Just diagnosed - vasculitis GPA : Hi, I am so... - Vasculitis UK

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Just diagnosed - vasculitis GPA

NacMacFeegle profile image
30 Replies

Hi, I am so glad I've found this site as I am just at the start of my vasculitis journey and from what I read, seen and heard I will need all the help I can get. I suspect my immune system got triggered when I donated blood in August 2018 - I got really sick during the process. Nothing unusual, it happens. But few days later I felt numbness in left arm and waves of nausea while at work. It was so sudden and unusual for me that I hotfooted straight to A&E. They ran the tests for heart attack - my ticker came back perfect. Doctor thought I might be experiencing anxiety attack. I actually felt relieved, phew, nothing wrong with me. For few days felt fine, then one morning woke up with pain in lymph node on left side of my neck and blocked left ear. I did not go to GP for few weeks because I had one bout of Eustachian Tube Dysfunction in 2016 and knew there is not much they could do about it. But my ear got worse, so off to GP - she gave me steroid spray. Few weeks go by, both ears in pain and pain in bones right under the big toes. Trip to GP again, given antibiotics and medication for gout. About a month later ears still giving me grief - third GP insists it is ETD and gives me another steroid nose spray and tells me to use it for 3 months, if I do not see improvement by then to come back. In the mean time the body starts hurting - everywhere. Severe pain in shoulder - sometimes left, sometime right. Pain in my feet - soles, toes, ankles. Knees. Joints on my hands. I started waking up during the night covered in sweat. Some nights the pain would get so bad I could not find a position comfortable enough to fall asleep. I could not go through a day without painkillers. In hindsight it seems ridiculous that I went to see my GP three times for blocked ear but suffered all this pain and waited 6 weeks to see a GP about it. But I changed jobs in November and went from sitting in office to being on my feet a lot and joined the gym - I thought I pulled a muscle, overdid it, wore wrong shoes. I wanted to believe that, believe it will all go away. But it did not. I was getting more tired, even if I managed to get a full night sleep I'd wake up exhausted. Almost Christmas time, I thought I'll get some rest over holidays, I'll be fine. It got worse. By January I noticed I am getting really breathless after only one flight of stairs. But was not breathless otherwise, so I was not to alarmed, thought maybe I am just out of shape. I start spitting out blood - but I am convinced this is a post nasal drip, from my blocked ear and from using the steroid noise spray. Finally I get an appointment with GP at beginning of January who listens to my symptoms and does a blood test for arthritis. Calls me back in few days and says you are fine, tests are negative. I drive straight to GP surgery and ask if I can have few minutes to talk about it. Credit to him, he did agree to see me without appointment, not an easy feat these days. I told him in how much pain I was and how I felt, and regardless of my test results saying otherwise, I am not fine. He agrees to refer me to rheumatologist. I ask "will I have to wait long"? He says no, 2-3 weeks. I get my referral appointment date in the mail - end of March. 2-3 months more like it. First lucky break - I go on referral web site and find one appointment free on 11.02 and book it straight away. I struggle through January, pain in my joints is really bad now. I can barely walk, barely get out of bed. As soon as the effect of painkillers wears off I can barely move. I still think - this will go away, I just need a right treatment. I will be fine. Lucky break number two - I see the rheumatologist on 11th, she listens to my symptoms and tells me they are all over the place so she orders bunch of blood tests, chest, feet and hand x-rays. She asks for urine test, but I am on my period so we skip that. She gives me steroid injection and some medication and sends me home. Three weeks later I am back in her office, my tests came back. I tested RNP positive and c-ANCA PR3 positive. She suspects vasculitis but needs to do more tests. Sends me to ENT for my blocked ear, cardiology for echo and pulmonary function, and CT of my chest. Gives me another steroid injection and antibiotic. Few days later, surprisingly, I wake up feeling well. The pain in my joints subsided, they look almost normal. I am optimistic, feel good.

First appointment I get is for pulmonary function - and this is my third lucky (or maybe unlucky) break. During the test they ask me to breathe deeply - I get lightheaded, so they have to stop the test. I feel numbness down my left side, leg, arm, tingling, strange feeling on the left side of the face and head. Nurse thinks this is just anxiety after hyperventilating, but I don't feel better so they get a porter to drop me off at A&E. Someone will come to see me they say. I sit there for 45 minutes, slowly feeling better. I think, if I was that ill they would have seen me by now. If I am not, there is no need for me to sit here. So I tell the receptionist I am leaving and drive home. All I want to do is sleep. An hour later, doctor from hospital calls, almost pleads with me to come back. Reluctantly I agree. Ambulatory care, they take some bloods, send me for chest x-ray. I wait for what seems hours. They take me from ambulatory to acute unit. Finally someone talks to me - my hemoglobin level is to low and I need urgent blood transfusion, they can give it to me overnight. I beg them to let me go home, have a shower, come back rested in the morning for it. They are reluctant, I live alone, what if I faint, get worse. OK, I stay. And here things go into NHS hyper drive. In no time I am hooked up to IV, they are poking me and prodding me every couple of hours to take ops, the transfusion machine beeps, pump is not working, the night is a blur. I feel fine, but in the morning get nausea, they give me something through IV to counteract it and get a porter to wheel me to CT. I am leaning forward to stop feeling dizzy, looking at footprint stickers on the floor, grateful for change of air. CT nurse speaks to me but I cannot open my eyes, I speak to a voice without a face. They talk me through the procedure, I almost enjoy it, the air here is cool, fresh, I feel bit better. It does not take long, they get a porter who wheels me back to acute unit. Soon after at my bed side I am looking at a respiratory consultant, my rheumatologist, a GP trainee and someone from cardiology. They talk a lot, speak in language I can barely follow - but the gist of it is - I am bleeding from somewhere, there is change on my lungs, they think my lungs are bleeding. They want to know how long I have been breathless, am I coughing, want to know about spitting out blood. They will start me on this or that medication. More blood tests, urine test. I cannot hear them anymore, the noise, the air is full of bad smells and it is hot, to hot in there. I agree with my rheumatologist to receive further IV as long as I can go home after, I need to get a shower, I am wearing the same clothes for 48 hours, I need a moment to think. She manages to get me on Cytoxan straight away, they transfer me to renal unit, only specialized nurses can administer Cytoxan. I am on saline solution for 2 hours, they still have to give me Mycophenolate and only after that Cytoxan. That is roughly 5 hours of IV. They seem confused, don't know what they are supposed to give me, put another cannula in my ankle, then it turns out I don't need it. I am tired, I am angry, they said I can go home, I want to go home. I demand to speak to doctor, start having second thoughts about Cytoxan, this is to fast, to soon, let me think. Let me have a shower. Renal unit doctors agree - medication takes a while to kick in, so few days delay will not make a huge impact. Finally I get home. I am not stupid, I want to live. I know this condition is serious, and everything they did or wanted to do was to save my life and preserve as much of my health as possible. I just needed to take a breath, have a moment where I felt normal. Like when you have a nice, long, hot shower, put on fresh, clean clothes. Have a cup of favorite tea, look up all these medications they wanted to pump me with, get to grips with it all. I had two more rounds of Mycophenolate IV over the weekend, popping in to ambulatory care. Today I went to see my rheumatologist - she confirmed vasculitis - GPA as it affects my lungs and there is some evidence of protein in urine, even though my kidneys so far work fine, and I am still to see the ETN for my blocked ears. I started taking 60 mg Prednisolone today, and will have my first round of Cytoxan on Friday.

Sorry for such a long post, but I needed to get it off my chest, to make little bit of sense of it all. I know I am at the beginning of the process and so far I believe I was lucky - it could have taken longer to get diagnosed and at the moment I am still living a normal life. I am more cautious and observant of my symptoms and try to get enough rest, not stress out, keep my breathing level at all times. I do worry - about being able to work, pay the bills, how sick I will feel after Cytoxan, how I will react to Prednisolone, about living alone, feeling so sick and not being able to call for help. I worry about the damage my body already sustained - how bad is it, how bad it will get, will I get better?

I am glad this place exists, there is not many people I can talk to about this and I know I will get advice and support here, I really need that now.

Thank you for reading and I am looking forward to getting to know you all.

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NacMacFeegle profile image
NacMacFeegle
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30 Replies
gilders profile image
gilders

I'm happy to hear you got a diagnosis - that's half the battle won already. Cyclophosphamide (Cytoxan) is a powerful drug (my body couldn't tolerate it), so it should get you in to remission. Your story is similar to mine. I'm currently sat in an hospital gown waiting for some platelets ready for my kidney transplant, all thanks to GPA. So make sure in future you see GP asap when unwell.

NacMacFeegle profile image
NacMacFeegle in reply to gilders

Hi Gilders, thank you for your support, sorry to hear things got to this stage for you, I hope you get through this and the transplant without any complications.

Samisntverywell profile image
Samisntverywell

Gosh, what a story you have. I'm so pleased you have been diagnosed and treated. You're right, the site helps a great deal, the people are really knowledgeable, and kind. Regarding money... Can you claim PIP/ESA? I think they are very sympathetic to this disease and the meds you are on, and the fatigue you experience will make it more straightforward. After all, that's what the system's there for, but if you're not familiar with the forms and the process do get some help with it, it's tricky and takes some effort. But when it's sorted it's one less worry.

A huge welcome!!

NacMacFeegle profile image
NacMacFeegle in reply to Samisntverywell

Thank you Samisntverywell, I am not sure if I am entitled to anything, officially I am still in full time employment. I am not out of my 6 months probationary period yet so I need to get advice on whether my employer can end my employment if I am ill....and then find out what I can do if they do. I spoke to the manager yesterday and he made all the right noises but I feel I better be prepared.

DevonLottie profile image
DevonLottie

Are you based in the uk? If so you need to ensure you are treated by a consultant with experience of gpa (as it is rare not all hospitals have the knowledge to provide the best treatment). As the others have said, you are in a much better place now you have a diagnosis and correct treatment. Ask any questions and voice any concerns on this site, you'll get good support. Have you found the vasculitis uk website yet? It's full Of reliable information that might help put your mind at rest.

NacMacFeegle profile image
NacMacFeegle in reply to DevonLottie

Hi DevonLottie, yes I am in UK and I went to the website, found advice there to get pneumonia and flu shots, spoke to GP surgery today they will get it for me - well pneumonia, flu shots are not "in season" apparently. I double checked, the shot contains dead virus so it should be safe. It gives me a feeling of some control over what is going on, like I can do something about it. Don't know how to confirm if my rheumatologist has experience - is there a register somewhere?

DevonLottie profile image
DevonLottie in reply to NacMacFeegle

Hi. Yes, yearly flu jabs in October/November are important and the pneumonia jab that is a one off. The two best ways to find out about your consultant are a) to ask him/her how many gpa patients they have had and b) ask on this forum. Which hospital are you under?

NacMacFeegle profile image
NacMacFeegle in reply to DevonLottie

Epsom & St Heliers - it is rated "requires improvement" (I agree), can I change hospitals?

DevonLottie profile image
DevonLottie in reply to NacMacFeegle

Yes you can. I suggest you call the vasculitis uk helpline as they will be able to advise you on the best consultant to ask to be referred to: 0300 365 0075

poppet2 profile image
poppet2

Wow, what a journey you've had but things will get better now you've been diagnosed. I remember how scary it was at first because of going through it on my own but with the aid of medications now live quite a normal and happy life for the biggest part. Good luck.

NacMacFeegle profile image
NacMacFeegle in reply to poppet2

Hi Poppet2, thank you for your words, I try to think of it that way - OK, this is a disease, no cure but people live with it. It is certainly a major wake up call - you really do not know how good you had it until you face something like this.

Assist2 profile image
Assist2

Right about the diagnosis being the hard part. There is very effective treatment for ANCA Associated Vasculitis. What has worked best for my friend is two years of Rituxan infusions, at the right dose for your weight, every 6 months and then maintenance on medical marijuana, which is legal here, on an ongoing basis, 30 to 40 mg of CBD capsules during the day, and 10 mg of THC at night (Indica). I sometimes wonder of the medical marijuana would have kicked the vasculitis using only it. Rituxan takes about a month to take effect fully, and left my friend feeling like she had a cold for a month after them and for a month before the next one (perhaps the infusions should have been every 4 months but she may have then had an extra month per year with post infusion effects. At any rate, the Rituxan is not toxic like the cyclophosphamide, which also makes you lose all your hair, and it does not have the likelihood of causing bladder cancer like the cyclophosphamide. She, unfortunately, started with Cyclophosphamide which made her unable to form thoughts and high dose prednisone, which gave her prednisone induced dementia. Fortunately, her brain has recovered from those awful, and scary side effects, until she was switched to Rituxan.

NacMacFeegle profile image
NacMacFeegle in reply to Assist2

Oh, wow, that sounds full on - so far I have not noticed effect of Prednisolone, but been on it for only two days. I have asked about alternatives to cyclophosphamide but the rheumatologist told me the renal unit doctors were in agreement with her - for my current condition this is the best course of action. But she also said I have a choice - so if I feel this is not right I can always regroup. I will certainly keep an open mind and keep researching and asking about the best course of action. As I read in someone's post here, you have to become your own medical secretary and advocate to get the best possible care.

in reply to NacMacFeegle

Depending on your age Rituximab might be an option. If you are still of “ child bearing “ potential then patients can access it. Some hospitals are using a mix of 2 to 3 infusions of low dose cyclo combined with Rituximab to induce remission.

NacMacFeegle profile image
NacMacFeegle in reply to

Thanks Tynemouth, I will ask about Rituximab next time I see her.

in reply to NacMacFeegle

Here is the link to the NICE guidance re Rituximab and the qualifying criteria. It has been approved in Scotland as well under much the same circumstances ( you don’t say where you are based ).

nice.org.uk/guidance/ta308/...

There is much about your story that is concerning, I have never heard of IV Mycophenolate being given for acute, severe GPA, it’s normally a maintenance medication or used in milder cases. As far as I am aware it doesn’t appear in any of the evidence based guidelines.

I think you have already realised that you will need to be your own best advocate and not take anything at face value.

NacMacFeegle profile image
NacMacFeegle in reply to

Hi, I think the reasoning behind giving me Mycophenolate along with Cyclophoshpamide was to create sort of bridge and tame my immune system until Cyclophosphamide starts working - from what I understand it does not kick in straight away.

NacMacFeegle profile image
NacMacFeegle in reply to

Hi Tynemouth, I had a look at my notes, you are right, what they gave me over those three days was 1gr IV of Methylprednisolone - not Mycophenolate - I will have to get a better grip on all these complicated names...does this make more sense to you? I called the number you gave me it went to voice mail, I'll try again. Thanks for all your input so far.

in reply to NacMacFeegle

Yes, IV Methylprednisolone makes much more sense!

Chris-Bromsgrove profile image
Chris-Bromsgrove

Cylophosphamide and a high tapering dose of Prednisolone tends to be the standard initial approach for getting ANCA associated vasculitis ie GPA into remission. It is effective in most cases but sometimes Rituximab is needed as an alternative to cyclo. I believe occurrence of hair loss is pretty rare and you are given Mesna to protect your bladder. The side effects of cyclo do seem to vary from person to person. I had ten pulses and they didn't effect me too badly although some were worse than others. I read you story with great interest and sometimes you do need someone to 'kick' you to the doctors. I had been fobbed off by doctors three times and if it wasn't for my wife pushing me I would have just left it. By that time I was anemic and was sent straight to hospital.

NacMacFeegle profile image
NacMacFeegle in reply to Chris-Bromsgrove

Hi Chris, thank you for your comment, I am hoping I will just "walk it", but I know it could knock me out so I asked at work to have a day off after treatment just in case. I think what is so difficult with this disease is that the symptoms do seem innocuous and unrelated at the start - even my rheumatologist said what I was presenting was all over the place.

stuc profile image
stuc

Hi NacMacFeege

You definitely have had a torrid time of it. Like most people who have this awful disease, GP,s don't know enough about GPA and diagnosis can be hellish to get confirmed. Over a period of 9 months I was told by my GP that I had an ear infection or a chest infection or a throat infection. (8 infections in 9 months) and all I ever got advised was take this antibiotic or try this other antibiotic. Even when I pleaded to be referred to ENT urgently, I was refused. 4 weeks later I ended up in a coma in a foreign country as my lungs collapsed. This was when I was diagnosed. I was told when I got back to the UK that this country does not test for the disease as it is so rare.

I have a great rheumatologist consultant now however I have discovered that you need to be really assertive and forceful when it comes to GP advice. Do not take no for an answer if you do not feel it is right. You will start to know your own body more and when you feel that something is not right, get it checked right away. I unfortunatly have relapsed twice since diagnosis in April 2017 and I am currently going through another course of rituximab but on both occasions I told my GP what I wanted to happen in terms of blood and urine tests etc instead of waiting for them to palm me off again.

Good luck going forward

Stuc

NacMacFeegle profile image
NacMacFeegle in reply to stuc

Hi Stuc, thank you for your words, I cannot imagine how scary must have been to wake up in a foreign country with such symptoms, I hope you are doing OK now. I find it is a common thread in the posts around here - GP not listening or being dismissive.

Christophene47 profile image
Christophene47

You have quite a story; I am curious if you were told what your PR3 titre was; do be aware that different hospitals and labs have different parameters. I was diagnosed with C-ANCA vasculitis in 9/16. I was put on 16mg Prednisone and within 36 hours, I felt wonderful. I am in the US, and thought to get a 2nd opinion. I found a vasculitis unit at Johns Hopkins in Baltimore, MD, just a 2 hour car trip from where I live. Johns Hopkins offers a review of all medical records which you send to a coordinator. They assign it to one of their 4 or 5 vasculitis experts. I did have to wait 5 months for the appt. In the interim, I had some bizarre skin outbreaks and I did have a ganuloma on my hand.(all photographed).

Eventually, I saw the doctor, a lovely lady who took her time with me. She decided to repeat the blood work and ordered a nuclear medicine test of my neck and chest. She examined me carefully. She said , "just by looking at you, I don't think you have GPA. Sure enough, she emailed me in a couple of days and gave her opinion that my blood titre for PR3 was too low to be diagnostic for GPA. She thought, and so have others thereafter that my symptoms we're more like polymyositis rheumatica. Her recommendation was a slow taper off Prednisone.

I left the first rheumatologist because he admitted that he had only seen 2 other pts. with this antibody in his entire career.

My point is that, yes, it's great to get a diagnosis, but make sure it is correct.. Subsequently, two other doctors disproved the diagnosis, with PR3 blood tests which all came back negative which could have been due to 2 years on Prednisone. To complicate things, 2 years prior to symptoms, upper body muscle pain. and joint, bone pain, I had an acute mosquito borne tropical virus (chickungunya) while in the Caribbean.

That virus knocked me out for about 5 days and symptoms similar except it affected my nervous system; I couldn't stand up or walk straight. Also had a high fever and a rash on my legs.

French medical researchers have found that people over 60 who get this virus, often have a repeat of symptoms in 2 years, and I was at the 2 year mark, now called chickungunya de novo .The first rheumatologist I saw blew that off quickly. Later I found an article in the British Medical Journal where Australian researchers back in the 1960's speculated that there was a connection between arboviruses which includes the chickungunya virus and the PR3 antibody. There is no way it can be proven now in my case, but be aware that the how high or low the titre is does mean something.

Long story short, get a 2nd opinion by a consultant with experience in vasculitis even if you have to pay private for that consultation. It has now been over 2 years; I am holding with just 4 mg. of Prednisone and believe I am flaring up with something because I have been feeling really lousy the last 2 weeks. I had blood drawn for 2 different doctors on the same day, and they both called concerned about the results. Not only is my white count high (to be expected on Prednisone, , but now my red count is not right and some other things are off as well. So now I am off to a hematologist Monday.

I have no idea what is going on with me, but I should say I had a traumatic fall down 13 hardwood steps and luckily did not break any bones or have a head injury, but a lot of bruising on my left side, and a hematoma lump in a thigh muscle, deforming the look of my leg. A muscle has been damaged. This may be responsible for changes in blood count b/c of so much bleeding under skin.

Just be sure you have a consultant who knows what he or she is doing and has plenty of experience with vasculitis and the and the ANCA diseases. Good luck in your experience going forward.

NacMacFeegle profile image
NacMacFeegle in reply to Christophene47

Hi Christophene47, thank you for your words, I am sorry to hear you are having difficulties with your diagnosis and your symptoms - it is easier to cope when you know what you are dealing with.

ZiggyDiego profile image
ZiggyDiego

I’ve got GPA and I’ve had cyclophosphamide and rituximab. Slowly the disease is coming under control. Hope things work out for you: there’s so much to get your head round.

NacMacFeegle profile image
NacMacFeegle in reply to ZiggyDiego

Hi ZiggyDiego, good to hear from someone with same diagnosis, gives me strenght when I hear "coming under control". One breath at the time, one day at the time.

ZiggyDiego profile image
ZiggyDiego

It’s ok to have others believe it will get better, on your behalf. This has got me through the worst of times.

brown136 profile image
brown136

very similar diagnosis i have had in the last 6 weeks having starting reducing the predolisne from 6 a day to 4 now

i now started to get at least some sleep

which a great relief

ian Brown

NacMacFeegle profile image
NacMacFeegle in reply to brown136

Glad to hear you are getting some sleep, it is so important to get good rest when dealing with all this. Hope it continues to improve for your. Take care

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