Getting It Right Once and For All

Brain fog is one thing, but I have forgotten the meaning of a certain phrase, looked it up, forgotten its meaning again, looked it up, forgotten its meaning again and so on for years. This has got to stop. That’s why I thought writing about it might ensconce the meaning in my brain once and for all. Bet you’re wondering what the phrase is by now. It’s multiple myeloma.

I think we all know that multiple means more than one, but more than one what in this case? And does adding it to the root word – myeloma – change its meaning in any way? Let’s find out together.

Do you know what the ICD is? Let me refresh your memory if you do. I defined it in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease in the following way:

“International Statistical Classification of Disease and Related Health Problems, provides the medical codes for illnesses.”

The Whole Health Organization currently released the 10th edition. There are three different codes for multiple myeloma in this latest edition according to www.findacode.com. I thought one of them would help us.

ICD-10-CM Diagnosis Code C90.00

Multiple myeloma not having achieved remission

Hypogammaglobulinemia co-occurrent and due to multiple myeloma; Light chain disease; Light chain nephropathy; Light chain nephropathy due to multiple myeloma; Multiple myeloma; Multiple myeloma stage i; Multiple myeloma stage ii; Multiple myeloma stage iii; Multiple myeloma w hypogammaglobulinemia; Smoldering multiple myeloma; Smoldering myeloma; Multiple myeloma with failed remission; Multiple myeloma NOS

ICD-10-CM Diagnosis Code C90.0

Multiple myeloma

solitary myeloma (C90.3-); solitary plasmactyoma (C90.3-); Kahler’s disease; Medullary plasmacytoma; Myelomatosis; Plasma cell myeloma

ICD-10-CM Diagnosis Code C90.01

Multiple myeloma in remission

ICD-10-CM Diagnosis Code C90.02

Multiple myeloma in relapse

We can discount C90.01 and C90.2 from the get go because we know that remission means subsiding and relapse means whatever it is has become active again.

I didn’t really understand the terms in the diagnosis codes but, from my fractured remembering, gathered this has to do with a sort of cancer. No harm; we know the coding and now need to find out what it is that’s being coded.

I jumped right over to the American Cancer Society at https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html and found exactly what I was afraid I would:

“Multiple myeloma is a cancer of plasma cells. Normal plasma cells are found in the bone marrow and are an important part of the immune system. The immune system is made up of several types of cells that work together to fight infections and other diseases. Lymphocytes (lymph cells) are one of the main types of white blood cells in the immune system and include T cells and B cells. Lymphocytes are in many areas of the body, such as lymph nodes, the bone marrow, the intestines, and the bloodstream.

When B cells respond to an infection, they mature and change into plasma cells. Plasma cells make the antibodies (also called immunoglobulins) that help the body attack and kill germs. Plasma cells are found mainly in the bone marrow. Bone marrow is the soft tissue inside bones. In addition to plasma cells, normal bone marrow is also the home for other blood cells such as red cells, white cells, and platelets.

In general, when plasma cells become cancerous and grow out of control, this is called multiple myeloma. The plasma cells make an abnormal protein (antibody) known by several different names, including monoclonal immunoglobulin, monoclonal protein (M-protein), M-spike, or paraprotein.

There are, however, other plasma cell disorders that also have abnormal plasma cells but do not meet the criteria to be called active multiple myeloma.”

One of them is monoclonal gammopathy of uncertain significance (MGUS) which I blogged about on April 30th of this year. Plasma cell disorders seem to be occupying my mind lately.

Wait, wait! Bone marrow. As was mentioned in SlowItDownCKD 2011, in writing about a Drugs.com article, it’s the kidneys that cause the

“…bone marrow … produce red blood cells.”

Yet, it’s the white blood cells that are part of the immune system. Remember my daughter Nima’s account of her gall bladder being removed in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2?

“…my white blood count was elevated to 12, an indication the gallbladder was infected.”

That 12 showed that she had many more than usual white blood cells which were necessary to fight the infection.

The University of Rochester Medical Center at https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=160&ContentID=35 explains succinctly:

“Your white blood cell count can be low for a number of reasons—when something is destroying the cells more quickly than the body can replenish them or when the bone marrow stops making enough white blood cells to keep you healthy. When your white blood cell count is low, you are extremely susceptible to any illness or infection, which can spiral into a serious health threat.”

One of those somethings could be multiple myeloma.

There’s another consideration here. As Chronic Kidney Disease patients, we have compromised immune systems. DaVita explained in SlowItDownCKD 2015:

DaVita at http://www.davita.com/kidney-disease/overview/treatment-overview/immunizations–which-shots-you-need-and-why/e/4837 tells us,

“…. The immune system of a person with chronic kidney disease (CKD) becomes weakened, making it difficult to fight off many diseases and infections….”

This is one great big ball of wax. While bone marrow replacement is one treatment and radiation another for multiple myeloma, the most often employed treatment is drug therapy. Here’s where the kidneys come into play again. In SlowItDownCKD 2012, I quoted myself because I felt the following was so important:

“You may need to take a lower dosage of whatever drug was prescribed or, perhaps, take it less often. If your kidneys  are  not  fully  functioning,  the  drugs  are  not  effectively being removed from your blood. It would be similar to willfully taking a drug overdose if you do not make your doctors aware of your CKD when they prescribe for you.”

Uh-oh. I need some help here. Healthline at https://www.healthline.com/health/cancer/multiple-myeloma-kidney-failure to the rescue!

“Kidney failure in multiple myeloma is a complicated process that involves different processes and mechanisms. The way this happens is the abnormal proteins travel to the kidneys and deposit there, causing obstruction in the kidney tubules and altered filtering properties. Additionally, elevated calcium levels can cause crystals to form in the kidneys, which causes damage. Dehydration, and medications such as NSAIDS (Ibuprofen, naproxen) can also cause kidney damage.”

This was difficult to write, so thanks for keeping me company as I struggled with it.

One final note. I blogged about Antidote, a clinical trial company, last year. You’ll find them on the blogroll, too. This Wednesday, they’ll be helping to celebrate Clinical Trials Day by hosting a Twitter chat from noon to 1 pm. The topic is storytelling for awareness and you (yes, you) are invited to join in. Use #research chat. For those new to twitter chats, you need to follow Antidote to join the chat. Their ‘handle’ is @antidote_me. I’d be there myself if I didn’t already have one of those specialists appointments that you have to wait months and months for. My loss.

Until next week,

Keep living your life!

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