I won the PCP lottery!

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elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 5/4/2006 6:12 PM (GMT -7)   

Continuing my strep throat saga, I went in this evening and insisted on a throat culture because of the enbrel situation.  I had been upset all day because I find it so frustrating that not one primary I've ever been to (aside from the one who initially referred me to a rheumatologist) seems to be that familiar with the drugs I'm taking, or autoimmune disease in general.  I was praying to God to please find me a primary that can at least spell my medications.  The only person I could get an appointment with tonight was a new physician's assistant in a different branch of the primary care office I normally go to.  As it turns out, this lady not only has a personal interest in autoimmune disease (her mother has lupus), but she is also intimately familiar with alot of the drugs used in rheumatological disease, including enbrel.  And here's the clincher--she personally knows who my rheumatologist is, and validates how extremely brilliant he is.  I didn't ask, but I suspect he's her mother's doctor. 

This PA seemed very knowledgeable about autoimmune disease in general, and was very easy to talk to.  She acted like she actually cared (what a novelty)!  She did a throat culture and sent it away to a lab.  Evidently, because of the high inaccuracy of the rapid strep test they do in the office, my insurance will not pay for it.  She said I probably did not have an active strep infection because my throat is not inflamed at all right now.  I'll get back my ASO titer tomorrow, and the throat culture should come back on Monday.  This is important because I suspect that I did have strep throat and my rheumatologist will want to know this for sure--the ASO titer will at least be a clue that I've had a recent infection.  The throat culture results could possibly tell me if I am still a carrier, since I do not have symptoms of strep throat anymore--if it's positive for strep A then I'm a carrier.  This is also important information for my rheumatologist to know. 

I was wondering, and perhaps you can correct me if my logic is wrong Erin, what happens if a strep A carrier goes on the biologics?  Would they continue to get minor strep infections, since they're already predisposed for them (meaning the bacteria already resides in their bodies)?  Or could the drugs actually act as a catalyst and cause more serious strep complications like rheumatic fever or kidney problems?

thanks for listening!  Oh, by the way the enbrel is definitely working now--I feel great!

Elcamino


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 5/5/2006 8:23 AM (GMT -7)   
hey elcamino,

i carry strep, for a long time now. since childhood when the ENT said, "it basically lives inactive in your tonsils". so personally i find it no big deal. over the past 3 years on TNFs and DMARDs i only had 2 strep throat infections that cleared with anitibiotics and i also continued my shots while on them. but everyone is different. i really do not see any reason why this should interfere with your treatment. depending on the doc, if you ever get an active infection of ANY KIND...let them know and they'll decide whether it is safe or not to be on the drugs.
one thing i can honestly say is, if you ever run a fever when sick...i wouldn't take any shots.
your safe bet is corresponding with the PA or rheummy that knows the drugs the best.
you're doing OK! much of this is so much easier than it seems, just takes some monitoring and communication with your doc.
just remember, all TNF and DMARDs act as immunosuppressants and can put a person at a higher risk of developing an infection or prone to illness....but it is not gauranteed. try not to have this weigh heavily on your shoulders.
you're doing all the right things.
take care
Active, Severe RA. Crohns Disease. Chiari Malformation & Right Brain venous anomoly. AS. Emphysema. Rheumatic Lung. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg every 4 days; pred; Pentasa; Imuran; dilaudid; diazepam; Avinza 30mg; MiraLax & too many others.


elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 5/5/2006 8:39 AM (GMT -7)   

Thanks Erin.  I figured lots of people had to be strep carriers.  I did have a fever with this latest "infection," but I specifically waited until the fever had passed before doing enbrel injection.  I know that if I had called my rheumy he would tell me NOT to do the injection until the entire virus/infection was gone!  I think he just has to be cautious for liability reasons.  Other than my autoimmune issues, I'm a fairly healthy person.  Never even got sick with the latest virus until I started the tnf-inhibitors.  I'm sure I could safely continue tx with enbrel, especially since it's started working.  Rheumy may disagree since I've had 3-4 viruses since I started these drugs in January.  I've read, though, that the increased risk of colds, etc... may decrease the longer you use the drug.  I'll see what he says in a couple of weeks.

Thanks for the reassurance.

Elcamino

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