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  Sunday, 10 May 2015
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What follow-up would you recommend for my husband who was diagnosed with light chain deposit disease in spring 2014 and who went on dialysis June 2014? I am worried about development of myeloma and we hope that early treatment with Velcade and dexa (whatever) may have allowed his kidneys to "heal" enough to get off dialysis?

Hello, Is your husband presently receiving Velcade and steroids? How long has he been on dialysis? The more details you provide, the more we can try to help. Dr. Jordan Weinstein
9 years ago
Thanks, Dr. Weinstein. These are my laymen's details. He was diagnosed around Februrary 2014 and he did do a course of Velcade and steroids in March, April, May 2014. His percent of plasma cells in bone marrow I think at the time was 5% (too low for myeloma?). He started dialysis on June 5, 2014. His M number s(65 down to 35?) were cut in half by end of treatment, so there was a response. During his Velcade treatment he had a resistant pneumonia and had that strong antibiotic (vancomycin?). They discontinued Velcade when he went on dialysis saying they were probably not helping him. He quickly dropped about 10 pounds of weight when they started dialysis (210 to 200 and now down to about 180ish; he is 6'2. ). On dialysis he is doing well. They have cut his time on the machine to 3 1/2 hours and his weight is holding steady at about 80.3 when he gets there and leaves with 79.5 (it was 83/84 down to 80). His urine output seems to be increasing. I am not sure what his BUN/Creatinine numbers are but his private physician said they were improving. His creatine never did go very high. He is 73 and in otherwise good health. No diabetes. His blood pressure is finally now under control with minimal medication (for years it was really high and not in control and no one could figure out why). His only complaints are back and shoulder pain, though his skeletal X-rays a year ago showed little bone issues except where he has had injuries/arthritis. He is slated to go back to oncologist/hematologist in August. I'm just wondering if it would be good to go to a specialist in MIDD for the follow up? Hope this helps. Thank you. Anne Streeter (I come from a family of doctors and nurses, and got my doctorate in health communication, so I hope I haven't totally messed up this information!).
Hi there, If your husband started dialysis in June of 2014, it is getting late to hope for recovery enough to come off dialysis. Having said that, in some light chain mediated diseases (e.g. myeloma and related disorders), I have been suprised in the past by some late recoveries, but that was in patients receiving active theraapy or a stem-cell transplant. One way to tell if any meaningful recovery is happening is to look at the change in the creatinine pre-dialysis. If the trend of that level is downwards, it might be a sign recovery is happening. However, whether
[/i][/quote] recovery happens to come off dialysis is another question and we would need to know creatinine values to decide that. In some cases, simply holding dialysis (under the supervision of his nephrologist) is warranted to see how he tolerates it both clinically and by lab parameters. Dr. Jordan Weinstein
9 years ago
Thank you, Dr. Weinstein. Physician rounds are tomorrow morning so we can talk with the nephrologist then. At one point he did say we could try holding dialysis, but back then my husband wasn't in as good a shape. On a related matter, what causes the severe nausea my husband suffers from? We can't seem to get a clear answer, and he is just given nausea medicine that makes him zonk out (Fenergan sp?). That is what makes his quality of life inbetween sessions so limited. He just dropped below 170 in weight (he is 6'2) because he has a hard time keeping things down. I'm sorry if I am "picking your brain" too much.
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