Con­fus­ing myeloma di­ag­no­sis needs more com­mu­ni­ca­tion

The Morning Journal (Lorain, OH) - - YOUR DAILY BREAK - Con­tact Dr. Roach at ToYourGoodHealth@med. cor­nell.edu.

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.

DEAR READER » Mul­ti­ple myeloma is a type of blood cancer of the cells that make an­ti­bod­ies. Myeloma is very un­usual at her age: Less than 2 per­cent 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 high-dose 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?

DEAR READER » Diver­tic­ula are small pouches in the wall of the colon, and the con­di­tion of hav­ing them is called di­ver­tic­u­lo­sis.

You ask a com­mon ques­tion. 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.

Keith Roach To Your Good Health

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