Jul 8 - MMP

MMP in todays's case coud mean multiple medical problems or multiple myeloma patient.  This case demonstrated how to take a rational approach to evaluating a complex patient with multiple simultaneous diseases presenting with a varied symptoms.  It shows that Occam's Razor is sometimes dull.  Never forget Saint's triad, or the famous Hickam's dictum - "A patient can have as many diagnoses as he damn well pleases!"

Some of this patients several diagnoses:

Obstructive Sleep Apnea:  given the growing waistlines of a growing population this is a growing problem.  OSA patients can have the same impairment driving as an intoxicated patient.  Treatment with CPAP improves quality of life and decreases car accidents.  Effect on other outcomes is not as well defined.  It is criticial to differentiate OSA from Central Sleep Apnea as CPAP might not be of much benefit in the latter.  One form of this is a rare genetic disease called Ondine's curse where patietns simply lack the respiratory drive when asleep.  So don't ever cheat on water nymphs.

Multiple myeloma was an almost indicental diagnosis in this patient.  Classic findings of bone pain and hypercalcemia were absent in this case, and the renal failure seemed to be largely due to obstruction in this case.  Nevertheless, SPEP and UPEP revealed a monoclonal spike and the bone marrow biopsuy revealed elevated plasma cells.  Skeletal survey had a few small lytic lesions in the femur and humerus.