Not So Fast, Buster

In the last post I celebrated three years’ stable disease in the pomalidomide drug study, and especially the disappearance of the bone lesions revealed by a PET scan three years ago. Yay!

But oops. The very last sentences of the very last-received test result (the new PET scan) say: “Significant incidental findings on the low-dose unehnanced CT fusion images. Coronary and vascular calcification. Bilateral renal calculi.”

What does this mean? I’m definitely not a radiologist, but I see two issues, neither related to myeloma:
Calcification (hardening) of blood vessels in the heart and elsewhere; and
Kidney stones.

Kidney Stones:

Dealing with the kidneys first, I took a good look at my calcium intake and found that I was getting about twice the recommend 1200 mg of calcium daily. I took 1200 in supplements, and most days got another 1200 or so from food, mostly dairy products. Kidney stones can cause infection, and of course the severe knife-in-the-gut pain that strikes if a stone enters the urinary tract, so they are a concern.

I stopped the calcium supplements, at least for now, except for one 300-mg tablet in the evening if the day’s intake from food is below 1200 mg. That should help the kidneys, though I can only hope that it doesn’t impact bone strength. Even more important is water intake, and I don’t drink much – getting water mostly from coffee and fruit. I need to find a way to make increased water intake a normal part of my day. I’ll start with one 16-oz glass of ice water at the desk every morning and afternoon, see how that goes. If I can make it work, that will be a big improvement.

Coronary and Vascular Calcification:

That’s athersclerosis. Yikes! What an awful-sounding word, even in print. How can this happen to a dedicated, competitive runner who eats as well as I do? A PET scan three years ago noted “scattered mild calcifications,” but the qualifiers “scattered” and “mild” are not found in this month’s scan, hence the concern. The images were interpreted by different radiologists, so it’s hard to know the amount of change, but the second radiologist was looking at the notes from the previous scan when he made his new notes. We’ve heard that the cure for myeloma is to live long enough to die of something else, but heart disease is a quick way to get there and I’m not in that much of a hurry. I’d prefer they would come out even.

Perhaps the reduction in calcium intake will help – the literature I’ve found seems to be mixed. One article suggested that calcium supplements may increase the risk of athersclerosis while normal amounts of calcium from food may not. But more can be done.

I now have at least four independent risk factors for serious heart disease:
Age of 70;
Family history – my paternal grandfather died of heart disease, and my father has heart disease;
Chronically low HDL; and
Now, diagnosed “coronary and vascular calcification.” Is that a risk, or actual disease?

I can’t fix the first two, but I may be able to do something about HDL, and thereby calcification as well. Since 1992 my HDL has wobbled between 26 and 42, most recently 36, where a desirable HDL is 60 or more g/dL. Total cholesterol is fine, at 154 g/dL, but HDL proteins are the blood-vessel scavengers capable of undoing damage done by LDL. Three years ago my HDL was 42, but since then dexamethasone (DEX) has destroyed some of my muscle tissue, which hasn’t returned since discontinuing DEX. In its place, or rather in a different place, my body has accumulated an equal weight of excess fat, especially around my belly. According to a Mayo Clinic article, this belly fat may significantly degrade HDL.

In past years I’ve tried and given up on statins, garlic, green tea, and niacin, none of which raised HDL and all of which were either unpleasant or had unwanted side effects. I do know how to lose weight, though, and the side effects are quite positive: Better body image, better overall health, faster as a runner, and hopefully, improved HDL. I’m not clinically overweight by any means, with a BMI of 22.1, but my body is now out of proportion, with a waist of 35 inches (89 cm) compared with a height of 70 inches (178 cm). I’m definitely not “trim” any more. Therefore, I’ve started back on the Weight Watchers program, keeping a journal of what I eat and making the best choices. It’s not easy but it works; the weight will come off, slowly and sensibly. 154.5 pounds (70.1 Kg) this morning, heading down.

Further, I have requested copies of both PET scans from Mayo, and will make copies and then give them to my new PCP, Dr NB. Depending on his recommendations, a visit to a cardiologist could be in my future as well. I’ll probabaly see my naturopathic doctor too, once we know more about the risk.

This has little or nothing to do with myeloma, I know. So if it becomes a big thing, I may start another blog, about heart disease. Uff-da.