Saturday, October 25, 2014

Tuesday, January 08, 2013 Ellen Galo, Community Member, asks

Q: What do these tests mean or imply? I already have RA - now what?

ok, here is one for the history books - or at least my medical history.  I stopped taking Enbrel around Oct 1 because it was making me feel worse, not better.  But I knew I would need someone else sooner or later.  I was waiting to meet with my rheumatologist when push came to shove, something was just WRONG.  On Nov 15, I went down to see him.  He was puzzled because he saw NO signs of inflammation, but he had been having suspicions for about a year that some of the markers were changing, but we didn't know to what.  At the end of the fall semester (I work at a university), everyone is always stressed and getting sick (faculty and students).  I was SO tired - but what else is new?  I asked my PCP for RX for 10 mg amitriptyline to sleep better (it had been very helpful several years back).  One helped but not quite enough. Just about that time, both my husband and I came down with flu (or so we thought).  At the end of the Flu week (Dec 14 -Dec 21), suddenly he had terrible spasms in his neck (totally new for him, he's very healthy). I took him to the ER on the 14th, and they did a spinal tap just to rule out meningitis.  Then they did a chest xray and said he had "some pneumonia" and sent him home with Levaquin, Cyclobenzaprine and Percocet (the last two are well known to me!)  In the meantime, I almost passed out while trying to give him moral support during the spinal tap.  The nurse gave me a wet washcloth for my forehead and I HAD to sit down the rest of the time. I figured I was just exhausted from FLU, right?  The next day my husband was feeling a little better, but I had a temp of 101 degrees, so it was my turn to go to the ER.  They discovered I had lobar pneumonia (upper right lobe) and advised me to stay for several days of IV antibiotics. I'm allergic to Levaquin, so the first set of IV meds was Zithromax and Rocephin, and they did absolutely nothing.  The doctor quickly switched me the next day from Rocephin to Zosyn (pipercillin and something else).  Within an hour I started feeling a little better.  Finally! I went home Dec 26 and was doing (still am) regular nebulizer treatments every 4-6 hours.  I'm getting a little better each day - but blood tests last Friday have my doctor concerned that something else totally unrelated is going on.  My SED (ESR) rate is 90 (NINETY!!) and my alkaline phosphatase is 261.  He's concerned something is happening in my bones.  II asked, cancer possibly? (Both my parents died of two different kinds of cancer, both were smokers, and though I'm not I developed asthma 2 years ago, after an URI.  I've done some reading and several organs make the Akl Phos, including my liver.  My liver has also acted strangely since I got RA (2004).  My PCP has ordered more tests (probably to determine the source of the AlkPhos.  Meanwhile, I'm wondering if I'm going to be hit with a superflare - I feel like an accident waiting to happen.  I have had a lot of foot trouble, but now my legs are starting to feel weak. We have a 'raised ranch' house and I can only go up and down the stairs a few times a day, so I try and plan and space it out.  On the other hand, I read that 30% of RA patients have elevated ALkPhos and that it's the hepatobiliary (liver/bile duct) involved ment that seems to be related to the RA.Can anyone make sense out of all this for me?  My husband is fine now and back to work.  I will have two weeks off before I have to return - but I have a strange feeling that something else will be found out in the meantime.  They did say the ESR could be elevated because of the infection (2 weeks after the diagnosis?), but that seems pretty extreme since it's 2 weeks after I started getting treated for the pneumonia.EllenPotsdam NY

Answer This
Answers (5)
V, Health Guide
1/ 9/13 8:35pm

Oh my gosh, Ellen.  My head is spinning after reading all you have been thru, so I know your head is spinning.  I have no idea what is up, but something is up.  Good that you have a doc who is on top of things.  With all the meds you were on for pneumonia, I would think a lot of tests could be off, and may return to normal.  I'm sorry I am no help in this department.  I just wanted to let you know I am thinking of you and will be praying for some quick answers and phsycial and mental relief for you soon. 

 

Hugs,

V
 

Reply
Ellen Galo, Community Member
1/ 9/13 8:42pm

Thank you so much, V!  Something interesting has happened since I wrote that: I had to get a fresh supply of nebulizer solution and when I went to throw out the old box (from Nov 2011), I discovered that it EXPIRED TWO MONTHS AGO!  Now I am feeling even better from non-expired solution (just today) and wondering if that could have also thrown off the tests - depending on what actually it degrades into! But the good news is, I am feeling better and better - so how bad can it be?

   I also got a very nice call from a nurse connected with my insurance, to follow up how I am doing and if I am in need of anything.  I gave her quite an earful of stories, I was just wound up and she happened to call just then! 

   I am also starting to get out now - it does tire me somewhat, but then I can take a good NAP, because being with people is GOOD.  I sat in the hospital bed long enough (but the nurses were really good too, and everyone explained things and gave me choices - it really felt like a team effort.  Wow....

Thanks for writing, I always love to hear form you!

How is your healing going?

Ellen

Reply
V, Health Guide
1/ 9/13 10:18pm

I am so happy you wrote back and let me know you were feeling better!  Sorry you had to spend Christmas in the hospital.  

 

I am fighting the flu that turned into a sinus infection and bronchitis.  Finally feel like I am getting a handle on it.  Now just mostly tired.  Still hoarse from all the coughing, etc.  I am taking Cipro and Albuterol inahler, etc.  What a bad flu year!!!

 

I hope to venture out tomorrow, even if just for a short time.  Would love to get out a bit.  I have missed two Orencia shots and two doses of MTX, and so the RA Troll is getting unhappy, but he will just have to get over it!  Gotta take care of this other nasty stuff first.  Wink

 

Please take care of yourself, and let me know how everything turns out. Hope your husband is better now, too...???

 

Hugs,

V

Reply
Ellen Galo, Community Member
1/ 9/13 10:24pm

That sounds like the same things that are circulating here!  I now have a number of friends that were sick over the entire break, like me!  Sinus, bronchitis, you name it!

Do know that if the Albuterol inhaler doesn't do enough, you could be prescribeda Nebulizer like me... but hopefully you won't need that!

 

I have a package of Orencia sitting in my fridge since early December!  Good thing I wasn't taking it when I got sick... yikes! Probably would be much worse...

 

Best,

Ellen

Reply
Ellen Galo, Community Member
1/10/13 8:06am

omigosh - I had read your message very quickly and missed the part about the RA Troll!  That is a wonderful way to refer to RA!   I think now there should be an RA Troll doll (like those little smurfy kind of trolls with big tummies, full head of unmanageable hair, and the puckish smile!  Then, when we're unhappy with our "troll" we can imagine throwing him/her/it into the toilet or out the window - a little sympathetic magic!

    As soon as I toook that part of the message in, I got a picture of MY troll - he is hiding under the bridge (isn't that where they live?) waiting to POUNCE on me at the moment when I least expect it - I love water and bridges and interesting paths....and so when I'm out for a nice walk (or a little vacation from work), enjoying peace and quiet --- BOOO! the troll jumps out with his nasty smile and runs me off the path  ARGGGGH!

Reply
V, Health Guide
1/10/13 4:38pm

LOL  Exactly!  That is what trolls do.  I picked up that term from my best friend, who also has RA.  Her rheumy calls it the RA Troll. Wink

 

I want a talking RA Troll doll, so I can punch him and then he can say something...like, 'Okay, okay, I'll go away".  LOL

 

V

Reply
Ellen Galo, Community Member
1/10/13 5:22pm

You make me laugh !  Smile (which is always GOOD THERAPY!) 

I wonder if I still have my grown-up daughter's trolls somewhere,,,otherwise I will start looking around at the local flea markets, etc.  (always fun to have a goal when shopping!)  In fact, there's a huge 'Snowflake Sale' this Saturday (if I'm up to it) at the local high school.  Every year the French Club holds it to raise funds for their trip to France.

Reply
Jane, Community Member
1/15/13 10:10am

I love the RA troll.  Thanks for the laugh as I lay here with my shoulder so inflammed can barely type.  FYI.  Saw trolls at the Family Dollar store and as soon as my shoulder is able to steer the wheel am going to go and get one.  Hope you all can find one too.  Happy Day!

Reply
Ellen Galo, Community Member
1/15/13 10:32am

Jane, thanks for the tip!  I'm actually about to head out to do a few errands (didn't get out at all yesterday and even looking forward to fresh air, even if it's colder (with a scarf around my neck and over my mouth!  I'll let you know if I find "my" RA Trol!

Reply
Lene Andersen, Health Guide
1/16/13 1:32pm

wow... this is totally beyond my expertise. I wish I could be more useful...

 

I can hypothesize a couple of things, though. Your body went through a really hard thing and it tends to take a while to recover from major health events. My mother had back surgery followed by a kidney infection last summer and her body was really inflamed for a long time. We spoke to our family doctor about the possibility of RA (despite her being in the late 70s) and although she got some blood tests, which were ultimately negative, the doctor said that it was quite normal for the inflammation to take a long time to simmer down. My mother's inflammation markers were really high for months and then gradually eased off. If you look at recovery from surgery, it also takes your body a good two months to get over the offense of being cut open. And that's for people who don't have RA. RA tends to add several weeks to any estimated healing period. You had a lot of stress, both emotionally and physically, and I think it's quite likely that your body is still freaking out.

 

I don't know enough to say anything about your AlkiPhos tests, except to say that your research indicates that 30% of people with RA have odd liver happenings. Since you've had liver oddness since you got RA, maybe you're one of the 30%?

 

Please keep us posted.

 

 

Reply
Ellen Galo, Community Member
1/16/13 2:03pm

I will definitely keep you posted - hopefully the suspense will diminish tomorrow after my doctor's appointment - have also had stress with the personnel office at my job bugging me to bug the doctor's office about getting the disability papers in.  Another whole story, just annoying (because they didn't get them to me as soon as they could, and now I'm paying for it, but it SHOULD work out...)

    I think you're probably right on - I emailed my cousin who also has RA ... and lymphoma .. and she said don't worry about it, my AlkPhos has been off for DECADES - but then again, she's in her second variety of cancer.... (nurses ignore their symptoms while paying attention to everyone else's - yes, she is a retired RHEUMATOLOGY nurse, too!   LOL

    Thanks for your support, everyone!  I'm going bonkers just feeling in limbo about so many things - guess that means it's time I got back to work.  I need a little more structure here, God.... talk about feeling helpless.  The most interesting thing I've learned through all this is that healing does not progress at all in a straight line.  When you think you're there, you're not  - and when you don't think you're there, you actually might just about be.   (har har)

Reply
Lene Andersen, Health Guide
1/17/13 12:43pm

yeah, and that's really frustrating thing about healing after a major illness/surgery. What I've learned though, is that when you start going stir crazy and being really bored, wanting to do something, but not quite having the energy to do it? It usually also means you should stay home a little bit longer to avoid a setback. , but you're on the right track. Almost there!

Reply
Ellen Galo, Community Member
1/17/13 4:12pm

Hi all - I had my last follow-up with my doc and I'm good to go - in fact, I will go in tomorrow and 'share my desk" for one day with the retired secretary I replaced!  She loves to come and fill in so that worked out well ...

   My doc says my lungs sound wonderful and my xray is all clear with only the tiniest trace of what was there.  He thinks the blood test results WERE just from having been ill etc.  The specific test he had mentioned before hasn't even come back yet, but he has pretty much dismissed the problem and is just repeating the standard blood tests from 2 weeks ago.

   So - as far as I know, all is well (except for my old RA pain, which is coming back with a vengeance - so I did bring up th equestion of when/how should/could I re-start (or begin) RA meds?   He says, unless something shows up on the repeat blood tests, I can probably start in a week or so.  Good deal!

Reply
Lene Andersen, Health Guide
1/17/13 8:21pm

woo! Good news!

Reply
Ellen Galo, Community Member
1/17/13 8:34pm

yes indeedy!   Ya hoo!

But I picked a cold day - it's going to be 13 below 0 (Fahrenheit) tonight so out come the long underwear!

Stay warm - - -

Ellen

Reply
Ellen Galo, Community Member
1/29/13 12:04pm

Back again - test results much improved this last time.  Alkaline phosphatase has dropped down to within the normal range (at the top) and though my ESr is still high, it too has droppepd to about half.   From 97 (yikes) it went down to 49 (now just Ra, not pneumonia on top of it!

So - BIG RELIEF!!

Reply
Lene Andersen, Health Guide
1/29/13 2:24pm

woo! Glad to hear it!

 

Reply
Carrie Beth Brown, Health Guide
1/16/13 2:17pm
Hi Ellen,

I wanted to reply to your post because I have a disease that frequently goes with Rheumatoid Arthritis and other autoimmune disease called Primary Billiary Cirrhosis. I developed it two years after being diagnosed for RA. It's hallmark is the Alk Phos. being high, but can also show as the ALT and AST being high...which is actually how mine presented, both in the 800-900 range for months. There is a test called the M2 Antibody test and if your doctors haven't run it they should. It is a highly specific test for Primary Biliary Cirrhosis (PBC) (96% of patients with PBC are positive for this test) which is a relative rare and mostly unheard of disease although its starting to come into the light and media more these days. Now, I'm not saying this is what you have, but since you aren't seeing a gastroenterologist who would most likely test you for this, I wanted to mention it so you can make sure you don't miss anything as catching the disease at its lowest stage is the key to keeping your liver healthier for longer as many people do end up needing liver transplants if it continues to progress to later stages. Also people can have PBC without being positive for the M2 Antibody (also called the AntiMitochondrial Antibody test (AMA). Symptoms from liver disease can be nausea, constant fatigue, upper right quadrant pain, joint and muscle aches, itching, jaundice (although usually only in later stages), etc. I hope you will at least mention this to your doctors to get tested for this disease and I hope they find out that you don't have it. Abut if you end up finding out you do show signs of it, get in touch with me again and I can help you to find info and great people who also live with the disease. Good luck with everything and I hope you get some answers soon.

Carrie Beth Reply
Ellen Galo, Community Member
1/16/13 3:26pm

Hi Carrie Beth, thanks for all the info - I did read up on some of this, and actually I do have a gastroenterologist who has been trying to figure out my weird liver for a number of years now (the good news is that all they have found is low iron - which is a good thing. But I asked him, did I really need a liver biopsy for all that?)  Both my PCP and GE docs are really good about being thorough, so I have no doubt they will do as much as necessary to sort things out - the first being some specific test  for protein electrophoresis, which I should find out the results tomorrow. Also, I will be redoing the blood tests from 2 weeks ago to see if they are heading back to 'normal' , or at least in the right direction.

    Thank you again - I'll keep you posted!

Reply
wonderwoman, Community Member
1/16/13 5:57pm
Hi and ain't you got fun Interesting comment on abnormal liver as my latest lft is showing a problem I'm off to the Rheumy today I stopped the metho s month ago due to blisters in the mouth but have been on extra high pain meds See ya'll Reply
Ellen Galo, Community Member
1/16/13 7:15pm

Hi - good luck on that liver stuff - have you been give any other medication when you stopped the methotrexate?  There are so many options, I don't know of any excuse to just leave you in pain!  (I was skipped right over all those nasty liver-hating drugs because when I was first diagnosed, my liver enzymes were tripled...

    Due to what's been happening, I'm not on any RA drugs right now (although I have Orencia in the fridge, waiting for the right time..)  I am however taking a small dose of amitriptyline, which in small doses really helps with pain & sleep, and in larger doses (i'm on the smallest...) is given for depression.  Ironic, as I got better from the pneumonia and off the antibiotics, ALL my old aches and pains from the RA started giving me grief again!  The amitriptyline has been a life-saver - as I found out the other day when i tried to skip it - the next day I felt SO AWFUL, I can't even tell you - so I won't do that again!  In fact, to make up for it, I took it during the day, and then the regular dose that night - and I felt SO much better today, and have not used the nebulizer at ALL today - FIRST DAY WITHOUT IT - YAY!

Reply
wonderwoman, Community Member
1/16/13 7:48pm
Hi I take tramadol every day but switched to endometrial After three weeks I went into profound death mentality so stopped that Back on tramadol and panadol plus feldene which is an anti inflammatory It d hard on the stomach do have just been given it in suppository We'll see if the hands are up to that little trick! Have been a sample of lyrica today but have to find out if I can take it with tramadol Still in significant pain in most joint and also have pelvic stress fractures which does not help Reply
wonderwoman, Community Member
1/17/13 12:38am

oops that should have been endone

 

Reply
Answer This

Important:
We hope you find this general health information helpful. Please note however, that this Q&A is meant to support not replace the professional medical advice you receive from your doctor. No information in the Answers above is intended to diagnose or treat any condition. The views expressed in the Answers above belong to the individuals who posted them and do not necessarily reflect the views of Remedy Health Media. Remedy Health Media does not review or edit content posted by our community members, but reserves the right to remove any material it deems inappropriate.

By Ellen Galo, Community Member— Last Modified: 05/19/14, First Published: 01/08/13