Wednesday, November 18, 2009

So...Do I worry now or later?


Finally my doctor has returned from his two week vacation and I finally get the results from the other blood test.

He stated that my blood test does show some slight elevation of my light chains...
I know you are like me...WHAT?
What the heck are light chains and why are they in my blood?

You know when you are sitting in the doctor's office and they are talking to you about all of these things and yes you are hearing them speak but you are really not listening...yes we are all guilty about it....and then they begin to speak in all of these big words and then before you know it you are nodding your head to Charlie Brown's teacher ...remember...wha wha wha...

So in a nut shell...Dr. Perselin (My RA) doctor is going to consult again with Dr. Likinstein (Hemotologist) again...because if you all remember they found something in my marrow over the summer then said no don't worry about it but now here we are again with the "LIGHT CHAINS" blood work....ugh....and they will call me after they "confer" to see what the next step is going to be if any....

So before you all kill me the research that I have found states this:

Multiple Myeloma and Monoclonal
Myeloma is a cancer of the plasma cells in the bone marrow. Myeloma is synonymous
with multiple myeloma and plasma cell. neoplasm. Plasma cells produce antibodies,
also known as immunoglobulins, which are proteins that help fight infection. Each type
of plasma cell produces only one type of immunoglobulin. There are many different
types of plasma cells in the body, resulting in the production of a variety of different
immunoglobulins. In multiple myeloma, one particular type of plasma cell is duplicated a
very large number of times, causing excess production of one type of immunoglobulin,
which is referred to as a monoclonal protein, or M-protein. M-protein is also called
myeloma protein, para-protein, or the protein spike. M-protein is important for diagnosis
and for monitoring treatment in multiple myeloma. The free light chains are derived
from the monoclonal protein (See Figure 1).

What are Free Light Chains?
Immunoglobulins or monoclonal proteins are composed of two types of smaller molecules,
one called a heavy chain and the other called a light chain (see Figure 1). There are five types of heavy chains, referred to by letter, with the abbreviation for immunoglobulin (Ig) before the letter: IgG, IgA, IgM, IgD, and IgE. There are two types of light chains, referred to as kappa (κ) and lambda (λ). Each plasma cell produces only one type of heavy chain and only one type of light chain. The heavy and light chains are produced separately within the plasma cell and are then assembled to form a whole immunoglobulin. When the light chains are attached to the
heavy chains, the light chains are referred to as bound light chains. However, when the
light chains are not attached to the heavy chains, they are called free light chains. For
unknown reasons, the plasma cells typically produce more light chains than are required
to create the whole immunoglobulin or monoclonal protein. The excess light chains enter
the blood stream as free light chains (i.e. unattached to the heavy chains). Thus both in the normal situation and in patients with myeloma and monoclonal gammopathies (e.g. MGUS, or monoclonal gammopathy of undetermined significance), excess light chains enter the blood stream as free light chains. The normal levels of free light chains in serum have recently been reported, along with the normal ratio of kappa free light chains to lambda free light chains. Normal levels of kappa free light chains are between 3.3 and 19.4 mg/L, while normal levels of
lambda free light chains are between 5.71 and 26.3 mg/L. The kappa/lambda ratio, which is normally between 0.26 and 1.65, is as important for diagnosis and monitoring of myeloma as are the levels of kappa and lambda light chains. As one might suspect in patients with active myeloma, the free light chain levels are higher than normal. In patients with myeloma in which only light chains are produced (Bence Jones myeloma), the type of light chain corresponding to the type of myeloma, either kappa or lambda, is present in increased amounts. But excess light chains in the serum can also occur to a greater or lesser extent with all types of myeloma, not just light chain or Bence Jones myeloma.

How is Monoclonal Protein
Normally Detected and Measured?
Monoclonal proteins can be detected and measured in both blood and urine. Serum is merely blood that has had the cells removed, leaving only the clear liquid. If multiple myeloma is suspected, your doctor will screen for abnormal monoclonal protein (M-protein) levels using a laboratory test known as protein electrophoresis. When protein electrophoresis is performed on serum samples, it is referred to as serum protein electrophoresis (SPEP), and when performed
on urine samples, it is called urine protein measure the amount of M-protein in a sample,
but cannot identify the type of M-protein in the sample. A second type of electrophoresis
test, referred to as immunofixation electrophoresis (IFE), is performed in order to identify the type of M-protein that is being produced by the myeloma cells. Typically, an SPEP is performed first, to determine if, and how much, of an M-protein is present. If the SPEP demonstrates evidence of an M-protein, an IFE will be done to determine what type of M-protein is there.
SPEP, UPEP, and IFE have both advantages and disadvantages. Among the disadvantages
is that they are relatively insensitive for the detection of free light chains, in that the free light chain level must typically be many times the normal level in order to be detected.
For instance, the normal level of one type of free light chain in blood is approximately 10
milligrams per liter (abbreviated as mg/L). However, the free light chain level in blood
would have to be at least 50 times the normal level to be detected by SPEP, and at least 15
times the normal level to be detected by IFE. An alternative test method, the serum free
light chain assay, is capable of detecting free light chains at their normal levels in blood serum. Thus, the serum free light chain assays can detect elevated levels of free light chains, even when these levels are undetectable by SPEP and IFE. This means that multiple myeloma could be detected earlier in the course of disease than is possible with either SPEP or IFE or in cases where small amounts of light chains are produced by the myeloma. The free light chain assays are best performed on serum rather than urine because of the filtering effects of the kidneys. Part of the normal function of the kidneys is to prevent losing proteins from the body into
urine. As a result, an elevated level of a protein, such as M-protein, will be present in blood serum before being present in urine. Hence, the serum free light chain assays may completely replace the 24-hour urine tests for M-protein: not only are the free light chain assays more sensitive in serum, but a 24-hour urine sample is difficult to collect and is more difficult to store than serum.

All of the above information was retrieved from:
on 11/18/2009

So, what does this all mean? I DON'T KNOW

It is a waiting game....Do I think I have cancer that has been started from the medication that they were giving me? No
Do I feel like I have cancer? NO
Do I feel like the next phone call that I am going to get is going to be a bad one all because they are trying to treat my Rheumatoid Arthritis....No

God is still in the business of keeping me calm
Just like I expect you to be because this is not bad...
I just like sharing the information that I hear and get so that If any one of you need to hear how to stay strong and positive can use me as a guide.....I am not worried.....
I am until the next one....

Please continue to pray for me and I will continue to pray for you....

I am not worried so don't you be either.....

Don't call me in a panic....because there is no reason to be.....

I feel good other than the normal day to day RA things.....


1 comment:

Donna Carroll said...

Thanks for your pist. I have RA for a little over two years. For the last year I've been seeing a hem/onc as well for MGUS as well. It's like playing a waiting game. Do I or don't I have the beginning of multiple myeloma? The information you gave has helped me tremendously. I've prayed and cried and resigned myself to the unknown. I almost wish they would diagnose MM and get this behind me. It's so hard not knowing! And like Paul the apostle said. To die is gain. I don't want to miss seeing my family meet their goals but I do know a much better life is ahead! Please pray for me as I will add you to mine