Flucuating Calcium Levels and Bone Pain

[tarrigo]

I have posted before but am looking for more answers.  I am a 25 yr. old male.  I am having some weird lab results, including elevated calcium levels.  They are not constant, but fluctuate from the high 9

[Skim56]

I have Multiple Myeloma (MM), stages II-III.  My last test all came back in good condition. My M-Spike is down to 1.6.  The only problem I have now is extreme itching around my eyes.  The skin there has turn scabby from scratching.  The skin on my knuckles has turned very dark  and rough.  I still have the vice like pulling  sensation around my waist and upper back.  My question has to do with "What happens to the female body?" with MM.  I had diarrhea for three day.  Today the fourth day, nothing.
There was some blood; however, I think that my have been from hems or the removal of the pol.  My urine is very dark almost like strong tea. I don't think  that is blood either, however, I am not sure.  When the urine hits the water, the color fades almost to clear.  I only notice the color on the toilet paper.  (I am sorry I have to be so literal about this.  I am not that informed on this subject as I should be.)  At the moment, I am afraid because I am almost too old for a transplant and I have a history of sarcoidoses.  My lungs still have some scar tissue there.  This may impact on the effectiveness of such an action.  I am on dexamethasone 10 pills one day a week.
Although I have these problem.  I am not "Sick" just a little exausted after a few hours work around the house.  Do you have any suggestions that I may present to my Doctor on my next visit?

[sagemgirl29]

hi i have persistent pain in my bones, mainly hands and legs and sometimes ribs and spine....but pain is not stabbing but between dull and stabbing, i don't run a fever and when i went to my doctor he told me that i should rule out any types of serious deseases, he did a normal physical exam like every doctor would; checking of pulse rate, lungs and heart work, and checking your gums with a torch apparatus, he also told me that i do not need blood test, still i wasn't convinced when i stepped out from the clinic, i still get them but having the Doctor said this releaved a bit of my tension, i have a big apetite and probably people with metastatic bone c. would show next symptom like fever and loss of apetite together with bone pain..but not sure, can you please put my mind at rest. i also had blood test done, and have a hemotocrit of 36 , i'm female however and female hematocrit fall in these rages from 0.36 to 0.37 ... rest is ok too.., including the liver..well i hope to get the answer soon , because of this reason i am getting sort of obession that is ruining my every day performance and creating more pain due to this tension.. i heard that even tension can build pain...
so please let me know when you can. Thanks

[diantus]

Oops!  Polythycemia Vera should be Polycythemia Vera.  I transposed the letters.

[diantus]

I was diagnosed with Myeloma, but my albumin levels are showing within range, and my calcium (and ionized calcium) have been elevated periodically.  I am not showing anemia on the lab tests.  That is very weird since my bone marrow biopsy showed absent storage iron.  The IMF can provide some good information on Myeloma.  Sometimes a small percentage of patients have Myeloma, but the proteins do not show up in the blood or urine. You can have a serum Freelight test done that checks the Kappa/Lambda light chains and shows the Kappa/Lambda ratio.  I, too, have horrible back pain, side pain, leg pain, and a myriad of other symptoms (including numbing and tingling in the hands and feet), sensitivity to the sun and heat, much sweating with hot flashes, etc.  I was told by Leukemia and Lymphoma Society even stated that Polythycemia Vera can cause the bone marrow to be absent storage iron.  Of course, I am much older than you, but younger and younger people are getting Myeloma.  

[tarrigo]

Docboston,

Thanks for the input.  I really appreciate it.  I do trust my doctors, but why can

[docboston]

Ya, normal PTH does point away from cancer related causes of high calcium. In those cases, the PTH is low.
I also wouldnt worry about the high albumin. Remember, when you see the "normal range" of albumin (usually around3.5g/dl to 4.5g/dl), it means that 95% of normal peoples albumin falls in that range. It also means that 5% of normal peoples albumin will be outside that range. You may be 1 in those 5%. As far as I know, there is no harm in having an albumin level of around 5. If you were dehydrated, it would have shown in the results of your kidney tests.

I cant tell you whats causing the back pain and balance problems. Please discuss it with your pcp, he seems to be a very competent  physician.

[tarrigo]

I forgot to mention, they checked my PTH and everything was within normal ranges.  Does this point away from myeloma as well?

Thanks,

T

[tarrigo]

As far as the phlebotomy goes...well I have had a high red cell count of and on for 3 yrs. according to my PCP.  It has been as high as 17.8.  My hematologist has ruled out all causes except sleep apnea.  I am having a sleep study done next week.  I even had a renal ultrasound to look for tumors back in December.  Nothing was found.  She did the phlebotomy (my hemoglobin was at 17.0 and my HCT was 51%) and when I returned a couple weeks later for blood counts, it was down to 16 (post-phlebotomy).  I am assuming that you are a doctor...based on your screen name, so do you think I need to worry about myeloma.  I did the UPEP and SPEP back in november and neither showed an M-spike.  Like I said before, my calcium has been up and down for 6 months.  I am just scared to death about myeloma, even though my PCP says we have already ruled that out.  Why is my back hurting now though?  It hurts at the bottom of my ribs and I am also having an off balance feeling when walking.  What about my elevated albumin level though?  It indicates dehydration from what I read, but I drink tons of water.  I am thinking the pain I am having is because of my kidneys, but all the tests say my kidneys are functioning fine.  My back has just started to hurt in the past couple of weeks, and I am fearing bone pain.  It is not intense pain, just some slight discomfort (stabbing pain, dull aching and it is not constant).  Can you provide some idea as to what is my problem?  Many Thanks.  T

[docboston]

When you have high calcium from myeloma, the levels dont come back to normal without treatment, they usually keep getting higher. In addition, albumin levels and hemoglobin are usually low in myeloma, not high. Majority (98-99%) of myeloma patients have a 'M" protein in their urine or blood. Your pcp and hematologist/oncologist are right in recommending retesting in 3 months. And you are right, if the high calcium was from myeloma, then over 4 months, you would have developed other problems like anemia, kidney problems etc. You mentioned your parathyroid was checked. If your PTH hormone level was normal or high, then chances of myeloma are almost zero. If PTH was suppressed (lower than normal) then further testing might be indicated.
I am curious about your hemoglobin. You actually required a phlebotomy!. What was the diagnosis for that?

[tarrigo]

I understand that albumin binds to calcium, but in the past I have had elevated calcium levels when my albumin level was normal.  My PCP checked my ionized calcium and regular calcium two weeks ago.  In addition, I did a 24-hr. urine sample to see how much calcium I was excreting per day.  All those tests were normal, and my calcium was back to 9.8.  I also forgot to mention that I also had elevated hemoglobin levels.  After a phlebotomy, my hemoglobin levels were normal again at 16.  They were running at 17.4 to 17.8.  With cancers like myeloma, shouldn

[docboston]

If you have high albumin, calcium will go up with that as most of the calcium in your blood binds to albumin. You can have you pcp check yout ionized calcium. If thats normal, then dont worry about calcium and calcium dosorders like pagets, myeloma etc. If back pain is persistent, get an X ray.