M-Spike, High Kappa and Kappa/Lambda Ratio

Posted by Kappa King @kappaking, Mar 8 10:34pm

After experiencing chronic diarrhea for > four weeks, I decided to contact my gastro doctor. He ordered blood work and performed a colonoscopy and upper endoscopy with various biopsies. The colonoscopy, upper endoscopy and biopsies showed no sign of cancer or microscopic colitis, however the blood work showed a quite elevated IgA level. He referred me to a hematologist/oncologist who did further blood work, the results of which showed:

• Borderline low white blood count
• Borderline high red cell distribution width
• Low lymphocytes
• Low monocytes

And the most troublesome results:

• Kappa Free Light Chain Level: 290.7 mg/L, well outside of the 3.3-19.4 mg/L acceptable range
• Kappa/Lambda Ratio: 45, well outside of the .26-1.65 acceptable range
• IgA Level: 2111 mg/dL, well outside of the 70-400 mg/dL acceptable range
• IgG level of 698 mg/dL, barely outside of the 700-1660 mg/dL
• M-Spike: 1.29

There are other data points outside the reference ranges, but these are the ones that concern me most. I had been overseas when I received the results and asked my hematologist if I should cut my vacation short to come home for further evaluation/tests. He urged me not to do so and told me it can wait. I managed to enjoy my vacation but now that I returned I can't stop worrying. I'm following up with my hematologist to see what the next step is. I'm scared.

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@kappaking

Good morning, @loribmt. Thanks for the info. I told my doctor that I wanted to be completely knocked out. He told me he can't do that unless "other arrangements" are made. I assume what he means is that it would need to be done in a hospital setting. So I'll be getting a local anesthesia. He's trying to convince me that he does many of these procedures and has never had to completely sedate a patient, and that the pain isn't all that bad. I'll just grit my teeth and hope for the best.

No questions about the procedure at the moment. My head is still swimming and spinning.

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The bone marrow biopsy of my left illiac crest was 8 years ago, no pain and the pressure differences were fascinating. Anesthesia was local and it was at the hematologist's office. I'm a woodturner and worked on drilling rigs so hear/feel when one drills through different densities of wood and rock. Same with a biopsy; the skin/fat, muscle, and bone layers all feel familiar. Hopefully I haven't grossed you out with this. Pain at the drill site afterwards was also minor (they use a small drill bit).

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@kappaking

I absolutely will let you know. Thanks for showing interest.

To add to the stress of it all, my primary care physician - whose care I was under for over 20 years and someone I hold in the highest regard - retired last year and I haven't found a new one yet.

Then there's the issue of health insurance. I have insurance, but I think it's a bit limiting in terms of who/where I can be treated. It's insurance provided to city government workers and I fear that I'm restricted to being treated by health care professionals only in my state. So if I want to seek treatment at, say, the Mayo Clinic in Rochester, MN, I may not be covered - at least not to the extent I otherwise would be. I'll need to read the finer details of the policy. That being said, however, I live in NY where the concentration of better doctors is higher than other parts of the country.

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Sometimes you can get permission to go out of network to a place like Mayo if you have a rare disease. Mayo has many amazing myeloma docs, it’s where I go for my myeloma. I assume it’s the same for all blood cancers. Often all you need is that expert opinion for your local doc to follow.

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@loribmt

There are differing opinions on whether to be sedated or have only local anesthesia with the bone marrow biopsies. Some swear by sedation, other people are just fine without. If you have an experienced doctor who has done quite of these you’ll be in good hands.
The sample will be taken from the area on your back, just near the large dimple above your butt. You most likely won’t need a gown and from my experience, you keep your skivvies on. They will be pulled down in the back just enough to access the site. I’ve had 13 of these done and just for laughs have worn some humorous underpants to break the tension. 😅

I’m sure your head is spinning! There’s a lot of unanswered questions right now so you’re feeling very uncertain. Having a diagnosis will allow you to be able to form a plan, if needed, and to move forward. Will you let me know what you find out please?

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Mayo does bone marrow biopsies using propofol. You’re out for the few minutes and then back! It’s amazing.

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@barbdk

Mayo does bone marrow biopsies using propofol. You’re out for the few minutes and then back! It’s amazing.

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I agree! Mayo is the best when it comes to those bmbx! I’ve had 10 of them there and now I’m so spoiled. 😉 Love waking up to Lorna Doone cookies and juice!

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@kayabbott

I use Qunol brand bioavailable curcumin. I don't use the tumeric (I assume you mean curcumin) with peperine. I looked at the Dr. Shah site and it is just a .com selling supplements, is pretty thin on science, and has no references. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061533/

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Dr. Urvi Shah was awarded the ASH Scholar award for the abstract she presented at the American Society of Hematology in December, 2023.

This Healthtree.org article presents Dr. Urvi Shah’s research.

https://healthtree.org/myeloma/community/articles/best-diet-for-precursor-myeloma-ash-2023
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Thanks for the background info; she is quite accomplished. It would be good if Dr. Shah fleshed out (so to speak) her website with some links to research papers. Great that she got a best abstract award. Reminds me of an abstract that I submitted years ago (retired) that was rejected for a symposium, although the resulting paper received a best paper award. Science is fun(damental).

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For those of you who have some kind of monoclonal gammopathy and who experience bone pain:

Is your bone pain something that comes and goes quickly or does it stay with you a while? The reason I ask is because I think I'm experiencing bone pain but it comes and goes so quickly, it's easy to just disregard it. Also, I live a very sedentary life and sit on my butt for the majority of the day, and I wonder if the occasional pain I feel is simply due to my sitting position/posture.

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@kappaking

For those of you who have some kind of monoclonal gammopathy and who experience bone pain:

Is your bone pain something that comes and goes quickly or does it stay with you a while? The reason I ask is because I think I'm experiencing bone pain but it comes and goes so quickly, it's easy to just disregard it. Also, I live a very sedentary life and sit on my butt for the majority of the day, and I wonder if the occasional pain I feel is simply due to my sitting position/posture.

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I would think if it’s pretty persistent then I’d worry.
Sounds like yours is fleeting - why not try exercising or going for a walk, and stretching your muscles to see if that helps?
I was diagnosed with MGUS but it’s been stable and now undetectable. I’m 65 and get aches & pains but they are mild and vary from day to day.
Don’t know if that’s helpful?

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@leslie2121

I would think if it’s pretty persistent then I’d worry.
Sounds like yours is fleeting - why not try exercising or going for a walk, and stretching your muscles to see if that helps?
I was diagnosed with MGUS but it’s been stable and now undetectable. I’m 65 and get aches & pains but they are mild and vary from day to day.
Don’t know if that’s helpful?

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Congratulations on now being undetectable. I’m curious, is there anything that was done to contribute to the decrease? Provable or not.

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@cheft

Congratulations on now being undetectable. I’m curious, is there anything that was done to contribute to the decrease? Provable or not.

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Good morning ChefT:

That’s the $64,000 question, right? The only things I can think of are time and adding curcumin capsules. I’ve since added omega 3 and tart Cherry extract for some aches & pains which seem to help. I took medication for osteoporosis that I think caused those arthritis like pains.
My doctor didn’t know why or how to explain my latest SPEP and without another BMB couldn’t know. But it said I had “ small peaks in several lanes with no clearly identifiable monoclonal protein”.
The other + thing is my proteinuria is gone and no sign of kidney disease. (Which was also a recent issue)
FLCs took a big drop too.
I was diagnosed about 2 years ago during a physical and work up for osteoporosis.
My (controversial) speculation is perhaps the Moderna vaccine triggered something. I had 2 + 2 boosters between 2021-2022.
I am generally pro-vaccine and a retired nurse. 🤷🏻‍♀️

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