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.

Need the email address of the family concerned about about graft rejection, in fact I would love everyone's email address

Someone just sent me an email about a family member rejecting his graft.

I am not sure which post you commented on and so I can't find your email address that you included in your comment.

Please simply email me at BkoffmanMD@gmail.com and I promise that I will get back to you.

Does anyone know how I might search through all the comments without going through each and every post one at a time?

Does anyone know how I could capture the email addresses of people who want to stay in contact or ask me a question?

Someone suggested setting up a Yahoo group around this adventure and my book. Any comments or advise would be most welcome.

Please do email me at the above address if you want to stay in touch.  I would like that. The blog is not an efficient way for back and forth communication. Email works much better. 

I did walk of the beach today at sunset, celebrated my daughter's triumph with the NY bar last night by eating out at the Veggie Grill, where I had cooked organic vegan food (Bali Bliss and sweet potato fries). How wild is that! Back to my raw ways today.

Thinking about surfing for the first time in 3 years, but I will wait for the water to warm up a bit.

The fog is lifting.

"When the world is running down, you make the best of what's still around" The Police

An' here I sit so patiently

Waiting to find out what price

You have to pay to get out of

Going through all these things twice.

Bob Dylan

I am still cancer free, but it looks like I may be rejecting my graft. My critical T cells fell to just over 50% donor down from 64% only 6 weeks ago, and my monocytes and granulocytes made in my marrow are all mine, 100%  recipient. No donors cells to be found. Looks like I needed to be hit with a bigger immunosuppressive hammer a the time of the graft. Looks like my own marrow and immune system were just too robust and beat back my invading donor. I was just too darn healthy at the time of transplant. I had this foreboding in hospital. It explains why I have had such an easy time of it and no (GVH) graft versus host disease.

This is bad news, no doubt, but the same blood test that showed the falling chimerism, also showed no CLL. So first I repeat the CT scan, repeat the bone marrow biopsy (BMB) and repeat all the lab test in 2 weeks and than I begin down a new path.

A donor leucocyte infusion (DLI) is possible, but not likely. Chemo is much more likely soon, and at sometime in the future almost for sure, a redo transplant, this time with a bigger chemo hammer. Could be real soon or years away. It could be never.

My leukemia sure took a dive with only 1 course of chemotherapy as it looks now like my remission was from the conditioning therapy (a common cocktail called FCR by its fans for its famed mix of the potent and poisonous fludarabine, cytoxan, and rituxan) and not  the much desired GVL (graft versus leukemia). Not really certain that is true. Not really certain of anything at this point. If it was the chemo, then it must be very sensitive which bodes well. And I feel well. And I look marvelous. Just ask my wife. All that is good.

I am off my anti-rejection drugs (tacrolimus and sirolimus) and my prophylactic antibiotics as of today. That may boost my donor T cells or maybe knock them out faster. Who knows?

I would say I won round one by a wide margin, but this will be a long fight. I was hoping for an early knock out, but I am dealing with a patient and wily, but weakened opponent. I remain certain of my ultimate victory. I'd be lying if I said this was a good day, but you would be mistaken if you thought I was going to be down for long.