Immune reaction, ending

On Saturday, August 20th, 2011 I decided to “get away from it all.”  This resulted in a massive attack by chiggers.  My immune system did not take kindly to skin-liquefying insects using me as a buffet and instituted TOTAL DESTRUCTION.  My initial symptoms were just really itchy chigger bites, but two weeks later my hands broke out in an unusual looking rash that took several doctors and rounds of prednisone and drug hell to control.  The initial diagnosis was erythema multiforme, but the problem continued.  A second skin biopsy was performed that showed nothing terribly helpful–same as before, mostly.  A different pathologist opted for “primarily T cell infiltrate consistent with drug reaction or insect bites”.  Okay.  So my immune system was royally pissed.  Multiple attempts to taper off the prednisone (in multiple ways) have resulted in breakthrough flares of new blisters… until a couple of days ago.

For the first time, the skin on my hands looks like NORMAL HUMAN SKIN!

My lower leg (the really badly chewed-up one) finally looks somewhat better.  I have small pinkish scars that show through hosiery and bother me mostly because, well, I’m female and vain, okay????  The exposures on these pictures suck and I really don’t care.  The point is that I think my immune system has finally been beaten into submission. I’m down to 10 mg prednisone and most of my body is handling the decrease well–my rosacea seems to flare at this point… but as long as I’m not getting blistering red horror, I’m vastly relieved.

The prednisone was difficult.  I had persistent, near-migraine intensity headaches, blood pressure through the roof (above 160/104 at one point), chest pain (severe  a couple of times), general fever/malaise, persistent low back aches, irritability, and INSANE CHOCOLATE CRAVINGS.  I know very, very well what risks I was running and what I was doing to my body, so no lectures please.  Remember, for once, that I do have a Ph.D. I don’t take a drug until I understand what it does and how it does it to the best of our cumulative human knowledge–or at least everything I can find out about target organs, serum half-lives, metabolism, etc.  I don’t feel much better yet, but I’m starting to feel… cautiously optimistic.  When my blood pressure returns to something below geyser level, I can start exercising and trying to repair myself.

I mentioned in another post tonight that it’s been a bad year for illness and injury–and it has.  I’ve never been sick so much, or had so many minor injuries.  I even fractured my radius (elbow end) earlier this year.  I’ve caught myself wondering if quitting smoking was hazardous to my health!  I don’t regret that one.  I suspect I’m going to have to make 2012 the year of “get my body fixed.”

Assuming I survive this year.






Immune Reactions

So after the chigger bites post, I should have posted this.  A couple weeks after the chigger bites, my hands broke out in what appeared to be a rash for what appeared to be no good reason.  I hadn’t come in contact with any new bugs, didn’t have any existing bugs, and it didn’t seem to be from touching something (contact-mediated dermatitis).

Options for what-the-HELL were going on included: allergic reaction to (????), scabies (ewwww), bug bites (other), fungal infection, bacterial infection, parasitic infection, rare and weird complications (my boss helped some there, with ID reactions).  I sprayed for bugs (fleas, bedbugs, scabies, etc.) and saturated my living space with toxic loveliness. I tried Neosporin.  I tried metrogel, cyclosporin, clotrimidazole, hydrocortisone, and fluocinonide.  And aloe, oatmeal, and caladryl.  Nothing worked or helped.  Having thus ruled out the obvious, what was left was most likely an allergy to… something.

I went to the doctor and was diagnosed with a rash.  That was terribly helpful. The general consensus, though, was that my immune system went a little haywire over the chigger bites (see previous) and was refusing to calm down.  This means a round of steroids (prednisone). Based on what was going on and what it looked like THEN, aggressive was preferred.  For the first two days, the symptoms started to recede, but then they came back with a vengeance.  This is not quite the ugliest picture I could have taken…. it’s hard to take a picture of your own hand with a cameraphone, by the way.  And it was 4 days before the worst of it.

Erythema Multiforme

My fingers blistered and swelled so much I couldn’t bend them. And, of course, ITCHED.  I started thinking about amputating my hands.  My backup plan was a bottle of nitric acid.  I went back to the doctor, who referred me out to another dermatologist (yes, I work for one; he was out of town).  I was diagnosed with erythema multiforme (minor), and again, more prednisone.  At this point my blood pressure was over 160/104 and shows no signs of coming back to the land of non-aneurism…. more steroids sounded great (to relieve symptoms) and not-so-great (side effects).  The side effects have been rough.  You can Google erythema multiforme (EM) for more pictures (ewww) and information, but I thought I’d offer a qualified summary.

EM is generally considered a Type IV hypersensitivity, also called a delayed-type hypersensitivity.  It looks like bulls-eye targets on your skin, though these can overlap so much that they’re hard to recognise (mine did).  It can also affect your mucous membranes (nose, mouth, throat) and eyes.  This type of allergy is different from the a type I (anaphylactic) reaction and isn’t controllable with “allergy meds” like Allegra, Zyrtec, or Benadryl, though these can help with some of the incidental symptoms.  An allergy occurs when your immune system recognises and attempts to destroy a foreign invader (that can’t really hurt you) like pollen, animal dander, something about your laundry detergent.  It usually does damage to surrounding cells at the same time.  EM is a sign that your immune system is, essentially, completely insane and destroying some harmless substance: your SKIN.  It really shouldn’t be attacking you at all (that’s supposed to be trained in the thymus).  But it does.  It’s not caused by the same kinds of cells that make an anaphylactic reaction (like hives/urticaria, or throat-swelling-shut reactions).  Instead, these are highly trained T cells that are… bored?  We don’t understand erythema multiforme well.  There are also indications that it might be related to herpes infections. 

So how do you treat it?  You have to get the immune system to CALM DOWN.  That means, partially, that you also have to calm down… which is easier said than done when you ITCH. I’ve also determined that I would rather break a bone than ITCH that badly.  To calm down the immune system, prednisone is often used.  Hey, it’s cheap and effective.  Now what’s really odd about this is that it’s a lot like your body’s own stress hormones: cortisone.  You’re just using SO MUCH prednisone that your body could never get to that level, and it temporarily forces a shutdown of the system—including your hyperreactive immune cells.  As you gradually decrease the dose, things should go back to normal (once you get the problem under control).  It’s a risky treatment, because you are suppressing your immune system: meaning colds and flu and everything just became a lot more challenging to fight off.  You also have to avoid some other medications (aspirin) and have weird food cravings, high blood pressure, increased risks of glaucoma and lots of other drawbacks—but these are generally temporary and go away once you stop taking the medication.  For short-term treatment, it shouldn’t cause lasting damage.  A couple of weeks of high blood pressure, mood swings, and chocolate cravings are likely better than losing your hands or going blind.

Other suggestions?  I wore a pair of black elbow-length gloves for a couple of days.  Keeping it hidden also helped me—not seeing it meant I didn’t obsess about it quite as much. The sensation from the gloves was at least consistent, and so easier to ignore than transient sensations that caused insane itch.  I got to make Lady Gaga jokes.  People weren’t as scared of me.  I couldn’t scratch effectively.  All good things.

Will it come back?  That depends on whether I get devoured by chiggers again… that might not have been the trigger, but it’s the most plausible.  I’m not actually going to worry about that unless I have to worry about that… I don’t think it’s likely, in this case.

An Ill-Fated Trip

So, over this last weekend I decided to “get away from it all.”  Obviously, based on previous posts, “it all” did not include escaping chiggers. I stopped at the Small Country Campground in Louisa, VA.  Yes, I was about 7 miles from the future epicenter of that rare Virginia earthquake.  No, there was no sign such a thing was coming. Overall, the trip was a total bust and wasted effort, but there was some very pretty scenery to share with you all.

Funny.  It doesn’t look like hell…

Two of Every Kind…

If Noah weren’t dead, I’d kill him.  Now that the title of the post makes more sense, I shall endeavour to explain.

You see, apparently God commanded Noah to take two of every kind of animal aboard the ark. Except that apparently Noah was more selective than God anticipated.  Unicorns? Nope.  Dragons? Nope.  Lions, tigers, and bears?  You betcha.  Trilobytes and dinosaurs? Nope.  Chiggers, fleas, and ticks?  OH HECK YEAH WE BETTER BRING THOSE!
Seriously, Noah, WTH?

When I die, I am SO putting you in the hurt locker for this.  Then I am quietly resuming my renovations to Hell.