Dear Doctor, I write as one of you, a Family Practice physician for 25 years. I dealt with the same vague CC's which you do: "Why am I so tired"?, Why don't I feel good"?, and "Why does my back still hurt"? Near the end of my practice I missed an important Dx......my own......by failing to include Multiple Myeloma in my Differential Diagnosis. My increasing back pain ultimately resulted in a T-10 compression fx. The plea in this short note is simple: better awareness. Please keep your Index of Suspicion high for this zebra hiding among so many common horses. If your patient doesn't respond to the conservative approach you recommend, please order a simple SPEP (serum protein electrophoresis). It is not part of a routine chem panel, but will quickly rule out this devastating diagnosis. An IFE (immuno fixation electrophoresis) is helpful to confirm and define your patients' cancerous clone which is producing myeloma protein. Also recall the acronym for myeloma diagnosis. CRAB reminds us to remember (1)HyperCalcemia, (2)Renal disease, (3)Anemia, and (4)Bone disease. When combined with lab values showing a monoclonal spike of a single immunoglobulin, the diagnosis is active multiple myeloma. Please don't miss this important diagnosis. Myeloma should be on your long Diff Dx list for chronic back pain, frequent infections, and extreme fatigue. Sincerely, Jim Omel MD
Congratulations to Kathy Ulrich and Abbie Rae who won today's MCRI challenge prize! They win two tickets each to the upcoming Trans-Siberian Orchestra concert in Salt Lake City on November 24th at the Energy Solutions Arena. Thanks to iHeart Radio for your generous donation to make this possible!
Thanks to our 12-Day Challenge sponsor, Takeda Oncology.
about the author
Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can help accelerate a cure by weighing in and participating in clinical research. Founder of Myeloma Crowd by HealthTree and the HealthTree Foundation.