Beware The Tests of March

The myeloma blood tests are "headed in the wrong direction", to use the expression of the nurse practitioner who reviewed this month's results with me. The free light chain numbers are virtually unchanged. But the SPEP comment reads: "Monoclonal spike seen in the gamma region = 0.2 g/dL." For IFE we have: "Monoclonal IgG Kappa seen."

Few phrases are as calculated to stoke the long-term myeloma patient's anxiety as "monoclonal spike". An ocean of bad memories lap at the veteran's feet. The notion that the cancer cells themselves seem to be multiplying is bad enough; but then one visualizes the garbage that they pump out, clogging the delicate filters of the kidneys, freezing the struggling musculature of the heart, crushing the shielding of the nerves as if in a slowly tightening vice. The tormented osteoclasts resume their mindlessly feverish drilling of the bones. The patient's mind and spirit are once again imprisoned in a body that is its own worst enemy.

In these circumstances, the oncologist's rationalizations are comforting: 0.2 g/dL is still minuscule; two data points don't make a curve; and so on. Only in case next month shows significant further deterioration must we consider taking evasive action. Wait until next month.