Author Topic: Father in law diagnosed with AL amyloidosis...I'm not convinced  (Read 3553 times)

burner

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  • Reason for joining: family member has been diagnosed with amyloidosis
  • Diagnosed: 6 months ago
My 70 year old father in law went for knee replacement surgery.  Prior to the surgery he was healthy other than knee pain.  After the surgery his health has been declining daily.  Lower leg swelling was the initial problem...then he began to have bouts where he would lose consciousness and fall for a few seconds.  He went to the emergency room several times for this with no explanation.  Finally they admitted him to the hospital for this mystery illness.  Two weeks later he was diagnosed with AL amyloidosis which is causing kidney problems.  (bear with me I don't know all of the technicalities)  The doctors told him it was treatable.  They installed a port and began dialysis 4 or 5 days a week.  They began giving him some type of chemo therapy injections.  This has been going on 6 months or so.  He has progressively gotten worse.  He has intense leg pain all of the time.  His knee is swollen about 2x normal size.  The dialysis folks routinely take off too much fluid and cause other issues.  He became seriously ill with diarrhea to the point he couldn't leave the toilet for a few weeks.  Finally diagnosed with C-DIFF infection which required another hospitalization and then rehab as he had lost 75lbs and could barely walk.  Now they have stopped the chemo till he gains his strength back.  I hope someone can help, does this sound like amyloidosis?  does the treatment plan sound like it is correct?  I guess I am not convinced his body isn't rejecting the knee or something else as he was fine prior to that surgery.  He isn't getting any better and he is losing hope.  I have asked for him to go to a major clinic such as Mayo to get a second opinion but for some reason he will not.  Thank you for any help or ideas.

Miriam Vered

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Re: Father in law diagnosed with AL amyloidosis...I'm not convinced
« Reply #1 on: August 03, 2018, 12:46:24 pm »
Hello burner,
Welcome to the forum. I'm sorry to hear abut your father in law's illness. It isn't possible to give personalised medical advice here about your father in law's diagnosis and treatment. In the UK all patients should be referred to the NAC. It sounds like you are in the US so it would be advisable to be referred to a centre with experience in amyloidosis.

merrin

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  • Diagnosed: December 2016
Re: Father in law diagnosed with AL amyloidosis...I'm not convinced
« Reply #2 on: August 06, 2018, 05:24:01 am »
I will say diagnosing Amyloidosis is not guesswork. There are specific tests.

I find it hard to imagine a mis-diagnosis, but second opinions are a good thing especially regarding treatment.

gordon1119

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  • Reason for joining: I have AL
  • Diagnosed: August 2017
Re: Father in law diagnosed with AL amyloidosis...I'm not convinced
« Reply #3 on: August 06, 2018, 07:23:36 am »
Hi.  From my perspective, it indeed sounds like amyloidosis with kidney involvement .  I agree with /miriam - you have a center of expertise with the NAC and they are the ones who can diagnose for certain.  My own amyloidosis was confirmed roughly 1 year ago at Seattle Cancer Care Alliance - approximately 2 months after i had begun experiencing serious swelling of my feet, ankles and calves.  My primary care physician was quite stumped with everything, but did send me to see a nephrologist.  She indicated I was experiencing chronic kidney disease or something, but then a blood test triggered something else in her that led her to think I had a high probability of multiple myeloma.  I had a kidney biopsy and a bone biopsy, and they found a high count of plasma cells leading to misfolded proteins.  I immediately contacted Seattle Cancer Care, and one of their leading hemetologists.  He confirmed my case as AL Amyloidosis - and NOT MM.  In fact, they did a second bone biopsy and found the 1st biopsy in error in terms of the % of plasma cells involved. 

During my CyborD treatments, I experienced significant diahhrea problems, reduced BP and dehydration.  My AL Amy primarily affects my kidneys, but also my heart amd nervous system.  I was tested via endoscopy, colonoscopy and so on for GI tract involvement (common with Amy) but was told it was not the case.  I would get to the NAC asap and see the experts there.  The amyloid deposits could indeed be causing all the issues you list.  During my 4 1/2 cycles of CyborD, I had to skip at least 3 or 4 of the weekly infusions because of the side effects, an infection, and finally pneumonia.  I went to the ER at the hospital at least twice, and was hospitalized for pneumonia one time, and then hospitalized again about two weeks after that episode because of dehyf=dration, BP falling, and the doctors just wanted to be cautious. 
« Last Edit: August 06, 2018, 11:22:03 am by Miriam Vered »

Miriam Vered

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Re: Father in law diagnosed with AL amyloidosis...I'm not convinced
« Reply #4 on: August 06, 2018, 12:32:25 pm »
Quote
I will say diagnosing Amyloidosis is not guesswork. There are specific tests.
You're right that there are specific tests for amyloidosis, but because amyloidosis is a very rare disease, many medical centres have limited experience with evaluating test results related to this condition. A recent audit by Janet Gilbertson in the National Amyloidosis Centre histopathology laboratory found that both false positives and false negatives in recent years, amongst biopsy specimens sent to her for review, have run at about 8% in both directions.
It is advisable to be evaluated in a medical centre with amyloidosis experience.
See here for more details on how amyloidosis is diagnosed: http://www.amyloidosis.org.uk/about-amyloidosis/diagnosis/biopsy/