When Is Snake Oil A Good Thing?

ˈsnāk ˌoil/
noun
North American informal
  1. a substance with no real medicinal value sold as a remedy for all diseases.
    • a product, policy, etc. of little real worth or value that is promoted as the solution to a problem.
      “the new medication was denounced as snake oil”

     

Chronic Illness seems hopeless at times.  We ALL want to feel better and have a better quality of life, we want our ‘old lives’ back, the way we remember it… as everything being semi perfect.  We want the magic pill, the healing elixir, the curative therapy, the thing we can do to be back to our old normal.  Trouble is people and companies want us to believe there may be an easy cure and we don’t have to take Western Traditional medicine that may help while it may also damage other parts of our body.

Recently on Social Media groups there seems to be a influx on posting about ‘cures’.  This scares the crap out of me…  I worry that someone may totally stop following doctor’s monitoring and instead go for one of these cures.  CSS/EGPA is a Chronic illness.  A person does not become cured.  Instead we have remission or quiet periods, times when the disease is not actively trying to kill us.  For some it may never be quiet, for others it may stay quiet for months, years or even decades.

That being said I am a believer in alternative and integrative medicine to alleviate some of the side effects of the drugs we take.

I have tried alternative medicine.  Even some weird shit…  I know where the hope for the magical cure comes from. I also did cupping ( it did help with my cough at the beginning of my CSS journey) and Chinese herbal meds ( I had difficulty with the taste and tended to puke them up ).  I have done acupuncture (really helped me with Cytoxan nausea) and massage therapy.

The strangest thing I ever did was Chelation Therapy.  This was just a month prior to my official CSS diagnosis.  I was told by an alternative medicine doctor, after he tested my spit and hair, that my body was filled with toxins and needed to be cleansed of them  At that point I was so sick I would have believed anything.  I went to his office twice a week and got Chelation Therapy via IV and a large IV bag of vitamins (aka bannana bag).  Yes, It made me feel better but later I realized it was the bag of vitamins that was making me feel somewhat better.  In the middle of one treatment I had a Major asthma attack, it scared me and the answer according to this doctor was that I need more frequent treatments at $300 a treatment.  Chelation Therapy actually did help me….  How?

It made me so sick, that the CSS came out in full force and became easier to diagnose.  My Vasculitic rash lit up like a Christmas tree and my breathing was at an all time low.  So, did Chelation cure me, as the doctor swore it would… NO.  Did it help me?  Yes, in the fact that my CSS diagnosis came a month later and I was put on high dose pred and Cytoxan.  Did it make it worse?  Absolutely!  Could it have killed me if I only relied on it?  Yes, but luckily I was being monitored also by a wonderful doctor who was busy running all sorts of tests trying to find the answer.

I am not saying Alternative medicine will make you sicker, what I’m saying is be careful.  I love the concept of Integrative medicine.  Where you get the best of both worlds, Alternative and Traditional medicine.  I believe both can work in harmony within our bodies.  I need my Traditional medicine of monthly monitoring of my blood to see how active my disease is but I also like Alternative medicine to help with some of the side effects of the Traditional meds I have to take to stay alive.

I currently have a shelf full of vitamins. I take B-12 for energy, D because I was told mine was a little low, multi-vitamins because they must help somehow …  d-mannose because a doctor asked me to try it for my frequent UTIs.  Corn silk pills, also UTI related and a new combo of some supplements which may help with energy but seem to be an epic fail for me (but I am still testing it).  I have tried California legal CBD oil and many other ointments and alternatives for nerve pain.  I am very careful as to where I obtain my vitamins from to make sure they are pure.

I am a firm believer in… If some alternative makes you feel better, and is doing no harm to your body then go for it.  We must remember that just because it makes you feel better does not mean it will work for everyone and the danger of telling someone that this ‘cured’ you of something.  Your reader may go out and stop all their meds and try the alternative instead only to have their vasculitis doing silent damage to their organs.  I am scared that someone may stop all meds and medical monitoring based upon a FaceBook post and instead, drink the tea, use the oil, swallow the herbs, cleanse their colons, starve their body of nutrients, or rely upon a healing circle and be silently killing themselves.

I think we owe it to each other in our chronic illness, Vasculitis community to share information but also make sure you are clear that the alternatives are not a cure.  This is no current cure for CSS and Vascultis.  We need to be clear on how it may have helped you with XX symptoms but you are also taking…xx. or were taking…xx with it.   We need to share how much it costs… most alternative therapies are not covered by insurance and vitamins alone could set you back hundreds of dollars a month.  We need to share how long you need to be on that alternative, there is a mistaken belief that some alternatives are a quick fix, many are life long.  We need to stress the importance of monitoring,  both laboratory and doctor.  CSS has killed one too many people that I have met online and many times it’s because a person was not being monitored closely enough and the disease flared.

So, in closing beware of Snake Oil — IF something seems too good to be true, it probably is false.  Now, I must go back online and send $$ to that Nigerian Prince who promised me millions in return.

This post was inspired by a FB post on alternative medicine is written by one of my favorite writers on FB.   She takes time to look into her thoughts on  alternative medicine while sharing her experience.  Her writing, under the FB page, Vasculitis Journey have always been open, honest and from the heart.  Go read her FB page and enjoy.
Also, if you want to read so medically sound pages on CSS and want more than the jargon and figures.  Go to Michael’s pages at www.EGPA.info  He gives some great information that is easy to read and understand and answers some of the major questions we have with CSS/EGPA.

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It’s Hard To Be Brave, When…

When you suddenly become sick with any illness you find yourself feeling very small.  Navigating the world of doctors, nurses and other medical personal is like entering a strange new world.  You find yourself losing your voice and unable to speak up when something is just not right.  Any insecurities you may have are magnified and suddenly you may be unable to advocate for yourself.

Now think about having a chronic illness, knowing you have a lifetime to deal with the medical profession and feeling your own self advocacy voice growing weaker and tired.

A.A. Milne’s Piglet in Winnie The Pooh says it best.  ” It’s hard to be brave when you are a very small animal”.

I am 10 1/2 years into a lifetime of Churg Strauss Vasculitis and my voice is scared and weak at times.  I pride myself in being able to help other patients out and helping them to self advocate but sometimes I find myself unable to follow my own advice.  As, a patient you get put in situations that are scary and you depend greatly on the trained medical staff around you.  Most of the time they are amazing, but sometimes you get someone who’s either having a bad day, needs more training, just doesn’t care or is totally burnt out.

Yesterday, I began home IVIG treatments.  I get Intravenous Immunoglobulin (IVIG) treatments once a month so my immune system is strong enough to fend off common illness and bacteria.  I have  hypogammaglobulinemia because of years of Rituxan usage to keep my Churg Strauss Syndrome under control.    I have been doing these at a medical center but my insurance company had decided that I was no longer allowed to have them at a medical center and I would have to get them at home from a home infusion nurse.  I was not happy about this, I fought it but finally had to give in so I anxiously awaited the nurses arrival.

She arrived and I was hesitantly psyching myself into the fact that this would be a better way to get my infusions.   I have a mediport installed so there was not the problem of trying to find a vein for an IV.  It’s a simple stick into the port installed under my skin, I’ve never had any issues with it.  That’s what I thought.

My first clue that something was up should have been how disorganized this nurse was and how I had to remind her I needed to take my premeds.  The putting the needle into a mediport is a sterile procedure, the chance for infection is high if procedures aren’t followed.  I watched her, and again saw some problems.  Once again, I did not speak up.  She was going to stick a needle into me, I sure as hell did not want to make her angry.

She inserted the needle and it burned like hell, something was NOT right!  no blood return…  I told her she was not in the port — she didn’t believe me.  Finally she believed me and pulled out the needle.  It was totally bent.  I pointed this out and she stated.. “sometimes the needles come that way”, I knew this was not right.  But I was feeling so small, and so vulnerable.

I stupidly allowed her to try three more times.  Each time was worse.  I actually cried since once she tried to insert in Heparin to prove it was in and instead it went into my tissues — I yelped, I cried, It burned like hell.  Still I was the polite patient… I actually told her not to feel bad about it.  What the heck was I thinking?  It was totally her fault.  IF I saw someone doing this to one of my family members I would have stepped in and yelled at them but instead I just cried and took it.

Finally she tried one last time.  It had to be the last time since she went through ALL my back-up supplies.  It went it and was finally working.  I then had to sit there and be pleasant to her and thank her.  She then proceeded to move my medication to IV bag from the original containers and give it to me (that was another fiasco…)

In the course of the conversations she had with me I found out she has severe carpal tunnel in her hands and had lack of feeling in them.  She shared this because she was going in for surgery in 2 weeks.  WTH?  What was she doing trying to insert needles then?  Suddenly all the things she dropped made sense.

Six hours later she left.  I actually Thanked her for coming (what was wrong with me?).  The door shut and I let it all out.  I screamed, I cried and I cussed like a sailor.  I thought I was going insane so I texted a friend and she was appalled by what happened.

WHY could I not advocate for myself and kick the nurse the hell out of my house?  Why did I allow her to cause me such great unnecessary pain?

The answer is weirdly simple.  I was always taught to respect people in the medical profession.  I was scared she might hurt me even more if I told her what I really thought.  I was sick and felt powerless.  I was Piglet.

The medical company that oversees my IVIG medication called me today.  I told then not to ever send that nurse again.  They asked me what happened.  I explained the 4 bent needles and her spending way too much time time transferring the IG solution into an IV bag.  They were taken back because it is not policy to break the sterile environment and transfer this medication, it was suppose to be given directly from the bottles.  I didn’t know this.  I also told them she had Carpal tunnel and the hand problems, they were also totally unaware of this.  There were a few other things but I thought this was enough to tell them.   They promised me a new nurse next month.  But, what happens if the next one is even worse?

I think we, as patients, can be strong for everyone else but have trouble sometimes advocating for ourselves.  This happens both with procedures and in a normal doctors visit too.   I have to Stop trying to do this all on my own (I prefer for nobody to see the ‘sick’ me).  I need to start having a loudmouth, outspoken advocate with me.  I need someone to ask the questions I am scared to ask and point out when something is not right.

I think, as chronic illness patients, we don’t like to ‘bother’ others.  So, we suck it up, and just do things on our own.  We don’t like for others to see us in pain, so we hide it.  We feel helpless at times and we keep it all inside.  We don’t want to be labeled as problem patients.

I have taken a friend, as an advocate, to a few of my doctors appointments in the past.  Usually difficult doctors and I want to know I am am crazy or it is a problem with the doctor.  My friends always introduce themselves as the advocate and have a list a questions we have talked about, one in particular can be a real forceful bitch, but that is just what I need sometimes.

Piglet learned to be brave with the help of his friends.  I need to take my hint from Piglet and learn that I am not a ‘bother’ to my real friends and let them help me.  Ten years in and I am still learning.  Please take my advice so you can get better care too.  Don’t wait 10 years to realize you may be very small but you can be brave and speak when something is wrong with your medical care.Other Posts by Karen in Wonderland

CSS Organizations and Medical Centers

CSS on Social media

CSS and Vasculitis in Videos

Useful Web pages for CSS

 

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Giving Tuesday 2016

Diagnosing Churg Strauss (CSS) is difficult at best and nearly as hard as finding a stethoscope-medical-book-2696008unicorn at it’s worst.  Part of the problem is that Doctors may have never heard about CSS.  In a lot of medical textbooks it takes up less than a page.  Diarrhea is more covered in medical textbooks than CSS and other types of Vasculitis.

We are rare.   I fully understand that we may be only case our doctors ever see.  imagesMost of us end up in the hospital with some organ damage before diagnosis.  Wouldn’t it be nice if more people could be diagnosed before organ damage?   before lengthy hospital stays?  before they have to numerous doctors all while feeling they are ‘making all their symptoms up’?  Is there a way to better educate doctors about CSS and other Vasculitis diseases?

How much is it worth to you to educate doctors?  How much would you be willing to give so doctors to know we are not such a rare anomaly? How much would you give to help doctors the knowledge to better manage our illness?

I ask these questions because you have a chance to help.  You can make a difference.

The vasculitis_logo  is sponsoring a class for doctors (aka CME class — doctors need to take so many of these per year to keep their licenses active).  They are partnering with the Cleveland Clinic to offer such a class.  It’s called, Primary Vasculitides: Best Practices and Future Advances.  They need OUR help in order to make this happen.  Would you be willing to give a few dollars to make this happen, especially on Giving Tuesday 2016?

It’s going to first originate as an in-person, one-time only presentation through the Cleveland Clinic next spring. They are going to record this entire session and then turn it into an online CME course that doctors anywhere can access and use.  This makes it so once available online we can gently steer our doctors toward it.

Here is the link to the course information:

giving-tuesday-300x265

http://www.vasculitisfoundation.org/giving-tuesday-november-29-2016/

Educating ourselves about our illness has always been my #1 priority.  So this opportunity to educate doctors is an easy donation for me to make.  I understand our medical expenses are astronomical at times and we barely have a few dollars to spare but if you do this would be a great cause.

sharingiscaring2Share and post this to you wall.  Can you imagine if just 1/4 of your friends and family gave $5 each what a difference this would make in helping to educate doctors.  Imagine if someone you knew was looking for a great cause to donate to before the end of the year decided to give $100 or more?  Don’t ever think small donations do not add up, they do!  So, please think seriously about giving any amount to help educate doctors so that they can better help us and yet to be diagnosed patients.  You do not have to wait till Tuesday to donate.

This post is easily shared though my Karen in Wonderland Facebook Page.

Also you are much better off donating to the Vasculitis Foundation than donating to dig a big hole.  

hole-4c32a341ed97d9f1fd88cdc4e33c34813c8e086d-s1300-c85

Seriously?

Here’s the very easy to use direct donation link.  Not the one to dig the hole.

https://vasculitisfoundation.secure.force.com/pmtx/cmpgn__Donations?

 

Thank you, and with Education we have a better chance of better outcomes and better quality of life.

Suzanne (aka Karen in Wonderland)

 

 

 

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Light at the End of the Tunnel

img_3413When I was first diagnosed with Churg Strauss Syndrome (CSS) all I wanted to do was run away.  Run away from the diagnosis, run away from reality, run away from my body.

After speaking with my doctor which quickly multiplies to be many doctors I was so confused, scared and just wanted answers.  Nobody seemed to have any, there were no clear cut medical protocols for CSS and I was the first CSS patient for most of my doctors.  I realized I had entered a tunnel… a long dark tunnel.img_3414

I was so ignorant of CSS and all that came with it.  I relied heavily on a Yahoo group for information and glimmers of hope.  SO many wonderful people told me things would be OK and helped me stand on my own while navigating the new world of specialist appointments and uncertainty.  At that time there were no Facebook groups about CSS.  I would say I had come out of the tunnel but the Winding road laid ahead.

I spent many, many hours at a local medical library getting research articles and reading everything I could find.  I ordered medical textbooks just to read one chapter on Vasculitis and CSS.  I was becoming an unofficial medical student out of necessity to understand my illness.  The road was less traveled but with each piece of knowledge I felt more empowered.  The information was both hopeful img_3418and doom and gloom.  I read it all… I kept researching, I needed to know everything to be in control.

I attended Vasculitis Conferences put on by the Vasculitis Foundation and tried to understand everything the medical experts were presenting.  What I did not understand, I looked up and studied.  The more educated about CSS I became, the more at peace I became.  I stopped running (although sometimes when new things pop up I still feel an urge to run).  I realized that for me education was the key to becoming empowered and calm about CSS. (link to my conference notes from 2014 UCLA conference on Vasculitis)and  ( 2016 UCLA conference) and (link to my Jacksonville FL conference notes)

Fast Forward ten years.  The internet is now so vital in researching any rare illness and there is such a wealth of information out there.  There are many good sites out there andimg_3425 many Facebook groups to ask other people with CSS questions.

For the past few years I have felt the need to share the knowledge that I have obtained and try my best to share things in these Face Book groups.  I try to read the articles and then pass them along with summaries or my own comments.  I get to share how I cope or things I find may work.  I get great pleasure out of taking complicated information and breaking it down to easy to understand parts (it’s the teacher in me coming out again).

I have found two other wonderful site and blog that seem to compliment what I do with my own web site and FB blog.  These are not big medical center sites — these are 2 sites run by CSS patients so they speak from the heart and understand what we are going through.

First off, Michael is from the UK and has a wonderful down to earth site about CSS/EGPA.  He speaks iheadern free flowing language that is easy to understand and poses things in question and answer format.  He also does his own artwork which is very quirky and fun.  If you have never seen his EGPA pages I highly recommend you spend some time investigating them.

Second is a FaceBook page called Vasculitis Journey.  The writer is newly diagnosed and 12341053_1673334592882647_837626086009016352_nwrites totally from the heart.  She is not putting on a show, she writes about her experiences and it is like reading a travel journal of her adventures with CSS.  I love her style and her positive attitude.  You can tell  she is searching for answers and scared.  By sharing this we see that she that she is actually a little bit of each one of us.  Scared and searching for answers.  She is a person that someday I want to sit in a coffee house with and talk for hours.

I appreciate the positive messages of both these sites and love the idea that our 3 sites are such compliments.  Michael’s EGPA.info is great info and full of resources and factual information.  My site and blog are personal experience with links to information and research.  I write from my heart and try to link it with information we may be craving about CSS.  Vasculitis Journey is like reading a wonderful book.  Chapters are her posts about life events and challenges with CSS as she continues her quest for answers.

I hope these three personal CSS sites/blogs will help you navigate your winding road of CSS and may help you get out of a tunnel, if you are stuck there.

img_3337

All road/tunnel photos were taken by me on a drive home from a doctors appointment in San Francisco along the California Coast to Santa Cruz.

 

 

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EULAR Report and informative Webinar on ANCA Vasculitis Treatment

We have a rare disease and it is up to us to make sure we get the best medical care and 9f4dfaa85e32a668c3063db2f8cc1833part of that is self education.  IF you read only one thing about your ANCA related Vasculitis all year… then THIS should be it.  Seriously, not kidding.

First off Granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) are termed the antineutrophil cytoplasmic antibody (ANCA)- associated vasculitides.  Even IF you are ANCA Negative (50% of CSS/EGPA patients you are still considered to have an ANCA Associated Vasculitis.

On June 23rd, 2016 a new document was published that updated the guidelines for treatment of ANCA Associated Vasculitis.  This was the first major revision of treatment guidelines since 2009 and in many ways it is a game changer because of the newer biological medicines.  It was created by European League Against Rheumatism (EULAR). Which includes doctors, nurses,  researchers and even a patient.

Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients.

Most of our doctors who oversee our Vasculitis diseases may have not come across this paper yet.  It is up to us, as a community that fight this illness every day to make sure our doctors know of the existence of this document and read it.  Please make copies, ask your doctor if they have seen it, hand them a copy… leave them a copy, mail them a copy.  b041636c2bce52c57a9149ccbb9487a6Many doctors do not have time to research and see the newest guidelines because they are too busy having to a patient every 15-30 mins.  It is really up to us, as educated patients to put this in out doctors hands.   I KNOW this is asking a lot but you may be helping yourself and others in the process.  Plus you owe it to yourself to read it…  and maybe reread it a few days later so things make sense.

What is reading and comprehending is Not you ‘thing’?  (gotta love brain fog)  Well, Great News then.  The Vasculitis Foundation offered an amazing Webinar last week in which Dr Richard Watts goes over the Guidelines for treatments and offers more background on the treatments with some very informative slides.

14725544_1584574984980762_2908869520809828059_nI had some misunderstanding about the EULAR report and Dr Watts really gave me more insight. (one was that things may have been rated a ‘C’ — not because they are unimportant but that there is lack of research on it).  These guidelines are not common practice yet and maybe by us, as patients, understanding them we can ask the questions that need to be asked and obtain better outcomes for ourselves or our loved ones.

So you should READ the EULAR report AND WATCH the Webinar.  Seriously… get yourself some popcorn.  Also ASK questions if you are having trouble understanding the contents of the webinar.  There are many very helpful groups on FaceeBook that can help or call / email the VF if you need help in seeking the best medical care or you just want to Thank them for the Webinar.  If you have ideas for future Webinars let the VF know too.

logo-blueEULAR REPORT on ANCA Associated Vasculitis Treatment

vasculitis-uk-logoThe Vasculitis UK has on their website a laymen’s guide to the new guidelines.  John Mills was the patient that participated in developing these guidelines.  Thank you Susan Mills for sending me this link.

 

logo1-300x60Webinar by Dr Watts on ANCA Associated Vasculitis Treatment

Webniar Time stamps — so you can go to the section that most interests you.
(thank you VF for publishing the time stamps)
What is ANCA Vasculitis 2:35
Aims of disease management 3:08
Future Challenges: Mortality Relapse 4:16
Background on the two sets of guidelines 5:40
Evidence Strength 7:51
Recommendation 1 9:34
Recommendation 2 10:20
Recommendation 3: 11:11
Cyclophosphamide Classical Approach 13:57
Rituximab–RITUXVAS 14:31
Outcomes based on ANCA Type 18:52
Recommendation 4 19:54
Recommendation 5 20:32
Recommendation 6 Plasma Exchange 21:00
Recommendation 7 23:01
Rituximab for remission maintenance in relapsing AAV 24:16
Recommendation 8 31:05
Conclusion 38:01
Q&A Session
Q: How do we get these recommendations out to the doctors? How do I get my doctor to read them? 40:19
Q: What do these recommendations mean to me as a GPA patient? What do they mean in terms of how my disease is managed? 42:16
Q: Please elaborate on the recommendation that says AAV patients should be treated by centers of excellence in vasculitis. Isn’t that what should be happening now? 46:54
Q: Can you explain what the Level and Grade numbers mean on your slides? 49:12
Q: How safe is it to be on Rituximab beyond the suggested 24 month term 51:40
Q: Are there any research studies that show a significant difference between stopping treatment with steroids and Rituximab after six months vs following up with Azathioprine? 58:52
 
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Living well with EGPA: The healing process

Living well with EGPA (Eosinophilic Granulomatosis with Polyangiitis )

5

The healing process

(EGPA) Eosinophilic Granulomatosis with Polyangiitis is also known as (CSS) Churg Strauss Syndrome

Written by Shawna

Being diagnosed with EGPA brought many things.  Relief because I finally knew what was wrong with me.  Disbelief that such a fit, healthy person could become so very sick so quickly. Fear of an uncertain future.  Resentment at no longer being able to do the things I used to do.

Nine years ago, after I was diagnosed and coming down from the euphoria of extremely high dose steroids, the reality of my disease – and my shattered life – really hit me. The doctors told me that I had done nothing “wrong” to cause the disease. They said that it was not my fault, and short of taking the meds they prescribed, there was nothing I could do that would reduce the impact of the disease on my life. It’s terrible, and we are sorry, but that’s the way it is, they said.

I refused to believe that there was nothing I could do, and poured myself into researching the condition and alternative therapies that might help me. In hindsight, I was frenetic and almost desperate to avoid what I perceived as the progressive horrors of things to come. To broaden the focus of my team of 6 medical specialists, psychologis1t, and family doctor, I began my very active, and completely exhausting search for answers. I read books, talked to anyone I could who had a chronic illness, and was willing to try just about anything. I adopted an anti-inflammatory diet. I visited Traditional Chinese Medicine (TCM) doctors for herbs and acupuncture, osteopaths, massage therapists, naturopaths to address food allergies, sensitivities and an overactive immune system, and yoga teachers for gentle exercise and “new age” spiritual guidance, among others. Some claimed that they could cure me. Some wanted me to stop taking the medication that had saved my life. Some were more realistic and happy to work with me and my core physicians. I was armed to the teeth, ready to fight this disease with everything I had.

Then I came across Dr. Andrew Weil’s book, “Spontaneous Healing”. It changed everything for me. Finding this book at the time that I did enabled me to slow down the constant searching for answers, take a deep breath, and really settle into living well.  Dr. Weil claims that he has witnessed seven characteristics in people who have experienced “spontaneous healing”, where the body heals itself.  (Not cured necessarily, but healed). My interpretation of the characteristics exhibited by people who have experienced “spontaneous healing” are:

1. Did not take “NO” for an answer

2. Actively sought out information, and took charge of their health

3. Sought out other people who had been healed (for support, guidance, and information)

4. Developed a constructive partnership with medical people

5. Made radical changes to their lives (usually lifestyle)

6. In hindsight, see their illness as a gift, because it forced them to change their lives

7. Cultivated an attitude of self-acceptance (of themselves, and who they are.  i.e., “I am not my disease”)

4Being “cured” and being “healed” are two very different things.  My disease is incurable.  But it can be quieted. I truly believe that I can heal.   I will heal in my own way, using the therapies that work best for me. I can live a productive, happy life.

I had already been addressing numbers 2, 3 and 4 with vigor before reading the book.

Number 1 – refusing to take “No” for an answer – was always, and still is, a fundamental part of my personality (like it or not). So that left three more things to work on…

Doctors told me that I did not require any lifestyle changes. Initially I believed them. I exercised, ate well, did not smoke and rarely drank, but I got sick anyway.  No one could definitively explain why.  After much soul-searching, I came to understand that my classic “Type A” personality likely contributed to my illness. I had never worried about my stress levels; my blood pressure, cholesterol, and weight were always well managed. But I believe that the constant pressure I put on myself, and the high expectations I had, certainly did not help my immune system deal with the situation that was brewing. I worked very hard to become more laid back, patient, and accepting of situations. Friends and co-workers who haven’t seen me for a while comment on how much I have changed. I am still a work in progress though, as new people I meet still find me to be determined and persistent.

How is it possible to see a life-threatening chronic illness as a gift? Accepting my illness as a gift required a massive shift.  My life “before” was pretty good.   But now that I cannot spend my precious energy on pursuing my career and squeezing fun and activities into every moment of every day, I have been given the gift of time…to notice birds singing, to walk my son to school, to read books, to practice yoga.  To nap – even if I do not really have a choice in that matter.

Time to heal all parts of me – physical, emotional, mental, and spiritual. Time to really live.

Developing an attitude of self-acceptance is a challenge for most people, health3y or not.  For me, I needed to acknowledge that I HAVE a disease, but I AM NOT my disease.  Often, people define themselves by what they “DO”… career, parent, activities, friend…. and not by what they really “ARE” deep down inside.  So when what we “DO” is taken from us through illness, we flounder, and feel like the disease has taken “US”.  It’s a very hard road at times.  I have been on this path for over 9 years, and acceptance is still difficult. Flares force me to revisit this acceptance piece, over and over again. It must be true that life lessons are presented repeatedly until they are learned. I am working hard on this one.

I still fight this disease every day; I absolutely refuse to lay down and let it kill me.  I also need to be gentle in my fight.  This is probably the most critical learning on my journey thus far. I do take responsibility for my medical issues, treatments and complementary therapies, stay on top of research, and fight for what I think is the right way to address this disease for me.  But I am gentle with my body.  Gentle with all of me. Pushing too far one day means that I pay for it for many days afterward.  I am grateful for what my body can do, even though it is only a fraction of what it used to be able to do.   I have immense gratitude for what I do have, and no longer grieve constantly for what I have lost.   In many ways I am so much happier and maybe even healthier than ever. Perhaps this is what “healing” really means.

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Some good articles for all CSS/EGPA patients to read

IMG_1078Just sitting around resting and came across some really great articles for CSS/EGPA patients.   Some of these I may have shared before but they are worth rereading.

Feel free to share and bookmark so you can read now or later.

  1. Eosinophilic granulomatosis with polyangiitis (formerly Churg–Strauss syndrome): where are we now? by Matthieu Groh, Christian Pagnoux, Loïc Guillevin
  2. Eosinophilic granulomatosis with polyangiitis (Churg–Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management.  September 2015

  3. Long-term patient survival in ANCA-associated vasculitis.  2010. (remember this report is 6 years old before Rituxan and other meds have become readily available)

  4. Value of commonly measured laboratory tests as biomarkers of disease activity and predictors of relapse in eosinophilic granulomatosis with polyangiitis.   June 2014

  5.   17 December 2015| PDF Full-text (903 KB) | HTML Full-text | XML Full-text
  6. Eosinophils in vasculitis: characteristics and roles in pathogenesis.  July 2015 (good graphics in this article)
  7. Acute Coronary Syndrome: An Emblematic Case and Literature Review.  PDF file 2014

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mepolizumab, reslizumab, lebrikizumab, tralokinumab, dupilumab

The UMABS have arrived!

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There is a group of new medicines hitting the market that may help patients with EGPA / CSS.  Since Asthma is such a large component in many patients with CSS these are mostly targeted at the asthma market.

These are various targeted biologic therapies that are currently in late-stage development for asthma, including GlaxoSmithKline’s Nucala (mepolizumab),  ( Teva’s Cinquil (reslizumab), Roche’s lebrikizumab, AstraZeneca’s tralokinumab, and Sanofi and Regeneron’s dupilumab.

Most of the new drugs in the asthma pipeline are interleukin inhibitors targeting inflammatory pathways.  Interleukin inhibitors are immunosuppressive agents which inhibit the action of interleukins. Interleukins are a group of cytokines which are synthesized by lymphocytes, monocytes, macrophages, and certain other cells. They function especially in regulation of the immune system.

I have attempted to gather information here about these new medicines and given links to find out more information.  I have Churg Strauss Syndrome (CSS) which has been renamed eosinophilic granulomatosis with polyangiitis (EGPA).   I live in  the USA, so my research is pertaining to the US market and focusing on CSS/EGPA.  A google search could give you more information pertaining to your country.  I do not work for these drug companies, nor am I in the medical profession.  I am a patient, a researcher and a life long teacher.

Mepolizumab under brand name Nucala in the USA

Nucalaapproved by FDA in November of 2015

Description:

Mepolizumab is a humanized IL-5 antagonist monoclonal antibody. Mepolizumab is produced by recombinant DNA technology in Chinese hamster ovary cells.

US- FDA-Approved Indications:

NUCALA is an interleukin-5 antagonist monoclonal antibody (IgG1 kappa) indicated for add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype.

Mepolizumab is an interleukin-5 antagonist (IgG1 kappa). IL-5 is the major cytokine responsible for the growth and differentiation, recruitment, activation, and survival of eosinophils.  Mepolizumab binds to IL-5 with a dissociation constant of 100 pM, inhibiting the bioactivity of IL-5 by blocking its binding to the alpha chain of the IL-5 receptor complex expressed on the eosinophil cell surface. Inflammation is an important component in the pathogenesis of asthma. Multiple cell types (e.g. , mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines) are involved in inflammation. Mepolizumab, by inhibiting IL-5 signaling, reduces the production and survival of eosinophils ; however, the mechanism of mepolizumab action in asthma has not been definitively established.

This is where it can help CSS patients.  If your asthma is the eosinophilic phenotype then Mepolizumab can lower the EOS in your airway which can lead to better asthma control.   This is not to be confused with Xolair which works on IGE / allergic type asthma by lowering the IGE level in patients.  Also note how it states “add-on” not replacement.

Dosage and Administration:

Nucala is given subcutaneously, 100mg administered once every 4 weeks under a doctors supervision.

At this time Mepolizumab is considered investigational and not medically necessary for all other conditions, including but not limited to:

  • aspirin-exacerbated respiratory disease (AERD)
  • atopic dermatitis
  • eosinophilic esophagitis
  • eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss syndrome)
  • nasal polyposis
  • hypereosinophilic syndromes (other than severe eosinophilic asthma)

At this time (5/11/2016) this is a kinda grey area for CSS patients.   You can in the USA get insurance approval for Mepolizumab for your EOS type asthma but NOT for CSS.  SO, usually you can (if you qualify) receive this medicine through your asthma or pulmonary doctor.

Now there are current studies going on using Mepolizumab at a dose of 300mg, every 4 weeks.  The study is due to conclude in August of 2016 then we can all await the results and see if Mepolizumab will be allowed at a higher dose for CSS patients.

Early, very non scientific, reports of CSS patients with the EOS type asthma using Mepolizumab has been very positive.  I can say that I have been able to lower my prednisone and am now off all asthma inhalers after just 4 months of Nucala / Mepolizumab.  Others have has similar results, although once your prednisone is lowered other CSS symptoms may become more prominent and this is why this is an add on medicine at the current 100mg dosage and not a total replacement medicine (in my opinion).   There are side effects, as in most of our immune suppressing medicines and it is up to the patient to really investigate these before making medicine choices.

Reslizumab under the name Cinqair

CINQAIR®

logoNOW APPROVED for use in the USA 4/26/2016.

CINQAIR® is a new anti-interleukin-5 approved as an add-on treatment for adults (18 years and older) with severe asthma and elevated eosinophil levels.

CINQAIR (reslizumab) is a humanized interleukin-5 antagonist monoclonal antibody (IgG4k).  Reslizumab is produced by recombinant DNA technology in murine myeloma non-secreting 0 (NS0) cells.

Reslizumab is an interleukin-5 antagonist (IgG4, kappa). IL-5 is the major cytokine responsible for the growth and differentiation, recruitment, activation, and survival of eosinophils. Reslizumab binds to IL-5 with a dissociation constant of 81 pM, inhibiting the bioactivity of IL-5 by blocking its binding to the alpha chain of the IL-5 receptor complex expressed on the eosinophil surface. Inflammation is an important component in the pathogenesis of asthma. Multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines) are involved in inflammation. Reslizumab, by inhibiting IL-5 signaling, reduces the production and survival of eosinophils; however,the mechanism of reslizumab action in asthma has not been definitively established.

INDICATIONS AND USAGE

CINQAIR is an interleukin-5 antagonist monoclonal antibody (IgG4 kappa) indicated for add-on maintenance treatment of patients with severe asthma aged 18 years and older, and with an eosinophilic phenotype (1).

Limitations of Use: CINQAIR is not indicated for:

• treatment of other eosinophilic conditions

• relief of acute bronchospasm or status asthmaticus

DOSAGE AND ADMINISTRATION

•  intravenous infusion only.

• Should be administered in a healthcare setting by a healthcare professional prepared to manage anaphylaxis

• Recommended dosage regimen is 3 mg/kg once every 4 weeks by intravenous infusion over 20-50 minutes

Reslizumab is also indicated for an add on in Eosinophilic Asthma so that is where CSS/EGPA patients can benefit from it.  Patients are just beginning to receive this medication in the USA so I do not have any patient remarks on it yet.

Lebrikizumab

being studies by Rorche and GeneTech not FDA approved in Phase III clinical trials

Lebrikizumab is a humanised monoclonal antibody designed to specifically block the action of interleukin-13. Roche is also conducting clinical studies of the injectable therapy in chronic obstructive pulmonary disease, atopic dermatitis and idiopathic pulmonary fibrosis.

About Lebrikizumab

Lebrikizumab is a novel humanized monoclonal antibody designed to specifically block the action of interleukin-13 (IL-13), a cytokine that is a key contributor to airway inflammation and asthma disease processes in some people. Clinical studies in asthma, chronic obstructive pulmonary disease (COPD), atopic dermatitis (AD) and idiopathic pulmonary fibrosis (IPF) are ongoing.

About Eosinophils

Eosinophils are inflammatory cells that can be present in increased numbers in the airways and blood of people with asthma (eosinophilia). Airway eosinophilia has been associated with key features of asthma. IL-13 plays an important role in attracting eosinophils from the blood to the airway, hence contributing to airway eosinophilia.

About Periostin

Periostin is a protein that has been identified as a key biomarker of inflammation in certain types of asthma. Its presence can be measured with a blood test. In people with asthma who have high levels of serum periostin, IL-13 appears to be a major contributor to their airway inflammation. An elevated serum periostin level has also been shown to be a predictor of airway eosinophilia, a prominent feature of asthma.

In February 2016 Roche reports mixed Phase III data for lebrikizumab in severe asthma.

Do your research on this one.  I am not finding a proposed marketing name in the US and the drug trials have very mixed reviews.  Interested to see how phase III trials go and what illnesses it is finally approved for.

Tralokinumab

being studied by AstraZeneca and Abbott

Interleukin (IL)-13 is a pleiotropic cytokine believed to be an important mediator in the development and maintenance of the human asthmatic phenotype through its role in key underlying mechanisms including inflammation , airway hyperresponsiveness (AHR) , fibrosis  and increased mucus production . Elevated IL-13 levels have been identified in the sputum of a proportion of subjects with asthma including those with severe disease treated with systemic corticosteroids.

Tralokinumab (CAT-354) is a human immunoglobulin (Ig)G4 monoclonal antibody which potently and specifically neutralises IL-13  and has been shown to inhibit a range of IL-13-mediated effects in pre-clinical studies. Tralokinumab is in clinical development for the treatment of asthma,

July 2015 — a study was done :

Efficacy and safety of tralokinumab in patients with severe uncontrolled asthma: a randomised, double-blind, placebo-controlled, phase 2b trial.   In this study it was found Tralokinumab does not significantly reduce asthma exacerbations.

This drug is still in the testing phases for asthma and other inflammatory illness.

 

Dupilumab

being developed by Regeneron and Sanofi

Dupilumab is a monoclonal antibody designed for the treatment of atopic diseases. It binds to the alpha subunit of the interleukin-4 receptor (IL-4Rα).[2] Through blockade of IL-4Rα, dupilumab modulates signaling of both the interleukin 4 and interleukin 13 pathway, which have been implicated in the pathophysiology of allergic disease, particularly asthma and atopic dermatitis.

Dupilumab is first systemic therapy to show positive Phase 3 results in patients with moderate-to-severe atopic dermatitis, a serious, chronic inflammatory skin disease marked by widespread rash, itching and associated psychosocial comorbidities.  U.S. regulatory submission for dupilumab planned for third quarter of 2016.

So, how does this drug enter the world of CSS you may be asking yourself.  Well, a clinical study was done, Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis, which showed some positive results.  As we know many CSS/EGPA patients suffer from Nasal Polyps and Sinusitis.

In 2013 there was a study of  Dupilumab in Persistent Asthma with Elevated Eosinophil Levels with promising results.

My Conclusions on the UMABS:

I think there is great promise here to help alleviate some of the symptoms of CSS and I am very excited to see how much research is being done.  We as a CSS/EGPA community because of the rarity of our illness depend on drugs being marketing to other communities and then being studied and used off label for CSS/EGPA (this was true for Rituxan many years ago).  As always it is up to you as a patient to do your research before beginning any new drug therapy, each have their burden of side effects and as always insist on careful and continued monitoring while on and after any drug therapy.

 A really good follow-up article to read

Novel targeted therapies for eosinophilic disorders by Michael E. Wechsler, MD, MMSc, Patricia C. Fulkerson, MD, PhD, […], and Amy D. Klion, MD

From 2012 but a great Table graphic explaining Biological drugs in asthma treatment.

PDF links to handouts and prescription information (including known side effects):

Nucala

Cinqair

want to read more about CSS/EGPA?

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It’s hard…. what Dr’s never tell you

Although this is written for CVID (people who are receiving IG replacements) — this really is an article for anyone with a chronic, incurable illness.
After reading this I felt like the feelings I was having recently are not mine alone.
“It’s hard.That’s what they don’t tell you when you get diagnosed. They tell you things like “It’s manageable.” Of course, that is what they’re supposed to do. They’re doctors. But nobody ever tells you that it’s hard”….. click on the link to read more.

http://www.igliving.com/BlogEngi…/post/living-with-cvid.aspx

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CSS /EGPA December Awareness Post

December’s Churg Strauss Awareness Post is up and ready for sharing.

Join Dennis L. on his journey.

Is That A Horse Or A Zebra?

by Dennis L.

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When I asked myself why I volunteered to write something about my history with  Churg Strauss Syndrome (CSS) (also known as eosinophilic granulomatosis with polyangiitis [EGPA] or allergic granulomatosis,)  I heard a voice that sounded like many doctors we’ve all seen and heard: “Could be the medications.”

Then I asked myself what angle should I take and I heard some of those same voices: “I don’t know, let’s run some more tests and see what develops.”

I underwent seven sinus/polyps surgeries prior to my diagnosis of CSS in 2005. The last surgery was in late 2004, from which I had trouble bouncing back…literally! Active in youth sports coaching for years, my attempt to return to basketball practice left me on the sidelines, dizzy and exhausted. I thought that maybe that nasty three letter word ”age” might have slowed my recovery, so I went about the business of living and working, acting as if everything was okay.

Two weeks later, I was hospitalized due to shortness of breath. imagesPulmonary Infiltrates showed up in both lungs, I was treated for pneumonia with antibiotics and oxygen, while giving the same “no” answer to that pleasant question: “Are you coughing up anything?” After two weeks of being unable to convince the pulmonary doctors that I did not have pneumonia, I heard from my primary care doctor about an article he had just read in The New England Journal of Medicine concerning CSS…First time he had heard the term, First time I had heard the term. He checked with the ENT who had performed the sinus surgery and found my Eosinophil Blausen_0352_Eosinophil count was excessively high. My primary care doctor had no hospital privileges so we worked together to get the disbelieving doctors to drop the antibiotics and start a high dose of Prednisone. Two days later, I walked out of the hospital without the aid of any added oxygen.

As I tried to reduce the Prednisone, other symptoms presented themselves; neuropathy in arms, legs, and feet, skin rash on legs, fatigue and blood clots. I was sent to the Medical University of South Carolina, where I was immediately started on around-the-clock IV’s of cyto500aCytoxan and steroids for four days. After dismissal, I received IV treatments of Cytoxan once per month for six months, along with being placed on oral dosages of Methotrexate and Prednisone.

 

Subsequent to that initial fun, I’ve had a number of illnesses: pulmonary embolisms, prostate cancer, phlebitis, cataracts in both eyes, and possible kidney and abdominal involvement.

I’ve also had many personal setbacks since 2005: my wife decided to leave after 34+ years together, the loss of work and the need to go on disability, personal bankruptcy, and the deaths of my parents in the past three years.

Understanding that not everybody’s symptoms, tolerances, or life situations are identical, I

'There are some things they don't teach you in medical school. I think you've got one of those things.'

believe there are two major stages in dealing with life with this disease. The first stage consists of sitting on the sidelines letting doctors, nurses, and tests run your life, becoming an accomplished actor when you know that something is not right with your body. Others don’t believe it so you use your acting skills to move into denial…maybe even believing you don’t really have CSS and everybody else must be right.

The second stage takes a more positive and proactive approach, believing and hoping that you do have some power over this unique syndrome. Actively question doctors and test results. Don’t accept snapshot results…make sure your medical team is looking at trends. Change doctors who don’t try to answer your questions. Believe that there are people out there who can help you. Get back in the game as much as possible…don’t let everything keep you on the bench!

Now to explain the title: in my recent search for another opinion, I was referred to a new nephrologist. He was a pleasant young man. We had a good discussion on autoimmune diseases and the need to treat them differently. He then related a quote from his medical professor: “If you hear hooves, it may not be a horse, it may be a zebra.” With autoimmune diseases, you need to be sure your medical team is looking for both the horse and the zebra!images-1

kevinselig
Kevin Selig  was diagnosed in January 2014 with Churg Strauss Syndrome and fought a courageous battle against the disease. Kevin passed away on Saturday, June 21, 2014, at the Mayo Clinic Hospital in Jacksonville, Florida.
We in the CSS community were saddened by the loss of such a vibrant human being and reminded how our illness often goes undetected until too late.  Glenys , a very brave CSS warrior, set us into motion to bring awareness to our disease with a challenge to raise awareness of Churg Strauss Syndrome by posting a story on the the 1st of every month in an effort to let the world know we exist and we want to help others obtain earlier diagnoses. 

Link to other CSS awareness posts in memory of Kevin Selig

General CSS/EGPA and Vasculitis Information

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