Thursday, January 2, 2014

ITP What?

Last Friday, I was diagnosed with ITP - idiopathic thrombocytopenic purpura. This was something I had never heard of, yet I have found out does affect lots of people.

I have always bruised very easily, so when a new bruise pops up, I think nothing of it. I just assume that I bumped into something. I am an incredible klutz, so bumping into the corners of tables and things like that, happen all the time. The past few months I have noticed more bruises than normal and the some of them were HUGE, very ugly, and took forever to go away. But, I still just assumed that I knocked into something.

Then a couple weeks ago, I started to notice red and purple dots on my lower legs. It kind of looked like a rash. It was not itchy at all. They did not hurt and there were no bumps. They really just looked like lots of red freckles. I thought maybe I was having a reaction to the laundry soap or something like that. I tried googling the rash, but I didn't find anything that really fit my situation. Anything that came close always had other symptoms and I felt perfectly fine. Well, the dots started spreading. Now they were all the way up my legs, feet, arms, belly,  and back. It was not solid, but patches of them here and there. I still continued to ignore them. If it was summer and I saw them all the time, it might have bothered me, but it's winter in Michigan, so I am in long pants and long sleeved shirts all the time. Out-of-sight, out-of-mind. I wish I would've taken a picture to post, but I didn't think anything was really wrong.

Then Christmas Eve rolled around. I woke up around 6:00 with what I thought was a stuffy nose. I have allergies, so this is a common occurrence. I got up, blew my nose and went back to bed. I did not turn the lights on at all. When I got back into bed, my nose was still running. This time, I walked into the bathroom and I noticed that I actually had a bloody nose. My house does get dry in the winter, so I do get bloody noses on occasion. I turned on the shower and sat down in the bathroom to apply pressure to my nose and to breathe in the steam. In the past, my nose bleeds have always stopped within 5-10 minutes. But this one kept going strong. I realized that I had blood on my pajama top, so I changed my clothes. Of course, in the process of changing I had to let go of my nose and I proceeded to get more blood on the floor, the couch, the clean shirt, etc. I stripped the bed, as there was blood on the pillow and the sheets. Apparently, the bleed had started before I woke up. So, I threw everything in the wash, the entire time holding tissues to my nose.

By this time, the dog was up and wanted to go outside. The cats wanted food and I was trying to do my normal morning stuff. Luckily, I was off of work this day, or it would have been even worse. I am not someone who will just sit and do nothing, so I was trying to take care of everything and hold my nose and it kept bleeding and bleeding. I'm not talking about a trickle. It would start dripping every time I let go of it. I knew that moving around was probably making it worse, so I resigned myself to just sit down.

I decided to search the Internet for ways to stop nose bleeds, because everything I had tried to this point was not working. Of course I started clicking around and I found all these health issues that can be associated with nose bleeds. I try not to take the advice of Dr. Google, but it was in the back of my mind that something with this nose bleed was not right. I eventually googled something about a nose bleed that would not stop and rash. If the nosebleed would have stopped sooner I would probably have never looked it up, but it took 5 hours before I finally got it to stop, so I had lots of time to play on the Internet. Anyway, in the process I found a picture of petechiae. This looked just like the "rash" that had now spread all over my body. At that point I realized that the petechiae and the nose bleed were definitely related and could potentially be a problem. The websites listed the causes of these symptoms from things that were very minor, like a virus or could be something serious like leukemia. Other than these two symptoms, I felt perfectly fine, so I didn't think it was anything serious.

However, I did think about making a doctor's appointment. But it was Christmas Eve, I still had some shopping to do and some things to get done so I just stopped by the fast care inside my local Shopko. They were backed up and after I read the list of things that they did at that location, I did not think they would be able to help me. So, I just continued on with my day. I did not think this was an emergency, so I didn't even consider going into the ER. I just carried on with my day. I was terrified to sneeze or even blow my nose all day long, but the nose bleed did not start up again.

The next day was Christmas and I made up my mind that I would go to the doctor the next day. Again, I did not view this as an emergency. So, the morning of the 26th rolled around. I called the doctor's office. My normal doctor was on vacation for the Holiday. Her back up was also on vacation and the other doctor had no available appointments. But they told me that if I had a nose bleed for that long, I definitely needed to come in. So they made an appointment for me at an after-hours clinic.

At my appointment, the doctor confirmed that the "rash" was petechiae and explained that it was basically bleeding under the skin, but that there were many possible causes. So, she ordered a ton of blood tests to try to figure out what the cause was. I left the office not really knowing anything besides the fact that I was bleeding under my skin and she told me that if I got another nosebleed, I should go back there or to the ER.

At 9:30 that evening, I received a phone call from the on-call doctor. I was told that the lab had contacted him because my platelet count was "dangerously low". He told me that I needed to go to the ER right away.

I went into the ER, still not really knowing much about what was going on. When they asked me why I was there, I told them that the on-call doctor told me I had to come in because of my lab results. But, I still felt absolutely fine. They did an exam and documented the location of the patches of petechiae and purpura (that's the big, ugly bruises). They took more blood and told me that they were calling a hematologist. They eventually diagnosed me with thrombocytopenia, released me and told me to call the hematologist's office in the morning. I still didn't know anything other than I had a low platelet count. When I looked at the doctor's contact information, I noticed that his office was located in the Cancer Care Unit of the hospital, which made me a little nervous, but I figured that since I felt fine, there was nothing to worry about.

The next morning, the doctor's office actually called me before I even had a chance to call them. It was literally at 8:02 am. They told me that I needed to come in right away. So, I drove over to the hospital and found the Cancer Care Unit. When I entered, it was actually the nicest waiting room I have ever been in. I am used to the standard waiting rooms with a bunch of sick people staring at a TV or reading old magazines that hundreds of other sick people had already touched and spread their germs on. But this waiting room had coffee, juice, water, snacks, etc. I was greeted right away. The people there were all talking to each other and laughing. It just seemed very comfortable. However, as I looked around, all the magazines that were in there were geared toward cancer. It made sense because I was in the Cancer Care Unit, but at the same time it made me wonder what I was doing there.

After a short period of time, I was called. I had to do the whole weight, blood pressure, temp, etc. thing and then the doctor came in. After introducing himself, the first thing he told me was this was not cancer, so I should not be worried about that. He then just sat and talked to me for almost an hour. He went on to explain the findings of my labs. A normal platelet count is between 150,000 and 450,000. The day before, I had only 25,000. This is not terrible, but it is not good either. He said that chances are, my count was much lower on the day that I had the nosebleed (3 days prior). Everything else that they had tested for came back fine. He still wanted to test me for some additional things that were not yet tested for, just to ensure nothing was missed, but he was fairly certain that it was ITP. This diagnosis is given when they rule out all the other causes of this. He explained how it was treated, what I could expect in the future, complications, and things to avoid doing.

I, ultimately, was given a prescription for 50 mg prednisone for a month. Then depending on the platelet count, it would be adjusted. I had some more blood drawn to rule out the last of the possible causes and I made an appointment for a two-week follow-up. Then, I finally got to go back home to digest it all.

So, far things are going well on the steroids. The petechiae is all cleared up and the purpura looks much better. I still have a bunch of bruises, but I think I am doing better. It's kind of hard to really judge since I never felt sick. The one side effect of the steroids that bothers me is that I cannot sleep, so that makes me a little crazy, but I figure I can live with that for a month if necessary.

So, I guess I just have to wait and see what happens at the next appointment. Until then, I am not supposed to do anything that could potentially injure me or cause straining. And if I do happen to get hurt or get another nosebleed, I am supposed to go to the ER.

In the meantime, I have been able to learn quite a bit about this condition. The most useful site I have found is I strongly suggest checking it out if you want to find out more.

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