multiple myeloma

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What is multiple myeloma?

Multiple myeloma is a cancer of the plasma cells. These white blood cells are found in the bone marrow and produce antibodies to help your immune system fight infections.

Cancerous plasma cells produce abnormal proteins called M proteins. A high level of M proteins can damage your kidneys and weaken your immune system. These cancerous cells also replace normal cells with tumors, usually in the bone marrow. This can cause bone damage and lead to bone pain or fractures.

Multiple myeloma symptoms

The symptoms of multiple myeloma can vary from person to person. Some people with multiple myeloma have no symptoms at all.

According to the American Cancer Society, the most common multiple myeloma symptoms include:

Bone problems

Bone pain that can be in any bone but is most often in your back, hips, and skull

Bone weakness, either all over (osteoporosis) or where there is a bone tumor

Broken bones or fractures, sometimes from minor stress or injury

Low blood count

Anemia — low levels of red blood cells, which may cause weakness, fatigue, shortness of breath, and dizziness

Leukopenia — low levels of white blood cells, which can increase your risk of infections and weaken the immune system

Thrombocytopenia — low blood platelet counts may cause serious bleeding even with minor scrapes, cuts, or bruises

High levels of calcium in the blood, which can cause:

1. Extreme thirst
2. Excessive urination
3. Dehydration
4. Kidney problems and even kidney failure
5. Severe constipation
6. Abdominal pain
7. Loss of appetite
8. Weakness
9. Drowsiness
10. Confusion

Frequent infections

Myeloma patients are much more likely to get infections. Pneumonia is a common and serious infection seen in myeloma patients.

Kidney damage Which can lead to:

1. Weakness
2. Shortness of breath
3. Itching
4. Leg swelling

Nervous system problems

Which can cause:

Sudden severe back pain

Numbness, most often in the legs

Muscle weakness, most often in the legs

atelectasis

 What is atelectasis? copy from : https://www.hopkinsmedicine.org/health/conditions-and-diseases/atelectasis#:~:text=What%20is%20atelectasis%3F,breathing%20and%20underlying%20lung%20disease.

Atelectasis, the collapse of part or all of a lung, is caused by a blockage of the air passages (bronchus or bronchioles) or by pressure on the lung. 

Risk factors for atelectasis include anesthesia, prolonged bed rest with few changes in position, shallow breathing and underlying lung disease.

Mucus that plugs the airway, foreign objects in the airway (common in children) and tumors that obstruct the airway may lead to atelectasis. Large-scale atelectasis may be life threatening, especially in someone who has another lung disease or illness. In a baby or small child, lung collapse due to a mucus obstruction or other causes can be life threatening. 

Symptoms

1. Breathing difficulty
2. Chest pain
3. Cough

Diagnosis

Exams and tests include chest X-ray and bronchoscopy.

Treatment

The goal of treatment is to remove lung secretions and re-expand the affected lung tissue. Treatments include: 

Aerosolized respiratory treatments to open the airway

Positioning the body on the unaffected side to allow the lung to re-expand

Removing obstructions by bronchoscopy

Breathing exercises (incentive spirometry)

Clap, or percussion, on the chest to loosen mucus

Tilting the body (postural drainage) so that the head is lower than the chest to drain mucus

Treating a tumor or underlying condition, if present.

Prognosis

The collapsed lung usually reinflates gradually once the obstruction has been removed. However, some residual scarring or damage may occur. 

Atelectasis is treated by the Division of Pulmonary Medicine.

Metabolic Encephalopathy

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Learning About Metabolic Encephalopathy

What is metabolic encephalopathy?

Metabolic encephalopathy is a problem in the brain. It is caused by a chemical imbalance in the blood. 

The imbalance is caused by an illness or organs that are not working as well as they should. It is not caused by a head injury.When the imbalance affects the brain, it can lead to personality changes.  (Alter Mental status)It can also make it harder to think clearly and remember things.The problems may only last a short time if you get treatment right away. But this depends on the cause. If the imbalance has been building up because you've been sick for a long time, the mental changes may be more severe. They may also last longer.

What happens when you have this problem?When things are working right, your body has many ways to keep the chemicals in your blood in balance. 

For example, your liver and kidneys remove waste from your blood. The kidneys also help keep fluids and sodium in balance. And your pancreas makes insulin. It is a hormone that helps control the amount of sugar in your blood.

But the chemicals in your blood can get out of balance and damage parts of your body because of a medical problem.

This may be kidney or liver failure. 

Or it could be diabetes that isn't controlled well. When the imbalance affects the brain, normal thinking and behavior can change.

What are the symptoms?

Symptoms may include:

Confusion.

Problems with thinking and remembering.

Being grouchy and depressed.

Feeling drowsy.

Not being able to sleep.

Passing out (fainting) now and then.

How is it treated?

The doctor will try to find the illness that's causing the problem. The doctor may ask questions about your past health.

The doctor will also do tests to find what is causing the chemical imbalance and to see how severe it is.

The doctor may treat the organ system that's causing the problem. 

For example, if it's a kidney problem, you may have treatment to help your kidneys work better. 

If you have an infection, you may need antibiotics. If the doctor can't treat the cause of the problem, the doctor will treat the symptoms.

The doctor will carefully watch your blood chemicals to make sure that your treatment is being done safely.

Follow-up care is a key part of your treatment and safety. 

Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Current as of: June 6, 2022

Author: Healthwise Staff

Medical Review:Adam Husney MD - Family Medicine