Saturday, January 7, 2012

What A Boring Idea For A Daytime Television Show

So here's the latest episode of "As Julia's Autoantibodies Turn". I just know y'all have been waiting for the next installment with baited breath.

Previously, Julia, covered with unsightly bright red spots and feeling as though her backside was made of a two ton anchor, presented herself to Dr. Young Guy. Our story resumes as DYG enters the exam room.....

Hello, Dr. Young Guy.

"How are you today, Julia?"


"That doesn't sound good. What's going on?"

Oh, Dr. Young Guy, whatever shall I do?!

Julia threw her forearm dramatically over her brow.

I hurt! And I'm spotty! And my butt is draggin'!

"Never fear!" DYG stepped out of the exam room and re-entered with a flourish wearing his super-doctor cape. And exam gloves. And carrying a procedure kit. And a syringe with a couple of very very long needles.

Tune in tomorrow as Julia throws her forearm theatrically over her brow and declares, Oh, John! Whatever shall I do? I have all of the Christmas decorations to deal with!!


Ok. Sorry about that little diversion there. I'm back.

Actually, aside from the super-doctor cape silliness, most of the above conversation actually took place. Oh - and I really do expect to repeat the theatrics regarding Christmas decor with hubby tomorrow. Don't tell him...shhhhh....

I have to sheepishly admit that I DID do the wah wah wah routine with Dr. YG. And after a medication review and physical exam of all those gross spots, my joints, and mouth and, well...y'all have been there and done that, we got down to the serious business of addressing my problems.

My primary concern for the visit was my biopsy results of said dumb stupid spots which did indicate a cutaneous form of Lupus. We will be adjusting my medications to try to reign in this newest autoimmune activity. Dr. YG felt that since I am home to a constant parade of both old, and more importantly, NEW spots, that this indicates an ongoing, active process. So I'll be making some medication changes. No surprise there. Here's a bit of what I learned about subacute cutaneous lupus erythematosis, found here on the National Institutes of Health Medscape site:

Subacute cutaneous lupus erythematosus (SCLE) is a nonscarring, non–atrophy-producing, photosensitive dermatosis. SCLE may occur in patients with systemic lupus erythematosus (SLE), Sjögren syndrome, or deficiency of the second component of complement (C2d), or it may be drug induced.......
Patients with SCLE frequently fulfill 4 or more of the criteria used to classify SLE. Serologic abnormalities are common.....
Approximately 50% of patients with SCLE have accompanying joint involvement. Arthralgias are common, often symmetrical, and usually affect small joints, such as the wrists or those of the hands. Arthritis may occur but is unusual (< 2%).
Patients commonly complain of fatigue. Some patients have Sjögren syndrome, while others note dryness of their eyes and mouth. Patients may manifest symptoms of SLE; therefore, the history should include an assessment for symptoms of pleuritis, pericarditis, neurologic involvement, and renal impairment.

Hm. Fatigue....Dermatosis.....Sjogren's syndrome, joint pain....yep. Sounds familiar, doesn't it?

We then moved on to the next item on my wah wah wah agenda: pain. Specifically, pain on the outer side of my hips which makes sleeping on my side very painful, as well as climbing stairs and lengthy walking. I have had this condition, also known as trochanteric bursitis, for over a year but it seems to have worsened over the last few months. Here's more about this particular kind of bursitis, which is basically an inflammation in the fluid filled sac near the hip joint; this from Medscape yet again:

Bursitis has many causes, such as autoimmune disorders, crystal deposition (gout or pseudogout), infectious diseases, traumatic events, and hemorrhagic disorders, as well as being secondary to overuse. Repetitive injury within the bursa results in local vasodilatation and increased vascular permeability, which stimulate the inflammatory cascade.
Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.
Dr. YG actually did re-appear in my exam room complete with a procedure kit, gloves, and a syringe with a couple of very long needles, then proceeded to inject the bursa on the outer side of each hip with a steroid solution, and I am happy to report that last night I slept on my side for the first time in a year! Yeah, DYG!

We finished our session with an admonition to get down to the lab and have my overdue tests drawn, a new prescription, and a return appointment.

I hope my new meds erase my dumb stupid spots. And that the injections ease my hip pain. And that my subacute cutaneous lupus erythematosis STAYS just that. This prognosis from Medscape just one more time:
Approximately one half of patients with SCLE have 4 or more of the criteria for classification as SLE, but in these patients, the disease is generally less severe, although in individual patients the full range of severity and end organ dysfunction is possible.
I have decided to ignore the above prognosis at the moment since I truly trust Dr. Young Guy's judgment and ongoing surveillance. I'm glad that my hip pain is relieved for now. And I'm glad that my lupus is not SLE (systemic lupus erythematosis) at present.

Here's hoping that my dopey autoimmune soap opera is too boring to have it's imaginary contract renewed.


Gertrude said...

Appreciate the update. Been a tough time for you! Glad you have a great doc. Miss you.

Amy Junod said...

Before the contract ends you need to go back to that gym and soap opera slap who ever put that sign up!

I hope that Dr. YG's plan works for you. Thanks for sharing your results. Will help lots and lots of people.

BTW, speaking of soap operas...One Life to Live (which is getting axed this week by ABC) has highlighted Lupus for years.

annie said...

Your doc's a keeper...he's knowledgeable and very helpful. Glad to know things are under control for you at this time. Thanks for the soap opera dramatic that I had to laugh (AGAIN!).

On Monday, I get to see a surgeon for the beauty spot my dermatologist removed this summer, and find out if I need further procedure on is a pre-cancerous spot. Plus I have blood work to do for my rheumatologist...he's added a few more tests for me, plus he's concerned as my ferritin level is quite a bit higher than it should be, while my iron is low. Anyone know anything about this? Thanks and have a great weekend.

Debbie said...
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