What the *^## is Antiphospholipid Syndrome–APS?

I felt like the doomed heroine of a bad sci-fi flick, zapped by zeta rays from planet Krypton when, a few weeks after my stroke, I first heard my unpronounceable, incomprehensible diagnosis: ‘antiphospholipid syndrome.’ I’d never heard of APS. Nobody I knew had ever heard of APS, even most of my doctors had never heard of APS. Many of them still havn’t.   Excerpt from Anne’s memoir

Anne AS log min text rev 3APS is sometimes called “sticky blood” because it causes an increased tendency to form blood clots in the veins and arteries. Clotting can lead to serious health complications ranging from miscarriages and migraine headaches to blood clots in the legs, in the lungs, heart attacks or, in my case and many others’, stroke.

Here are some important facts about Antiphospholipid Syndrome:

  • APS is a blood clotting disorder that causes the blood to clot when it shouldn’t.
  • It does this by signaling the immune system to make antibodies to attack blood proteins called phospholipids (phos-pho-lipids). These proteins help moderate the body’s natural blood-clotting process so it stops when it should. Thus the name: anti (against) phos-pho-lipids.
  • I think of it this way: the APS antibodies are like out of control PacMen, dashing through my blood gobbling up the good little minions who help put the brakes on my clotting system.
  • In the UK, APS is called Hughes Syndrome, named after Dr. Graham Hughes, the professor and Lupus specialist who first described APS in 1983. I rather wish we called it Hughes Syndrome in the US, too. It’s a lot easier to learn and think about something I can pronounce.APS awareness month stamp
  • APS is a common cause of miscarriage, blood clots in the legs (deep vein thrombosis), the lungs (pulmonary embolism), the heart (heart attack), and the brain (stroke).
  • APS is also an autoimmune disease, because the antibodies that attack our blood proteins are attacking parts the ‘self’ instead of invading organisms like virus and bacteria.
  • Like lupus and other autoimmune diseases, APS can “flare” at times, causing weakness, fatigue, achy muscles and joints, especially when we’re tired or stressed.
  • Because most patients with APS take some kind of bloodthinner, we must try hard to avoid bleeding accidents. For some of us, this is one of the most vexing aspects of the disease: walking a line between blood that’s so “thick” it causes clots, or so “thin” it causes abnormal bleeding.
  • APS is sometimes found in conjunction with other autoimmune diseases, particularly lupus.  It’s estimated that 50% of Lupus patients also have APS. (Johns Hopkins Lupus Center)
  • APS can also occur on its own. This is called primary APS.

 

Learn more about antiphospholipid syndrome on the APS resources page.

Coming up—Information on:

  • APS symptoms
  • How APS is diagnosed
  • How APS is treated
  • Clearing up confusion about APS: Questions I frequently hear from other  patients
  • Resources for APS patients
  • Blood thinning: it’s more complicated than it looks
  • Living with Coumadin
  • Why I rejected the new blood thinners like Xaralto.

 

New Yorker essay shines a spotlight on the scourge of autoimmune disease

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For autoimmune patients—and I’m one of them—life sometimes feels like a lonely uphill climb:

“getting sick for no good reason, falling prey to esoteric infections and mysterious skin outbreaks, sliding into spells of lethargy and exhaustion that looked so much like laziness it was maddening.”

Excerpt from A Stroke of Bad Luck and the Potholed Road to Recovery

In her essay “What’s Wrong With Me” published in this week’s New Yorker (Aug. 26, 2013), author Meghan O’Rourke shines a spotlight on what it’s like to live with autoimmune disease. Recounting experiences all too familiar to autoimmune patients, and to me, O’Rourke describes:

  • symptoms ranging from hives to migraines, buzzing in her throat, numbness in her feet;
  • terrible fatigue that made her feel like “a mechanism that moved arduously through the world, simply trying to complete its tasks. Sitting upright at my father’s birthday party required a huge act of will.”
  • her brain often “enveloped in a thick gray fog”
  • a susceptibility to viruses (in her case cytomegalovirus, parvovirus, and Epstein-Barr)
  • a family history sprinkled with various seemingly unrelated illnesses that (she learned later) are all autoimmune in nature.

 

Like many autoimmune patients, O’Rourke rattled from doctor to doctor for years before any of them believed she had a disease.  “Many clinicians assume that the patient, who is often a young woman, is just one of the ‘worried well,’” she writes. Finally, after six years, she had her diagnosis: autoimmune thyroiditis, often called Hashimoto’s, the same disease that plagued my grandmother.

I missed the the doctor-to-doctor crawl because I had no clue that my body was harboring any kind of illness until I was felled by a stroke caused by my particular autoimmune disease: antiphospholipid syndrome (APS).

O’Rourke writes movingly about what it’s like to struggle with a debilitating condition—autoimmunity—that no one, even specialists, understands well.

The lack of knowledge is shocking to me, considering the magnitude of the problem: The American Association of Autoimmune Related Diseases (AARDA) estimates that as many as fifty million Americans suffer from autoimmunity—a greater number than cancer.  

 

There are somewhere between eighty and one hundred autoimmune diseases, yet “autoimmune disease is as much of a medical frontier today as syphilis or tuberculosis was in the nineteenth century,” O’Rourke writes. “Some researchers say the number of cases is rising at almost epidemic rates.”

At times during the course of searching for a diagnosis and treatment of her illness O’Rourke questioned her own sanity:

  • “Was I going mad?” she asks.
  • “The worst part of my fatigue, the one I couldn’t explain to anyone—I knew I’d seem crazy—was the loss of an intact sense of self.”
  • “To be sick in this way is to have the unpleasant feeling that you are impersonating yourself.”

 

“It was a struggle,” she writes, “to do anything—to teach my class, to tidy the house, to go to the gym. My joints hurt, my neck hurt; I had nosebleeds and large bruises up and down my legs. I spend hours everyday unable to work …” This situation is all too familiar to me and other autoimmune patients.

Like many who suffer from autoimmunity, O’Rourke found information and solace in on-line support groups, “people, rich and poor, who were connected by one thing: the inability of doctors to alleviate their symptoms.”   She also turned to diet hoping to mediate her disease. She followed a diet similar to the so-called Paleo regimen: “no gluten, no refined sugar, little dairy” so strictly that, while it did ease some of her symptoms, she spent “at least half of each day” shopping for food, eating, and cleaning up.

“What I had wasn’t just an illness now; it was an identity, a membership in a peculiarly demanding sect. I had joined the First Assembly of the Diffusely Unwell …”

But O’Rourke realized that she didn’t want her life to be defined by illness.

Echoing the concern of many autoimmune patients, she writes: “I worried that I would no longer have friends.”

“The chronically ill patient has to hold in mind two contradictory modes: insistence on the reality of her disease, and resistance to her own catastrophic fears.” Amen to that.

CV1_TNY_08_26_13Drooker.inddO’Rourke’s thoughtful essay has much more to say about autoimmune disease and her experience.  Anyone concerned about the scourge of autoimmunity should read it.  If you’re not a New Yorker subscriber, you can find this issue at newsstands this week, or order a single copy from The New Yorker here.

12 Safety Tips for Managing Your Meds

Healthy hard bodies whose ills amount to the occasional cold or case of shin splints from overdoing the marathon circuit don’t need advice on managing medications. For rest of us these common sense tips on drug safety can apply to everyone, but are but are crucial for stroke and autoimmune patients, anyone with impaired memory, or chronic illnesses that involve multiple meds.

1. Take a notebook to the doctor’s office and write down all instructions–preferably the same notebook each time. (Have a little fun–choose a notebook with cartoon characters or my personal favorite, the skull and crossbones in vivid pink by Peter Pauper Press.)

2. Know what you’re taking. Ask the doctor:

  • the name of the medication
  • what it’s for
  • how to take it (how often? what times? with food or without?)
  • how long to take it
  • what side effects to expect
  • whether there may be interactions with any other medications

Pay attention to the answers and write them down.

3. Make sure every doctor knows every drug you take, including any over-the-counter remedies. (No cheating ‘cause you don’t want the doc to know about those shyster weight-loss pills you ordered from late night TV!)

4. Watch out for drug interactions! Each time you receive a new prescription, ask the doctor about possible interactions with any other medications you’re taking, whether prescription or over-the-counter.

5. Find a pharmacy that’s convenient and seems to have a good safety culture (It’s hard, I know, with mass-market chains invading our neighborhoods like alien mother ships. Just do the best you can.)

6. Make sure you can open the bottle. If you have trouble opening child safety caps (like many stroke or arthritis patients, including me), ask for easy-open caps; but be sure to store to store them out of the reach of children.

7. Resist the urge to grab ‘n go. For every new prescription, take a minute to go over the instructions with the pharmacist before you leave the store. If you buy any new over-the-counter products, ask the pharmacist about interactions with your prescriptions.

8. Mail order? If you order prescriptions through the mail, make sure the service allows you to speak to  a pharmacist by phone if you have questions.

9. With every refill, check before you leave the store. Make sure it’s the right drug, the right brand, the correct dose, and in a bottle you can manage.

10. Have a set routine for taking your medicines.  I take my most important ones at bedtime after I brush my teeth. At pill-taking time, pause, clear your mind and pay attention to what you’re doing. (See related post STAR Check for Drug Safety.)

11. Store your medications properly. Read the package insert for instructions. Most medications do well in a cool and dry place, away from heat and light, and well out of reach of children. (Note: the warm, humidity of the bathroom is usually not the best place!) Some prescriptions require refrigeration. Don’t mix different medications in the same container.

12. Watch the expiration date. The dates are conservative and there’s almost always a little wiggle-room. But if you store your meds in the warm humidity of a bathroom they may degrade more quickly.  Discard medications that have become discolored or powdery or small strong.

Other Resources:

The Five Most Dangerous Medicine Mistakes that Way Too Many People Make

Please share your own tips for safe management of meds.