Martien Atkins was a 67-year-old grandmother who began to have pain in the bones, compression fractures in the spine and ribs and a loss of height and weight. The symptoms pointed to osteoporosis, a condition that will affect one-third of American women over the age of 65. Atkins was mistakenly treated for osteoporosis for almost a year until receiving a new diagnosis of multiple myeloma – cancer of the bone marrow. She died within six months of the disease that is discovered in 13,500 individuals each year. It is more common among men than in women and among blacks than whites.
The symptoms of multiple myeloma are frighteningly similar to those of osteoporosis: severe pain in the affected bones, lower back pain, weight loss and compression fractures. Even spinal X-rays are similar to those of osteoporosis, but differences show up in blood tests. “Every orthopedic surgeon fears missing the diagnosis of multiple myeloma,” says Letha Griffin, M.D., an orthopedic surgeon in Atlanta. “It is difficult to diagnose because the symptoms may not be diagnostic until advanced stages of the disease.”
In multiple myeloma, bone marrow plasma cells multiply wildly. They produce enzymes that can dissolve bone. When more than 30 percent of a bone has been eaten away, the damage will appear as a dark spot on an X-ray. These “holes” weaken the bone and cause fractures, which may be the first noticeable symptoms. While the bone is being destroyed, other chemical changes take place. Calcium released by dissolved bone appears in the bloodstream and can cause nausea, weakness, weight loss and kidney damage. At the same time, the plasma cells secrete protein-based antibodies that are a key part of the immune system. An overproduction of protein can cause a stroke-producing thickening of the blood. The whole process damages blood cells, leading to fatigue and anemia. The immune system is weakened, making the victim susceptible to infection.
There is no known cure for multiple myeloma. It is a fatal disease. Although some people live for decades after diagnosis, the average life expectancy is three years. The objectives of treatment can take any combination of four directions: 1) stabilizing the condition by countering the changes in body chemistry; 2) relieving the discomfort; 3) slowing or arresting the disease; and 4) attempting to achieve permanent remission, a process that has never been achieved. The type of treatment depends on the stage of the disease and the individual being treated. The specific methods of treatment include chemotherapy (Melphalan and Prednisone), antibiotics, radiation and supervised exercise. Hormones to treat anemia and drinking large amounts of water to counter kidney failure are also recommended.
“The outlook for patients with multiple myeloma continues to improve,” according to a Myeloma Today article by Morie Gertz, M.D., and Martha Lacy, M.D. “Of all the interventions, none appears to have the impact of stem cell and bone marrow transplant.” The “seeds” that grow into bone marrow are collected, stored, partially cleansed of myeloma cells and returned to the patient, who is then able to withstand additional chemotherapy. The bad news is that the average cost of a transplant is $75,000 and it is considered experimental by Medicare and many insurers.
Multiple myeloma continues to be a disease that is hard to diagnose and even harder to treat. It is common, even essential, to get second and third diagnostic opinions.