2010

My medical metamorphosis began.
I read, and read, and read and researched and researched MM. I trusted my expert Oncology/Hematology team's plan and began my "New Normal" as a cancer patient.
My treatment plan was developed to include powerful Dexemthesone steroids paired with Revlimid chemotherapy, with the plan to be hospitalized for an Autologous Stem Cell Transplant July 2010.

I began living "one day at a time" like never before.
Jim was a wreck. Alissa and Scott were stunned; family and friends shocked.

Me... Cowgirl Up! I got back in the saddle and knew I was in for the ride of my life!
I did well on my initial pill-form Revlimid Chemo, "roid-rage" Dex Steroids and other supportive meds. I am forever deeply grateful and appreciative for all the love and support from everyone in my personal and professional life! I thank all of you for working along with me, and allowing me to continue to lead a semi "normal" life!
YOU have helped save my life!

My treatment trail ride forks to City of Hope hospital as I will saddle up beginning June 9, 2010 for a new rodeo called an Autologous Stem Cell Transplant!
Ye-Ha, let the adventure begin!

Chemical Warfare...

January 2010 - May 2010:
My initial chemo regimen:

Pill form Chemo= Revlimid (10mg, 15mg capsules)
Pill form Dexamethasone Steroids (40 mg, 4 days on, 4 days off!
Omeprazole for steroid acid reflux
Mepron (looks like yellow finger paint) Anti-fungal, Anti-viral, etc for my very compromised immune system
.81 Aspirin to prevent DVT, Revlimid complications
Allopurinol- keeping the kidneys healthy
Acyclovir- anti-Shingles, anti-viral

June 2010:
High dose IV Cytoxan chemo
Neupogen to build up stem cells for Apheresis, stem cell harvest, which was very successful, as City of Hope was able to collect 9.5 million of my own stem cells

July 2010 Hospitalization:
Two days of high dose Melphalan chemo
Then July 5, 2010 = my Autologous Stem Cell transplant infusion!

And you can read my whole story from that point forward in this blog!

What is multiple myeloma?

What is multiple myeloma?

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

Multiple myeloma is a cancer formed by malignant plasma cells. Normal plasma cells are found in the bone marrow and are an important part of the immune system.

The immune system is made up of several types of cells that work together to fight infections and other diseases. Lymphocytes (lymph cells) are the main cell type of the immune system. The major types of lymphocytes are T cells and B cells.

When B cells respond to an infection, they mature and change into plasma cells. Plasma cells make the antibodies (also called immunoglobulins) that help the body attack and kill germs. Lymphocytes are in many areas of the body, such as lymph nodes, the bone marrow, the intestines, and the bloodstream. Plasma cells, however, are mainly found in the bone marrow. Bone marrow is the soft tissue inside some hollow bones. In addition to plasma cells, normal bone marrow has cells that make the different normal blood cells.

When plasma cells become cancerous and grow out of control, they can produce a tumor called a plasmacytoma. These tumors generally develop in a bone, but they are also rarely found in other tissues. If someone has only a single plasma cell tumor, the disease is called an isolated (or solitary) plasmacytoma. If someone has more than one plasmacytoma, they have multiple myeloma.

Multiple myeloma is characterized by several features, including:

Low blood counts

In multiple myeloma, the overgrowth of plasma cells in the bone marrow can crowd out normal blood-forming cells, leading to low blood counts. This can cause anemia – a shortage of red blood cells. People with anemia become pale, weak, and fatigued. Multiple myeloma can also cause the level of platelets in the blood to become low (called thrombocytopenia). This can lead to increased bleeding and bruising. Another condition that can develop is leukopenia – a shortage of normal white blood cells. This can lead to problems fighting infections.

Bone and calcium problems

Myeloma cells also interfere with cells that help keep the bones strong. Bones are constantly being remade to keep them strong. Two major kinds of bone cells normally work together to keep bones healthy and strong. The cells that lay down new bone are called osteoblasts. The cells that break down old bone are called osteoclasts. Myeloma cells make a substance that tells the osteoclasts to speed up dissolving the bone. Since the osteoblasts do not get a signal to put down new bone, old bone is broken down without new bone to replace it. This makes the bones weak and they break easily. Fractured bones are a major problem in people with myeloma. This increase in bone break-down can also raise calcium levels in the blood. (Problems caused by high calcium levels are discussed in the section “How is multiple myeloma diagnosed?”)


Abnormal plasma cells do not protect the body from infections. As mentioned before, normal plasma cells produce antibodies that attack germs. For example, if you developed pneumonia, normal plasma cells would produce antibodies aimed at the specific bacteria that were causing the illness. These antibodies help the body attack and kill the bacteria. In multiple myeloma, the myeloma cells crowd out the normal plasma cells, so that antibodies to fight the infection can’t be made. The antibody made by the myeloma cells does not help fight infections. That’s because the myeloma cells are just many copies of the same plasma cell – all making copies of the same exact (or monoclonal) antibody.

Kidney problems

The antibody made by myeloma cells can harm the kidneys. This can lead to kidney damage and even kidney failure.