Multiple Myeloma: Diagnosis and Treatment.

Multiple myeloma accounts for 1.6% of all cancer cases and approximately 10% of hematologic malignancies in the United States. In 2015, an estimated 28,850 new cases of multiple myeloma were diagnosed in the United States, and the disease caused more than 11,000 deaths. Patients older than 65 years account for 85% of those diagnosed with multiple myeloma, and there is a twofold increased incidence in blacks compared with whites. Patients may present with bone pain or with symptoms that are often nonspecific, such as nausea, vomiting, malaise, weakness, recurrent infections, and weight loss. Many patients present with only laboratory abnormalities, such as anemia, renal disease, and elevated protein levels. The diagnosis of multiple myeloma requires increased numbers of immature, abnormal, or atypical plasma cells in the bone marrow; a monoclonal protein in the serum or urine; or characteristic bone lesions. The diagnostic workup in a patient with suspected multiple myeloma should include a complete blood count with differential; serum chemistries; creatinine, lactate dehydrogenase, and beta2-microglobulin tests; immunoglobulin studies; skeletal survey; and bone marrow evaluation. Initiation of chemotherapy and assessment of eligibility for autologous stem cell transplantation require referral to an oncologist. Most patients with multiple myeloma will receive thromboprophylaxis, bisphosphonate therapy, and prophylaxis against infection at some point in their treatment. Family physicians play a role in assessing these patients for infection, adverse treatment effects, and renal and thrombotic complications, and in managing issues related to pain, nutrition, and psychosocial support.

Suspected hypercalcemia induced ST-segment elevation in a patient with sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease that affects 10 to 20 people per 100,000 in the United States. Hypercalcemia is a known side effect of the disease and in rare instances has been shown to cause ST-segment elevation on electrocardiogram testing that mimics myocardial infarction. Herein, we present a rare case of a 55-year-old, asymptomatic African-American male with sarcoidosis and hydrochlorothiazide usage presenting with ST-segment elevation of the anterior leads secondary to hypercalcemia. Urgent cardiac catheterization showed normal coronary arteries without blockage. The patient's hypercalcemia was corrected with intravenous fluids and the ST-segment elevation resolved. The exact mechanism of ST-segment elevation induced hypercalcemia is unknown. Treatment of the underlying cause of the hypercalcemia is the mainstay of therapy.

Doing double duty. Interview by Charlotte Huff.

In a number of rural areas, one executive leads two, or even three, hospitals. They have to juggle staffs, boards of trustees and where to spend their time.