Multiple myeloma diagnosis at young age raises red flags

Dear Dr. Roach: My son (early 40s) has been romantically involved with a woman (early 30s) for the past two years. She has always been underweight, but seems to be in good health. She has a past history of endometrial cancer, and has had no recurrence since treatment. Now she has been diagnosed with myeloma. Her treatment consists of blood transfusions when needed. This is a delicate situation, and I am having difficulty learning more about this form of cancer, other than through online searches. I have questions about treatment options, lifestyle changes, prognosis, fertility, longevity — all the biggies. Your input would be greatly appreciated.

M.T. Multiple myeloma is a type of blood cancer of the cells that make antibodies. Myeloma is very unusual at her age: Less than two per cent of people are diagnosed before age 40, with half of people being over the age of 66 at diagnosis. It is unusual enough that I would be concerned about the diagnosis being a possible mistake.

Two conditions can be mistaken for multiple myeloma: smoldering myeloma and monoclonal gammopathy of uncertain significance (MGUS). These conditions often are not treated, as opposed to multiple myeloma, which needs effective treatment. Without effective treatment for someone with multiple myeloma, only half of people will live more than six months.

Treatment for a young person ideally would be an autologous hematopoietic cell transplantation. Often called a bone marrow transplant, this procedure takes the person’s own healthy cells and gives them back after highdose chemotherapy. There are several new approaches, with more-effective and less-toxic treatments available, yet HCT remains the best chance for cure. Not everyone is a candidate for it. Pregnancy is possible, but rare, after this treatment.

I don’t understand the treatment you describe. Blood transfusions are not effective for myeloma, and are not usually needed for smoldering myeloma or MGUS. I can provide some general information about myeloma, but to find out about her individual prognosis, you need to ask her or your son, who surely must have talked to her about these issues. The combination of early endometrial cancer and early myeloma has been reported: People with a history of endometrial cancer are at higher risk for myeloma. Dear Dr. Roach: I have had a couple of colonoscopies and was told that I have diverticulosis. The first doctor told me not to eat corn. The second doctor didn’t mention not eating corn. What do you think?

P.W. Diverticula are small pouches in the wall of the colon, and the condition of having them is called diverticulosis.

In the past, many people were told not to eat seeds, nuts or other foods that might lodge into diverticula. It was thought that if the pouches got blocked, they could become inflamed and infected (which is called diverticulitis, and usually causes abdominal pain and often fever). However, recent studies show that this fear probably is unfounded, and that food lodging in the diverticula is only a very rare cause of infection or inflammation. In fact, people who eat more nuts and seeds are at lower risk for diverticular problems than people who don’t.

I can’t tell you to do something your doctor told you not to, but the accepted scientific wisdom (as of right now) is that nuts and seeds (and that includes corn kernels) are safe in people with diverticulosis.