Sunday, May 03, 2009

Health update

It began about a month and a half or two months ago. I thought I must have strained my muscles. My thumbs and big toes began "killing" me. And then I realized it was my pointer fingers and middle fingers, too, were causing me pain as well . . . as well as the equivalent toes in my feet . . . and the outside of my little toes . . . and the balls of my feet.

A weird pain pattern, but . . . who knows?

I took some ibuprofen.

It didn't touch it.

I got thinking (as I have a few times over the past couple of years): You can be in great shape, but if something comes along to cause you severe pain, it will be whatever that source of pain is that will cause you to quit exercising as you ought . . . which, of course, then, will lead to loss of muscle tone, loss of muscle mass, loss of flexibility, loss of cardio function, and an increase in all the other concomitant factors that lead to general physical decline.


I was finally motivated, this past week, to contact my vitality and longevity doctor. I thought, perhaps, I could be dealing with gout or some other condition brought on by a decline in liver function due to the high levels of niacin he's having me take (2500 mg/day).

He's been keeping an eye on my liver function. He said he didn't think my pain was related to the niacin or any of the other supplements he's had me taking. Instead, "The locations are consistent with Rheumatoid arthritis. Worth a trip to your Primary Care Physician (PCP) and possibly referral to a Rheumatologist depending what the PCP finds."

So I got an appointment with my PCP at Kaiser Permanente on Thursday afternoon, and he had me go down for several blood tests and X-rays of my feet and hands.

Kaiser sent me an email last night: "You have a test result" . . . and then provided a URL where I could view whatever-it-was they came up with.

So I visited their site this morning. (I love how Kaiser operates! Truly. I don't think I've ever had such friendly, upbeat, competent health care as at Kaiser. . . . But back to my story.)

Erythrocyte sedimentation rate (whatever that is) was normal.

Oh. Wait a second. I just found out Kaiser actually explains all test results. And for erythrocyte sedimentation, they say:
The sedimentation rate (sed rate) blood test measures how quickly red blood cells (erythrocytes) settle in a test tube in one hour. The more red cells that fall to the bottom of the test tube in one hour, the higher the sed rate.

When inflammation is present in the body, certain proteins cause red blood cells to stick together and fall more quickly than normal to the bottom of the tube. These proteins are produced by the liver and the immune system under many abnormal conditions, such as an infection, an autoimmune disease, or cancer.

There are many possible causes of a high sedimentation rate. For this reason, a sed rate is done with other tests to confirm a diagnosis. After a diagnosis has been made, a sed rate can be done to help check on the disease or see how well treatment is working.
But the rheumatoid factor screen doesn't look so good:
ComponentValueStandard RangeFlag
Rheumatoid factor, nephelometry168<=13- IU/mLHigh

So, now, what does the rheumatoid factor screen mean?
A rheumatoid factor (RF) blood test measures the amount of the RF antibody present in the blood. Normally, antibodies are produced by the immune system to help destroy and eliminate invading bacteria and viruses that can cause disease. But the RF antibody can attach to normal body tissue, resulting in damage.

A high level of rheumatoid factor can be caused by several autoimmune diseases (including rheumatoid arthritis) and some infections. Occasionally an elevated level of RF is present in healthy people.

The amount of rheumatoid factor in blood can be measured in two ways:
  • Agglutination tests. One test method mixes blood with tiny rubber (latex) beads that are covered with human antibodies. If RF is present, the latex beads clump together (agglutinate). This method is best used as a first-time screening test for rheumatoid arthritis. Another agglutination test mixes the blood being tested with a sheep's red blood cells that have been covered with rabbit antibodies. If RF is present, the red blood cells clump together. This method is often used to confirm the presence of RF.
  • Nephelometry test. This test mixes the blood being tested with antibodies that cause the blood to clump if RF is present. A laser light is shined on the tube containing the mixture and the amount of light blocked by the blood sample is measured. As levels of RF increase, more clumping occurs, causing a cloudier sample and less light to pass through the tube.
So. Of course, without a doctor to provide any further interpretive or diagnostic or strategic clues (concerning "where we go from here"), I begin thinking:
  • Interesting, that the one test seems to contra-indicate for autoimmune disease, yet rheumatoid arthritis is an autoimmune disease.
So what could the high RF mean?

Ah! Kaiser has another page that explains results:
High RF levels may be caused by:
  • Rheumatoid arthritis. This is the most common reason for a positive rheumatoid factor (RF) level.
  • Hepatitis C infection.
  • Other autoimmune diseases, such as systemic lupus erythematosus (SLE), scleroderma, Sjögren's syndrome, and vasculitis.
  • Infectious diseases, such as tuberculosis, mononucleosis, syphilis, and malaria.
  • Liver diseases, such as cirrhosis and chronic active hepatitis.
  • Infection of the heart (endocarditis).
  • Leukemia.
One more note (on another page):
  • A small number of people have a high RF level but do not have rheumatoid arthritis. A small number of these people will later have rheumatoid arthritis.
  • A health professional always uses the results of an RF test along with information gained from a medical history and physical examination before diagnosing rheumatoid arthritis.
  • Cyclic citrullinated peptide (CCP) is an antibody that is found in the blood of more than half of all people who have rheumatoid arthritis. It is used to confirm a diagnosis of rheumatoid arthritis.
Should be an interesting conversation when (I expect) my doctor contacts me tomorrow!
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