Part II Waldenstrom’s Macroglobulinemia (WM) & Lymphoplasmacytic Lymphoma (LPL)


Waldenstrom’s macroglobulinemia is named for the Swedish physician Jan Gosta Waldenström (1906-1996), who in 1944 identified a rare condition in which two patients experienced a thickening of their blood serum, bleeding of the mouth, nose, and blood vessels of the retina, low red blood cell and platelet counts, high erythrocyte sedimentation rates, and lymph node involvement. Bone marrow biopsies showed an excess of lymphoid cells and bone X-rays were normal, excluding a diagnosis of multiple myeloma. Both patients also had a large amount of a single unknown blood protein with an extremely high molecular weight, a “macro” globulin. We now know this globulin as IgM.

Waldenström macroglobulinemia (WM) is an indolent (slow-growing) subtype of non-Hodgkin lymphoma that affects small lymphocytes (white blood cells).
Under the microscope, WM cells have characteristics of both B-lymphocytes and plasma cells, and they are called lymphoplasmacytic cells. For that reason, WM is classified as a type of non-Hodgkin’s lymphoma called lymphoplasmacytic lymphoma (LPL).
As a result of proliferation in the bone marrow and other sites, the lymphoplasmacytic cells of WM may interfere with normal functioning. In the bone marrow where blood cells are produced, the WM cells “crowd out” the normal blood cells and may lead to a reduction in normal blood counts. How this works is the WM cells grow mainly in the bone marrow, where they can crowd out the normal cells (that grow in our bone marrow). This can lead to low levels of red blood cells (called anemia), which can make people feel tired and weak.; WM effects the lymph nodes and other organs (ex. Spleen), the WM cells may lead to enlargement of these structures and other complications.

The over-production of IgM may also cause many of the symptoms associated with the disease. IgM is a large antibody and tends to make the blood thicker than normal, a condition called hyperviscosity. Unlike normal antibodies that fight infection, the IgM produced by WM cells has no useful function. Sometimes the IgM may incorrectly recognize the body’s tissues as “foreign” and attach to them, causing inflammation and injury.

What are the symptoms of this condition?                      

People with Waldenstrom’s macroglobulinemia may experience the following symptoms or signs. Sometimes, people with Waldenstrom’s macroglobulinemia do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • Fatigue
  • Unexplained weight loss
  • Enlarged lymph nodes or spleen
  • Numbness, weakness or other nervous system problems, pain in the hands or feet, sometimes called peripheral neuropathy
  • Abdominal swelling and diarrhea
  • Weakness and shortness of breath
  • Infections
  • Raised pink or flesh-colored lesions on the skin
  • Changes in the color of the fingertips when exposed to cold
  • Changes in vision, which may include blurry vision or “double” vision

May signal a more aggressive cancer:

  • Unexplained weight loss
  • Unexplained fever
  • Heavy sweating, especially at night, which may drench one’s nightclothes or sheets on the bed.
  • Severe and/or extensive skin itchiness

How is it diagnosed?

For starters LAB TESTS:

WM might be suspected if your doctor finds you have low blood cell counts or unusual protein levels on blood tests. If so, your doctor may order a blood test called serum protein electrophoresis to find out what the abnormal proteins are. It is usually only after these tests are done that a biopsy of either the bone marrow or a lymph node is considered.

Simply a CBC Complete blood count, that measures the levels of red blood cells, white blood cells, and platelets. If lymphoma cells occupy too much of the bone marrow, these levels will be low.

Quantitative Immunoglobulins – This test measures the levels of the different antibodies (immunoglobulins) in the blood – IgA, IgE, IgG, and IgM – to see if any are abnormally high or low. In WM the level of IgM is high but the IgG level is often low.


The abnormal immunoglobulin made in WM is an IgM antibody. This antibody is monoclonal, meaning that it is many copies of the exact same antibody. Serum protein electrophoresi  s (SPEP) is a test that measures the total amount of immunoglobulins in the blood and finds any monoclonal immunoglobulin. Another test, such as immunofixation or immunoelectrophoresis, is then used to determine the type of antibody that is abnormal (IgM or some other type).

Finding a monoclonal IgM antibody in the blood is needed to diagnose WM. This abnormal protein in WM is known by many different names, including monoclonal immunoglobulin M, IgM protein, IgM spike, IgM paraprotein, M protein, and M-spike. High levels of other types of monoclonal immunoglobulins, like IgA or IgG, are seen in different disorders (like multiple myeloma and some other lymphomas).

Sometimes pieces of the IgM protein are excreted by the kidneys into the urine. These proteins can be detected with a test called urine protein electrophoresis (or UPEP).


Viscosity is a measure of how thick the blood is. If the IgM level is too high, the blood will become thick (viscous) and can’t flow freely (think about pouring honey compared to pouring water).


This test measures the blood levels of cryoglobulins (proteins that clump together in cool temperatures and can block blood vessels).

Cold agglutinins

Cold agglutinins are antibodies that attack and kill red blood cells, especially at cooler temperatures. These dead cells can then build up and block blood vessels. A blood test can be used to detect these antibodies.

Beta-2 microglobulin (β2M)

This test measures another protein made by the cancer cells in WM. This protein itself doesn’t cause any problems, but it’s a useful indicator of a patient’s prognosis (outlook). High levels of β2M are linked with a worse outlook.


The symptoms of WM and NHL are not distinctive enough for a doctor to know for certain if person has one of them, based on symptoms alone. Most symptoms can also be caused by non-cancerous problems like infections or by other kinds of cancers. Blood tests can help point to the correct diagnosis, but a biopsy (removing samples of affected tissue to look at under a microscope) is the only way to be sure. Several types of biopsies might be used.

Bone marrow aspiration and biopsy

This is the most important type of biopsy for WM, and is needed to confirm the diagnosis. It can be done at the doctor’s office or at the hospital.

The bone marrow aspiration and biopsy are usually done at the same time. The samples are taken from the back of the pelvic (hip) bone, although in some cases they may be taken from the sternum (breast bone) or other bones.

In bone marrow aspiration, you lie on a table (either on your side or on your belly). The doctor cleans the skin over the hip and then numbs the area and the surface of the bone by injecting a local anesthetic. This may briefly sting or burn. A thin, hollow needle is then inserted into the bone, and a syringe is used to suck out a small amount of liquid bone marrow. Even with the anesthetic, most patients still have some brief pain when the marrow is removed.

A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that is pushed down into the bone. This may also cause some brief pain.

Once the biopsy is done, pressure is applied to the site to help stop any bleeding. There will be some soreness in the biopsy area when the numbing medicine wears off. Most patients can go home right after the procedure.

The bone marrow samples are then sent to a lab, where they are tested to see if they have lymphoma cells (see below). For a diagnosis of WM, at least 10% of the cells in the bone marrow must be lymphoplasmacytoid lymphoma cells.

Fine needle aspiration (FNA) biopsy

In an FNA biopsy, the doctor uses a very thin, hollow needle with a syringe to withdraw a small amount of tissue from a tumor or lymph node. This type of biopsy is useful for sampling lymph nodes to see if they are enlarged because of cancer or another cause such as infection. FNA can help diagnose some lymphomas, but WM is usually diagnosed with a bone marrow biopsy instead.

For an FNA on an enlarged node near the surface of the body, the doctor can aim the needle while feeling the node. If the enlarged node (or tumor) is deep inside the body, the needle can be guided while it is seen on a computed tomography (CT) scan or ultrasound (see the descriptions of imaging tests later in this section).

The main advantage of FNA is that it does not require surgery and can often be done in a doctor’s office. The main drawback is that in some cases it might not get enough tissue to make a definite diagnosis of lymphoma. However, advances in lab tests (discussed later in this section) and the growing experience of many doctors with FNA have improved the accuracy of this procedure.

Excisional or incisional biopsy

For these types of biopsies, a surgeon cuts through the skin to remove an entire lymph node or tumor (excisional biopsy) or a just a small part of a large tumor or lymph node (incisional biopsy). These biopsies are rarely needed in people with WM because the diagnosis is usually made with a bone marrow biopsy. They are used more often for other types of lymphoma.

If the area to be biopsied is near the skin surface, this can be done using local anesthesia (numbing medicine). If the area is inside the chest or abdomen, general anesthesia or deep sedation is used (where the patient is asleep). These types of biopsies almost always provide enough tissue to diagnose the exact type of lymphoma.

Fat pad fine needle aspiration

This type of biopsy may be used in some people with WM to check for amyloid. In this procedure, a thin, hollow needle with a syringe attached is inserted into an area of fat (usually under the skin of the abdomen/belly). A small amount of fat is removed and sent to the lab for testing.

Lab tests on biopsy specimens

All biopsy specimens are looked at under a microscope by a pathologist – a doctor with special training in using lab tests to diagnose diseases. In some cases, a hematopathologist, a doctor with further training in diagnosing blood and lymph node diseases, might also look at the biopsy. The doctors look at the size and shape of the cells and how the cells are arranged. Sometimes just looking at the cells doesn’t provide a clear answer, so other lab tests are needed.


In this test, a part of the biopsy sample is treated with special man-made antibodies that attach to cells only if they contain specific molecules. These antibodies cause color changes, which can be seen under a microscope. This test may help tell different types of lymphoma from one another and from other diseases.

Flow cytometry

In this test, cells are treated with special man-made antibodies. Each antibody sticks only to certain types of cells. The cells are then passed in front of a laser beam. If the cells now have antibodies attached to them, the laser will make them give off light, which is measured and analyzed by a computer.

This is the most common test for immunophenotyping – classifying lymphoma cells according to the substances (antigens) on their surfaces. Different types of lymphocytes have different antigens on their surface. These antigens also change as each cell matures.

This test can help show whether a lymph node is swollen because of lymphoma, some other cancer, or a non-cancerous disease. It has become very important in helping doctors determine the exact type of lymphoma so they can select the best treatment.


Doctors use this technique to look at the chromosomes (long strands of DNA) inside lymphoma cells. Cells (usually from the bone marrow) are first grown in the lab. Then the chromosomes are stained and looked at under a microscope. Because it takes time for the cells to start dividing, this test can take weeks.

In some lymphomas, the cells may have too many chromosomes, too few chromosomes, missing parts of chromosomes (called deletions), or other abnormalities. These changes can help identify the type of lymphoma. In WM, deletions are the most common type of chromosome change.

Molecular genetic tests

Molecular tests such as fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR) are not usually needed to diagnose WM, but they are sometimes used to diagnose other types of NHL. These tests look at the cells’ DNA without having to grow the cells in the lab first. The tests can give results in less time than cytogenetics and can be done on cells from different sources (like lymph nodes, blood, and bone marrow). They are generally used to look for specific chromosome or gene changes, not just any change.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive particles to produce pictures of the inside of the body. These tests are not needed to diagnose WM, but one or more of them might be done to help show the extent of the disease in the body.

Chest x-ray

An x-ray might be done to look at the chest for enlarged lymph nodes.

Computed tomography (CT) scan

The CT scan uses x-rays to make detailed cross-sectional images of your body. Unlike a regular x-ray, CT scans can show the detail in soft tissues (such as internal organs). This scan can help show if any lymph nodes or organs in your body are enlarged. CT scans are useful for looking for signs of lymphoma in the chest, abdomen, and pelvis.

Before the test, you may be asked to drink a contrast solution and/or get an intravenous (IV) injection of a contrast dye to better outline abnormal areas in the body. You might need an IV line through which the contrast dye is injected. The injection can cause some flushing (a feeling of warmth, especially in the face). Some people are allergic to the dye and get hives or a flushed feeling or, rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies (especially iodine or shellfish) or have ever had a reaction to any contrast material used for x-rays. Medication can be given to help prevent and treat allergic reactions.

A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle opening. You need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and some people might feel a bit confined by the ring while the pictures are being taken.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a suspicious area. For this procedure, the patient lies on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the area. CT scans are repeated until the needle is in the right place. A biopsy sample is then removed and sent to the lab to be looked at under a microscope.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans make detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. This test is rarely used in WM, but if your doctor is concerned about the brain or spinal cord, MRI is very useful for looking at these areas.

Sometimes a contrast material is injected into a vein to make some structures clearer. This contrast is not the same as the contrast used for CT scans, but allergic reactions can still occur. Again, medicine can be given to prevent and treat allergic reactions.

MRI scans take longer than CT scans – often up to an hour. You may have to lie inside a narrow tube, which is confining and can upset some people. Newer, more open MRI machines might be another option. The machine makes loud buzzing and clicking noises that some people find disturbing. Some places provide headphones or earplugs to help block this noise out.


Ultrasound uses sound waves and their echoes to make pictures of internal organs or masses.

Ultrasound can be used to look at lymph nodes near the surface of the body or to look inside your abdomen for enlarged lymph nodes or organs such as the liver, spleen, and kidneys. (It can’t be used to look at organs or lymph nodes in the chest because the ribs block the sound waves.) It is sometimes used to help guide a biopsy needle into an enlarged lymph node.

For this test, a small, microphone-like instrument called a transducer is placed on the skin (which is first lubricated with a gel). It gives off sound waves and picks up the echoes as they bounce off the organs. A computer then converts the echoes into a black and white image on a screen.

This is an easy test to have, and it uses no radiation. For most ultrasounds, you simply lie on a table, and a technician moves the transducer over the part of your body being looked at.

Positron emission tomography (PET) scan

For a PET scan, a radioactive sugar (known as FDG) is injected into the blood. (The amount of radioactivity used is very low and will pass out of the body in a day or so.) Because cancer cells in the body grow quickly, they absorb large amounts of the sugar. You then lie on a table in the PET scanner for about 30 minutes while a special camera creates a picture of areas of radioactivity. The picture is not detailed like a CT or MRI scan, but it can provide helpful informa- tion about your whole body.

PET scans can help tell if an enlarged lymph node contains lymphoma or not. It can also help spot small areas that might be lymphoma, even if the area looks normal on a CT scan. These tests can be used to tell if a lymphoma is responding to treatment. They can also be used after treatment to help decide whether an enlarged lymph node still contains lymphoma or is merely scar tissue.

Many medical centers now use a machine that combines the PET scan with a CT scan (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.

Questions you might be thinking and would like answered.

Should I get a second opinion? If so when?

It is not unusual for newly diagnosed patients or patients needing treatment to get a second opinion from a recognized
WM expert or from a hematologist/oncologist who
has an interest and experiencewith the diagnosis and treatment of
WM. WM is a rare disease and as a result, many hematologist/oncologists may have little experience dealing with WM patients.  The IWMF newsletter, the Torch, has published an article on this subject, called “Should I Get a Second Opinion,” written by Morie A. Gertz MD, MACP. You can find this article at
How do I find a good doctor for a second opinion?
Generally speaking, large teaching hospitals see more WM patients and have staff physicians more experienced with
WM. The IWMF website maintains a list of
physicians who have an interest and experience in the management and treatment of WM
When should I get treatment?
Patients should be treated when they become symptomatic
or infrequently when blood tests
results pose a health risk.
To some extent, the decision to begin treatment is dependent on a particular patient’s tolerance of symptoms and how
they are affecting their quality of life. The IgM level in and of itself is not an indication for treatment.
Additional treatment indicators can be found at
Also, the IWMF newsletter, the Torch, has published an article on this subject, called “Who Needs Treatment for Waldenstrom’s
Macroglobulinemia and When?” written by Stephen M. Ansell MD, PhD. This article can be found at

What treatments are approved for WM?

Currently,Imbruvica (ibrutinib) is the only approved treatment
specifically for WM in the US, Israel, Canada and many European countries. Most treatments are based on results achieved for similar diseases such as follicular lymphoma, chronic lymphocytic leukemia and multiple myeloma.
There are a number of treatment options available for WM
patients, and information regarding many of them can be accessed
Also, several major cancer centers have developed guidelines for WM treatment.  You can find these at
The treatment landscape continues to evolve, with novel therapies being discovered and tested in clinical trials. For an updated list of trials, go to the US government website,
which contains all US trials and trials in many other countries.
What should I do to protect my immune system?
Wash your hands frequently and avoid touching your hands to your face, especially during cold and flu season. Keep up to date on your flu and pneumonia vaccinations. Eat a healthy, well-balanced diet and get the proper amount of sleep. Avoid close contact with people who are exhibiting obvious symptoms of colds, flu, or other diseases. Be sure to washraw fruits and vegetables before eating and make sure that meat and seafood are cooked to the proper temperature.
These are all common sense things that everyone should do, no matter their state of health but especially if your immune system is down.
Will I still be able to travel?
You should still be able to travel, but possibly with some limitations or additional precautions. Enclosed places like
airplanes, crowded airports, and public transportation are sources of infection, especially during cold and flu season. If your disease is progressing to a point where you require treatment, or if you are currently on treatment that can adversely affect your immune system, you should ask your hematologist/oncologist if any travel
restrictions arenecessary.  Consultation with your physicianis suggested if you are planning to travel to unusual or exotic destinations where specific disease alerts might be in effect or where additional vaccinations are required.
Again-its reinforced, remember to keep up-to-date on your recommended vaccinations (with consulting your MD first to check if there would be any contraindications due to the disease and what degree this illness has put on your immunity system) and exercise. Again, common sense by washing your hands frequently and watching your diet in areas that are prone to food-and water-borne diseases.
How often should I see my hematologist/oncologist?
This depends greatly on your disease status or whether you are receiving treatment. If you have smoldering WM and are stable, you may not need to see your hematologist/oncologist more than a few times a year. If you are newly diagnosed or have progressing disease, your hematologist/oncologist willwant to follow you at more frequent intervals, perhaps once every 2-3 months. If you are currently being treated, your hematologist/oncologist may choose to monitor you even more frequently during this period because some treatments can cause side effects, which need to be recognized early and managed appropriately.
It’s advised that you consult with your hematologist/oncologist, they would know the best.
References for Part I and II Blood Cancer Awareness striveforgoodhealth would like to thank which were:
1. International Waldenstrom’s Macroglobulinemia Foundation
2. Leukemia and Lymphoma Society
3. American Cancer Society
4.Resident Short Review LPL and WM by Nadia Naderi, MD; David T. Yang, M.



Waldenstrom macroglobulinemia (WM, Lymphoplasmacytic lymphoma) is a rare slow-growing cancer that affects your blood cells. WM happens when genetic mutations change certain blood cells. Providers can’t cure this condition, but they do have treatments that ease and sometime eliminate its symptoms.


Part I Waldenstrom’s Macroglobulinemia (WM) also referred as Lymphoplasmacyctic Lymphoma (LPL)

Affects older persons; peak incidence between 6 -7th decades. Tumor cells secrete an M protein (commonly IgM) Mixture of B cells ranging from small lymphocytes to plasmacytic lymphocytes to plasma cells. Involves lymph nodes, bone marrow, and spleen at presentation.

Initially, you will need to learn some basics about Waldenstrom’s macroglobulinemia (WM), sometimes referred to as a lymphoplasmacytic lymphoma (LPL).  Newly diagnosed?  Well understands that this is a very difficult time for you. Not only are you, your family and your friends experiencing the gamut of different emotions that come with a cancer diagnosis, but there is so much new information to learn.

Here’s one place to start in getting information on this diagnosis!

Let’s understand first what is effected in the body and answer the questions that probably you are asking yourself  (pt or family or friends).

What is effected in this disease? 

B Lymphocytes are effected; they are a type of white blood cell that makes antibodies. B lymphocytes are part of the immune system and develop from stem cells in the bone marrow. Same with T cells.  T- and B-cells are highly specialized defender cells – different groups of cells are tailored to different germs. When your body is infected with a particular germ, only the T- and B-cells that recognise it will respond. These selected cells then quickly multiply, creating an army of identical cells to fight the infection. Special types of T- and B-cells ‘remember’ the invader, making you immune to a second attack.

What’s so special about the B cells?

With the help of T-cells, B-cells make special Y-shaped proteins called antibodies. Antibodies stick to antigens on the surface of germs, stopping them in their tracks, creating clumps that alert your body to the presence of intruders. Your body then starts to make toxic substances to fight them. Patrolling defender cells called phagocytes engulf and destroy antibody-covered intruders.

With this disease what happens to the B Cells?

When diagnosed with Waldenstrom’s macroglobulinemia (WM) which is a lymphoma or cancer. It affects a type of white blood cell called a B-lymphocyte or B-cell, which normally matures into a plasma cell whose job is to manufacture immunoglobulins (antibodies) to help the body fight infection. In WM, there is a malignant change to the B-cell in the late stages of maturing and it continues to proliferate as a clone of identical cells, primarily in the bone marrow, but also in the lymph nodes and other tissues and organs.  It is known as lymphoplasmacytic lymphoma (LPL) and must be associated with the production of an antibody protein or immunoglobulin known as IgM in order for WM to be diagnosed.

What’s the difference of WM versus LPL?  Are they the same disease? 

Sometimes WM and LPL (lymphoplasmacytic lymphoma) are used interchangeably although WM is really an LPL. However, WM comprises about 90 – 95% of all LPL patients.

The cancer cells of LPL have the appearance of both B-lymphocytes and plasma cells, hence the term lymphoplasmacytic.  LPL cells can secrete immunoglobulin antibodies (IgM, IgA, IgG, IgE or IgD), but those who secrete IgM are called WM.  Currently, the clinical term in cases of LPL with circulating monoclonal IgM is WM.  LPL is the term that describes the appearance of the bone marrow or lymph node used by pathologists.
My doctor said WM was a rare disease. How rare is it?
What does that mean for me?
WM is a rare cancer seen only in approximately three to five per million people per year with about 1500 new cases diagnosed in the US each year. This disorder is age-dependent and is quite rare under the age of 40 (less than 1 percent
of patients).  Typically, patients present between the ages of 60 and 70. For reasons that are unclear, WM is almost twice as common in men as in women and is more common in Caucasians than other ethnic groups. There is a familial predisposition to WM, with most studies suggesting that approximately 20-25% of patients have a first degree relative with WM or other B cell disorders. WM is a rare disease and as such it does not command much support for research dollars because there are few financial incentives for pharmaceutical companies; as much as I hate to document this.
Is there a cure for WM?
No, although quality of life and survival for WM patients are continuing to improve because of better treatments.
How long do I have left to live?
Although WM is incurable, in most cases it can be effectively treated to provide a good quality of life for many years.
In most patients, WM is a fairly indolent, chronic disease.

The median survival has varied in studies, from 5 years to 10

years. Median survival suggests that half of all patients survive 5 to 10 years. Another way to answer this question is to look at the 5
-year survival rate. The 5-year survival rate tells you what percentage of people live at least 5 years after the
cancer is found. Percent is how many out of 100. The 5
-year survival rate for people with Waldenstrom’s
macroglobulinemia is about 75%.
However, it is important to note that survival rates vary based on a number of individual factors including the patient’s age and whether the patient has other medical problems.
It is also important to remember that statistics on the survival rates for people with WM are an estimate.
As newer agents and treatments that
are more effective and less toxic become available, the life expectancy will continue to increase. The main causes of
death because of WM include disease progression, transformation to high-grade lymphoma, or complications of
therapy. However, because of the advanced age of patients with WM, many will die of unrelated causes.





“The funny bone is actually a nerve that runs along the outside of your elbow. It is called the ulnar nerve. When it bangs or rubs up against your humerus, one of the bones in your upper arms, it creates the strange burning or tingling sensation from which it gets its name.
Why does this feel different than other bumps and bruises? Most of the time when you get an injury, the nerves near the damaged area send pain signals to your brain letting you know that something is wrong. Your body tries to get you to stop the painful activity or to remove yourself from a dangerous situation. However, when a nerve is stimulated directly, the actual nerve is irritated, causing a different type of pain.
Nerve pain feels more like electricity, burning, stinging, or tingling.”

Why would anyone call this bone the funny bone; especially if it was fractured?

Updated the article on 4/25/22 by Elizabeth Lynch RN

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest unprotected nerve in the human body (meaning unprotected by muscle or bone), so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar side of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

This nerve can cause an electric shock-like sensation by striking the medial epicondyle of the humerus from posteriorly, or inferiorly with the elbow flexed. The ulnar nerve is trapped between the bone and the overlying skin at this point. This is commonly referred to as bumping one’s “funny bone“. This name is thought to be a pun, based on the sound resemblance between the name of the bone of the upper arm, the “humerus” and the word “humorous”.  Alternatively, according to the Oxford English Dictionary it may refer to “the peculiar sensation experienced when it is struck”.

A distal humerus fracture is a break in the lower end of the upper arm bone (humerus), one of the three bones that come together to form the elbow joint. A fracture in this area can be very painful and make elbow motion difficult or impossible.

Most distal humerus fractures are caused by some type of high-energy event—such as receiving a direct blow to the elbow during a car collision. In an older person who has weaker bones, however, even a minor fall may be enough to cause a fracture.

Your elbow is a joint made up of three bones:

  • The humerus (upper arm bone)
  • The radius (forearm bone on the thumb side)
  • The ulna (forearm bone on the pinky side)

The elbow joint bends and straightens like a hinge. It is also important for rotation of the forearm; that is, the ability to turn your hand palm up (like accepting change from a cashier) or palm down (like typing or playing the piano).

A distal humerus fracture occurs when there is a break anywhere within the distal region (lower end) of the humerus. The bone can crack just slightly or break into many pieces (comminuted fracture). The broken pieces of bone may line up straight or may be far out of place (displaced fracture).

In some cases, the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the bone. This is called an open fracture. Open fractures are particularly serious because, once the skin is broken, infection in both the wound and the bone is more likely to occur. Immediate treatment is required to prevent infection.

Distal humerus fractures are uncommon; they account for just about 2 percent of all adult fractures. They can occur on their own, with no other injuries, but can also be a part of a more complex elbow injury.


Obviously falls, but different ways.  Falls can be major or minor falls.

One is a direct fall on the elbow, the arm extended out and hits against something even when falling and trying to break the fall.

Also a direct blow to the area like from a MVA with the elbow hitting the dash board or even hit by a baseball bat or an item like it whether accidentally or done intentionally.

Falling on an outstretched arm with the elbow held tightly to brace against the fall. In this situation, the triceps muscle, which attaches to the olecranon, can pull a piece of the bone off of the ulna. Injuries to the ligaments around the elbow may occur with this type of injury, as well.

Fracture of the elbow is due to:

  • Falling directly on the elbow
  • Receiving a direct blow to the elbow from something hard, like a baseball bat, or a dashboard or car door during a vehicle collision.
  • Falling on an outstretched arm with the elbow held tightly to brace against the fall. In this situation, the triceps muscle, which attaches to the olecranon, can pull a piece of the bone off of the ulna. Injuries to the ligaments around the elbow may occur with this type of injury, as well.

The signs and symptoms of a fracture usually include:

Signs and Symptoms for a any distal humerus fracture or any fracture may be very painful and can prevent you from moving your elbow or area fractured.

  • Swelling due to blood running to the area.  RX:  This is the logic of putting ice to the area for 24-48 hrs intermittently to cause vasoconstriction of blood to the area to decrease the swelling; helping this would be raise the fracture limb above the heart causing blood by gravity back to the heart which furthers decrease the swelling.
  • Intense pain and not able to move the elbow at all.
  • Bruising caused by old blood in the area (think of just twisting your wrist or elbow or ankle and you know you see bruising well expect it with fractures).
  • Tenderness to the touch due to the bone broken.
  • Stiffness due to the swelling and injury being painful.
  • A feeling of instability in the joint, as if your elbow is going to “pop out” due to simply the bone is broken.  Just like a beam broken holding a part of a house up and due to the brake that area of the home starts falling.

Prognosis for most arm fractures is very good if treated early.

Complications may include:

  • Uneven growth. Because a child’s arm bones are still growing, a fracture in a growth plate — the area where growth occurs near each end of a long bone — can interfere with that bone’s normal growth.
  • Osteoarthritis. Fractures that extend into a joint can cause arthritis there years later.
  • Stiffness. The immobilization required to heal a fracture in the upper arm bone can sometimes result in painfully limited range of motion of the elbow or shoulder.
  • Bone infection. If any part of your broken bone protrudes through your skin, it may be exposed to germs that can cause infection. Prompt treatment of this type of fracture is critical.
  • Nerve or blood vessel injury. If the upper arm bone (humerus) fractures into two or more pieces, the jagged ends may injure nearby nerves and blood vessels. Seek immediate medical attention if you notice any numbness or circulation problems.
  • Compartment syndrome. Excessive swelling of the injured arm can cut off the blood supply to part of the arm, causing pain and numbness. Typically occurring 24 to 48 hours after the injury, compartment syndrome is a medical emergency that requires surgery. It can also be caused by a too-tight cast.


Treatment for fractures are simply splints to casts and in complex fractures and penetrating fractures (bone going through the skin) would be surgery.

Treatment for a distal humerus fracture usually involves surgery to restore the normal anatomy and motion of the elbow.





“”Smoking and use of any tobacco product including e-cigarettes, cigars, smokeless tobacco or other nicotine containing product cause or worsen numerous diseases and conditions. Smoking is the number one cause of preventable disease and death worldwide. Smoking-related illness in the U.S. costs more than $600 billion a year, including over $241 billion in direct medical care for adults and $184 billion in lost productivity.”

American Lung Association (


Part 2 Smoking? Why don’t you just drink poison. What is does to our body!

Know when the lungs get effected in time the heart gets effected. One Affects the other in time. The heart can’t live without the lungs and viCE versa.

Now knowing just this you’ll understand why smoking alone can cause the following conditions, Through the Centers for Disease Control and Prevention. They state the following:

Smoking and Increased Health Risks

Compared with nonsmokers, smoking is estimated to increase the risk of—

  • Coronary heart disease by 2 to 4 times, (causing atherosclerosis=thickening of the vessels or due to arteriosclerosis=hardening of the arteries and remember smoking causes vasoconstriction of the vessels = increase pressure in the vessels = high B/P.
  • Stroke by 2 to 4 times(Due to causingthe above problems listed under coronary heart disease.)
  • Men developing lung cancer by 23 times,
  • Women developing lung cancer by 13 times(cancers due to constant irritation of the tissues) , and
  • Dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times.( Explained at the top)

Smoking and Cardiovascular Disease

  • Smoking causes coronary heart disease, the leading cause of death in the United States.
  • Cigarette smoking causes reduced circulation by narrowing the blood vessels (arteries) and puts smokers at risk of developing peripheral vascular disease (i.e., obstruction of the large arteries in the arms and legs that can cause a range of problems from pain to tissue loss or gangrene) This pain to gangrene to amputation is due to lack of oxygenated blood getting to the tissue caused by the vasoconstriction the cigarette smoking caused.
  • Smoking causes abdominal aortic aneurysm (i.e., a swelling or weakening of the main artery of the body—the aorta—where it runs through the abdomen). An aneurysm with constant vasoconstriction (increases pressure) puts the aneurysm at risk for rupture because the aneurysm area isn’t as strong as the other vessels=Rupture of the aortic aneurysm

Smoking and Respiratory Disease

  • Smoking causes lung cancer.
  • Smoking causes lung diseases (e.g., emphysema, bronchitis, chronic airway obstruction) by damaging the airways and alveoli (i.e., small air sacs) of the lungs.

Smoking and Cancer

Smoking causes the following cancers: (in alphabetical order)

  • Acute myeloid leukemia
  • Bladder cancer
  • Cancer of the cervix
  • Cancer of the esophagus
  • Kidney cancer
  • Cancer of the larynx (voice box)
  • Lung cancer
  • Cancer of the oral cavity (mouth)
  • Pancreatic cancer
  • Cancer of the pharynx (throat)
  • Stomach cancer

Smoking and Other Health Effects:

Smoking has many adverse reproductive and early childhood effects, including increased risk for—

  • Infertility
  • Preterm delivery
  • Stillbirth
  • Low birth weight
  • Sudden infant death syndrome (SIDS).1,2,9Smoking is associated with the following adverse health effects:1
  • Postmenopausal women who smoke have lower bone density than women who never smoked.
  • Women who smoke have an increased risk for hip fracture than women who never smoked.


  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004 [accessed 2013 June 28].
  2. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2013 June 28].
  3. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;57(45):1226–8 [accessed 2013 June 28].
  4. Centers for Disease Control and Prevention. QuickStats: Number of Deaths from 10 Leading Causes–National Vital Statistics System, United States, 2010. Morbidity and Mortality Weekly Report 2013:62(08);155. [accessed 2013 June 28].
  5. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States. JAMA: Journal of the American Medical Association 2004;291(10):1238–45 [cited 2013 June 28].
  6. U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989 [accessed 2013 June 28].
  7. Ockene IS, Miller NH. Cigarette Smoking, Cardiovascular Disease, and Stroke: A Statement for Healthcare Professionals from the American Heart Association. Circulation 1997;96(9):3243–7 [accessed 2013 June 28].
  8. Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence.   [PDF–707 KB] Washington: National Academy of Sciences, Institute of Medicine, 2009 [accessed 2013 June 28].
  9. U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 [accessed 2013 June 28].

GET IT NOw? Please say yes. Smoking rots for your body not just in the lungs but everywhere. How do you make a complete turn-around? Look at your health in regards to what your goal is out of life. Do you want to live longer and most importantly HEALTHIER? When healthier in mind and body you are able to do more with your life in activities of daily living and more than that, so QUIT. If you want to sit most of your life with continuing to smoke but if not you must stop smoking now unless you have a unusual discipline in your way of living that allows you to have a about 6 cigarettes to 1 pack a YEAR, not daily. It is recommended you stop completely but if it actually has to be a part of your life than do it in moderation or less.  If you’re able to do that your definitely not addicted to the bad habit physically, if anything addicted to it mentally. That would still make your life healthier as to smoking frequently every day. Know you take the risk of increasing your quantity in time so I recommend Quit.

Various lifestyle factors have been associated with increasing the risk of stroke. These include lack of exercise, alcohol, diet, obesity, smoking, drug use, and stress. Guidelines endorsed by the Centers for Disease Control and Prevention and the National Institutes of Health recommend that Americans should exercise for at least 30 minutes of moderately intense physical activity on most, and preferably all, days of the week. Recent epidemiologic studies have shown a U-shaped curve for alcohol consumption and coronary heart disease mortality, with low-to-moderate alcohol consumption associated with lower overall mortality. High daily dietary intake of fat is associated with obesity and may act as an independent risk factor or may affect other stroke risk factors such as hypertension, diabetes, hyperlipidemia, and cardiac disease. Homocysteine is another important dietary component associated with stroke risk, while other dietary stroke risk factors are thought to be mediated through the daily intake of several vitamins and antioxidants. Smoking, especially current smoking, is a crucial and extremely modifiable independent determinant of stroke. Despite the obstacles to the modification of lifestyle factors, health professionals should be encouraged to continue to identify such factors and help improve our ability to prevent stroke, decrease cancers caused by smoking, decrease coronary artery disease, and obesity.   Learn healthy habits or healthier habits, broaden your knowledge on the 4 food groups in what is lean or leaner or leanest with each group, increase your activity 30 minutes a day and learn what a healthy diet actually is through Dr. Wayne Scott Anderson’s book “Dr. A’s habits of health” and even if you need to lose weight we can show you the way to do it healthy. It’s not a diet for 3 months or even 6 to a year but it is learning how to get to your body mass index in the ideal weight range for your height and you decide how low you want to go. We can show you through the book and those having more difficulty can buy our foods for 6 months or even a year or in my case I started almost a year ago and I use both their healthy foods as well as healthy foods from the store. You decide the choices, no one else. If you are interested go to my website and peek at what we offer for no prescription, no charge, no donation and no hacking. If you like what you see join me and so many others trying to get America healthier and in time decrease our population in diseases or illnesses primarily impacted by health habits, diet, and weight. Wouldn’t you and the future want to get better in mind and body to impact our health care system that includes our insurance and most importantly lives of citizens in the USA in how they live (which would be more active). It is your choice and I hope you decide to come aboard to my website and I know if I could do it so can too. It just takes discipline and the drive to want to stay healthy or get in a better state of heath. Hope I have helped someone out there in broadening your knowledge regarding how to keep or reach a healthier life.


Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths. More women die from lung cancer each year than from breast cancer. Smoking causes about 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD). Cigarette smoking increases risk for death from all causes in men and women.”

Center for Disease Control and Prevention CDC

Simple facts with consequences you face if you decide to start or continue smoking.

Through an accurate reference the Centers for Disease Control and Prevention, who wants to save lives and protect people, support the following:

Smoking is estimated to increase the risk—

    • For coronary heart disease by 2 to 4 times1,6
    • For stroke by 2 to 4 times1
    • Of men developing lung cancer by 25 times1
    • Of women developing lung cancer by 25.7 times1

Smoking causes diminished overall heath, such as self-reported poor health, increased absenteeism from work, and increased health care utilization and cost.

Smokers are at greater risk for diseases that affect the engine of the body=The heart and its branches=The circulatory system (putting a smoker at high risk for cardiovascular disease).

  • Smoking causes stroke and coronary heart disease—the leading causes of death in the United States.
  • Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.
  • Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form.
  • A heart attack occurs when a clot blocks the blood flow to your heart. When this happens, your heart cannot get enough oxygen causing starvation of food, being oxygen to the heart tissue. This damages the heart muscle, and part of the heart muscle can die, which is what exactly happens with a heart attack where angina (lack of 02 is reversible).
  • A stroke occurs when a clot blocks the blood flow to part of your brain or when a blood vessel in or around your brain bursts causing again starvation of food, being 02, just in a different tissue part. Get it oxygen is the food to all our tissues of the body
  • Blockages caused by smoking can also reduce blood flow to your skin and legs (For example Peripheral Vascular Disease= PVD). Ever see the commercial with a person telling you to stop smoking with fingers surgically removed or limbs, PVD is what occurred to that individual and the person didn’t stop smoking. Due to this behavior what happened the vessels of the individual’s limbs became so narrowed that it cut off oxygenated blood supply to those tissue parts causing ischemia-lack of oxygen, which led to necrosis of the tissue (death) and the part had to be surgi-cally removed. Now that individual can’t walk or grasp things with those limbs that were operated on. Is smoking worth this consequence? I don’t think so, what about you? Just think about it if you still smoke.Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs. What actually happens to the lung tissue is the pin point openings (alveoli) keeps expanding to a wider opening. The alveoli is responsible of oxygen and carbon dioxide exchange when we inhale and exhale but with the alveoli stretched the exchange of the gases gets poor.
  • Smoking effects the transmission of the body=The Lungs
  • Lung diseases caused by smoking include COPD, which includes emphysema (especially) and chronic bronchitis.
  • Cigarette smoking causes most cases of lung cancer.
  • If you have asthma, tobacco smoke can trigger an attack or make an attack worse.1,2
  • Smokers are 12 to 13 times more likely to die from COPD than nonsmokers.

Smoking can cause cancer in almost every area of the body. If nobody smoked, one of every three cancer deaths in the United States would not happen. Smoking increases risk of dying from cancer and other diseases in cancer patients and survivors.

For those who quit smoking what risks you reduce:

  • Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.2
  • Within 2 to 5 years after quitting smoking, your risk for stroke could fall to about the same as a nonsmoker’s.2
  • If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.2
  • Ten years after you quit smoking, your risk for lung cancer drops by half.

Again, if you smoke you may want to consider stopping; give it a thought.



“Bones support your body and allow you to move. They protect your brain, heart, and other organs from injury.

Bone is a living, growing tissue. It is made mostly of two materials: collagen (KOL-uh-juhn), a protein that provides a soft framework, and calcium (KAL-see-uhm), a mineral that adds strength and hardness. This combination makes bone strong and flexible enough to hold up under stress.

Bone releases calcium and other minerals into the body when you need them for other uses.

Think of your bones as a “bank” where you “deposit” and “withdraw” bone tissue. During your childhood and teenage years, new bone is added (or deposited) to the skeleton faster than old bone is removed (or withdrawn). As a result, your bones become larger, heavier, and denser.”

National Institute of Arthritis and Musculosketetal and Skin Disease (