I went to visit Dr. SH on Nov. 7, 2008 to do further diagnostics. I had so much blood drawn that I told the Doctor if I didn't have anemia when I came in, I certainly did now. He told me what I more or less had guessed from my research, which is that two other tests were needed: x-rays and a bone marrow biopsy. Readers of the previous blog entry will understand the diagnostic value of these tests.
I wasn't quite prepared psychologically (or pharmacalogically) for the bone marrow biopsy (also called an "aspiration", which is the nicest name I can think of for a needle the girth of a pencil to be punched through your hip bone), plus I had to get back to my office so I scheduled these for the following Monday. Meanwhile, Dr. SH told me a bit more about MGUS and Myeloma.
He again seemed to characterize MGUS as a slightly different condition, but I believe that it is a full precursor to Myeloma -- it's just that for most people it never develops. In any case, once Myeloma is there, there are four stages: (1) smoldering myeloma, which is very, very early stage and may take years or even decades to progress, (2) stage 1 myeloma, which isn't treated, (3) stage 2 myeloma, where there is debate on whether or not it is treated and how aggressively, and (4) stage 3 myeloma which everybody agrees should be treated.
I told SH that I wanted Versed, which is a "waking sleep" kind of medication, before the bone marrow aspiration and he said that was done commonly and that it would be no problem. Dr. PZ, who I've mentioned is not alarmist, said that marrow biopsies are "uncomfortable" but that he had seen a range of reactions, from little old ladies going through it and saying "oh, you're done already?" to healthy young men screaming loud enough to peel paint from the walls. Between this, my good friend Dr. BM's comments that it's painful, and comments from another Dr. friend that they are "extremely unpleasant", I was not going into this without some medication.
The following Monday, Nov. 10th, I got my X-rays, and bone marrow biopsy. As the aspiration site near the small of my back was being prepped for the bone marrow biopsy, Dr. SH told me that all the blood work was negative save for the monoclonal protein spike, and that the X-rays were all negative (no lesions were observed on the bones). Everything, he said, was pointing in the direction of MGUS. Terrific, I thought. And I left the office without any sense of dread.
I reported back to Dr. BM, my friend, who had expressed concern. When I told him it looked like MGUS, he was relieved. Myeloma was a very serious condition, he said, with average life expectancy from diagnosis of less than five years. That certainly sounded horrible...I was glad it looked like I didn't have it...