The myeloma specialist has a good sense of humor. He said "If a dog has fleas, it can still get ticks." So having cancer doesn't mean you can't still get an entirely unrelated disease. I love a doc who laughs. He said MGN isn't in his expertise, so he will let the nephrologist take care of that.
The good news from the myeloma specialist is the cancer is still under control. Doug will remain on the maintenance regime of 5 mg Revlimid every other day, and he will resume Zometa at a lower dose and frequency: 2 mg every six months. The Zometa is good because it reduces the chance of fractures, and bad because it can harm the kidneys, so it is a balancing act. Another bit of good news is the creatinine level is 1.2.
Doug will get a blood draw for a MM panel every two months, and see the specialist every two months.
Today we went to see the nephrologist. She spent a big chunk of time with us explaining everything. She said the clinic owners want her to spend less time on patient visits so she can cram more in, but she is ignoring that directive. Good doc!
She said that MGN is not an uncommon kidney disease. 50% of patients go into spontaneous remission. Maybe Doug will be fortunate enough to fall into that category! The other half will eventually need treatment, with 20% progressing to kidney failure if treatment doesn't work. Treatment would be the immunosuppressive drug Prograf and dexamethasone.
The biopsy showed 30% of Doug's kidneys are permanently damaged - "globally sclerotic." Another name for scarring or fibrosis. The remaining 70% is capable of doing the job. Thankfully God made us with extra capacity.
She feels Doug does not need treatment yet. It is better to wait and monitor him; the drugs have side effects so she doesn't want to use them unless necessary. As long as the creatinine level stays under 2 and the protein level stays under 4 she will just watch. Right now his creatinine is 1.2 and his protein in urine is 3.4, so that is good.
Doug has to take his blood pressure twice a week at home and record it. And watch for ankle swelling. Once a month he will get a pee test and a blood draw for a basic metabolic panel. She will see him every three months for now.
He has some dietary restrictions but nothing dramatic. Not more than 4 servings animal protein per day. One serving is the size of a deck of cards. Drink at least 2 quarts fluid a day. Low sodium diet which we try to follow anyway. Carbs are okay.
We are happy with all this. The awful waiting period is over, we know what Doug has and a plan to follow. We have two wonderful caring specialists who take time to share their knowledge. God has blessed us and we are thankful.
Love to all.
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