Monday, October 18, 2010

It's Always Something: High Uric Acid

My uric acid or UA level shot up to 9.4 over two weeks from 7.9. It should be under 6, but up to 8 is rarely an issue.

This jump is a recognized complication of my miraculous cyclosporin or CSA that has greatly helped me hold onto my platelets.

In fact, aggressive, destructive gout is a well known risk of CSA. My personal risk of getting that pleasant malady unless things change is about one in four. Besides pain and joint destruction, it can damage kidneys.

Like it does to many others, cyclosporin has also pushed up my blood pressure. That lead to a slight increased dose of my thiazide diuretic to control the pressure. That too can raise the uric acid.

Cyclosporin also is tough on kidneys itself. My kidney function is still normal, but not as good as it was before I started the CSA this time. Last time I took it for this same problem, I had to reduce the dose as my kidney function was compromised. The reduced dose continued to work just as well for my ITP and my renal function normalized.

So I am rechecking the lab in two days, stopping the thiazide, adding losartan for BP control, an ARB that tends to lower UA while it blocks renin receptors that tell the blood vessels to constrict. It is not only good for BP, it is protects the kidney, and it just went generic. Still, I had to get a prior authorization to get the insurance to cover it.

And I will be drinking lots of water. That is easy and should help all the issues.

None of my docs seem keen on reducing the cyclosporin like last time, but rather want to fuss with my other meds to lower the UA while controlling my blood pressure.

The consensus is no allopurinol yet. No gout symptoms, so why add another complicated drug to the mix.

I also got my flu shot today, before I restart rituximab in two days. Normal dose. Don't trust the pharmacists to give me the shot (I am not over 65) and they seem to be the only ones to have the high dose vaccine. Started on the unproven ranitidine trick (300 mg. 2 x a day for 6 weeks, then repeat the flu vaccine) to see if I can boost my response that way. Honestly, I doubt I will mount much of an antibody response, but I am 100% certain that I won't get any after all my vitamin R wipes up the the remnants of my antibody forming B cells.

And just to add another twist, rituximab may raise the uric acid as it goes about the business of killing my cancer cells. This is not very likely as most of my cancer is my nodes and marrow and not in my bloodstream (my lymphocyte count is already suppressed from my last rounds of R) where the kill rate is much slower, so the chance of a tumor lysis leading to another jump in UA is extremely remote.

So many balls in the air for such minor issues.

As Roseanne Roseannadanna said: It is always something.

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2 Comments:

Anonymous Anonymous said...

For some time I have been taking two flu shots spaced about a month apart.
This year, I'll do the same but get the Fluzone High-dose for the second.
I do not believe the High-dose version has H1N1 added so I am glad I got the regular one first.
Have you considered the conjugate Hib vaccine? It seems to be appropriate to HIV patients and we are not that dissimilar to them.
Regards,TomD

October 19, 2010 at 12:01 PM  
Blogger Brian Koffman said...

@TomD

I did get the HIB, along with Prevnar (the kid's vaccine), and the meningitis vaccines early after my diagnosis and recommend the same to all.

I recently got a Tdap

As for flu shot, I got the regular dose and will take Ranitidine for 6 weeks and then repeat it, though with my rituximab therapy, I doubt it will help much

Be well

Brian

October 19, 2010 at 11:53 PM  

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