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Treating symptoms

Myeloma can affect you in different ways. The symptoms you might have depend on how it is affecting your body. Treatment for myeloma can also cause side effects. There are treatments that can help to control or reduce the symptoms of myeloma or side effects of myeloma treatment. 

Tell your doctor or nurse about any symptoms that you have so they can help you.

Symptoms

Anaemia means that you have a low red blood cell count. Red blood cells carry oxygen around the body. Your body cells don't have a good supply of oxygen if the level of red blood cells is low. So you feel tired (fatigued) and might also feel breathless.

Anaemia is quite common in people with myeloma, particularly if your kidneys are not working very well. Healthy kidneys make a hormone called erythropoietin (EPO) which helps the bone marrow to make red blood cells.

You might have blood transfusions to increase your red cell count.

You might have treatment with erythropoietin if your kidneys are not working properly and you have severe anaemia that keeps coming back (despite blood transfusions).

You have erythropoietin as an injection under the skin, usually in the leg or in the tummy (abdomen).

Fatigue means tiredness and lack of energy. It is a common symptom of myeloma and affects everyone differently.

Fatigue can be due to anaemia or might be a side effect of treatment. It may be mild or it can impact greatly on your daily life. For some people it affects their memory and their concentration. It can also cause low moods and feeling irritable. and it can make you to feel weak and have difficulty sleeping.

Your doctor can assess you and try to treat any underlying cause of your tiredness. If your myeloma treatment is making your fatigue worse, this should improve once treatment finishes.

There are things you can do that might help you cope with fatigue. 

Frequent infections are another common problem with myeloma. You might need to have treatment with antibiotics.

You might need to go into hospital if you have an infection. This is so that you can have the antibiotics into your bloodstream through a drip.

Your doctors might recommend that you have vaccinations to protect against flu and chest infections. Your doctor or specialist nurse can advise you about this.

Myeloma often causes damage to areas of bone. This can weaken the bone in these places and might cause pain. If the damage is severe, the bone might break (fracture).

Bone pain is qiute common in myeloma. There are different painkillers (analgesics) that might help. If one doesn't work, tell the team looking after you so they can prescribe something else. People with myeloma need to avoid non steroidal anti inflammatory drugs because they can cause kidney damage. 

Bisphosphonate drugs can help to reduce bone damage. They slow down the damage caused by myeloma cells. There are different types of bisphosphonates, but the most common are pomidronate and zolendronic acid (zometa). You usually have these as a drip into the vein (intravensouly) every 4 weeks. 

Radiotherapy to an area of myeloma might reduce pain. There may be a limit to the amount of radiotherapy you can have to any part of your body. If you have pain in an area where you have had radiotherapy, you might not be able to have this treatment again. 

Some people with myeloma have breaks (fractures) of the spinal bones. Fractures caused by myeloma put pressure on the spine and can be very painful. The bones of your spine (vertebrae) can collapse, making the spine change shape. It can become very curved, doctors call this kyphosis. You might lose some height because of this.

Your doctor might recommend you have a specialist technique called vertebroplasty or balloon kyphoplasty. During a vertebroplasty your doctor injects special cement into your spine to strengthen it and reduce pain.

Balloon kyphoplasty is similar but little balloons are put into your spine. The balloons are slowly inflated so that the spinal bones go back to as near normal height as possible. The doctor injects special cement into the space created by the balloon. This can strengthen your bone, relieve pain and restore some height. 

Other treatments for spinal fractures include surgery or radiotherapy. Or your doctor might suggest you wear a neck brace or back brace to support your neck or spine and to relieve pain . 

Tingling, numbness or burning sensation in your fingers and toes can be a sign of damage to the nerves. This is called peripheral neuropathy. It is most common with thalidomide and bortezomib treatment, but might be caused by:

  • the myeloma itself 
  • other medical conditions 

Peripheral neuropathy can also cause nerve pain, loss of sensation, or burning and might also affect your balance. It most commonly affects your feet and hands, but it may also affect nerves elsewhere in your body. 

Your team will check for signs of peripheral neuropathy during treatment. Let them know if you noticy any new symptoms. 

Nerve pain

There are medicines (such as gabapentin and pregabalin) that can help with nerve pain. Painkillers such as paracetamol might also help. Or a cream called capacisin can be useful in some people.

Peripheral neuropathy as a result of treatment is often temporary. It might improve once treatment stops, or the dose of the drug is reduced. Rarely, these effects can be permanent in some people. 

Some people with myeloma have kidney damage. Some people might have this at diagnosis, but more people develop this problem at a later time.

Causes
Kidney damage happens for different reasons. Myeloma cells make an abnormal protein called paraprotein. These block the small tubes in the kidney that filter urine, causing damage to the kidney.This is the most common way that myeloma cells can damage the kidney.

Another reason is that myeloma causes bone disease or damage. Bones contain calcium. As the bones are damaged, high levels of calcium are released into the blood. As the blood passes through the kidneys it can cause damage. 

Some drugs such as non steroidal anti inflammatory drugs (NSAIDS) may also affect the kidneys, and so your doctor might advise you not to take these.

Dehydration can make the situation worse, so it is important to drink as much as you can. Doctors generally encourage patients with myeloma to drink 2 to 3 litres each day.

Symptoms
The symptoms of kidney damage include: 

  • thirst
  • loss of appetite
  • feeling or being sick
  • passing much more or much less urine than usual
  • swollen ankles
  • breathing problems

It is very important to let your doctor or nurse know of any new symptoms as soon as you notice them. They will monitor how well your kidneys are working. This means that they are likely to notice early changes in how your kidneys are working before you have any symptoms.

Treatment
Kidney damage is often improved with fluids into your vein, and other treatments. The main treatment is treating the myeloma itself, because this is the cause of the kidney damage. You might need to see a kidney specialist. Kidney specialists are called renal doctors.

Some people with myeloma need heamodialysis, usually 3 times a week. This happens if the kidneys stop working. It is usually temporary, but can be permanent for some people.

This condition is rare.

Symptoms such as dizziness, headaches and confusion can happen with advanced myeloma. These symptoms are caused by the increased amounts of protein produced by myeloma cells (paraprotein). The extra protein in the blood makes the blood thicker and it circulates around the body more slowly than normal. This is called hyperviscosity.

Hyperviscosity can clog up small blood vessels and cause symptoms such as confusion, dizziness, headaches and stroke like symptoms. This is due to the thickened blood blocking very small blood vessels in the brain.

Plasmapheresis
A procedure known as plasmapheresis (or plasma exchange) quickly removes the excess protein from the blood. Your nurse or technician connects you to the plasmapheresis machine by 2 tubes similar to the infusion tubes used for drips. One tube takes your blood into the machine and the other gives it back into your vein.

The machine separates the blood cells from the blood plasma (the liquid part of the blood). The protein is in the plasma. The machine replaces the plasma with a solution that is very similar to normal plasma. It is given back to you with your blood cells. This process takes 2 to 3 hours.

You can have this treatment more than once if you need to. Your doctor will closely monitor your protein levels.

Help controlling symptoms

Your doctor or specialist nurse can:

  • give you medicines
  • get equipment that you need
  • suggest other ways of controlling your symptoms
  • refer you to a symptom control team (a palliative care team)

Symptom control team

Members of this team are experts in controlling symptoms. They can help you to stay as well as possible for as long as possible. There are symptom control teams in most cancer units. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.