Classic Churg Strauss Bingo

beoneonright

Yup, this symbolizes me. Basically the girl on the right.

When I was first diagnosed and in the process of coming to terms with being chronically ill I wrote A LOT!   Now that I have started this blog,  I want to share some of those posts.

Some posts are funny, Some are sad and  Some make you wonder how I woke up each morning and moved forward.   These posts are my history, a part of me and weather they are good, bad or ugly they are part of who I am and have become.

Originally Written on : April 5th, 2007

(I was officially diagnosed on April 1st, 2007)

BingoClassic Churg Strauss BINGO

(this was before the name change to also known as eosinophilic granulomatosis with polyangiitis EPGA)

Funny how after months of doctors not knowing what was wrong with me, I now hear the term, “you are presenting with Classic Churg Strauss” from too many of them.

What is ‘Classic Churg Strauss’? And why I am one of those lucky few? And how would they know since I catch them using the internet to search for it and pulling down those dusty medical textbooks.

As defined on dictionary.com —dictionary
Classic –(adjective)
1. of the first or highest quality, class, or rank: a classic piece of work.
2. serving as a standard, model, or guide: the classic method of teaching arithmetic.
3. of or pertaining to Greek and Roman antiquity, esp. with reference to literature and art.
4. modeled upon or imitating the style or thought of ancient Greece and Rome: The 17th and 18th centuries were obsessed with classic ideals.
6. basic; fundamental: the classic rules of warfare.
7. of enduring interest, quality, or style: a classic design; classic clothes.
8. traditional or typical: a classic comedy routine.
9. definitive: the classic reference work on ornithology.
10. of or pertaining to automobiles distinguished by elegant styling, outstanding engineering, and fine workmanship that were built between about 1925 and 1948.

Now after reading all these definitions I have to come to realize I am NOT a car nor was I born between 1925 and 1948.   Although I have Greek Ancestry I am not an antique (that I know of).  This autoimmune disease has made me fight it but it has it has own rules so the warfare one is out.

I think I am of the highest quality and doctors seem to think my Churg Strauss is of enduring interest.  They must because they keep wanting to see me in their offices.

Am I a classic comedy routine? Well, I tend to make the doctors laugh, even if it is a nervous laugh sometimes.

Definitive… am I definitive? Well if we were playing Churg Strauss BINGO I would not need the free space to fill in my row. I can picture it now…

Ok Ladies and Gentlemen,bingo-685x320

Time to get out your BINGO card and play the new and exciting game of Churg Strauss Bingo. Tonight’s jackpot is a lifetime of prednisone and oral low dose chemotherapy. We are playing by The American College of Rheumatology rules.

In order to fill your card you need to fill in 4 criteria and you may use the free middle space.

If  you want the special autoimmune jackpot then you need 5 squares.   Go for 6 and get the wildcard prize.

Remember we are not playing any regular vasculitis game here; this is the highly specialized Churg Strauss BINGO.   Many will play few will win.  Be the 2.4 per million. Play today.

Ok-
B = asthma
I= eosinophilia [>10% on differential WBC count]
N= mononeuropathy
G= transient pulmonary infiltrates on chest X-rays
O=paranasal sinus abnormalities

And the elusive Wildcard card is…..biopsy containing a blood vessel with extravascular eosinophils.

I got BINGO with the wildcard as of today.   What are your scores?

It’s been 8 years since I wrote the above post on Churg Strauss Bingo but the diagnostic criteria is still correct today.  Notice how it never mentions you have to be ANCA positive to have CSS.  This is a common misconception about CSS but as far back as 1990 it was recognized that you can be ANCA positive or negative and still have a definitive diagnosis 10956057_10153034950254114_900640331162474468_nof Churg Strauss Syndrome (CSS) now which changed got renamed in 2011 to be descriptive of the symptoms to Eosinophilic Granulomatosis with Polyangiitis (EPGA).

I wish once you got a BINGO your prize was a cure.  There is no cure, at this time, for CSS.  It is considered to be a Chronic Illness and will go through periods of Flares (active disease) and quiet periods.  Most CSS patients will be on some sort of ‘control’ medicine for the rest of their lives, these meds may be to control the CSS and keep it quiet or to deal with the damage to the blood vessels and organs that CSS caused.

With each passing year, I see more research into Vasculitis, which CSS is a form of, and progress is now being made to pinpoint something genetically.  Years ago we only had Cytoxan but now we have more biological meds like Rituxan and now is testing is a drug called Mepolizumab (clinical studies now being conducted for patients with relapsing or refractory Eosinophilic Granulomatosis with Polyangiitis).  They have even found out that HLA-DRB4 gene positivity may be a genetic risk factor for the development of Churg Strauss syndrome and may increase the likelihood of vasculitic manifestations of the disease.

So,  although my BINGO card is full so is my heart.  Filled with hope that we will find a drug combination that will minimize the effects CSS will have on patients in the future.1902939_10152826110132881_4264012896430159962_n

 

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Karen in CSS Land — My Pathway to Diagnosis

In the spirit of Vasculitis Awareness Month I am going to republish the story of my diagnosis with Churg Strauss Syndrome, a rare type of Vasculitis.IMG_0845

This is my CSS story. The one I wrote when my world was all confused and I was in both physical and emotional pain. I would like to say things have gotten all back to normal 8 years later but they haven’t.  I don’t want to let this stupid illness rule my life but at times it does. It decides when I can be active and when I need to rest. It flares at the worst times and since I am  labeled as highly refractory, I have never had the joy of remission.  CSS may rule a major part of my life but it does not define me as a person. I still love to cook, and watch my daughter ride her horses. I love to snuggle with my son and have have the weirdest conversations with my eldest daughter. I am still trying to raise so rather co-dependent poultry and laugh and smile whenever I can, which is often!

Please read on, rather lengthy but a look inside myself , my pathway to diagnosis and this rather strange illness.

March – April, 2007
My Churg-Strauss Story

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As I sit here attempting to write my story about being diagnosed with Churg Strauss Syndrome I am amazed of how this came to be. The last 7 months seem to be a blur. And my future is a haze. So somehow I sit here caught in the middle. Too scared at times to go backwards or forward. But I know I must go forward. So here is my look back.

Ten months ago (May 06) I was hiking the Grand Canyon with my family without any health concerns. Sure, I was slightly overweight (who doesn’t want to be one dress size less) and I had high blood pressure ever since the birth of my 3rd child 9 years ago. But that was all manageable; 1 tiny pill a day. I was an ex-teacher turned supermom and loving every moment of it.

After 9 years of living with a leaky roof I finally got my husband to agree to a remodel. The work began the 1st week of September 06 with a total roof tear off; lots of yucky black stuff fell inside the house.

My first signs of illness began by the end of that week. It started with hives – mean and ugly ones. Then came a cold with a cough but the cough never ended and I ended up at an urgent care center. I was diagnosed with reactive airways and sent home with my very first albuterol inhalerinhaler_1024x1024 and prednisone (little was I to know that prednisone was soon to become my best friend). As the prednisone was tapered down my symptoms became stronger and now I was running a fever and having night sweats. So back to urgent care where after some chest x-rays (told they were mostly ‘normal’.  I really want to know why doctors use words like ‘mostly’ normal.) I was put on more prednisone and some antibiotics.

Two more weeks passed and by now I was coughing so hard that I was throwing up. Back to urgent care and my first nebulizer treatment. WOW! I thought that was amazing.  I could actually stop coughing for an hour.  It was short lived.

Finally I broke down and went to my regular internist. I started crying in his office because I felt so bad. He listened, shook his head,  patted me on the shoulder and stated I had acid reflux (GERD). Another round of prednisone and antibiotics were started and an acid reflux pill. I walked out of his office in disbelief. I was so upset and I coughed so hard, I threw up on his sidewalk (that will show him!).

By now the only way I could sleep was by sitting up and using the nebulizer every 3 hours. But if it was only acid reflux, then what was my problem? I got ANGRY! This was NOT all in my head. I called an asthma/allergy office and after crying on the phone obtained a header_physicianssame day appointment. It was here that I meet my savior (aka my asthma doctor). He walked in the room and even before meeting me put his hand on my shoulder and stated, “Man are you sick!” Then he sat down and stated, “Talk to me…” It was the most refreshing three words I think I had every heard. And he listened.  Really listened! Never interrupting, never judging.  I suddenly felt like I was going to get better.

The next weeks are a blur.  CT scans of chest and sinus, bronchoscopy of my lungs, allergy testing that showed I had all these allergies (shocking since I had never had an allergy in my life), visits to an ENT (who recommended I go off all inhaled steroids!), visits to an eye doctor because suddenly I was getting blurry vision and my eye pressure was dramatically increasing, too many blood tests and once again an increase of prednisone to 60mg (by now I was gaining weight and began referring to prednisone as ‘evil candy’devils-tic-tacs – I hated it but needed it to breath). And what came of all this? A diagnosis of severe, persistent asthma that was hard to control. Sure they found a rather large amount of Eosinophils (EOS) in my lungs but I did have allergic asthma after all. I was now taking 10 different medications a day! But I was functioning – sure my resting heart rate was over 110 and my blood pressure was dangerously high; but at least I was functioning again! How bad could that be? My asthma doctor had nicknamed my cough as ‘the cough from hell’ and every time I went to see him he always started our conversation with those most comforting 3 words.  “Talk to me….”IMG_3072

Then came the sinus infection. More antibiotics, more prednisone.  I was having a bunch of other strange symptoms too (my one kidney was hurting all the time, I was breaking out in strange rashes, I had this funny pins and needles sensation in my left hand, my chest was hurting) but I kept them all to myself.  I began to think that I was making this all up!  I must be! It was all too strange.  I mean,  I must be a middle age, bored housewife that had nothing better to do but go to different doctor’s. I began to hate myself and my body.

Once off the prednisone (again… can you say taper #8?) Things went downhill quickly. I called the asthma doctor again and asked him I thought it was funny how I always broke out in strange rashes a few days before a major asthma attack. He sent me for another set of blood work. He wanted it done when I was off prednisone.

He called me a few days later and wanted to see me in his office. It was at this appointment that I told him I really thought this was all in my head. I kept apologizing for wasting his time. He listened, I talked.  He got me to ‘fess-up’ to some of my hidden symptoms. He was surprised that I had so many other symptoms. I explained to him that he was my asthma doctor and since my internist 10956057_10153034950254114_900640331162474468_nthought it was nothing (and prescribed anxiety pills for me) I didn’t want to bother him. At this point the asthma doctor showed me my blood work – he explained that my EOS level was at 25% and I was showing signs of a kidney infection. I begged not to go on prednisone again (the mood swings and the weight gain were getting to me). He used the words ‘organ failure’ and I unhappily accepted the pills. I would taper off prednisone once again and then we would do a skin biopsy and another blood test. I was scared! I knew something was not right. The asthma doctor spent an hour talking to me in his office when I told him I thought he should go because he was backing up other patients he answered,  “If they don’t understand than they shouldn’t be patients of mine”

This was the first time I had an out of body experience. I realized when he was talking to me his voice became far away and I was an observer of the conversation. This would happen a lot to me in the coming weeks. I soon came to discover it was my coping lifedidntgoasplannedmechanism.

The next time I tapered off prednisone we attempted to find the definitive diagnosis.   It was at that time that I wrote this.  I think it is best shared in its original format

1 day… 4 doctors.. long day…

Quest for diagnosis continues… Sometimes I think the doctors want
me to become REALLY sick in order to diagnose this! I’m not in the
hospital so I must be OK is the thought…

Today I got to see my asthma guy (who I love!) – and he basically set up a bunch of other specialist appt for me in the coming weeks. He still thinks it’s Churg-Strauss even though my ANCA tests come back within normal limits. Just came off a prednisone taper so we can run tests this week and my cough and my rash is taking over more body parts every day.

Vampire_PNG_Clipart_PictureDid the blood test thing (note to self.. blood techs don’t like being
referred to as vampires…)

Went back to dermatologist to have him re-stitch one of my biopsy
sites. Although my husband offered to do it at home I just thought it was more sterile to go back to the dermatologist.

Visited my friendly neighbor eye doctor to check eye pressure. Still high but just shy of official glaucoma. Noticed he got new office furniture; asked if my frequent visits had helped pay for it. He laughed nervously.

Then it was off to the pulmanologist. We played the “what makes you think this is anything but normal asthma game”.  He had copies of my latest blood work — did a chest x-ray and then came back into my exam room and said he thought it might be obscure auto immune thing called churg-strauss (no **** sherlock!). But he had to run to an off site appt. — as he was leaving he keep saying he needed to see me again. I told him to have his secretary call my secretary. He gave me one of those strange looks.

You know sometimes I think my strange sense of humor is the only thing keeping me sane. In between appointments I went to a book store to look at cookbooks — while there I started crying and couldn’t stop – very embarrassing.  I think I am fine as long as I am busy.  It’s those quiet moments that sneak up on you.

Have an appointment with a cardiologist at the end of the week. My heart just likes to race and make me short of breath. And the earliest neurology appointment I could get was in early May (numbness and tingling in left hand) Now they also want to send me to kidney specialist (darn kidney just wants some attention — I told the asthma guy that it just felt neglected and we should ignore it.  He gave me one of those looks again.) and they also want a GI consult — Hey I thought it was a good thing that on this last prednisone taper I actually lost 10 pounds — I think it all averages out in the end.

It was at this time that I realized I needed to write things down. I suddenly felt the need to sort my feeling out. Too many things were happening.

april-fools-day-bannerWithin a few days my diagnosis came in, the date was April 1st, 2007.   The skin biopsies showed vasculitis. My EOS level was back up to 21%. My asthma was unstable again and the rash was taking over major parts of my body. When I got the call stating it was Churg-Strauss didn’t know what to do. I felt like I was drowning. I explained to my doctor I was waiting for him to say, “April Fools!” – Although I had emailed family and close friends preparing them for this diagnosis; I think in my logical, systematic approach I neglected to prepare myself. Would you believe I even sent a letter to my asthma doctor making him feel better about having to give me such life changing news? I am so busy trying to make others feel better about my illness that I forget that I am the one that needs the comforting.

I tried to explain it to my husband that I feel like I am running and if I stop this illness, known as Churg Strauss, is going to run over me like a freight train. I just keep moving.  Currently I am at the stage that we are trying to figure out what organ systems have been affected. We know it got to my lungs and skin. We have a strong suspicion it has affected my heart (the uncontrollable blood pressure and the tachycardia are all symptoms). I still have to visit a neurologist to see about that tingling in my hand. There are questions about my kidneys (you mean one shouldn’t be able to feel their left kidney?) Since I have lost a lot of weight (18 pounds in 3 weeks but I look great in jeans now!) they are now questioning my GI tract. It is overwhelming! I keep running from doctor to doctor in hopes that the train will not catch up to me.

I am scared.  Who wouldn’t be? I have these unseen cells in my body attacking.eosino I even went through a stage where I refused to eat for a week, deciding that if I didn’t feed these cells they wouldn’t multiply and harm me (dumb! I know!). I am grieving. A good friend helped me understand that having an illness like this makes you grieve. Grieve for what you lost, that carefree feeling; the not worrying about every ache and pain. I know that will settle down in time too. Logically I know – emotionally I am in turmoil.

A few days ago I crashed.  Emotionally.  I went to a doctor’s appointment only to forget that it was rescheduled for another day. After leaving the office I began crying – I felt like that juggler that has all those balls up in the air. juggle-228x300This was my first ball to come crashing down – I panicked, thinking that once one ball came down they were all going to fall. I got in my car and began driving – to nowhere in particular – the important thing was that I was ‘running’ – I needed to keep moving. I drove, and drove and drove. Then I got tired and stopped. I fantasized about going to the airport and getting on the first plane to anywhere; just to run away. I knew this was neither logical or sensible but it was emotional. It was at this time that my phone rang and it was my asthma doctor, he uttered those three words I used to find so comforting, “Talk to me ” but this time I answered NO! I think I scared him! He was trying to figure out if I should increase my prednisone again, since my rheumatologist appointment was still 3 days off. I was running and he was interrupting. He told me to, “hang in there” ; I said it was easy for him to say.  He apologized. I hung up after agreeing to another 10mg of prednisone increase – he kept stating that he didn’t want to visit me in the hospital. After a good cry I returned home to my family. I knew that is where I belong (but a big part of me still wants to run away from this illness).

We will be throwing this thing into remission in the coming weeks/months and then it is all about being vigilant with weekly/monthly blood tests to make sure it stays in remission. The drug mix they use for remission is not always a pleasant one but it’s better than the alternative.

Everything will work out — I will be limiting my activities. (what no skydiving?) The annual camping trip is definitely a no-go this summer. The only camping I should be doing involves room service and a butler. And it’s a bummer that I will have to hire house cleaners two days a week now (no downside here) I have to remember to rest a whole lot more.  A tired body is ripe for the overtaking by these cells.

There are humorous moments during all this. When the dermatologist grabbed me by the arm and keep patting my hand as he lead me to a chair to sit down (note to doctors, don’t ever do this! YouIMG_2930 freak the heck out of your patients!) He then asked me if I knew what vasculitis meant? I was so tempted to say “No, is that something bad?” but I couldn’t I let him off the hook and let him know I realized the seriousness of my illness. There are those days of getting blood taken where you have that hidden set of plastic vampire teeth in your purse – not daring to take them out but it makes you smile as you get poked one more time. There are those well meaning nurses that hand me a glass of water to drink when I am in the middle of an asthma attack (I cough rather than wheeze so this confuses them) – I say thank-you politely. There was my dentist with a sad look in her eyes when I told her about my illness – she asked if there was anything her office could do for me.  I mentioned my house needed to be painted. I need humor to get through my days – sometimes it allows me to stop running for a little while.

I found myself stating to people how ‘lucky’ I was that my illness was caught early. But darn it—I am NOT lucky! I hate that word! I find myself using it as a defensive mechanism

horseshoefor-0317-2
ie: I am so lucky I have a doctor that kept testing things.
I am so lucky in was caught early (wait I have vasculitis already and am in stage 3)
I am lucky I can afford this illness (who in their right mind can afford an illness?)
I am lucky I have kept myself out of the hospital (that’s not luck; that’s pure stubborn woman!)
There is nothing LUCKY about having Churg Strauss Syndrome! It STINKS! But with time and patience I will learn how to adapt my lifestyle. I will stop running and the freight train will not run me down. And when my wonderful asthma doctor says, “Talk to me” I will!  I need to talk and to cry and to scream.

I have learned that life is a precious thing — we get caught in our daily activities and forget that. My new message tagline is, “When life gives you lemons,  say they are from a small independent organic farmer and sell them for three times as much.”IMG_3163

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May CSS awareness post is up

Here is the link to the May 2015 CSS Awareness Post.  Please enjoy  and this month is a little different.  Instead of focusing on CSS as an individual the focus was on how can you help CSS and Vasculitis awareness.

May 2015 CSS AWARENESS Post by Karen in Wonderland aka Suzanne

 


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