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The Symptoms and Side Effects of
Multiple Myeloma

and What You Can Do about Them


Photo by Cancer Type

When you’re going through treatment for multiple myeloma, listen to your body. Keep a journal of how you feel physically and emotionally. Keeping notes can help you keep track of how you’re doing over time and of symp­toms or side effects that may come and go. This can help you work closely with your doctor to manage the side effects that you experience from mul­tiple myeloma or its treatment, and ensure that your questions are answered.

Pain
Pain can result from the myeloma itself or from nerve damage caused by the disease or its treatment. It can also occur after a bone marrow biopsy. Let your healthcare team know how you feel so they can suggest ways to relieve or reduce your pain.

Think of your pain in terms of a 10-point scale, with no pain having a score of 0 and extreme pain having a score of 9 or 10. You’ll also want to track the location of the pain, its fre­quency and duration, the type of pain it is (Is it burning or stabbing? Sharp or dull?), and what makes the pain change (Does medication relieve the pain?).

Some people get pain relief from complementary medical techniques such as Qi Gong or acupuncture. Talk with your doctor before considering this type of pain-relief strategy. You may also benefit from relaxation strategies, such as deep and slow breathing, meditation, or hypnosis. Ask your healthcare team for recommendations; many treatment facilities have these resources on site. If you’re feeling depressed about your pain, talk with an oncology social worker or an experienced psychologist.

Bone Health
Bone weakness is a common problem for people with mul­tiple myeloma. Regular physical fitness, including daily walks, yoga, or exercise that is more strenuous (if comfortable and approved by your doctor) will help to keep bones strong and help you feel less frail.

Because previously healthy cells can usually repair themselves after chemotherapy ends, many side effects of chemotherapy are temporary and can be managed.

Bisphosphonates, such as pamidro­nate (Aredia) and zoledronic acid (Zometa), are commonly used drugs that work to maintain bone strength by slowing the way multiple myeloma cells dissolve and weaken bones. Treatment with bisphosphonates helps to prevent further bone damage; however, bisphos­phonates have been found to cause potentially severe dental problems. It’s important to inform your dentist about your use of bisphosphonates and to have a dental exam before starting these drugs. Maintaining good oral health while using these drugs is also important. If a tooth or gum infection occurs, your doctor may want to stop bisphosphonate treatment.

Anemia
Myeloma and its treatment can lead to anemia, which means that your red blood cells aren’t carrying enough oxygen through your body. This makes you feel very tired. Other symptoms of anemia include shortness of breath, feeling your heart pound, feeling dizzy or faint, or having diffi­culty concentrating.

If you’re concerned about anemia, there are medications that can help, or sometimes a blood transfusion is recommended. Your healthcare team will routinely assess if you are experi­encing a low red blood cell count through blood tests.

Infections
People with multiple myeloma may experience very low white blood cell counts due to the dis­ease and its treatment, making them more susceptible to infections. Your healthcare team may advise you to stay away from crowds and people with colds or other contagious diseases. If an infection develops, it can be seri­ous and should be treated promptly.

Kidney Problems
Some people with multiple myeloma may develop kidney problems due to the disease, treatment for the disease, or a combination of both. The kidneys help regulate the body’s hydration and water balance and are responsible for getting rid of the body’s waste. When the kidneys can no longer do this, excess fluid can build up in tissues (edema) and you may notice swollen feet or ankles, or you may be short of breath if fluid builds in the lungs. If kidney problems are severe, you may need dialysis, which artificially removes waste and excess water from the blood.

A person with serious end-stage kidney problems may need a kidney transplant. This is a very challenging process for someone whose immune system is compromised from multiple myeloma. You and your doctor should discuss the potential benefits and the risks of a kidney transplant if this is warranted.

Too Much Calcium in the Blood
When calcium leaves the bones and enters the bloodstream due to multiple myeloma, you may experience many troublesome side effects. You may lose your appetite or feel nauseated, rest­less, or confused. A high calcium level can also make you very tired, weak, dehydrated, and thirsty. If you have a high level of calcium in your blood, you will be asked to drink a lot of fluids and take medications that lower calcium levels in your blood. These things can relieve your discomfort.

Amyloidosis
Some people with myeloma may develop amyloidosis, which is the collection of abnormal proteins in tissues of the body. For example, proteins can build up in the heart, caus­ing chest pain and swollen feet. There are drugs to treat amyloidosis, as well as supportive measures that may help.

Side Effects of Chemotherapy
Side effects from chemotherapy often result from damage to healthy cells. Some examples include damage to the cells in your mouth (resulting in mouth sores), your hair follicles (resulting in hair loss), and the cells in your gastro­intestinal tract (resulting in vomiting, diarrhea, and constipation). Because previously healthy cells can usually repair themselves after chemotherapy ends, many of these side effects are temporary and can be managed.

Every drug causes a unique set of side effects. Talk with your oncology nurse about the side effects you may experience based upon your treatment plan. If you are enrolled in a clinical trial, the research nurse will talk with you about side effects. Ask for infor­mation about the best way to manage potential problems even before they begin so you can feel prepared and avoid difficulties.

Side Effects of Stem Cell Transplant
There are several potential risks from a major procedure such as a stem cell transplant, but there are also many longer-term benefits. Talk with your doctor and nurse about what you should expect from the procedure, how to pre­pare for it, what recovery will be like, and what side effects to plan for.

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Reprinted with permission from Frankly Speaking About Cancer: Multiple Myeloma © 2013 Cancer Support Community. For more information, visit CancerSupportCommunity.org.

This article was published in Coping® with Cancer magazine, January/February 2014.