MGUS I need help understanding my lab report.

Posted by nsnipes11 @nsnipes11, Dec 29, 2023

I've had MGUS for about 10 years, give or take. Next year, I'll be 80. Since I've been dealing with other issues: coronary artery disease (one stent); neuropathy, cervical stenosis (severe degenerative disc disease cervical and lumbar), osteoporosis, asthma, Barrett's esophagus and other smaller issues, I haven't paid a lot of attention to the MGUS.
My lab work says "immunofixation shows IgG monoclonal protein with lambda light chain. My M-spike is 1.5. My IGg is 1819. My Lambda is 27.00. K/L Ratio 0.39; RBC is 3.50; HCT 34.7; MCH 34.2; GLUC 110.0; CREA 1.1; eGFR 53.
My oncologist was out of the office, and a nurse practitioner said all was well last visit, and again this visit my doc was not available. I will see her next week. I just wonder if I should consider seeing someone else. I have also been experiencing sharp pains in mid-back and hips. They don't linger though. Any thoughts are appreciated.

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@nsnipes11

Thank you, Patty, for the good advice. My doctor just doesn't have time anymore. I've tried to write the patient portal, but have received no response. I've just assumed that if there are any issues, she would let me know. I know to be my own advocate, and I've read quite a bit about MGUS, but have gotten more confused than when I started. LOL. As I said, the doctor seems to be allowing the nurse practitioner to take over more. I saw the NP once, but the next time, I expressly said I wanted to see the doctor. I completely understand there are many patients who are far worse off than I am, so I'm reluctant to take up too much of the doctor's time.

I'll be seeing her next week for recent labs, which were done in two different labs. A partial one at her office by one lab and one by Quest, who did my cardiac labs.

Thank you for all your good advice.

Nan

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Stress is not good for patients. This doctor has to find time to respond to your messages. The Mayo location I use has what is called a Cancer Navigator (Social Worker with additonal training.) I have used this Cancer Navigator on several occasions when I needed help. This has been a great help for me and my husband as we ourselves "Navigate Things." This might work for you. Signing off as a full day of things to do. (As always, smile)

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@smiles1951

Stress is not good for patients. This doctor has to find time to respond to your messages. The Mayo location I use has what is called a Cancer Navigator (Social Worker with additonal training.) I have used this Cancer Navigator on several occasions when I needed help. This has been a great help for me and my husband as we ourselves "Navigate Things." This might work for you. Signing off as a full day of things to do. (As always, smile)

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Thank you, Smiles! I will look into this.

Blessings,
Nan

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@nancyworld

Nan (@nsnipes11), I'm happy to say that I had a very pleasant meeting with my doctor today and that all my questions were responded to. I'm due to go back for repeat blood tests in 5 months, but I might pay out of pocket for an FLC test at an independent lab earlier, just for my own reassurance. Thank you for asking!

Nancy

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I've been following your post about MGUS, which I also have. If you don't mind me asking what's a FLAC test?
I'm trying to keep as knowledgeable about this disease as I can comprehend. I called the Multiple Myeloma Foundation for more information & to get involved with group members with MGUS. They're very informative & pleasant to help us & are sending me alot of information to help myself personally & knowledge wise that my Oncologist didn't have time to answer.
Jean

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@rockergirl43

I've been following your post about MGUS, which I also have. If you don't mind me asking what's a FLAC test?
I'm trying to keep as knowledgeable about this disease as I can comprehend. I called the Multiple Myeloma Foundation for more information & to get involved with group members with MGUS. They're very informative & pleasant to help us & are sending me alot of information to help myself personally & knowledge wise that my Oncologist didn't have time to answer.
Jean

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@rockergirl143 Welcome to Mayo Clinic connect! I see you have been a long-time member and this is your first post.

I believe the reference is as to the Free Light Chain test. Here is news from the International Myeloma foundation about recent findings: https://www.myeloma.org/videos/icelands-istopmm-study-revises-definition-free-light-chains-serum-light-chain-monoclonal

You mention that your oncologist doesn't seem to have the time to answer questions for you. If I may, is he/she a hematologist/oncologist?
Ginger

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@gingerw

@rockergirl143 Welcome to Mayo Clinic connect! I see you have been a long-time member and this is your first post.

I believe the reference is as to the Free Light Chain test. Here is news from the International Myeloma foundation about recent findings: https://www.myeloma.org/videos/icelands-istopmm-study-revises-definition-free-light-chains-serum-light-chain-monoclonal

You mention that your oncologist doesn't seem to have the time to answer questions for you. If I may, is he/she a hematologist/oncologist?
Ginger

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Yes, Ginger, she is. She used to be pretty on top of things, but the last year or so, she doesn't allow much time. Her practice has expanded, and I'm turning 80. Maybe those things play into it. I don't know. I also am dealing with a couple of other serious issues as well, so I don't push things as I have plenty on my plate.
Thank you for the link. I'll look into it right now.
And thank you for taking the time to send this info to me.

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@nancyworld

@nsnipes11 , I'm sorry you didn't get to discuss your MGUS concerns with your doctor. It can be hard to stay on track if they have a lot of things to go over.

I started to take a crack at comparing your immunoglobulin test values here with the Mayo (at least) standard ranges for those tests, and then realized that I don't know if the amounts are in mg/dL or mg/L. It makes a big difference! And different labs use different reference ranges for some lab tests.

Do you possibly have the reference ranges for those lab tests in your reports, and the units of measure (mg/dL vs. mg/L)? If so, maybe I or someone here can help put the results in perspective.

Even so, it can be tough to do without knowing your other physical conditions that can affect some of the measures, especially since most of us don't have the medical knowledge to figure out how one condition can affect another. I'm just empathetic because I'm trying to assess my own situation.

Best wishes, Nancy

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Before I see my doctor I make a "grocery list" of what I want to ask. I am a retired RN and Behavior specialist and understand well how anxiety can get in the way with getting adequate information. I make sure my MD or NP sees my pad with my list and she makes sure she has answered my questions. I don't know about your portal, but I am with UCLA health and when a lab report come in, they have a explanation of what that test has to do with the function of the body. It is not complete but helpful. Check your portal for that. Presently I have a diagnosis of WM but am on a watch and wait. My symptoms fluctuate and are minimal and my labs are inconsistent. I have a wonderful doctor and that is very helpful. Good luck. Susan

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@careysuzi

Before I see my doctor I make a "grocery list" of what I want to ask. I am a retired RN and Behavior specialist and understand well how anxiety can get in the way with getting adequate information. I make sure my MD or NP sees my pad with my list and she makes sure she has answered my questions. I don't know about your portal, but I am with UCLA health and when a lab report come in, they have a explanation of what that test has to do with the function of the body. It is not complete but helpful. Check your portal for that. Presently I have a diagnosis of WM but am on a watch and wait. My symptoms fluctuate and are minimal and my labs are inconsistent. I have a wonderful doctor and that is very helpful. Good luck. Susan

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Thank you, Susan. I too have a list (not as much as a grocery list). At the last visit, I asked about my prior report that had eGFR at 53 (LOW), GLUC at 110, CREA AT 1.1, both of which were high. I also had low RBC, HCT, and high MCH. My current labs (at two separate labs) seemed to be closer to normal with the exception of MCHC, which was minimally high. I say all of this to let you know that I asked about having another urine test since it's been awhile and since I had a low eGFR and high CREA, and she countered with, "Do you think that it's multiple myeloma?" I said no, and it was totally dropped. I hesitate asking her anything now. Before Covid, she was much more on top of things. I guess I've just lost faith in her. I hesitate changing doctors unless I have a good reason to do so since I have so many other issues I'm dealing with right now. My current tests seem OK. My Immunoglobulin G, Qn, Serum was 2029 (range 586-1602). Immunoglobulin A, Qn, Serum 36 (range 64-422). My K/L ratio was within range.
One other thing, I've had two bone marrow biopsies. The first one at the beginning of MGUS, and the second one was a mistake. She mixed up my information with someone else. My most recent report says "plasma cells comprise about 5% of the cellularity with occasional large atypical forms seen." Would you happen to know what "occasional large atypical forms" are? I attempted to look them up, and came up with nothing.

I hope you have a blessed day.
Nan

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Hi Nan,
As far as I am concerned there is no room for "mixing up results". I would at least get a second opinion. What is the plan with your present doctor? Are you on "watch and wait"? Be sure to stay proactive with your health care. There is a lot of good stuff in research out there. keep in touch and good luck. Susan

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I had a baseline bone marrow biopsy 8 years ago, at the onset of MGUS. My deranged plasma cells were at 5% (a peer-reviewed paper I read referred to the precancerous cells as deranged. I like that better). If your K/L ratio is within range (between 0.26 and 1.65) then that is reason to celebrate. Mine is 11, still OK but been ramping up for a few years. Your GFR (kidney filtration rate) and some other numbers are tied more to kidney function. My kidney function bloodwork didn't decrease until my MGUS progressed, and in my case is mostly due to meds, not MGUS. My red and white blood cells have been low for many years and are probably genetic (celiac). If you are on meds then it would be good to see if any of them have kidney or other side effects, or interfere with each other (pharmacist, doctors aren't good at this). I am a 69 yo woman and try to slow my MGUS with diet, exercise, avoiding stress, and dark chocolate (just because I'm a chocoholic).

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@kayabbott

I had a baseline bone marrow biopsy 8 years ago, at the onset of MGUS. My deranged plasma cells were at 5% (a peer-reviewed paper I read referred to the precancerous cells as deranged. I like that better). If your K/L ratio is within range (between 0.26 and 1.65) then that is reason to celebrate. Mine is 11, still OK but been ramping up for a few years. Your GFR (kidney filtration rate) and some other numbers are tied more to kidney function. My kidney function bloodwork didn't decrease until my MGUS progressed, and in my case is mostly due to meds, not MGUS. My red and white blood cells have been low for many years and are probably genetic (celiac). If you are on meds then it would be good to see if any of them have kidney or other side effects, or interfere with each other (pharmacist, doctors aren't good at this). I am a 69 yo woman and try to slow my MGUS with diet, exercise, avoiding stress, and dark chocolate (just because I'm a chocoholic).

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Thanks, Kay!
I love the "deranged" plasma cells!
I think I'll use that term too. And yes, my K/L ratio is good. That's a plus, for sure.

I'm with you, Kay, I love dark chocolate too. Not fond of milk chocolate though.

I'm still working two to three weeks out of each month, so I'll try to make time to check on my meds' side effects.

Thanks for taking the time to comment.
Nan

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