Saturday, June 1, 2013

Who/What Dunnit

Now that the Julia neutrophil tank is full, Dr. Young Guy and I are left with the question: WHY did they go away in the first place?

.::Slaps on Sherlock Holmes style hat and lights pipe::.

.::cough cough.....throws pipe into the fireplace....good grief who actually SMOKES these things?...::.


Back to my neutropenia episode, and more importantly -- what caused my white blood count to drop to dangerously low levels? It's a mystery. And who better to solve the case than my all time favorite detective?

You guys get to be Watson. I'm Sherlock, for obvious reasons. Ahem.

So, Watson. What do you think is the culprit? Or WHO? Hmm? We can eliminate a few of the usual suspects right from the get-go. Moriarty probably can be removed from consideration since stealing body parts and blood cells is not his usual modus operandi. Besides, since he's a fictional character, his abilities are significantly diminished, I would think.

Here's the Mayo Clinic's Most Wanted list for neutrophil theft:

  • Cancer or other diseases that damage bone marrow
  • Congenital disorders characterized by poor bone marrow function
  • Viral infections that disrupt bone marrow function
  • Autoimmune disorders that destroy neutrophils or bone marrow cells
  • Overwhelming infections that use up neutrophils faster than they can be produced
  • Drugs that destroy neutrophils or damage bone marrow

Dr Young Guy..... (Wait. I suppose I should hand over the Sherlock role to Dr. YG...but I get to be Watson, then. Y'all may have to play the role of interested onlookers) .... strongly suspects that a medication is the culprit in my case. The reason he can do that is because rheumatologists have amazing deduction capabilities. Thank goodness.

So Sherlock YG's first action once he realized that my whites had dropped was to discontinue my daily medications that have the potential to alter my CBC, one of which was hydroxychloroquine, aka Plaquenil. The other was omeprazole, or Prilosec. My next rituximab, or Rituxan infusion isn't due for another five months, so there's no manipulating that drug except to consider not receiving it again.

On SYG's instruction, I began taking the Plaquenil again a few days ago. And, after just three doses, some of the very perplexing symptoms of the weeks before re-appeared: ringing in my ears, feeling weak, and odd sensations in my muscles of my shoulders, arms, and legs.

Incriminating evidence, that. Interesting.

After reporting my symptoms, I was advised to discontinue the Plaquenil yet again.


If these weirdo symptoms don't diminish in the next week or so, I need to report back to Sherlock, and I will have weekly labs to re-assess my CBC.

The plot thickens. Stay tuned...


annie said...

Plaquenil seems like the first med all doctors give when first diagnosed, but for someone who is intolerant of this med, what else is there on the market?

For the longest time, I was taking only one pill per day as I could not tolerate two, but I am now splitting the dose in am and pm doses and it seems to be more tolerableso far. Thanks for making me smile as I was reading your post today.

Blogger Mama said...

Interesting. Did he say why the Plaquenil would suddenly cause these problems when you have been on it for so long without symptoms like these?

SLCCOM said...

Very interesting. I posted this one on the SJogren's World. Look for more subscribers!

Thanks for sharing. BTW, you said neutropenia where you needed neutrophils. (I can't help it -- I used to teach English Composition.)

One Woman's Journey - a journal being written from Woodhaven - her cottage in the woods. said...

I could not take Plaquenil dose of 2 a day or one a day (new rh said since I only weigh 108 this was to
big a dose for me) so I take one pill every other day. Severe symptoms started almost a year ago
and the fatigue is terrible. I live solo, love to garden and have never had help. In late 70's have starting having some help in garden and 1/2 day once a week..

Julia Oleinik said...

Excellent catch on the neutrophil/neutropenia blunder! I'm on it!