Dear Dr. Roach: Can someone have diffuse multiple myeloma with serious symptoms (like bone pain, pale skin, amber-coloured urine, constipation, fatigue, insomnia, excessive sweating, and dizziness) and still be alive after four years?
J.O.
Multiple myeloma is a type of cancer of the bone marrow. The cells in the bone marrow (called plasma cells) stop responding as they should and make large amounts of antibodies. Unfortunately, these antibodies don’t help you fight off infections; they consist of a single clone that usually doesn’t have any discernible activity.
What myeloma does do is crowd out the rest of the cells in the bone marrow so that the person can’t make adequate red blood cells (causing pale skin and dizziness), blood-clotting cells (platelets, which predispose people to bleeding), and other immune system cells. This puts a person at a high risk for infection. The myeloma cells can get into the bone and cause bone pain. The high metabolic activity can also cause dizziness and sweating, and many cancers cause more nonspecific symptoms like fatigue, insomnia and constipation. Myeloma can also damage the kidney.
Although myeloma is generally considered incurable, new treatments have greatly improved the prognosis. In people with the standard type of myeloma, survival with the usual treatment is eight years. With a stem cell transplant, survival with average-risk myeloma is over 12 years. Some highly aggressive forms of myeloma have a much worse survival rate.
I don’t have enough information to tell you whether you have standard or high-risk myeloma. Your symptoms suggests that your disease isn’t under good control. But the majority of people treated with the best available treatment do live longer than four years.
Dear Dr. Roach: I have had stronger body odour during the past few months and can’t figure out why. I am a healthy, 69-year-old woman in great shape. There hasn’t been any changes in my exercise regimen, diet or medications at all. Why is this happening?
K.D.
Body odour is mostly caused by bacteria that live on the skin. These bacteria can change under a variety of conditions. One of those conditions is sweat, so a change in sweat due to a change in temperature or humidity can favour the growth of different bacteria, which affects your body odour. It has been a very hot summer for most of the country, so this could be a possibility. Also, the regular sweat that perspires is different from the sweat we have under times of high stress or anxiety, and many people recognize that this also leads to a particular odour.
Although exercise, changes in diet, and some kinds of medications can change the bacteria that live near the sweat glands, you’ve eliminated all of these. Hormonal changes, most notably among adolescents, lead to different bacteria, but menopause can also have a similar effect (although age 69 is not typically a time when we see major hormone changes in women).
Medical issues, like diabetes or kidney or liver disease, lead to changes in body odour that some, but not all, people can recognize. Finally, if you are living with someone, their skin bacteria can become your skin bacteria, so this is another possibility.
Regular soap and water and deodorants are effective for most people, but I have had a handful of patients who benefitted from the cleansers we use prior to surgery, like chlorhexidine gluconate. They can dramatically change body bacteria and restore equilibrium.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
