Mr. Porter is a 76 year old retired steelworker who has had a long history of chronic back pain. He visits his family physician because over the last two months the pain has become more severe and now wakes him from sleep. He cannot recall any injury. Plain views of his thoracic and lumbar spine demonstrate a number of lytic lesions. A chest X-ray demonstrates that the ribs are similarly mottled. Blood work and a urine test are done. A complete blood count demonstrates mild anemia. His total protein is increased and protein electrophoresis demonstrates a monoclonal peak. Urine is positive for Bence Jones protein. His creatinine is at the high end of normal. A diagnosis of multiple myeloma is made and he is referred to a haematologist. A bone marrow biopsy demonstrates plasma cells.