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Managing Complications and Side Effects

The build-up of myeloma cells in the bone marrow can lead to a number of medical problems that need to be identified, monitored and treated. 

Bone complications 

Throughout our lives, our bones are constantly being remodeled by two types of cells with complementary functions:

  • Osteoclasts break down old bone to make room for new bone. 
  • Osteoblasts lay down new bone to replace the bone broken down by osteoclasts.

Under normal conditions, both types of cells keep the rate of bone formation and bone breakdown equal, so that bone mass remains the same.

Myeloma cells stimulate the osteoclasts (the cells that break down bone) while at the same time interfering with the production of osteoblasts (the bone-forming cells).

As a result, bone is broken down faster than it can be replaced, leading to:

  • Areas of damage (or "holes") in the bone (i.e., osteolytic or lytic lesions).
  • Progressive thinning of the bones (i.e., osteoporosis). 
How do bone complications affect you? How are they managed? 

Increased risk of fractures

  • Even everyday activities can cause bones to break.

Bone pain

  • Experienced by the majority of myeloma patients.
  • X-rays and bone density scans are used to monitor bone loss and check for damage.
  • Bisphosphonate drugs are routinely prescribed to strengthen the bones.
  • Radiation therapy can be used to treat bone lesions and relieve pain.
  • Procedures can be performed to stabilize fractures of the spine (i.e., vertebropasty, kyphoplasty).  

Is exercise safe?

Unless there are reasons not to exercise, mild or moderate activity, such as walking or swimming, may be physically and emotionally beneficial. Avoid contact sports or activities that could result in falls. Ask a physical therapist or your healthcare team to suggest activities that are appropriate for you. 

Anemia

The high number of myolema cells crowds out red blood cells and decreases their production in the bone marrow, leading to a reduced red blood cell count. Red blood cells contain hemoglobin that carries oxygen from the lungs to cells throughout the body, providing stamina and energy. A low hemoglobin count can lead to anemia. 

How does anemia affect you? How is it managed?

Fatigue

  • You feel tired even though you are getting enough rest.

Shortness of breath

  • You're out of breath after even mild exertion.

Difficulty concentrating

  • You may find it hard to focus, to do daily chores, or to remember things.

Other symptoms

  • You may look pale, feel lightheaded or dizzy, experience headaches, have leg pains or feel cold. 
  • If your anemia is related to a change in your diet, eating healthier or taking iron, vitamin B12 or folic acid (folate) supplements may help.
    IMPORTANT: Always check with your doctor before taking any over-the-counter iron, vitamin or herbal supplement, as these can interact with prescription medication.
  • In severe cases, blood transfusions can be used to quickly increase the hemoglobin in the short term.
  • Your doctor may prescribe medication to stimulate the production of red blood cells. 

Why treat anemia? 

Studies have shown that, in people with cancer, treating anemia can help:

  • Relieve fatigue.
  • Make everyday activities easier.
  • Reduce the need for blood transfusions.
  • Improve the quality of life.
  • Make it more likely they will be able to complete their cancer therapy.

Infections

Myeloma and some of its treatments can affect the normal production of antibodies and reduce the white blood cell count, making it harder for the body to fight off infections. 

How does a low white blood cell count affect you? How is it managed? 

Increased susceptibility to infections

  • Repeated infections (especially respiratory infections) or illnesses.

Longer time required to recover from infections or illnesses
  • Fever or signs of infection should be reported promptly to your healthcare team.
  • Antibiotics may be required before dental work to reduce the risk of infection.
  • You can help reduce the risk of infections and illnesses by:
    • Practicing good hand-washing techniques.
    • Washing your hands frequently or using a hand sanitizer.
    • Avoiding situations that place you in contact with people who are ill. 

Kidney damage

The M-proteins produced by myeloma are cleared from the body by the kidneys. Over time, the elevated levels of abnormal M-proteins in the blood and urine can damage the kidneys. 

How does kidney damage affect you? How is it managed?

Severe kidney disease may require dialysis (infrequently) 
  • The best way to prevent kidney damage is to treat the myeloma and keep the M-proteins as low as possible.
  • Kidney function should be assessed regularly by measuring levels of creatinine in the blood.
  • Drinking lots of fluids (ideally, 6-8 glasses of water per day) can help:
    • Flush medication and toxins from your body.
    • Maintain normal blood volume and pressure.
    • Lubricate the joints.
    • Limit fatigue.
    • Prevent kidney damage.
  • Limit your consumption of drinks that contain caffeine (i.e,. coffee, tea, soft drinks, etc.) and alcohol. 

High blood calcium

As bone is broken down, it releases calcium in the bloodstream. If the myeloma is causing a lot of bone damage, the levels of calcium in the blood can become excessively high – a condition known as hypercalcemia. 

How does high blood calcium affect you? How is it managed? 

Constipation

More frequent urination

Weakness

Confusion (in extreme cases) 
  • If you have myeloma, NEVER take a calcium supplement without checking with your doctor. 
    • Too much calcium in the blood can be unhealthy. 

Other blood complications

Myeloma can result in other blood complications, although they are relatively rare. Potential blood complication include:  

  • Low platelet levels.
    • Normal blood clotting is affected, which can lead to bruising or excessive bleeding.
  • Increased risk of blood clots in the veins, associated with some medication.
    • Known as deep vein thrombosis (DVT), a potentially dangerous condition.
    • Blood-thinning medication can be prescribed to reduce the risk.
  • Thicker-than-normal blood (i.e., hyperviscosity) resulting from a high M-protein level.
    • Can affect blood flow to the skin, fingers, toes, nose, kidneys or brain. 

Bone pain, nerve pain and neuropathy

There are three main causes of pain for myeloma patients.

The type of treatment you require will depend on the cause of the pain, the severity of symptoms and how you respond to different therapies. 

Main causes of pain in myeloma patients How is pain managed? 

Bone pain

  • Associated with bone damage and fractures.

Nerve damage

  • Often due to compression fractures.

Peripheral neuropathy

  • Usually occurs in the feet, legs, hands or arms.
  • Can be experienced as:
  • A painful sensitivity to touch.
  • The sensation of "electric jolts."
  • A burning, tight or pulling sensation.
  • Numbness or a "pins-and-needles" feeling.
  • Treatment options include:
    • Pain medication and anti-inflammatories
    • Radiation (for bone pain)
    • Vertebroplasty or kyphoplasty (for nerve damage due to compression fractures)
    • Other types of medication, such as tricyclic antidepressants and anticonvulsant medications (for neuropathic pain). 

Pain medication dependency and addiction 

Some myeloma patients are reluctant to take opioid medication for their pain, because they're concerned about the potential for addiction.

Most healthcare professionals agree that there is very little risk that someone with no history of dependency will develop a true addiction.

Don't hesitate to discuss any concerns you may have with your medical team, who can answer your questions and recommend pain relief options that are right for you.  

Dental health

Dental health is very important for myeloma patients.

Encourage your dentist to talk to your oncologist, to discuss any special precautions you may require, especially while you are receiving treatment.

How does myeloma affect dental health?  How can potential risks be reduced? 

Increased risk of infection

Osteonecrosis of the jaw (ONJ)

  • Rare side effect of long-term use of bisphosphonate.
  • Practice good oral hygiene to reduce the odds of needing dental care.
  • See your dentist regularly to catch potential problems when they are small.
  • Get a complete dental examination before starting any therapy.
  • Because myeloma increases the risk of infection, antibiotics may be required before undergoing dental work.
  • Avoid extractions and periodontal surgery, if possible, as well as dental implants.

Side effects of medication

In addition to their intended effects, all prescription medication have other effects that you may not want – i.e., side effects. Ask your healthcare team, particularly your pharmacist and your nurse-educator, about:

  • The potential side effects of the medications you are prescribed.
  • Which side effects you should report immediately.
  • What you can do to relieve side effects you may experience. 
Common side effects of chemotherapy How are they managed? 

Nausea and vomiting
  • Anti-sickness (anti-emetic) drugs can help prevent nausea and vomiting.
  • Avoiding strong smells and getting lots of fresh air can also help.
  • Try to stay hydrated by taking frequent sips of cool drinks.
Hair loss
  • Common with some – but not all – types of chemotherapy.
  • If it happens, remember that your hair will grow back when your treatment is finished.

Changes in the mouth

  • Mouth sores
  • Sore or dry mouth
  • Medicines or special mouthwashes (without alcohol) can help.
  • During high-dose intravenous therapy, sucking on ice chips can help prevent mouth sores.
  • Keep your teeth clean, using a soft toothbrush.
  • Avoid spicy, salty or tangy foods that can irritate your mouth, as well as food that stick to the roof of your mouth (i.e., peanut butter, chocolate, etc.).
  • Moisten your food with gravy or sauces.
Loss of appetite
  • To avoid losing weight, try to eat small amounts of food (particularly fresh fruits and vegetables) frequently throughout the day.
  • If you feel hungry at some parts of the day and not at others, eat your larger meal when you are hungry.
  • No matter what you eat, be sure to always drink plenty of fluids.

 

Common side effects of corticosteroids (steroids) that are frequently used to treat myeloma

Fluid retention and swelling

Increase in blood sugar

  • Of concern to people with diabetes or at risk of diabetes.

Insomnia

Increased appetite

Indigestion or heartburn

Hiccups

Blurred vision

Mood or emotional changes

  • May include depression, mood swings, agitation, anxiety or even psychosis.

Long-term use of high-dose steroids can result in:

  • Cushingold appearance (weight gain, with a "moon face")
  • Osteoporosis or bone loss
  • Muscle weakness and/or wasting

Other potential side effects

  • Fatigue
  • Cataracts

Coping with "Roid Rage"

Dealing with a diagnosis of cancer is hard for you and your loved ones. The mood changes that can be brought on by steroids can make things even harder.

Be sure to explain to your loved ones how steroids can affect your mood and activity levels. Give them a "heads up" when you go on or off your medication.

Chances are they'll be more supportive and understanding (and won't take things too personally) if they know that sometimes "it's the 'roids talking"... not you! 

Depression

40%... That's the percentage of cancer patients who experience depression or anxiety, according to some studies.

As you deal with your disease, there may be periods when you're feeling "blue" or "down." You may sometimes feel like you're no longer the person you used to be. The physical and mental changes that are occurring may take a toll on your self-esteem.

While these feelings are completely understandable considering what you're going through, it's important for you to reach out to a health professional if you experience five or more of the symptoms on the checklist below for more than two weeks.

Symptoms (experienced for more than 2 weeks)
Feelings of sadness, anxiety, irritability, nervousness and/or guilt
Feelings of worthlessness or hopelessness
Changes in your usual sleep patterns (having trouble sleeping or sleeping more than usual)
Changes in your appetite (gaining or losing weight without trying)
Loss of interest in activities that you used to enjoy
Restlessness or slowed behaviour
Persistent or recurring headaches, digestive disorders or chronic pain
Difficulty concentrating, remembering or making decisions
Fatigue, loss of energy
Changes in work style or productivity

Thoughts of suicide (if these occur, seek immediate professional help)

If the depression continues for a period of several weeks without relief, or interferes with your everyday life, you may need help.

Don't try to deal with this all by yourself. Talk to your doctor, nurse or counselor. Sometimes, just sharing your thoughts and feelings is enough. In other cases, medication can be helpful. No matter what, always remember that you're not alone. 

Before considering alternative therapies...

...there's something you should know.

Many vitamins, supplements and herbal products can interact with your cancer medications.

NEVER take any vitamins, supplement or herbal therapy without first consulting your physician and/or your pharmacist. 

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