Although some patients with multiple myeloma have no symptoms at all, here are the most common symptoms:
Normally, two major kinds of bone cells work together to keep bones healthy and strong: osteoblasts- cells that lay down new bone; and osteoclasts- cells that break down old bone. Myeloma cells make a substance that tells the osteoclasts to speed up the dissolving of bone. The osteoblasts do not get a signal to put down new bone, so old bone is being broken down without new bone to replace it. This can cause areas of bone weakness that are painful. Any bone can be affected, but back, hip and skull pain is most common. These changes also increase the chance that the bones will break, often from a minor stress or injury.
Bone pain is another symptom that can indicate myeloma. Pain in the spine or ribs are common as myeloma lesions are commonly found in these areas. Having bone pain from normal daily activities or persistent bone pain for no reason in one area can indicate bone fractures. Bone pain is more common the older we get, so it's easy to write it off to age, a muscle pull or even the need for a chiropractor. Listen to your body and ask for an x-ray or other imaging to see if you have any bone damage that could be caused by myeloma.
When one antibody grows out of control, it can crowd out normal red blood cells and white blood cells, causing fatigue and anemia. It's easy to shrug off being "extra tired" and account it to a lack of sleep, older age or being out of shape, but anemia is an indicator of multiple myeloma. It's a good idea to get blood tests yearly to see if your blood levels are in normal ranges.
Anemia is caused when a patient has a reduced number of red blood cells, causes weakness, reduced ability to exercise, shortness of breath, and dizziness. Leukopenia, is when there are too few white cells, lowering resistance to infections like pneumonia. When blood platelet counts are low (thrombocytopenia), even minor scrapes, cuts, or bruises may cause serious bleeding.
When myeloma damages the bone, the bones release calcium into the blood. Having high levels of calcium in the blood or "hypercalcemia" is an indicator of multiple myeloma. High calcium can also cause nausea or vomiting, which you'd never relate to elevated calcium. A simple blood test can indicate if your calcium levels are higher than normal. Other side effects of elevated calcium can include thirst, drinking a lot of fluids, frequent urination, severe constipation and loss of appetite. It can make patients feel weak, drowsy, and confused. If the level of calcium gets high enough, it can even cause one to lapse into a coma.
If myeloma weakens the bones in the spine, they can collapse and press on spinal nerves. This can cause sudden severe pain, numbness, and/or muscle weakness. This is a medical emergency and patients should seek medical care immediately.
Sometimes the abnormal proteins produced by myeloma cells can be toxic to the nerves. This damage can lead to weakness and numbness. In some patients, large amounts of myeloma protein can cause the blood to “thicken.” This thickening is called hyperviscosity. and it can slow blood flow to the brain and cause confusion, dizziness, and stroke-like symptoms. Patients with these symptoms should call their doctor immediately. Removing the protein from the blood by a procedure called plasmapheresis can rapidly reverse this problem.
Myeloma protein can damage the kidneys. Initially, it can be asymptomatic but can be found with a blood test. As the kidneys start to fail, they lose the ability to dispose of excess salt, fluid, and body waste products, which can lead to symptoms such as weakness and leg swelling.
Myeloma patients are about 15 times more likely to get infections because the body is unable to make the antibodies that help fight infection. Often, once someone with myeloma gets an infection, it is slow to respond to treatment. That person may stay sick for a long time. Pneumonia is a common and serious infection seen in myeloma patients.
Multiple myeloma creates too much of one type of protein (a "monoclonal" protein). Too much protein can damage nerves and cause neuropathy, or numbness and tingling in the hands or feet. Neuropathy can also be caused by diabetes which can be more common as we get older. If your hands or feet feel "fuzzy" or you are having "pins and needles" sensations, ask your doctor to test for a monoclonal protein. It's a simple blood test.
There are many myeloma patients who report that they went months or years with these types of symptoms, brushing them off or even having a doctor ignore their thoughts that "something" was wrong. If you think something is not quite right, then talk to your doctor and insist they run simple blood tests and an x-ray to rule out multiple myeloma. The longer you wait, the more end-organ damage can occur. As Dr. Lentzsch says, "The patient is always right!" You know your body better than anyone and should feel confident that you can track the symptoms down with the help of a doctor.
For more information, learn more about the basics of multiple myeloma here.