Showing posts with label lupus. Show all posts
Showing posts with label lupus. Show all posts

Tuesday, May 28, 2013

Part I: Um, So It Might Be Lupus...

Wow.  This month has been full of medical drama with skin biopsies, ignorant nurses, and arrogant dermatologists with a couple of amazingly awesome doctors sprinkled in.

Read my entry Not Mitochondrial Disease, Probably Not Lupus for background.

I received the copy of my ANA results, and they were indeed the same as my previous results (1:160).  Though the nurse told me over the phone that my results were negative, 1:160 is a POSITIVE result and the report actually says "positive" by my number.  I know nurses are human and make mistakes, but telling someone test results are negative when they are actually positive is a major error!

In the meantime my sun rash came back, so I went back to the dermatologist's office assuming I was going to get a biopsy and saw a different doctor in the same practice.  That doctor took one glance at my rash and told me I had keratosis pilaris, which is pretty much like acne.  He didn't look closely at the rash or ask me any questions about my symptoms.  I told him the previous two doctors had mentioned lupus or PMLE as possibilities and asked him about getting a biopsy.  He said a biopsy wasn't necessary because I couldn't have lupus since my ANA was negative.  I told him I had a 1:160.  He looked surprised and said "oh, that's positive."  He then looked at the nurse (the same one who called me before) and said to her: "I thought you said it was negative."

The doctor ended up doing a scrape biopsy on the inside of my right arm, where there was no rash.  I told him that I was confused because it was my understanding that I was supposed to get a biopsy of the rash area.  He said there was no point in doing a biopsy where the rash was because it would only show keratosis pilaris.  Really?  He was that sure of his diagnosis.  He would not answer my questions about lupus or PMLE and dismissed my concerns about doing a biopsy on an area of active rash.

After he left, I tried to get clarification with the nurse, but she was extremely rude and mean to me (probably because she was mad she got in trouble for giving the doctor incorrect info about my ANA results).  When I said I was just trying to get answers to my health questions and figure out why I wasn't a normal thirtysomething, she responded in a terrible tone saying that she's not normal either and everyone has problems.  Ouch.

Yup.  With one comment she completely dismissed the last 15 years of my life -- the years I couldn't work, the ER visits and  hospitalizations, the times on disability, the times I had to be pushed around in wheelchairs because I was too weak to walk, the anaphylaxis, the hair loss, the isolation, the tears.  I realize the nurse must have been having a bad day, but she still managed to make me feel completely crushed and invalidated.  I cried a lot that evening.

The next day or so I decided that I needed to go back to the dermatologist -- the first one who actually suggested the possibility of lupus -- for a biopsy of the active rash area because I didn't know how long my sun rash would stay around.  I got an appointment with her that afternoon.  I told her about my experience with the other doctor in her practice, and she defended him.  Even though she did not think my rash was keratosis pilaris, she defended him and said dermatologists really hate it when patients question their diagnoses.  I was still feeling pretty emotional about my previous encounter, so I immediately burst into tears.    

The doctor backtracked a little and said she understood how frustrating it can be for patients trying to get answers.  She also said it would be a good idea to have a biopsy of a rashy area.

I need to go to bed now.  I'll write more another day.  I still have to talk about my recent neurologist and rheumatologist appointments, as well as the skin biopsy results, of course.

By the way, I do NOT have keratosis pilaris.

Stay tuned...


Wednesday, May 1, 2013

Not Mitochondrial Disease. Probably Not Lupus, but...

I'm up later than usual because I was home sick and slept nearly all day.  

Yesterday I received the last of my nuclear DNA test results.  After both my mitochondrial DNA and nuclear DNA test results showed nothing of clinical significance, it's pretty safe to say I don't have mitochondrial disease.  They did find a few interesting abnormalities, but nothing that warrants a diagnosis.  I'll try to remember to give specific explanations and results from the tests in a future post.  

I received my ANA results by telephone today.  If you'll recall, I went to a dermatologist for rashes I'd been getting lately, and she mentioned the possibility of lupus (see Looking for Lupus AGAIN?! and No Skin Biopsy For Lupus. Blood Test Instead.).  

The nurse who called me said that my ANA level was the "same" as my last ANA level.  She said my ANA was 1.6.  I was a little confused.  My ANA result in 2011 was 1:160.  Other than having ones and sixes in both numbers, I didn't really understand how those two numbers were the same.  

Just to make sure I was hearing things correctly, I repeated the numbers back to the nurse.  "So a 1.6 is the same as a 1:160 result?"  She said yes.  She continued and said a 1.6 is a "negative" result and a positive result would be in the "tens of thousands."  I tried to get clarification about the numbers, but she wasn't able to answer my questions very well, so I gave up.

It's my understanding that a 1:160 ANA is considered a positive result (albeit not that high).  If a 1:160 is positive and a 1.6 is "negative" (according to the nurse), how can these numbers be "the same"?  

The nurse assured me I didn't have lupus because my result wasn't "high enough."  Something being "negative" and something being "not high enough" mean two different things to me.  I wondered, how could she know that I don't have lupus if the doctor never asked me about any of my symptoms other than the rashes?  I can only assume she was repeating what the doctor told her to tell me.  

The nurse then said I should get monitor my rashes and be sure to come in as soon as they flare up again.  She also said the doctor thought I should get my ANA retested in six months.  Okay, if my results were "negative" and they don't think I have lupus, why would I need to get retested in six months?  

After I hung up I tried to find something online that has a comparison chart of the two values.  No luck!  however, I did find a couple of message boards with people mentioning having a 1.6 and getting treated for lupus.  Very confusing...

I've decided to go see the same rheumatologist I saw two years ago the last time someone else suspected lupus.  I have an appointment with him for about four weeks from now, so I am again in a wait-and-see mode.  I have great respect for this rheumatologist because he's the one who figured out I have fairly significant muscle weakness and suggested I see a neurologist.  

I'm also glad I'm going to see him because I've been having pain and stiffness in my finger joints on and off for the last few months, and I wanted to ask him about that.  

I also plan to make an appointment with my neurologist (I will probably call tomorrow).  Though my energy levels have improved dramatically thanks to the high levels of CoQ10 I've been taking, my muscle weakness seems to be worse lately.  I'm not sure if it's because I've been more active (too active?), or if it's something more problematic.  

Anyway, that's the update.  Good night! 

Thursday, April 25, 2013

No Skin Biopsy for Lupus. Blood Test Instead.

I didn't have the skin biopsy after all.

When I got to the doctor, she did not think the rash was "active" enough to warrant a biopsy, so she ordered an ANA blood test instead.  (For the record, my rash was not active at all when I first went to the dermatologist, which is why I didn't have the biopsy then.)  To her credit, she doesn't believe in doing a biopsy if the information obtained might not be helpful.

It turns out that the type of biopsy she wanted to do is called a "punch biopsy," which involves cutting out a small chunk of skin about the size of a pencil eraser (imagine a paper hole punch).  After that lovely image, I'm actually ok not having the procedure just yet.  I still have unpleasant memories (and a nasty scar) from my muscle biopsy. 

I still may have a punch biopsy, but it will depend on my ANA blood test results and if/when the rash comes back more strongly.  The doctor said I could just call the office during normal work hours as soon as my rash reappears and I'll get scheduled for that same day or first thing the next day (assuming it's not a weekend). 

The doctor also thinks it's entirely possible that my rashes are due to Polymorphous Light Eruption (PMLE), which some consider a kind of allergy to the sun; others call call it "sun poisoning."  (Here's some info from the Mayo Clinic.  If you're a science nerd, read the medical explanation on Medscape.)

If my ANA comes back negative or really low, I probably have PMLE.  If it's positive, it's probably lupus.  Either way, I have something.  Knowing my weird body, I'm probably allergic to the sun.  Fun times.

At this point, there's nothing for me to do except wait for my ANA results.  I should be used to waiting for medical test results by now, but I'm not.

I hate waiting!  

To be honest, I wouldn't mind a lupus diagnosis because it would give me something definitive that most doctors would both believe and understand.  I look so young and fit on the outside that I have a hard time getting doctors (and others) to understand how miserable it can be to live in my body.

I have so many random symptoms which are not typically associated with ME/CFS that I'm no longer convinced I have it.  On the other hand, I'm not convinced that I don't have it (can I use a double negative?).

I'm not scared of lupus.

A lupus diagnosis really wouldn't change much for me; it would neither cure me nor make me worse.  I would still live the way I'm living and feel the way I'm feeling.  The fundamental shift would be in the way others perceive me. 

More would believe me without question.

Tuesday, April 23, 2013

Looking for Lupus AGAIN?!

I know I still have to write an update on my nuclear DNA and CoQ10 tests, but something more pressing has come up that I thought I should blog about...

I'm getting tested for lupus again.

I've been tested for lupus at least three times before.  There's not actually a specific test for lupus, but I've had ANA and other related tests done.  The first two ANA tests (in 2005 and 2009) were completely negative.  The most recent one in late 2011 was mildly elevated (1:160) but not high enough with the right constellation of symptoms to warrant any kind of diagnosis.  You can read about my previous lupus excitement here (Lupus or Not? and It's Not Lupus, But...).

Unfortunately, this time around does not involve a simple blood test.  I am scheduled to get a skin biopsy tomorrow.  Ugh.  The reason for the biopsy is because for the past couple of years I've been getting random rashes.

At first, I thought the rashes were from something I was eating, then I thought they might be from my laundry detergent.  After paying closer attention to what I ate and switching laundry detergents, the rashes still seemed to come and go randomly.  Eventually, I realized that the rashes were showing up in the same places as my first photoallergic rash from 2011 (see September Already? July was Itchy.)

I complained to my allergist about my worsening rashes, and she referred me to a dermatologist because the rashes were not like my normal eczema.  I went to the dermatologist last month, thinking she'd give me a different topical medication or suggest ways to figure out what I'm allergic to.

To my surprise, the dermatologist asked if I had ever been tested for lupus.  I told her about my past ANA results, and she was intrigued that my last ANA came back a bit elevated.

Long story short, I'm getting a skin biopsy tomorrow.  In addition to looking for signs of lupus, they're going to look for another condition that has to do with being allergic to the sun (yes, you read that correctly).  Whee...

I'm nervous about the skin biopsy because I don't know how much they are going to take, if it will hurt, or if I'll need stitches.  My last biopsy was a muscle biopsy, and it was truly awful.  I realize skin is not as deep as muscle (I did learn something in 9th grade biology), but I really dislike not knowing what to expect.

Anyway, I'll keep you updated!  Must sleep now...

Sunday, January 29, 2012

It's not Lupus, but...

Has it really been two months since my last post?  I really have no idea how time can be passing so quickly...sheesh!  Well, Merry Christmas, Happy Hanukkah, and Happy New Year!

I went back to the dermatologist to review my results with her, and she said I do not have lupus.  All my follow up tests had come back normal.  She did not have any suggestions as to why my other tests were abnormal or why I was losing my hair.  She suggested I use maximum strength Rogaine for men and come back in a few months. 

Uh, no thanks.  I will not be going back to a dermatologist who doesn't even examine my hair, skin, or nails. 

After my last experience with a specialist (i.e., when I was MISdiagnosed with epilepsy), I vowed to always seek a second opinion when it comes to more complex diseases and conditions.  I made an appointment with a rheumatologist recommend by my local Lupus Foundation chapter. 

The good doctor took a very thorough medical history and did a full exam.  He confirmed that I did not have lupus, but he noticed that I had unusual muscle weakness.  He asked if I had ever been to a neurologist for the weakness.  I told him no because I had always assumed it was Chronic Fatigue Syndrome.  He suggested the possibility of a metabolic myopathy. 

Metabolic what?

Sigh.  I often dream of what life would be like if I were normal and healthy and not scheduling medical appointments with specialist after specialist.  Wouldn't that be nice? 

Deciding to follow up on this new possibility, I ended up making an appointment with a neurologist who specializes in neuromuscular diseases (I didn't want to take any chances going to a general neurologist again).  I'll write more about my initial appointment in my next post. 

Tuesday, November 22, 2011

Lupus or Not?

I had my appointment with the "specialist" today.  I put quotation marks around "specialist" because I'm using that term loosely. It turns out that she was another dermatologist in the same practice who sometimes sees patients with cutaneous lupus, which I'm pretty sure I don't have because I do not have the typical scaly rashes associated with the disease.  I was expecting someone who was actually familiar with autoimmune diseases in general, including the systemic version of lupus. 

Here's why I think the doctor did not do a good job. My blood pressure and temperature were never taken.  I was wearing jeans and a sweater, yet she never asked to examine my skin. She did not examine my nails (which, by the way, are soft and have some pitting). She never looked at my scalp or examined my hair (which I'm losing), which was my main complaint to begin with. She never asked about my energy level (terrible fatigue), lymph nodes (they're sore), any rashes (eczema and past photoallergic reaction), etc., etc., etc.

What she did do was tell me she didn't think I had lupus or any sort of autoimmune disease....based on what? I'm not sure.  She simply said I didn't fit the criteria. Considering she didn't ask me many questions or do any examination at all, I don't really know what "criteria" she was referring to.

I can only guess that she was referring to the lupus diagnostic criteria developed by the American College of Rheumatology; however, she never asked me about most of those symptoms, and I'm pretty darn sure it's impossible to know how someone's urine is doing without a test.

Don't get me wrong. I don't actually want lupus.  Heck, I don't want CFS/ME or anything else for that matter.  I just want to know what's wrong with me, and I would like a doctor to be thorough. If I'm seeing a dermatologist, I would expect that person to examine my skin, hair, and nails. She did exactly none of the above.

What she did do right was order some appropriate follow-up tests (in no particular order):
  • Anti RNP: often found with many autoimmune diseases
  • Anti Ro/SS-A and Anti La/SS-B: often found in people with Sjogren's syndrome or cutaneous lupus
  • Anti Scl-70: often found in people with scleroderma
  • Rheumatoid factor: high levels often found in people with rheumatoid arthritis
  • Anti double-stranded DNA: found in 30 to 50% of people with lupus
  • C3 and C4 Complement Proteins: low levels may indicate active lupus (or other infections)
  • C-reactive protein: high levels indicate inflammation, people with active lupus or other types of inflammatory diseases or other infections often have high levels
  • Erythrocyte sedimentation rate (a.k.a. sed rate): people with active lupus (or other infections) often have high levels
  • Thyroid peroxidase antibodies: presence indicates autoimmune thyroid disease
  • Hepatitis panel and HIV: I'm not entirely sure why she ordered these because I don't have symptoms or risk factors, but whatever...

What she didn't order, but I think she should have are: urine test (presence of protein indicates problems with the kidneys) and Anti-Sm antibody (found almost exclusively in people with lupus; 20 to 40% of people with lupus have it), parasite tests (some of my most recent blood test results could indicate allergic response, autoimmune disease, other illness, or parasites).

What she didn't order, but could have because they wouldn't be a bad idea: anti-histone (sometimes found in people with systemic lupus, but often found in drug-induced lupus), anti-phospholipids (found in approximately 30% of people with lupus).

In case you were wondering where I was getting my data and suggested tests, here are the links to the Lupus Foundation of America and the Johns Hopkins Lupus Center.

Speaking of blood test results, the following things were normal (or at least normal for me) for the tests the original dermatologist did about a week and a half ago: RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, lymphocytes, monocytes, platelet count, ferritin, glucose, free T4, TSH, RPR (syphilis), DHEA. Here's a link to understand what some of the acronyms stand for.

The following results were abnormal:

Obviously, something is going on in my body.  I am anxious to get the results of the tests they drew blood for today, but it will be at least a week or two. The doctor today did also mention one thing that makes good sense. She said if my follow-up blood tests come up negative/normal, it might be a good idea for me to see an immunologist.

In addition to the wacky immune system results above, I have chronically low Natural Killer cells (not unusual in people with ME/CFS). On a side note, I found an interesting web page with info about NK cell deficiency. I have never heard of this website before, so I have no idea how legitimate it is. Read at your own risk.

At some point after I get all my results back, I will be seeking a second opinion. I am tempted to see a rheumatologist/immunologist who specializes in lupus and other immune system diseases. That person might be able to sort through all my weird results and help figure out why I'm losing my hair!

I'm exhausted. Good night!

Monday, November 21, 2011

I'm Losing My Hair (Part II): Visit to the Dermatologist

My visit to the dermatologist on Friday, November 11 was a blur because I was just so shocked that she could easily see my hair loss. I didn't even have the chance to tell her I had collected hairs to prove I was losing an unusual amount of hair each day. She could see the loss clearly.

I told the doctor I had a history of hair loss presumably due to medications. She went through several additional reasons why I might be losing hair. Here are the ones I remember her mentioning:
  • Genetics (i.e., female pattern hair loss)
  • Extreme stress
  • Major physical event (such as a severe illness)
  • Nutritional deficiency, usually iron
  • Thyroid problems
  • Certain diseases (She did not mention any particular ones.)

She didn't mention PCOS, but I have read that some women with this condition experience hair loss, so I asked her to also check my hormone levels. The dermatologist ordered the following blood tests (in alphabetical order):
  • ANA - the presence of antinuclear antibodies can indicate autoimmune diseases such as lupus, which can cause hair loss
  • CBC - complete blood count, a general overall blood test to check for abnormalities in the blood
  • DHEA - dehydroepiandrosterone, a hormone that at high levels is sometimes associated with hair loss
  • Ferritin - the protein that binds to iron in the blood, there is some evidence that low iron can lead to hair loss
  • Glucose - sugar in the blood, diabetes can cause hair loss
  • RPR - rapid plasma reagin, a screening test for syphilis, which is known to cause hair loss
  • Testosterone - a hormone indirectly associated with scalp hair loss (as well as unwanted hair growth)
  • T4, Free and TSH - thyroxine and thyroid stimulating hormone, both hypothyroidism and hyperthyroidism can cause hair loss

The doctor really needs to work on her bedside manner because she said that if all the blood tests came back negative, there was nothing she could do to help me. Sheesh, talk about a morale crusher.

After I left the doctor's office, I was very upset. I was sad that my hair loss had been confirmed and angry that the doctor left me feeling hopeless (I assumed everything would come back normal like it nearly always does). I took the confirmation that I really was losing my hair quite hard. I cried... a lot.

Even though I didn't have any sort of diagnosis yet, the knowledge that I really was losing my hair was enough to shake my confidence. I entered a weird state of mourning over my past and future lost hairs, not knowing if my hair would ever grow back to its former thickness or if I would continue to lose it until it was too obvious for others to miss.

I feel guilty that I am so sad about something so superficial as hair loss; after all, it's not as though I'm dying or horribly disfigured. In fact, at this point, most people can't tell my hair is thinner than it used to be. I know it's what's inside that counts and that we all have inner beauty (blah, blah, blah), but I can't help how I feel. I suppose I need time to adjust.

I heard back from the dermatologist a week later on Friday, November 18. She left a message that said that my lab results were abnormal and I had elevated ANA levels. She said my results may indicate lupus or some other type of autoimmune or connective tissue disease, so she wanted me to see their specialist.

Lupus?! I did not see that coming. I've been tested for autoimmune diseases at least twice before (in 2005 when I got my initial ME/CFS diagnosis and again in 2009 when I participated in CFS medical research), and both times came out negative.

More tears. I was hoping for something simple like low iron. All I have now are questions. Is it possible that I've developed Lupus in addition to CFIDS? Has it been Lupus all along? Or was this test a false positive and am I wasting emotional energy? If it is an autoimmune disease, how sick will I get? If it's not Lupus, then I still don't know why I'm losing my hair...

I can't quite explain why I'm so upset. Maybe it's because I've gotten used to ME/CFS and have already experienced its range -- from being so sick that I couldn't have a job and slept up to 20 hours per day to having a full time job and being mostly functional. I understand ME/CFS; I generally know what to expect. Lupus is foreign and new.

Coincidentally, I had an appointment scheduled with my CFIDS doctor today. I told her about the recent events, and she was not particularly concerned about my ANA results. She said she often sees elevated ANA levels in people with fibromyalgia (I should mention that I've never actually been diagnosed with fibro) and that her lupus patients usually had much higher levels than my modestly elevated 1:160.

I felt a lot better after my visit to my CFIDS doctor. She has a much better way of conveying information than the dermatologist who did not do a good job of offering hope.

Obviously, I will be having more tests done, but I hate waiting and wondering about the unknown.

My appointment with the autoimmune specialist is tomorrow. I will be going in armed with my medical history, questions, and research. No matter what happens, though, I will be seeking a second opinion. I have learned my lesson in going with single opinions in significant health matters.