Vitamin D

Spring

In the UK we have just moved to British Summer Time, and this weekend Spring has well and truly arrived with mild temperatures and clear skies. Clear skies mean more sun and more skin exposure to sun  means more vitamin D, which apparently most of us Brits are short of. Here are a couple of related things which recently happened together - but are they related? 

Since 2011 I have been on Azathioprine and the main side-effect has been various warts on my fingers of two varieties - the common ones (about 8 at the moment) and so-called periungual warts (present on 7 out of 10 fingers) which appear as dry thickened skin patches down the side of the fingernails which tend to merge together over time. These are apparently a direct result of a suppressed immune system and common when taking this medication. In the last few years I have tried to treat them with duct-tape and with cryotherapy, neither of which were very effective. 

1. In the last four weeks all of the periungual warts have either cleared or significantly reduced and two of the older conventional warts have also gone. I am closely watching the rest.

2. In the last four weeks I started taking daily vitamin D supplements of 10𝞵g (= 400 International  Units) which is the recommended daily dose (at least in the UK). 

So are these two events a happy coincidence or is there a link? Vitamin D is supposed to benefit the immune system, amongst other things; it's role as a treatment for warts (in higher doses) is not proven. On the other hand, my doctor told me a while ago that eventually my immune system would probably figure out how to deal with these warts, but it would likely take several years.

It became more interesting when I started looking into it a bit further and found that there is thought to be a link between low levels of vitamin D and auto-immune disease. However, and this is a BIG, however some studies suggest that these low levels may be a result not a cause, and that taking additional vitamin D could make some auto-immune disease WORSE. The jury is clearly still out (link) and I'm not qualified to comment further. I'll cautiously continue with the vitamin D for now, especially if the warts keep improving.

(Just in case anyone is in any doubt, I am not a doctor and recounting my personal experience, not advocating vitamin D. Anyone considering taking supplements of any kind should always consult with their doctor, especially if already taking other medication.)

Read other articles in this series at Living With CLIPPERS.


Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Up and down, like the FTSE 100.

Wormwood Scrubs Common (London)

Well not quite as bad as the FTSE 100 but that's another story (not helped by lots of people on strike and those that aren't on strike going into meltdown over potential Brexit). Of course I'm talking about my meandering white blood cell count which has been wandering a bit further than it should recently.

As my CLIPPERS medication of choice, Azathioprine, willfully interferes with the immune system (which is presumably why it helps keep CLIPPERS at bay), it is expected for my white blood cells to be more thinly populated compared with the norm. The expected range is somewhere between 4 and 7 (I am not a doctor) and mine tends to hover between 3 and 4. About 7 weeks ago it dipped to a historic low of 2.6 and there was much muttering amongst the medics behind closed doors which resulted in me being allowed to stay on Azathioprine for now, but in exchange for having further tests every 3 weeks or so.

On the next test the count had gone back up to 3.something - hurrah! However, on the one I had last week it had dipped back down to 2.9; this is still better than my previous historic low of 2.8. So the tests will continue and I'll let you know if anything strange happens. 

There are no specific symptoms associated with low white blood cells but I was already being as careful as possible to avoid sources of infection - lots of hand-washing and keeping hands away from my mouth, nose, eyes etc. Public transport in the mornings makes me uneasy - too many germs! My doctor emphasised that if I get fevers or unexplained illness I need to see him immediately - presumably under these circumstances I will be able to bypass the 3 week wait for an appointment that is the current situation here.

Read other articles in this series at Living With CLIPPERS.


Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

More blood.

Filled tubes, 9 of them.

So, following on from last time, I finally managed to get my blood sample collected for the Mayo CLIPPERS study. In fact, I had no problem filling all 9 tubes - I have good veins apparently. Hopefully it survived the trip over the Atlantic with FedEx and will contribute in some small way to helping understand more about CLIPPERS. 

Two warts merged into one.

As of the beginning of June, I am over four years since first symptoms and still taking Azathioprine with few side-effects. Apart from occasional blips in liver scores, I have a few warts (7ish) which is apparently quite common on Azathioprine. They are confined to fingers with a few periungual ones for good luck. Not very pleasant, but could be worse - I had them blasted with cryotherapy recently which will hopefully help. That's enough about warts.

Finally, I'm not sure how long this has been live, but CLIPPERS now has a short entry on Radiopaedia (think of Wikipedia, but for doctors)

Read other articles in this series at Living With CLIPPERS.


Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Sides

Sometimes it's easy to get into a routine with treatment, especially when it is pill-popping. Until something "interesting" (read "bad") happens I am not seeing the docs very often at all. To save me getting too complacent though, there are always treatment-related side-effects to worry about. While taking Azathioprine these have been very mild, at least the overt ones. In fact, the only thing I can report is occasional bouts of a metallic taste, and that seems quite common over a range of drugs. It is the covert side-effects which are potentially the more worrying which is why regular blood tests are the order of the day. 

I recently had one of those worrying phone messages from the medical centre which have zero information content and much larger worrying content "Please call the centre as soon as possible.". This was 2 days after I had been in for blood tests. So something obviously amiss, but what? Well to cut a long story short, one of my liver scores came back as "borderline" which triggered a "make an appointment to see your doctor" call. However this was done without reference to my history so when I phoned up and it got referred back to my regular doctor, he said it was OK. So in the land of CLIPPERS, "borderline" equals "fine" on this occasion ...

This, and some recent email correspondence with other CLIPPERS sufferers, made me think about side-effects a bit more, as I think they are often under-reported. So I started a new Forum topic if anyone is interested in relating their experience on medication.

Read other articles in this series at Living With CLIPPERS.


Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.