Paranoid over Imuran

Infection

1.       I still get pustules on my 5^th LIT. My immunologist said there must be an infection somewhere. He then asked for pap smear, urinalysis and chest xray. Upon seeing my xray, he asked if that was my xray? That film looks like a smoker’s lungs, and I claim that I am not a smoker. I have tuberculosis.

2.       I hate this report. “… right apex appear to be old lesion and insignificant”

a.       How can this be an old lesion if the 2009 xray report doesn’t have such comment?

b.      How can this be insignificant if the lesion is new? I mean if I have active tuberculosis

3.       I went to a rheumatologist because she said: “Xray was done to detect any apical lesions that may be part of ankylosing spondylitis.”  Honestly, she can’t see any lesion. She said she believes a pulmonologist may not be able to see it as well. I better go to an infectious doctor.

4.       I went to an infectious doctor. She suggested a tuberculin skin test. I withheld because I cannot go back to her in 2 days for the interpretation.  Sputum test is difficult to detect since I am not coughing. 

5.       I went back to my immunologist, I told him I had #3 and #4. I told him that I am afraid of getting a false positive from the tuberculin skin test because I always get a delayed type cytotoxic reaction from LIT. The skin test cannot differentiate active from latent tuberculosis. I am dying of smoker’s lungs already yet he never referred me to a pulmonologist. ^.^ What is the worst case scenario, if I have latent tuberculosis? Immune suppressants may give opportunistic growth to my tuberculosis bacteria. He said he can use minimum suppression + Ivig. Let him do the worrying. 

6.       I went to a pulmonologist. He said I don’t have a lesion; no smoker’s lungs. 

7.       Case closed! I just got challenged with #2. To distinguish an old from new scar. If the radiologist writes “A small calcific density and very minimal streaky densities are seen at the right apex.” I will not look for other specialist. I will take her word for it.

TNF-A inhibitor and cancer

12 years has lapse since my last check up with my rheumatologist. I told her I will be having my ivf soon. Any comment on immune suppressants? What will be my pain reliever? The last time I remembered, cox-2 was recalled. Ai, never mind…  I told her that I pray I will not need to see her. I don’t know what my immunologist will prescribe. I hope we will never need to use a TNF-a inhibitor. If I go to the websites of some tnf-a inhibitors like Embrel or Humira, there is a warning that their product may cause cancer. Yes, it is mandated by FDA that drug companies should make post market surveillance and report all cases. Even if  1/1000 patients had side effects, the consumers must be warned. I know my immunologist is very fond of Imuran. Imuran can also lowers TNF-a why its warning is it contraindicated to leukemia patients/ family history of leukemia only? Hehe... no comment ^.^  What is the most strongest immune suppressant she had used on her patient? No comment. ^.^ I need to pray over my medicine. Like for example, Methotrexate it can cause drug-induced lupus etc… but it was the only available medicine in the past. One of her patient died of gastric ulcer because he refused to take the DMARD. Ai… pregnancy is dumb I do, dumb I don’t. I have family history of cancer. It seems to me that cancer is inevitable.

My new gynecologist strongly advised me not to get pregnant on the very first day she saw me. She told me that I tell my immunologist not to use Imuran. Pls use a milder immune suppressant. She said immune suppressants may cause cancer.

Does having autoimmune disorder increase my risk of having cancer with immune suppressant?

I don’t want to think too much. I told my immunologist that I trust him on whether lowering tnf-a will cause cancer or not. I was willing to take Imuran but I remembered the tuberculosis scare.