Jim's Posts

We finally have a diagnosis of the kind of anemia she is suffering from. Iron deficiency anemia is often caused by malabsorption of dietary iron. It is treated with supplements and her numbers quickly improved along with her symptoms of anemia. One of my concerns has been her aortitis and the inflammation caused by Giant Cell Aortitis. It is a large vessel vasculitis, and she has been on long term corticosteroid use. There are inflammatory markers C-RP that can indicate a flare but it isn't a dependable indicator. It can also rise when the body is fighting any infection or in her case recent tooth extractions a side effect of long-term prednisone usage. Between her dental procedures and anemia her INR has been very difficult to control. Some people when on antibiotics can have an increase in INR and Debbie is one of those people. While anemic her INR ran low and with increased dosage as her anemia improved her INR increased. Then when on prophylactic use of Amoxicillin pre and post procedure her INR shot up to 7.9. A little vitamin K quickly brought down in range. Another problem she has been dealing with is her isolated systolic hypertension. Even after the Actemra biologic immunosuppressant was stopped her systolic blood pressure is 140 to 160 while here diastolic has remained in the 60's. It has been attributed to the rigidity of her aortic grafts and stents that run from just above the aortic root to her SMA artery. It changes the hemodynamics and disrupts the mechanisms that control BP. The problem is when you adjust the systolic lower you also can lower the diastolic and when that happens you run the risk of organ mal perfusion which can lead to heart and or organ failure in general. Her doctors are reluctant to try to adjust her meds because of this however the worst thing for an aneurysm is high blood pressure. We are still trying to delay the need to address the abdominal aneurysm which would require the BEVAR procedure to extend her current stents to below her kidney arteries where her aorta returns to normal size and has a good landing zone for the stent. The only medication safe to add it seems is a diuretic. Which brings with it a whole other set of side effects. Electrolyte imbalances and kidney damage. She already has a reduced e GFR rate and low sodium. The good news there no need for low salt diet. No body wants to add medications to an already excessive daily amount, but we thought it worth the risk because having another procedure carries as much risk if not more. On a lighter note, I'm enjoying having and AI assistant to help me do my research in a matter of minutes instead of hours it used to take and Debbie has been enjoying meeting up with old classmates as we plan our 50th reunion. We both are 1976 grads from John Marshall in Oklahoma City.

It's been almost a year since our last CT scan to monitor her abdominal aorta. She is still being treated for her autoimmune disease Giant Cell Aortitis. Low dose prednisone. We have decided to not try Biologics like Rinvoq as we prefer the devil we know to experimenting with another pharmaceutical with questionable efficacy. We will have the CT scan in Oklahoma City with her new vascular surgeon consult via zoom. Dr Oderich is at Baylor Medical Cardiovascular Center in Houston. She was diagnosed with anemia this fall after being chronically fatigued short of breath. They believe it is caused by malabsorption due to her blood supply restrictions to her mid gut with her Celiac artery blocked by the EVAR stent placed last year. She has responded to iron supplements. However, my older cousin a retired Internal Medicine physician says we may need to explore Mechanical hemolytic anemia. It's caused by red blood cell shear and destruction by the valves themselves. It's a rare complication of mechanical valves. Yet another reason to reconsider mechanical valves. Debbie has had a difficult time with keeping her INR in range. Anemia causes inaccurate INR readings as well as interfering with the Warfarin dose, so her INR was extremely low until her anemia improved. Then when having a dental procedure and being given Amoxicillin as a prophylactic her INR shot up to dangerous level of 7.9. So she has had a difficult time scheduling a follow up procedure. The Corticosteroid has played havoc on her teeth. Dr Kapravinac at Cleveland Clinic thought she needed mechanical valves because she had porcine valves fail at 3 years and again at 5 years. He said her body doesn't appear to like them but in hindsight it could of been the autoimmune condition. Giant Cell Arteritis is a condition they don't fully understand. She has had a rough time with the chronic nature of her health problems and is really exhausted by the constant medical issues it just never seems to end. The doctors locally here just seem as baffled as I am by the inability to stabilize her INR and control her inflammation to keep any further damage to her aorta from causing failure of her aortic stents that would require intervention and the next EVAR procedure. Hopefully 2026 is a better year.