Normal. What is ‘normal’ for RA?
There is no normal. And when it comes to lab work, I find that the doctors are pretty blasé. ‘Oh, well, that’s nothing. That’s just because of the RA.’
I get copies of all my lab work. I like to look at it myself. I am familiar with all the usual tests, and the reference ranges are clearly printed on the results. I’m not prone to anxiety or drama queening. I don’t freak out every time a level is a few points outside of normal.
Because my blood work is always outside of normal. Not my inflammatory markers though. Nope, those are always fine. Bang smacking perfect!
It’s the other stuff. White cell count. Liver enzymes. Kidney function.
Those are always a little (or a lot) off. Luckily not enough so that I have to stop my biological.
But looking at my bloodwork last time I was a little shocked.
My cholesterol is high. It’s 6.8. Anything over 5.5 is generally flagged and treated with medication. Mine hasn’t even been flagged, because elevated cholesterol is a well known side effect of my biological. High cholesterol is not good, but it’s the lessor evil when compared with out of control RA, with systemic inflammation and organ involvement.
But just having that level of cholesterol raises my chance of heart disease four fold. It’s a risk. Diet can help, but I don’t eat a lot of saturated fat as it is. And a lot of research is now saying that saturated fat isn’t the problem anyway. So I’m not sure that I can do anything about it with diet anyway.
Heart disease is the greatest killer of RA patients. RA raises your risk of heart disease, but so do some of the medications. It’s a bit like playing Russian Roulette. No one can really say which is worse, the disease or the treatment.
I choose to stick with my biological. And my doctors, by not mentioning my cholesterol to me, agree.
But then there’ s my blood pressure. It has been measured several times recently at 145/90. 153/105. The highest was 195/110. Then sometimes it falls back to 140/80. All of this is very high for me. My blood pressure used to be on the low end of normal. Typically it was 110/60 or so. Until I started my first biological – Enbrel – when it shot up. It remained high when I switched to Humira. And then when I switched to Orencia.
Enbrel and Humira are TNF blockers, and are known to cause elevated blood pressure as a side effect. Orencia has a different mechanism so I was hoping my blood pressure may normalise. But no. It is still high. Even higher, if anything.
High blood pressure is another risk factor for heart disease. That’s two bullets in the Russian Roulette chamber.
My blood sugar is also high. Sometimes in the diabetic range. This is because I am on prednisone. I need to be on prednisone, otherwise I am bedridden and would be in a wheelchair. So we just ignore the blood sugar. I take metformin because I am classed as having pre-diabetes. And I watch my sugar/carb intake. Another reason to eat a healthy diet.
But high blood sugar and diabetes also increase your risk of heart disease. It’s starting to make perfect sense that heart disease is the leading cause of death in RA patients.*
A third bullet in the Russian roulette chamber.
But what can I do?
Nothing really. I did bring it up with my doctor. He said I could take a statin for cholesterol. A beta blocker for the high blood pressure. But with all the medications I am already on (thyroid replacement, metformin, prednisone, orencia, methotrexate, arava, Naprosyn and plaquenil) he said he really isn’t keen to keep adding more medications. He would prefer to just monitor me carefully. He knows I exercise as much as possible. He knows I eat a diet full of fresh whole foods. He knows I work hard to be as healthy as possible within the constraints of living with several autoimmune diseases.
So we agreed. We’ll watch. And we’ll wait and see. I’ll get my monthly blood tests without fail. And we’ll just hope for the best.
Lucky I’m an optimist.
* Source: PubMed.gov “Rheumatoid arthritis and cardiovascular disease.” “http://www.ncbi.nlm.nih.gov/pubmed/18417067”
Please note that the content of this post reflects the personal experience of the blogger and does not constitute medical advice. Success or failure with a drug, a personal fitness program, diet, or psychological outlook is individual. Readers cannot assume that they can replicate any success or failure they read about in a blog. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding your medical condition or medications.