Poetry Thursday

The Thrush

Black tears leak
from this nib

marked
with the blood of memory

Do you hear me?
Thrush cries
from a lonely bush



**PS. Sorry again for not-writing. I am back to working on the Nevada Hazard Mitigation Plan. Lots and lots of work...still.

Marsha, Marsha, Marsha... I've been tagged

Yes, I have been tagged again by Marsha Loftis. She's my favorite military wife blogster.

So sorry, if you already know these random facts. Because of the pred-head (prednisone usage), I can't guarantee that I know everything that I have written on this blogspot. ;-)

So here it goes.

1) In 5th and 6th grade, I was in a marching group. Once we got the hang of marching, we did some demonstrations for some of the schools in Vernal, Utah, including the high school. What is so random about this skill is that in boot camp I couldn't march. Go figure.

2) Even though I didn't want a baby of my own, I know how to calm 'em. I gained the skill as the oldest of nine. I can tell you some hoary stories about changing diapers on male babies. Yes, as soon as the pressure goes off, it starts to squirt ... far... (eyebrow lift).

3) I washed clothes in a ditch. Alum is very good for settling dirty ditch water. However, after washing jeans it takes almost 5 days for them to dry.

4) Reading is my favorite skill. Even now, I read everyday--usually fantasy, romance, and mysteries.

5) I don't like T.V. I read while my husband watches the telly.

6) I can sing. I am a performer. Also, I am shy. When I try to perform, I get the shakes.

7) My favorite birthday present was an electronic tool case. I still don't like dolls.

8) I have been doing some geneology. Three of my lines run into king lines. Two of those lines have mental disorders and the other one has bleeding disorders.

So you can thank Marsha for this little tagilicious meme. Anyone who wants to be tagged--go for it. The rest of youse can go home...

Silica and Asbestos Exposure in ANCA-Associated Vasculitis with Pulmonary Involvement

Authors: Zuzana Rihova a; Dita Maixnerova a; Eva Jancova a; Daniela Pelclova b; Jirina Bartunkova c; Zdenka Fenclova b; Zdenka Vankova a; Jana Reiterova a; Miroslav Merta a; Romana Rysava a; Vladimir Tesar a

Affiliations: a Nephrology Unit, 1st Medical Faculty, Charles University. Prague. Czech Republic
b Occupational Medicine Department, 1st Medical Faculty, Charles University. Prague. Czech Republic
c Immunology Department, 2nd Medical Faculty, Charles University. Prague. Czech Republic

DOI: 10.1080/08860220500200395
Publication Frequency: 8 issues per year
Published in: Renal Failure, Volume 27, Issue 5 September 2005 , pages 605 - 608
Subject: Dialysis;

Abstract
Silica and asbestos exposure are thought to belong to the triggering factors of antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis. We carried out a study to find out whether patients with pulmonary involvement attributable to ANCA-associated vasculitis (AAV) have been exposed to silicon-containing materials. Thirty-one patients (12 women, 19 men, median age 51 years) were interviewed using a structured questionnaire. Occupational exposure to silicon-containing chemicals was reported by 22.6% of the patients (12.9% to SiO2, 9.7% to asbestos), compared with 0% of control subjects (p < 0.05). Our findings support the pathophysiologic role of silica in AAV.

My Analysis: When I first presented with WG, my doctors told me that I was C-ANCA positive. At that time (2003), they did not know what had triggered my disease. My doctors were more concerned about saving my life. I may never know what triggered my disease. However, I have been around asbestos cleanups (when I was in Pensacola--the Navy was cleaning it up from the old buildings there).

This sample is very small, but I am happy that the researchers are finally looking at industrial pollution as the trigger. Maybe we will have a better chance at curing this disease with this information.

ANCA in Chinese Patients

Postgraduate Medical Journal 2005;81:723-727; doi:10.1136/pgmj.2005.034215© 2005 by Fellowship of Postgraduate Medicine

ORIGINAL ARTICLE
Cinical and pathological characteristics of Chinese patients with antineutrophil cytoplasmic autoantibody associated systemic vasculitides: a study of 426 patients from a single centre M

Chen, F Yu, Y Zhang and M H Zhao
Renal Division and Institute of Nephrology, Peking University First Hospital, Beijing, PR China
Correspondence to: Dr M H Zhao Renal Division and Institute of Nephrology, Peking University First Hospital, Beijing 100034, PR China; mhzhao@bjmu.edu.cn

Background: Antineutrophil cytoplasmic autoantibodies (ANCA) are serological markers of ANCA associated systemic vasculitides (AASV), which is one of the most common multisystem autoimmune diseases. Features of Chinese patients with AASV have not been fully investigated.

Objective: To analyse the clinical and pathological characteristics of Chinese patients with AASV.

Methods: 426 Chinese patients with AASV diagnosed in the past eight years were retrospectively studied and their clinical and pathological data were analysed.

Results: Of the 426 patients, 87 (20.4%) were Wegener’s granulomatosis, 337 (79.1%) were microscopic polyangiitis and two (0.5%) were Churg-Strauss syndrome. Only 201 of 426 (47.2%) patients were diagnosed within three months. Clinically, the patients had multisystem involvement. Altogether 371 of 426 (87.1%) had kidney involvement and 260 of 426 (61.0%) had lung involvement. The prevalences of renal involvement and fatigue were significantly higher in patients with MPO-ANCA than that in patients with PR3-ANCA; the prevalences of ophthalmic, nasal involvement, rash, and arthragia were significantly higher in patients with PR3-ANCA than those in patients with MPO-ANCA. The one and five year death rates were 13.1% and 22.4%, respectively. The percentage of patients progressing to end stage renal disease at one and five years was 15.9% and 27.1%, respectively.

Conclusions: AASV is not a rare autoimmune disease in Chinese people. Kidney and lung were the most vulnerable organs. For patients with multiorgan damage, an ANCA test should be performed to make an early diagnosis and to start treatment in time.

My analysis: ANCA is an imortant test for any multisystem disease. If positive, ANCA will point to vasculitis disease and can be treated. I think that we are finding that vasculitis diseases are not as rare as we first thought.

Sunday Scribblings: Hair

I used to have long golden blonde hair. Every couple of years I would cut it to my chin and let it grow down my back. One year it grew to my waist.

My husband would touch my hair. He would caress it. He would roll it in his hands. It was fine and thick. He liked the feel of it.

But, as you know, life changes things. What changed my hair was cytoxan. Cytoxan is the first chemo-drug found to help cancer patients. In Wegener's Granulomatosis patients, it stops the inflammation. Of course, there are side-effects.

I was in my bed in a German hospital and one of the doctors came into my room.

"We have found your disease," she said, as she set up the I.V. treatment that was going into my arm. "Are you ready?"

"What is it?" I asked.

"You weren't prepared?" she asked. She proceeded to name the side effects, which included infertility and hair loss.

I panicked. She gave me about ten minutes to decide whether I wanted the treatment or not. I have to admit that I was more worried about the infertility. I didn't realize how much my childhood training had affected me. I was not a woman if I could not have a child. I didn't want a child, but there you go...

I realized that without the treatment I would not live. I wanted to live. So I agreed. I cried, but I agreed.

Two days later as I brushed my hair, clumps of hair fell out. In a few days, I still had hair. It was thin and brittle. I cried. My hair had been my beauty. It was gone.

Later, more like four years later, I am still on chemo-therapy (not cytoxan). My hair has grown back. My thickness is back. But, that beautiful gold color is gone. I am a dark dirty blonde with few highlights. I try to forget the beautiful mane that I lost.

I try not to cry about hair.

Poetry Thursday

A Summer's Day


She licks the raspberry
like a young girl
with a lollipop.
Mother's voice whirs
in the distance
as the fluffy cloud
floats above the horizon.

"Lazy hands are the devil's work."
She rests under a shaded cliff.

Psychiatric Adverse Effects of Corticosteroids

Psychiatric Adverse Effects of Corticosteroids. Corticosteroid is another name for prednisone. Prednisone is a common treatment for Wegener's Granulomatosis, Vasculitis, Rhuematoid diseases, and asthma.

Another article about mood changes attributed to corticosteroids (prednisone) is in this article.

Analysis: After I had been on prednisone for three months, I was weaned from 100 mg to about 60 mg (oral). I went from an almost vegetative state to a paranoid state. My husband called the doctor. Luckily my rheumatologist knew that it was the prednisone causing the problem. In a week, I was weaned to 40 mg. About then, I started to become human again. I was very happy when I reached 20 mg.

The second time I was put on prednisone, I discussed my problems with this drug with my doctor. I used 20 mg. (which caused euphoria). I have been on prednisone for two years, but with lower dosages. Thankfully, I have not had the severe problems this time.

This side-effect is important for caretakers and doctors to know, especially if the patient is on high dosages for long periods of time--prednisone is used this way when the patient has a systemic disease.

Also, it saved my mental life when I knew that it was the medication causing my extreme behavior and not me (or the Wegener's). It is a scary place to be.

Poetry Thursday

The Way of Death

I lost myself
in a maze of dreams
under the covers
of a midnight moon.

My breath died
on the down pillow
as I sank beneath
the weary sky.

One day I may rise
and touch the feathered clouds.

One day I may fly
amid the burning stars.

Happy 4th

Jefferson was the primary author of the Declaration of Independence and a contributor to American political and civil culture. The Continental Congress delegated the task of writing the Declaration to a Committee of Five that unanimously solicited Jefferson, considered the best writer, to write the first draft, and in fact wrote all of them with no help at all.

ANCA are detectable in nearly all patients with active severe Wegener's granulomatosis

Finkielman JD, Lee AS, Hummel AM, Viss MA, Jacob GL, Homburger HA, Peikert T, Hoffman GS, Merkel PA, Spiera R, St Clair EW, Davis JC, McCune WJ, Tibbs AK, Ytterberg SR, Stone JH, Specks U; WGET Research Group.
Thoracic Disease Research Unit, Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.

BACKGROUND: The pathogenic significance of antineutrophilic cytoplasmic antibodies (ANCA) in Wegener's granulomatosis is controversial. Their presence is influenced by the extent, severity, and activity of the disease at the time of sampling. The objective of this study was to determine the frequency of ANCA in patients with active Wegener's granulomatosis and to assess the influence of disease severity on test results.

METHODS: Baseline serum samples from the 180 participants in a multicentric prospective trial were tested for ANCA by indirect immunofluorescence, direct enzyme-linked immunosorbent assay (ELISA), and capture ELISA. Disease activity was measured using the Birmingham Vasculitis Activity Score for Wegener's granulomatosis. All patients had active disease at enrollment. Patients were categorized as having severe (n=128) or limited (n=52) Wegener's granulomatosis.

RESULTS: When all ANCA detection methods were combined, 166 patients (92%) were ANCA positive, including 96% with severe disease and 83% with limited disease.

CONCLUSION: ANCA are detectable in nearly all patients with active severe Wegener's granulomatosis, but approximately 1 of 5 patients with active limited disease are ANCA negative. Immunofluorescence and both direct and capture ELISAs are required for optimal detection, suggesting that ANCA are not recognized equally well by all testing methods.

PMID: 17602941 [PubMed - in process]

My Analysis: I have the severe form of the disease. My Rheumatologist was able to diagnose me because I was C-ANCA positive and had granulomas in my kidneys. Not all WG patients are C-ANCA or P-ANCA. And, it is sometimes hard to find granulomas in the lungs or other organs. These facts are misunderstood by some doctors. It is better to be diagnosed before the ANCA can be detected because the disease is in a milder form. It is easier to put this disease in remission then.

Angora Fire

Angora Fire was 100 percent contained today. Some firefighters are staying to keep the fire under control. There are a several hotspots that need to be cooled and monitored. The other significant number is the cost of the fire: approximately 13 million dollars.

Thank you-- firefighters, police, and support personnel for your diligience and courage.

Even at the loss of 3100 acres, there is a lot more Tahoe to see and love.

Sunday Scribblings: What's Your Sign?

In the 1980's when I was dating (that sure dates me, I know), one of the pickup lines was "What's your sign?" followed by "We could be compatible." It was just before the AIDS scare and the sexual revolution was in full swing.

My sign, Leo, didn't quite describe me. In those days, I was a very shy and retiring girl. If a man or boy talked to me, I would blush for days. I would like to perform, but I had a sister that was a much better performer (actor and singer) than I was. So what did the horoscope do for me? Absolutely nothing.

It wasn't until I met the Chinese horoscope that I realized that there might be somthing to this stuff. I was an Ox. I was a metal Ox. It fit me to a T. I won't go into the explanation here. You can find out about this type of person if you look through any Chinese horoscope explanation.

So, I went back to the Western horoscope. I found that to truly understand a horoscope that was not GENERAL, I had to look at the three legs--ascendent, Sun, and Moon signs--for a true understanding.

My outer sign (or ascendent)is Gemini. Yes, I do project a very confusing outer persona. Also, this is the sign of the writer. Yep, I fit there.

My emotional sign (Moon) was Scorpio. Yes, I have deep inner landscapes. It is sometimes hard to explain the colors and textures that I feel. I am very guarded in my emotional life.

My Sun sign is Leo. Performer and dazzler.

When I combine these three outlooks, I do see the real me.

Do I recommend horoscopes for foreseeing? No. To me, it shows my potential. And yes, I still like the Chinese horoscope better. But, I now have a better understanding and respect for these ancient teachings.