Eddie & I posed a few respectful but direct questions for the doctor:
Has our dad had a cytogenetic analysis on his myeloma cells? We would like to know if this is a 'high-risk' multiple myeloma, showing mutations/chromosome rearrangements. The cytogenetic analysis will tell whether the cells have specific changes in their genome. If so, wouldn't the treatment be different for high-risk vs. standard risk.
Have you ruled out "smoldering myeloma" and Monoclonal Gammopathy of Undetermined Significance (MGUS). Don't you hold off on "treating the disease" until myeloma symptoms are observed. Smoldering (asymptomatic) MM - characterized by an M-protein ≥ 3 g/dL and/or bone marrow plasma cells ≥ 10% but no evidence of anemia, hypercalcemia, renal insufficiency, or lytic bone lesions (CRAB).
I know you ordered the bone scan (done today). I remember dad telling me that the doctor that sampled his bone marrow said it was very thick, but did not see any actual report on the biopsies from the spinal mass or the marrow. And he relayed that his platelettes were low and proteins high, from boodwork and or urinalysis. So this is partially indicative of MGUS, right?
Our reasons for asking about smoldering myeloma and MGUS is to make sure all the criteria for warranting certain types of treatment match up to Dad's test results, and if you are considering autologous stem cell transplantation.
Regarding the spinal mass and cord compression, do you or the neurologists think we have significant permanent damage? Considering his ability to move his legs a little, what do you think about partial or full recovery for ambulation, and fecal & urinary incontinence? (I am assuming you feel 98% confident of distroying the spinal mass with radiation.) Finally, with Stage 3 MM, what is your opinion on survivability on this case?
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