Flaring

It's not a good sign when Rheumy starts my appointment by asking if I've been sick.  On the contrary, I've been feeling pretty good.  Then he asks if I've had any mouth sores, rashes, or symptoms of Raynaud's.  My fingers have gotten white when cold, but that is fairly normal for me.  He asks if I've experienced any lupus symptoms lately...I recall that my finger joints were bothering me a little bit last week.  Then he hits me with the news -- my blood work does not look good and he thinks I may actually be flaring.

My hemoglobin level dropped back down to 9.5.  As a reminder, hemoglobin measures the amount of oxygen being carried by your red blood cells.  Normal levels for a female are between 12-16 g/dL.  I have been hovering around the 10.5 range for the past couple months with the help of taking weekly Procrit shots.  I was quite surprised to hear that my hemoglobin level dropped to the level I was at before starting Procrit, because I've been feeling like I have more energy lately.  Previously when I was at this level, I had very little energy and could barely make it through the day.

My sedimentation rate also shot up.  As a reminder, The  Erythrocyte Sedimentation Rate (ESR) test is a blood test used to detect and monitor inflammation in the body. The test measures the rate at which red blood cells (RBC) settle and is measured in millimeters per hour. The sedimentation rate increases with more inflammation. The normal rate 0-15 mm/hr for men and 0-20 mm/hr for women.  Rheumy said that when I first came in, my sedimentation rate was in the 60s.  This is when I was experiencing extreme joint pain and could barely stand or do things with my hands.  With treatment, it has steadily gone down and I've been hovering in the 20s-30s.  With this last test, I was in the 80s!  I did notice a little joint pain last week, but nothing like what I had a year ago.

The biggest worry with my bloodtest, however, was my white blood cell count.  It had dropped to 1.2 (normal range is 3.8-10.8).  There are different types of white blood cells, and the one Rheumy was particularly concerned about was my neutrophil count.  Neutrophils are the white blood cells that help your body fight off infection.  I'm not sure exactly what the unit of measure is, but Rheumy mentioned that when you level hits 0.5, you are usually hospitalized.  My level is at 0.75, so it is dangerously low.  Rheumy warned me that if I get sick or have a fever, I need to call him right away.  I came home and did a little research on Neutropenia.  It is interesting to note that when the Absolute Neutrophil Count (ANC) level is below 500 (which may be equivalent to the 0.5 measure Rheumy used), people do not show any sign of infection.  This is because of the lack of neutrophils to elicit any biological response.  Hopefully that is not why I don't feel sick...

We discussed starting me back on prednisone to bring my blood counts back up, but I was hesitant to get back on steroids.  We could stop taking the azathioprine, which could be causing the low blood counts.  However, if the low blood counts were caused by lupus and not azathioprine, getting off of the medicine would make it worse.  Since I was feeling good, we decided to wait and test again next week.  It may have been that my body was being temporarily stressed and caused these abnormal blood counts.  If things don't look better next week, we'll need to take action.

For now, I'm going to try to take it easy and let my body rest.  I may be to blame for this flare because I have been pushing my body too hard.  When I start to feel good and have more energy, I want to take advantage of it.  Trying to do too much, however, will send me into a flare.  I think this is a problem that many lupies deal with.

- a little lupie -