What are the signs and symptoms of kidney disease in myeloma patients and what creatinine level is considered having reduced kidney function? And how can patients stay hydrated especially if they are having nausea or other gastrointestinal issues?
Most patients with kidney disease do not experience any signs or symptoms. Usually, only when kidneys are severely compromised would a patient know they have kidney problems (for example, they may not be producing the same amount of urine as they used to) and at this point a patient would need to be placed on dialysis. The best way to assess the extent of kidney function and disease is to measure creatinine. Creatinine is a component of a patient’s blood that is measured during routine blood tests. A high creatinine number indicates a more compromised kidney function. A creatinine value of 1 or more would indicate having reduced kidney function but the actual value (and normal ranges) are different for each lab so be sure to talk to your doctor about your specific number.
Most doctors and nurses tell their patients to always have a bottle of water handy to make sure they stay hydrated as a way to protect the kidneys. However, not many people just like the taste of plain water! Some suggestions to make water more flavorful is to mix in fruits or other additives. Another important way to keep from becoming dehydrated is to avoid alcohol, caffeinated drinks, or overly sugary beverages. However, some patients may not be able to easily hydrate because they can’t keep fluids down to due nausea or vomiting. Patients must let their providers know if they are at this point because the provider may want to aggressively rehydrate the patient with either intravenous fluids or prescribe an anti-nausea medication.
How can peripheral neuropathy be managed?
Peripheral neuropathy is a condition that affects the nerves, resulting in pain, tingling, burning sensations, and numbness in the hands and feet. The development of peripheral neuropathy in patients with myeloma is typically caused by certain myeloma treatments such as Velcade and is extremely frustrating. Physicians can reduce the dose of Velcade or administer the drug less frequently to help minimize the severity of neuropathy. About two-thirds of cases will resolve on their own, but one-third of cases are irreversible.
Strategies for managing peripheral neuropathy include proper foot care and medications that help relieve nerve pain (like gabapentin). There are accounts suggesting that certain B vitamins or other supplements may be helpful, but these are unproven and should only be taken after consultation with the health care team. Many patients seek alternative therapies (such as creams on the feet) or acupuncture to alleviate pain. In some cases, referral to a neurologist may be appropriate.
Ultimately, time improves neuropathy; that is, time away from therapy. The more time away from the aggravating agent, the better the neuropathy is; however, in some cases people may suffer from peripheral neuropathy years after therapy.
Any recommendations to beat insomnia?
Typical recommendations include practicing good sleep hygiene (that is, not watching television in bed or drinking too many beverages before bedtime), but there are other items to consider to help patients get proper sleep. First, consider the timing of taking dexamethasone which is a major cause of insomnia (maybe think of switching from afternoon/nighttime to first thing in the morning). Second, talk to the health care team; they can’t know a patient is having problems unless the patient tells them! Providers may be able to:
- Reduce the dose of the dexamethasone
- Pinpoint an underlying cause of the insomnia such as depression or enlarged prostate (meaning, a patient may be getting up throughout the night to go to the bathroom)
- Provide you with medicines that help you sleep or deal with the underlying cause of the insomnia
MMRF Patient Webinar – Supportive Care for Myeloma Patients 3/24/21
This webinar helps patients with multiple myeloma manage fatigue, risks for bone fractures, infections, and other complications that can result from myeloma or from anti-myeloma therapies. View Patient Webinar now.
