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Frustrated and hopeless!

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14 years 3 months ago #16421 by Crystal361
Frustrated and hopeless! was created by Crystal361
I was diagnosed with ITP in Aug 2009 when I went for bloodwork to confirm my pregnancy with my son. Prior to then I was terrified of needles so refused to have bloodwork done. I have no idea when this really started although I have alway bruised easily so can only assume it's been something that i've had for a long time. During my pregnancy with my son my platelet counts stayed 45-60. Before delivery I was treated with IVIG to boost platelets. I have a great response to the IVIG, usually counts over 200 with doses of 1 mg/kg.

After delivering my son and the IVIG wearing off my platelets seemed to hang around 20-25 range dropping to 10. At this time I was given another infusion of the IVIG. After that infusion I found out in Sept 2010 that I was pregnant again.

My counts for this pregnancy were 20-35 for the entire pregnancy. I was given IVIG again for safe delivery, platelets went up to over 200 again. After only 10 days my counts dropped to 54. Then a week later I had a platelet count of 4. I was given IVIG and my doctor started me on prednisone (which I had been desperately trying to avoid).

I was on 60 mg of prednisone for 21 days and my levels were 28. My doctor increased me to 80 mg of prednisone for 5 days and now is starting to have me taper off without getting another count. I can tell it's not working as I am having all kinds of unexplained bruising.

I am aching all over (joint pain), tremors, head aches, hungry all the time, insomnia, sweating a lot etc. Not sure if all these are symptoms associated with the prednisone but they've just started in this last week?

The doctor said that if the prednisone doesn't work that she would like to move onto a splenectomy. I was told by the same doctor though that a splenectomy is only effective in about 60% of people and if it does work it's usually only temporary (like 1 year). I just don't know why I would have such an invasive thing done that's only going to help for a year (if at all).

But if prednisone isn't working, IVIG only lasts about 6 weeks and I don't want a splenectomy what other options are there? She told me that there was 1 med she didnt want to give me because they believe it could be linked to bone marrow problems? and the other one she said that if prednisone didn't work it probably wouldn't either?

I'm so stressed out! I'm only 24 years old and have two kids under 2 that I want to be around to see grow up. I'm worried about having a serious bleed. I can't continue to go for weekly appointments to get my platelets checked. I don't know what to do. Any suggestions? Advice? Words of wisdom? Treatment suggestions?

I really appreciate any feedback people have!:woohoo:
  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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14 years 3 months ago #16423 by Sandi
Replied by Sandi on topic Re: Frustrated and hopeless!
Hi Crystal. You've only begun to go through the list of treatments, so you have a lot of options left. Not time to feel hopeless yet!

Serious bleeds are very rare. You will live to see your children grow up.

First of all, I think I'd get a second opinion. IVIG usually is temporary and very few people use it on a long term basis. Prednisone doesn't work for everyone, but the other steroid she mentioned, Decadron, can work even if Prednisone does not. It is pretty potent and is only used for 4 days at a time. Withdrawal can be pretty nasty, but some people get a good count from it. Win-Rho is also another treatment option. If a person is responsive, they can get a few months from a treatment. It's an infusion that takes about an hour and most have few side effects if they pre-treat. Rituxan is also another treatment option and works very well for ITP a good bit of the time. It is a 6 hour infusion, given once a week for four weeks. Most people, if they respond, get a year or more of remission.

The treatment that your doctor mentioned that can cause bone marrow problems is N-Plate. The thing is, with careful monitoring, very few people ever have a problem. The bone marrow problem is also reversible when the drug is stopped. Many people do quite well, and there are even children on this drug. It is a maintenance drug though, and you have to keep using it to keep counts up. I've heard of remissions, but it is rare.

There is a lot of hope for you - but you need to find a doctor who will explain ALL of the options and help you decide on one that can make your life better. It is possible. Most people start out like you and think ITP will just go on forever - not true.
  • dru
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  • I developed hemolytic anemia in 1999 and ITP in 2005. Treatments have been splenectomy, prednisone, IVIG, and Rituxan.
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14 years 3 months ago #16424 by dru
Replied by dru on topic Re: Frustrated and hopeless!
Sorry you feel frustrated and hopeless. But, like Sandi said, there really is alot of hope for us with ITP. It is most likely that you will find something that works for you. A second opinion is a great idea and would go a long way in making you feel more in control. I'm sure it is hard dealing with ITP along with the normal stress of caring for 2 young children.

I think many of us have felt hopeless at one time or another, I know I have. Rituxan worked very well for me and I had a 4 1/2 year remission from it. My doctor was telling me about several patients she had who did very well with Nplate.

I think it helps to vent out some frustration here with those of us who understand, so hopefully we can help a bit!
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14 years 3 months ago #16428 by Dean
Replied by Dean on topic Re: Frustrated and hopeless!
You are not out of options and Do Not give up hope. We have all had the feeling of hopelessness at first but as time goes on we all learn to live with the ups and down of ITP. My treatments have been Prednisone and Rituxin so I cannot give any commente on the rest of the treatments. Prednisone slightly increased my counts as long as I was on it. Have had two rounds of Rituxin the last one is going on 20mo now. Personally, I would hold off on a Spleenectomy. A Spleenectomy is a permanent procedure and not solution for ITP. Even after 7yrs a Spleenectomy is not even an option for me. I would consider Rituxin.
Understand the stress you are going through and you will be around to see your kids grow up!!! The stress of ITP was horrible for me for the first few years, now I just roll with the punches and that is the point you will get to also. So Please try to stay positive we are here for you!!
14 years 3 months ago #16431 by
Replied by on topic Re: Frustrated and hopeless!
Hi Crystal,

Here's an article that I've posted before, written by a couple of hematologists with a busy practice. I think you may find if reassuring, as far as being around to watch your babies grow up (which may seem like a long way away right now, but it's amazing how all the sudden it happens that they're all grown up!).

And, there are a lot of options out there. You may want to check out the Natural Treatments section as well, for some alternative views on treatments, as some of us have had success with that, without the unpleasant or dangerous side effects that can come with most of the other treatments. The symptoms you're currently describing are very likely from your Pred taper. Not sure how fast you're tapering, but going more gradually may lessen the symptoms. If you're breastfeeding or postpartem, you're likely more sensitive to the symptoms as well, with hormones changing. You might check out a thread in that section called, "HOW TO ATTENUATE SIDE EFFECTS OR ALLERGIC REACTION TO MEDICATIONS", too. You can use this method to lessen the side effects of Pred.

Here's the article:

Can I die from ITP?
By James. N George, M.D., Oklahoma City, George R. Buchanan, M.D., Dallas

www.itpsupport.org.uk/american/%209.%20Can%20I%20Die%20from%20ITP.pdf

The question is often asked, directly or implicitly, whether ITP can be, or is often, fatal? Such concerns are expressed, not only by ITP patients and/or their parents, but also by physicians who may or may not be familiar with the condition. The concerns are inevitable during the initial days after discovery of a very low platelet count, when dangerous diseases such as acute leukemia are also considered. So, in this brief essay, we will try to address what is obviously a very important question.

Yes, ITP can potentially be fatal. However, that could be said for virtually every disease, including many which are usually not very serious. Extremely rare, but fatal, complications can occur from strep throats, the common cold (which may lead to pneumonia), chickenpox, or what seems to be a mild case of indigestion. But, to put things in perspective, ITP, although troublesome, and occasionally, a truly serious problem, is rarely fatal. The fear of serious and even fatal hemorrhage, far exceeds its actual occurrence. This, of course, is due to the otherwise good health of most patients with ITP, and the fact that their platelets, though few in number, are younger and stickier than platelets of normal people. This is due to the rapid platelet destruction in ITP, and the increased production of new platelets, by the bone marrow. The younger platelets are more effective in protecting hemorrhage in the brain and elsewhere, even following minor injuries.

The most common cause of death in children with ITP is intercranial hemorrhage (bleeding in the brain). We lack accurate scientific information about how often that occurs and whether any specific treatment prevents it. The best study, performed in the United Kingdom, by Professor lilleyman and his colleagues, suggest that it happens in about 1 in 800 children with ITP. Since slightly more than half of children with intercranial hemorrhage due to ITP recover, the actual death rate is probably about 1 in 2,000. This would translate into approximately two deaths annually, due to childhood ITP in the United States, and 1 every other year in the U.K. So, fortunately, fatal bleeding in ITP is extremely rare. Since splenectomy is so infrequently performed in children with ITP, it’s most feared complication is fatal septecemia, or blood poisoning, and is also now very rare. One important job that we as physicians interested in ITP have, is to educate patients and parents, as well as our physician colleagues, about this reassuringly low incidence of death, due to ITP or it’s treatment.

The situation may be somewhat different in adults, who are more likely to have other conditions that contribute to fatal bleeding, whose disease is longstanding, or who suffer from fatal consequences of long-term treatment of ITP. Hence, some adults die ‘with’ ITP, rather than necessarily ‘from’ ITP. Good data are hard to come by, but it seems that death due to hemorrhage in adults with ITP is, like in children, extremely rare. Many hematologists have never experienced fatal ITP in their practice.

So, what does all of this mean? We can’t say, ‘don’t worry’ about ITP. Clearly, as the recent survey conducted in the UK showed, ITP causes a great deal of anxiety, and bleeding problems resulting from ITP, as well as the side effects of steroids and other treatments, can be difficult. However, most people with ITP fully recover or eventually improve with few or no bleeding problems. ITP rarely caused life-threatening or fatal bleeding complications. Therefore, the fear of hemorrhage in ITP should not influence patients and their physicians, to pursue toxic, arduous and costly forms of treatment. As we often tell our ITP patients and their families, “If you have to have a blood disease, ITP is a lot better than most of the alternatives!”


april
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14 years 3 months ago #16432 by SteveC
Replied by SteveC on topic Re: Frustrated and hopeless!
Hi Crystal - welcome to the ITP family. I often think the worse part of ITP is fear. Many ITP'ers were otherwise healthy or simply unaware of their condition until that day the MD first scared the devil into us and we heard we might die. We're suddenly confronted this frightful disorder and literally told by an MD we're at risk of bleeding to death, put in the hospital without comprehensive and understandable explanations and told we've got to have immediate surgery! It's more than I could comprehend and without knowledge we're left to worry. And on top of that there's a lot of time to think and worry!

You're no longer left to fear alone! This group has been there and fully understand the fears, concerns and choices that you're experiencing.

As impossible as it seems now, we can help you quickly. Knowledge is key. Knowledge of treatment options and questions to ask will ease the fears. Knowledge of shared experiences will bring Comfort that there can be normalcy in the midst of this storm of life. Knowledge breeds Acceptance there is life with ITP. Knowledge will soon encourage Confidence that you will experience a full and joyful life and your kids will know their Mom throughout their lives.

It may be a "bumpy" road because knowledge can scare the devil out of us! ITP is a serious disorder that requires attention and awareness. There are things we need to do (CBC's) and maybe there are some things we can't do, but do's and do nots are few in my experience.

Certainly some of the treatments have negative side effects - heck there are warnings on aspirin! Steroids side effects are legendary - moodiness, sleeplessness, hunger... - but they disappear as we taper off the steroids but we all know it isn't fun. Treatment decisions; spleenectomy, WinRho, Rituxan, N-plate.... They are made easier if you are confident and comfortable with your MD. You should be able to question your MD and they should take the time to explain options and answer questions. Experiences here show there are MD's that have little, if any, practical experience with ITP and just have the book knowledge (A=B therefore C). If your MD isn't working with and for you, find another one who will!

You can start your knowledge quest right here - ask questions, express anxieties, share your experience, read the info embedded in this site. I like to say you're now part of a new family, a family that never sleeps (no pun intended - ok maybe a little intended :laugh:) This family spans the globe and is available 24x7.

Most of all, know we care, know we share and know you're not alone!

Blessings of enough...
Faith to trust our Lord
Joy to share with others
Strength to help the weak
Love to share with the hurting

Steve C
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14 years 3 months ago #16446 by ananta
Replied by ananta on topic Re: Frustrated and hopeless!
Love your posts Steve! :) They are always so helpful and uplifting. If anyone hasn't read "Excellent Advice" in the Newly Diagnosed section, they really should. It is also by Steve, (although typed by Sandi) It's great to read anytime you are feeling overwhelmed.
  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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14 years 3 months ago #16452 by Sandi
Replied by Sandi on topic Re: Frustrated and hopeless!
Steve typed it, I just copied, pasted and stickied it.
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14 years 3 months ago #16470 by Crystal361
Replied by Crystal361 on topic Re: Frustrated and hopeless!
Thank you so much to everyone for your responses. I am still feeling pretty emotional about it all but can also say I am relieved. I know that what I am going through definately isn't the worse case out there, not even close, but it's just such a scary thing to have (at 24) and feel like there are no options.

I am going to get a referral to an ITP specialist to discuss more treatment options. My doctor is pretty good but i'm not sure how much she knows about ITP itself. She keeps telling me that this is usually the treatment path they follow when I question things about why I would have a spleenectomy done when there's a good chance that it won't help me.

Today is my birthday and this was exactly the PICK ME UP that I needed!

THANK YOU, THANK YOU, THANK YOU!
  • dru
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  • I developed hemolytic anemia in 1999 and ITP in 2005. Treatments have been splenectomy, prednisone, IVIG, and Rituxan.
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14 years 3 months ago #16478 by dru
Replied by dru on topic Re: Frustrated and hopeless!
Happy Birthday! And that is a great plan to be seen by an ITP specialist. That will give you much more of a feeling of being in control and knowing your choices.
  • server
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  • newcreationchangingdaily
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14 years 3 months ago #16487 by server
Replied by server on topic Re: Frustrated and hopeless!
Happy Birthday Crystal! I bet you don't look any different!
I think everyone has offered as much advice as I could ever think of!
We all need to remember that there is hope. There is ALWAYS hope!

My flesh and my heart may fail, but God is the strength of my heart and my portion forever.
Psalm 73:26
Blessings,
gretchen
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14 years 3 months ago #16508 by milly
Replied by milly on topic Re: Frustrated and hopeless!
Happy birthday Crystal and I look forward to saying Happy Birthday many more times!!!!!

There is no practice run in life.
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14 years 2 months ago #16895 by Gort
Replied by Gort on topic Re: Frustrated and hopeless!
You may feel hopeless, but it's not. There is a difference between "out there" and how we feel about, and react to, "out there." Don't beat yourself up too much about feeling down -- it happens to all of us at times. The key is to stop those feelings from overwhelming you and your life. The way to do that is to remember two cardinal rules of ITP: (i) one step at a time, and (ii) learn as much as you can about ITP. And, if you need help, or someone to talk to, ask.

--Steve
Living with ITP since 1967.
"Abandon negative action; Create perfect virtue; Subdue your own mind. This is the teaching of the Buddha."
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14 years 2 months ago #16983 by marcar0904
Replied by marcar0904 on topic Re: Frustrated and hopeless!
I would consider any other option, agree on not having the spleen taking out. Done pretty much everything meds wise, so far N Plate is working well for me been on it over a year