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Myeloma Cancer

Sep12

What is Multiple Myeloma?

Multiple myeloma is a cancer of plasma cells (B and T cells).  Multiple myeloma is a cancer of 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.

We stated yesterday myeloma is most often found in bone marrow. Remember normal plasma cells are found in the bone marrow & 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 one of the main types of white blood cells in the immune system and include T cells and B cells. Lymphocytes are in many areas of the body, such as lymph nodes, the bone marrow, the intestines, and the bloodstream.

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.

When plasma cells become cancerous=cancer cells (intially made in the bone marrow than released in the blood), they multiply and begin to crowd out healthy cells and produce abnormal antibodies called M proteins.  This continues to to replicate till the body dies or some treatment takes over decreasing them by destroying them (Ex. Chemo) or possibly putting the patient in remission.

What are the major types of myeloma?

There are four major sub-types of myeloma. Diagnosis depends on how localized or spread out the cancer has become and where it originated. The most common form of myeloma is multiple myeloma. Over 90% of people with myeloma have multiple myeloma.

Multiple myeloma -This is the one we will be discussing in this topic.
Plasmacytoma
Localized myeloma
Extramedullary myelom
Multiple Myeloma Complications:

In multiple myeloma, the overgrowth of plasma cells in the bone marrow can crowd out normal blood-forming cells:

1-Leading to low cell counts=RBCs-low in iron/anemia, level of platelets in the become low (called thrombocytopenia)=increased bleeding and bruising & WBCs low called leukopenia=problems fighting infections.

2-Myeloma cells make a substance that tells the osteoclasts to speed up dissolving the bone. So old bone is broken down without new bone to replace it, making the bones painful, weak, thinning the bones and easy to break.

3-Abnormal plasma cells cannot protect the body from infections. As mentioned before, normal plasma cells produce antibodies that attack germs. 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.

A monoclonal gammopathy is when plasma cells make too many copies of the same antibody. It is usually found on a routine blood test when looking for other conditions.In monoclonal gammopathy of undetermined significance (MGUS), abnormal plasma cells make many copies of the same antibody (called a monoclonal protein). However, these plasma cells do not form an actual tumor or mass and do not cause any of the problems seen in multiple myeloma. MGUS usually does not affect a person’s health. It doesn’t cause weak bones, high calcium levels, kidney problems, or low blood counts.

4-Myeloma cells make an antibody that can harm the kidneys, leading to kidney damage and even kidney failure.

Factors that may increase your risk of multiple myeloma include:

Increasing age. Your risk of multiple myeloma increases as you age, with most people diagnosed in their mid-60s.
Male sex. Men are more likely to develop the disease than are women.
Black race. Black people are about twice as likely to develop multiple myeloma as are white people.
Family history of multiple myeloma. If a brother, sister or parent has multiple myeloma, you have an increased risk of the disease.
Personal history of a monoclonal gammopathy of undetermined significance (MGUS). Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.
Diagnosing Multiple Myeloma:
Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.
Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they’re detected in urine.
Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.
Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).

After someone is diagnosed with cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging (I,II,III,IV). The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it.

Treatment:

1-Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Targeted-therapy drugs may be administered through a vein in your arm or in pill form.

Other targeted-therapy treatments include monoclonal antibody drugs that bind to the specific proteins present on myeloma cells, causing them to die.

2-Biological therapy. Biological therapy drugs use your body’s immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are commonly taken in pill form.

3-Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a bone marrow transplant.

4-Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.

5-Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.

Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.

6-Radiation therapy. This treatment uses beams of energy, such as X-rays and protons, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that’s causing pain or destroying a bone.

Part I Legionnaires/Pontiac Fever- What is this illness, the symptoms, & who is at increased risk?

Nov25

Legionairres outbreak 

legionnaires how its picked up

Legionnaires’ disease is a severe form of pneumonia — lung inflammation usually caused by infection. Legionnaires’ disease is caused by a bacterium known as legionella.

Legionella bacteria are found naturally in freshwater environments, like lakes and streams. The bacteria can become a health concern when they grow and spread in human-made building water systems like

  • Showerheads and sink faucets
  • Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for buildings or industrial processes)
  • Hot tubs
  • Decorative fountains and water features
  • Hot water tanks and heaters
  • Large, complex plumbing systems

Home and car air-conditioning units do not use water to cool the air, so they are not a risk for Legionella growth.

However, Legionella can grow in the windshield wiper fluid tank of a vehicle (such as a car, truck, van, school bus, or taxi), particularly if the tank is filled with water and not genuine windshield cleaner fluid.

You can’t catch Legionnaires’ disease from person-to-person contact. Instead, most people get Legionnaires’ disease from inhaling the bacteria. Older adults, smokers and people with weakened immune systems are particularly susceptible to Legionnaires’ disease.

The legionella bacterium also causes Pontiac fever, a milder illness resembling the flu. Separately or together, the two illnesses are sometimes called legionellosis. Pontiac fever usually clears on its own, but untreated Legionnaires’ disease can be fatal. Although prompt treatment with antibiotics usually cures Legionnaires’ disease, some people continue to experience problems after treatment.

Know this about Legionnaire’s disease, although the disease primarily affects the lungs, it occasionally can cause infections in wounds and in other parts of the body, including the heart.

Legionnaires’ disease usually develops two to 10 days after exposure to legionella bacteria. It frequently begins with the following signs and symptoms:

  • Headache
  • Muscle pain
  • Chills
  • Fever that may be 104 F (40 C) or higher
  • By the second or third day, you’ll develop other signs and symptoms that may include:
  • Cough, which may bring up mucus and sometimes blood
  • Shortness of breath
  • Chest pain
  • Gastrointestinal symptoms, such as nausea, vomiting and diarrhea
  • Confusion or other mental changesA mild form of Legionnaires’ disease — known as Pontiac fever — may produce signs and symptoms including fever, chills, headache and muscle aches. Pontiac fever doesn’t infect your lungs, and symptoms usually clear within two to five days.WHEN TO SEE A DOCTOR:

Who are at risk for Legionnaires’ disease:

Most healthy people exposed to Legionella do not get sick. People at increased risk of getting sick are:

  • People 50 years or older
  • Current or former smokers
  • People with a chronic lung disease (like chronic obstructive pulmonary disease or emphysema)
  • People with weak immune systems or who take drugs that weaken the immune system (like after a transplant operation or chemotherapy)
  • People with cancer
  • People with underlying illnesses such as diabetes, kidney failure, or liver failure

See your doctor if you think you’ve been exposed to legionella bacteria. Diagnosing and treating Legionnaires’ disease as soon as possible can help shorten the recovery period and prevent serious complications. For people at high risk, prompt treatment is critical.

updated 11/21/2023 by strive for good health.

Part I Is it true or a myth that all pregnant women taking tylenol is the cause for autism later diagnosed in their baby!

Oct20

Taking Tylenol during pregnancy associated with elevated risks for autism, ADHD

A Johns Hopkins study analyzing umbilical cord blood samples found that newborns with the highest exposure to acetaminophen were about three times more likely to be diagnosed with ADHD or autism spectrum disorder in childhood

(https://hub.jhu.edu/2019/11/05/acetaminophen-pregnancy-autism-adhd/)

Published Nov 5, 2019

John Hopkins report:

“Published Nov 5, 2019

A new study from researchers at the Johns Hopkins Bloomberg School of Public Health has found that exposure to acetaminophen in the womb may increase a child’s risk for attention deficit hyperactivity disorder or autism spectrum disorder.

The researchers analyzed data from the Boston Birth Cohort, a 20-year study of early life factors influencing pregnancy and child development. They found that children whose cord blood samples contained the highest levels of acetaminophen—the generic name for the drug Tylenol—were roughly three times more likely to be diagnosed with ADHD or autism spectrum disorder later in childhood, compared to children with the lowest levels of acetaminophen in their cord blood.

Their findings were published last week in JAMA Psychiatry.

Previous studies have found an association between maternal use of acetaminophen during pregnancy and increased risks of adverse childhood outcomes, including neurodevelopmental disorders such as ADHD—which is marked by hyperactivity and difficulty paying attention or controlling impulsive behavior—and autism spectrum disorder, a complex developmental disorder that can affect how a person socializes, communicates, and behaves. Because these studies relied on mothers self-reporting their acetaminophen use, critics have said the findings may be affected by recall bias or lack an objective measure of in-utero exposure. As a result, the U.S. Food and Drug Administration has refrained from making recommendations regarding the use of acetaminophen during pregnancy.

“People in general believe Tylenol is benign, and it can be used safely for headaches, fever, aches, and pains,” says Xiaobin Wang, a professor in the Bloomberg School’s Department of Population, Family, and Reproductive Health and the study’s corresponding author. “Our study further supports the concerns raised by previous studies—that there is a link between Tylenol use during pregnancy and increased risk for autism or ADHD.”

For the study, which was authored by Johns Hopkins postdoctoral fellow Yuelong Ji and colleagues, the team measured the biomarkers of acetaminophen and two of its metabolic byproducts in umbilical cord blood samples from 996 individual births. Every sample analyzed contained some level of acetaminophen—confirming the drug’s widespread use during pregnancy, labor, and delivery. The researchers then divided the study children into three groups based on the amount of acetaminophen and its metabolites present in their cord blood samples.

RESEARCH
Understanding autism

Related coverage of what scientists know about autism—and what they’re still working to discover

Compared to the group with the lowest amount of acetaminophen exposure, the children in the middle third group were about 2.26 times more likely to have an ADHD diagnosis and 2.14 times more likely to have an autism spectrum disorder diagnosis. Those with the highest levels of exposure were associated with 2.86 times the risk of ADHD and 3.62 times the risk for autism spectrum disorder, compared to those with the lowest exposure.

The researchers found consistent associations between the drug and the disorders across a variety of other factors that correlate with ADHD and autism spectrum disorder diagnoses, such as maternal BMI, preterm birth, child sex, and reports of maternal stressors and substance use.

Wang points out that although the study found a consistent association between biomarkers of acetaminophen and its metabolites in cord blood and child risk of ADHD and autism spectrum disorder, it should not be interpreted that the Tylenol use causes these disorders.

“More studies are clearly needed to further clarify the concern,” Wang says. “Until it is certain, parents and providers may want to consider the benefit and potential risk when making a decision on the use of acetaminophen during pregnancy or the peripartum period.”

(https://hub.jhu.edu/2019/11/05/acetaminophen-pregnancy-autism-adhd/)

Part II Acute Renal Failure versus Chronic Renal Failure

Aug18

 

Chronic Renal (Kidney) Failure:

In giving a short and easily understandable definition Chronic kidney disease happens when your kidneys no longer filter your blood the way they should, so wastes (toxins, usually end products of an acid) build up in your blood. This has probably been going on for years, and it may keep getting worse over time. Just like a car engine damaged but still using the car without getting the engine repaired sooner or later in time the engine no longer functions the same with any organ of the body getting damaged by some long term condition. If your disease gets worse and worse over time, you could have kidney failure for some multi organ failure, depending on the condition causing this.*

The most common causes of Chronic Renal Failure are:

-Diabetes (uncontrolled diabetes (Type 1 or 2) for many years. *-High blood pressure for many years.                                   These are the top 2 causes of most chronic kidney disease. Controlling these diseases can help slow or stop the damage to the individual’s kidneys who has one of these, if not both.

Other causes that can lead to chronic kidney disease include:   -Kidney diseases and infections, such as polycystic kidney disease, pyelonephritis, and glomerulonephritis, or a kidney problem you were born with.

-A narrowed or blocked renal artery. A renal artery carries blood to the kidneys.

-Long-term use of medicines that can damage the kidneys. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), such as celecoxib and ibuprofen.

Know this for starters, each of your kidneys has about a million tiny filters, called nephrons.The nephron is the tiny filtering structure in your kidneys. Each of your kidneys contain more than a million tiny filtering nephrons that help clean your blood removing toxins dumping them into your urinary bladder so you can evacuate them though urine (urea, urine; get it). Your nephrons play a vital role to our essential daily living. They help all humans do the following if there kidneys or one kidney is functioning properly. They:

  • -Remove excess water, wastes (like urea, ammonia, etc.) & other substances from your blood.
  • -Return substances like sodium, potassium or phosphorus whenever any of these substances run low in your body.
  • If nephrons are damaged by the high sugar content or high blood pressure in the kidneys, they stop working. For a while, healthy nephrons can take on the extra work or overload. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you’re blood filtered properly to keep you healthy. Just like running from a bear in the street chancing you. We can run only so long but sooner or later we will run out of energy and not be able to run anymore, same concept for the kidney nephrons when they run out of enough not properly working.-Urinate less than normal. *
  •  -Have swelling and weight gain from fluid buildup in your tissues. This is called edema.*
  • -Feel very tired or sleepy. *
  • -Not feel hungry, or you may lose weight without trying.*
  • -Often feel sick to your stomach (nauseated) or vomit.*
  • -Have trouble sleeping.*
  • -Have headaches or trouble thinking clearly.
  • Your doctor will do blood and urine tests to help find out how well your kidneys are working. These tests can show signs of kidney disease and anemia. (You can get anemia from having damaged kidneys.) You may have other tests to help rule out other problems that could cause your symptoms.
  • To diagnose chronic renal failure is pretty much the same tests that are listed above on acute renal failure plus:Chronic kidney disease is also called chronic renal failure or chronic renal insufficiency.There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.  So GFR will help the MD rule out acute versus chronic to give the MD direction on Rx.Your doctor will ask questions about any past kidney problems. He or she will also ask whether you have a family history of kidney disease and what medicines you take, both prescription and over-the-counter drugs. 
  • Treatment (Rx) for Chronic Kidney (Renal) Failure:There are things you can do to slow or stop the damage to your kidneys. Taking medicines and making some lifestyle changes can help you manage your disease, prevent further damage to the kidneys, if their functioning at all and make you possibly feel better.
  • Kidney disease is a complex problem. You will probably need to take a number of medicines and have many tests. To stay as healthy as possible, take your medicines just the way your doctor says to and work closely with your doctor. Go to all your appointments for the MD to see a increase in function or decrease in function of your kidney or kidneys you have still functioning to a level. To do that you can’t just go every 6 months especially when first diagnosed with it or with a collapse of an exacerbation of kidney failure in a worse level that brought on new symptoms that brought you to the ER. Lifestyle changes are an important part of your treatment. Taking these steps can help slow down kidney disease and reduce your symptoms. These steps may also help with high blood pressure, diabetes, and other problems that make kidney disease worse or made the kidney disease happen with the secondary diagnosis you had originally for years (ex. Hypertension or Diabetes if not both especially is uncontrolled).
  • Very hard, never a complete 100 % resolution. It is like emphysema done by smokers the damage is done or like a heart attack the area of the infarction is heart muscle now scared and the damage is done, so its get the organ to its optimal level of functioning.
  • You may have a test that lets your doctor look at a picture of your kidneys, such as an ultrasound or CT (Cat Scan of the kidneys). These tests can help your doctor measure the size of your kidneys, estimate blood flow to the kidneys, and see if urine flow is blocked. In some cases, your doctor may take a tiny sample of kidney tissue (biopsy) to help find out what caused your kidney disease.
  • Chronic kidney disease is caused by damage of the kidneys whether the cause of it be primary a Renal or Kidney problem or a secondary, another disease or disorder that affects the kidneys in doing their job, like hyperglycemia related to a individual with uncontrolled diabetes, for instance.
  • Chronic kidney disease may seem to have come on suddenly. But it has been happening bit by bit for many years as a result of damage to your kidneys.
  • One way to measure how well your kidneys are working is to figure out your glomelular filtration rate (GFR). The GFR is usually calculated using results from your blood creatinine test. Then the stage of kidney disease is figured out using the GFR (glomelular filtration rate). There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.
  • Your doctor will do tests that measure the amount of urea (BUN) and creatinine in your blood. These tests can help measure how well your kidneys are filtering your blood. As your kidney function gets worse, the amount of nitrogen (shown by the BUN test) and creatinine in your blood increases. The level of creatinine in your blood is used to find out the glomerular filtration rate (GFR). The GFR is used to show how much kidney function you still have. The GFR is also used to find out the stage of your kidney disease your in if you have it and its to guide decisions about treatment.
  • To help diagnose Chronic Renal Failure:
  • How well your kidneys work is called kidney function. As your kidney function gets worse so do your symptoms, you may show these symptoms:
  • Follow a diet that is easy on your kidneys. A dietitian can help you make an eating plan with the right amounts of salt (sodium) and protein. You may also need to watch how much fluid you drink each day.
  • Make exercise a routine part of your life. Work with your doctor to design an exercise program that is right for you.
  • Do not smoke or use tobacco.
  • Do not drink alcohol. When kidney function falls below a certain point, it is called Kidney failure. Kidney failure affects your whole body. It can cause serious heart, bone, and brain problems and make you feel very ill. Untreated kidney failure will be life-threatening at some point.
  • When you have kidney failure, you will probably have two choices: start dialysis or get a new kidney (transplant). Both of these treatments have risks and benefits. Talk with your doctor to decide which would be best for you.
  • Always talk to your doctor before you take any new medicine, including over-the-counter remedies, prescription drugs, vitamins, or herbs. Some of these can hurt your kidneys further.
  • In complete renal failure you have 2 choices for Rx. **Dialysis is a process that filters your blood when your kidneys no longer can. It is not a cure, but it can help you feel better and live longer.
  • **Kidney transplant may be the best choice if you are otherwise healthy. With a new kidney, you will feel much better and will be able to live a more normal life. But you may have to wait for a kidney that is a good match for your blood and tissue type. And you will have to take medicine for the rest of your life to keep your body from rejecting the new kidney.    
  • Making treatment decisions when you are very ill is hard. It is normal to be worried and afraid. Discuss your concerns with your loved ones and your doctor. It may help to visit a dialysis center or transplant center and talk to others who have made these choices.