More Good News

I stopped my diuretic (water pill) that tends to raise uric acid. Replaced it with losartan, an ARB that blocks renin from the kidney that constricts blood vessels and raises pressure. In the blockage, the pressure drops and the kidney does better. I am also aware that it can modestly lower uric acid. This is one of the benefits of doing so much lecturing. This little known beneficial side effect of this common blood pressure pill is something I learned when teaching about gout. I am very lucky to have such access to such helpful esoterica.

The magic worked. Uric acid fell in a week to 7.9 from 9.4 suggesting either:

1: I heal fast

2: My medication changes were magical

3: The prior test was a lab error

4: My uric acid has a mind of its own

Moreover, my blood pressure is back in the normal range, though it could be better. My kidney function remains normal and stable.

On the hematology front, my platelets were a remarkable 344,000. The rest of my CBC is all good, though my Hbg (hemoglobin) was down a bit at 13.7 and my MCV (mean cell volume) up a bit at 100. More on that later if it turns out to be an actual worrisome trend. Right now I feel very secure in ignoring it. Or at least just monitoring it.

Had my first rituximab of six weekly infusions (500mg/M2) last week, and happy to say it went off without a hiccup. My small neck nodes and even smaller, but not gone so that suggests I am still sensitive to its effects and still need more. It is probably busy shrinking my critical mesenteric nodes as I am typing away.

This is all good news.

That's good because I am scheduled to be in 7 cities for lectures or meetings over the next 4 weeks.

Included is a visit with Dr. Kanti Rai in Long Island, while I am lecturing nearby, also Chicago, then St Charles and Springfield, Missouri, another visit to my daughter and son-in-law in San Francisco, and a very short drive to speak in Anaheim.

I am already tired before the first flight.

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.