Thursday, June 19, 2008

The Immunologist Visit

This is just a quick update on yesterday's visit to the immunologist. I need to head out to the rheumatologist soon, so this is just the basics on my test results. I'm sorry that I haven't been posting much lately, but I've been on a downward trend for the past few weeks and it's been hard to spend much time online. Apologies also to those who have emailed and I haven't responded to. :(

I had neglected to ask during my first visit what blood tests he was going to run, so it was a little bit of a surprise when he gave me the good news that I'm HIV negative. Of course, I knew that. It's state law to test pregnant women in Oregon, so I was tested back in 2004. But it's always nice to get confirmation that it's still true. :) I also found it interesting that there's now an HIV-1 and an HIV-2 test. Both were negative, which is always nice.

The immunologist apologized for not telling me in advance they were running the HIV test. Apparently, they're supposed to. But he said it's standard protocol to run that test when they suspect any immune problems, even when they don't expect the patient to have HIV.

My tetanus antitoxoid antibody was very strong at 6.08. Anything over 0.15 IU/ml is considered a protective level. (I had a little trouble with the concept of "protective level" rather than positive/negative or high/low. This is all so new to me.)

He also ran an Immunoglobulin G subclass panel and serum level. Those were all within normal range, as were my Immunoglobulin M and E levels.

My Immunoglobulin A level was low at 50 mg/dL. Normal range is 81-463. My doctor said that's sort of a nebulous test result. It says something is going on, probably, but it's very unspecific. He also says many people have low levels of it with no symptoms whatsoever.

Since we had discussed my frequent sinus infection and rounds of bronchitis and pneumonia over the past couple years, he also wanted to look at how well my immunity to those kinds of infections were. The test name is streptococcus pneumoniae IgG AB (14 serotypes). The doctor said this test essentially looks at how well the immunoglobulins actually work when faced with the disease even though the overall immunoglobulin levels are fine.

The paperwork says any S. pneumoniae type-specific antibody levels of about 2.0 were considered protective against the disease. The doctor says the typical person is protected on 75 to 100 percent of the serotypes. I was above the 2.0 level on four of the 14 tested plus a fifth was at 1.9, which is essentially at the protected level.

I was below 1.0 for seven of the 14 serotypes, and at 1.2 for two of them. He found that concerning.

Normally, the next step is to give the patient a pneumonia vaccine and then run those serotypes again four to six weeks later. But as in everything else medical, I make that complicated. I had an allergic reaction to the vaccine in March 2000 that resulted in an ER visit five days later, when my arm was red, hot and swollen around the injection point pretty much from elbow to shoulder, I was running a fever and I had started having trouble breathing. They gave me a shot of something and put me on Prednisone.

So I need to be allergy tested before they will administer it. I go back on Wednesday for a three hour visit where they will do a series of tests to see if I react. If not, they will give me the injection at the end of the appointment. If I do react, I don't know what happens next.

The immunologist said that because of my serotype test results that even though the immunoglobulin tests were mostly normal, he would do a more indepth test looking at the cellular structure of my immunoglobulins.

So, on Saturday I have to stop taking my allergy medicine because I need to be off all antihistimines for five days before they can test me. I also will need to change pain meds because I currently have to take Benedryl to counteract the itchiness I get from Percoset, a mild allergic reaction I'm told.

What sucks is that I asked if at the same time, they could do the full allergy testing, which the doctor had told me he was going to want done at some point. But because I've had a reaction to the pneumonia vaccine (which he told me is very rare -- aren't I lucky? :), they can't risk not being able to tell whether a reaction is caused by the vaccine or the other allergens.

I have horrible, year-round allergies and I just can't imagine going five days without medication for it twice. Sigh. But at least he's not saying I need to do the full panel anytime soon so maybe I can wait long enough to forget about how horrible it is without allergy medicine before I have to do it again.

Also, the immunologist did say that he doesn't really think my main problem is going to turn out to be an immunology issue. He said he is fairly certain it's an autoimmune disease and that he would lean toward believing it is lupus. Of course, he says he defers to my rheumatologist to make that diagnosis.

The immunologist is also going to continue to monitor me for my monoclonal immunoglobulin issue (MGUS), which is sometimes but not always a precursor to multiple myeloma. That's a relief because I found out recently that my hemotologist is getting married and moving to Medford, OR, at the end of July and I really don't feel like starting a relationship with another new doctor right now.

Yikes, now I'm late to leave for the next doctor appointment! I'm definitely supporting the Portland medical community this month with my almost daily doctor appointments.

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