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Our Stories A very special thanks to all those who have contributed so graciously to our stories. You have definitely made a difference in the lives of other CADdys. To send us your Story, use the Contact Us page.
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2007
Betty's story Ever since my 30’s, I had been considered to have low-normal hemoglobin trending between 11.6 and the low 12s. In early 2000, I wasn’t at all concerned when my gynecologist suggested I should consult my internist because my 11.3 number was too low. I was in for a rude awakening. After several rechecks over the next 3 months, my internist referred me to a hematologist/oncologist for more in-depth testing In the late fall of 2000, I was very upset when I learned of my diagnosis of Cold Agglutinin Disease Auto-immune Hemolytic Anemia. I knew of no one with that diagnosis and felt very frightened and isolated. To arrive at that diagnosis I had been given many sophisticated blood tests, GI testing--colonoscopy & gastroscopy, a CT scan of my internal organs, and a gallium x-ray with radloisotopes of my lymph nodes. Ultimately, I had the bone marrow test also. Fortunately, all tests were negative Since no underlying disease was noted, the diagnosis was Primary Chronic CAD (Cold Agglutinin Disease). It is considered idiopathic (no known cause) Cold Agglutinin Disease. Secondary CAD is caused by an underlying lymphoproliferative disorder such as lymphoma or an infection such as mycoplasma pneumonia or another autoimmune condition like lupus etc. I had monthly CBC (complete blood count) checkups when my hemoglobin was fairly steady in the 11 range and as it went lower, the visits became more frequent I could almost predict what my hemoglobin number would be by the way I felt. When it was high, I’d be full of energy and could “chop wood”. When low, I’d be very tired and wake up feeling as tired as when I went to sleep. Also, I tended to feel more out of breath on exertion, was very pale, my eyes looked yellow, gums and inside eyelids were a very light pink color and workout seemed impossible because my muscles in my legs felt strained as if I couldn’t take another step and had to sit down. On two occasions I experienced brown urine--both times I was sick with the flu and a virus infection. In 2002, I was started on Procrit, a bone marrow stimulator for red cell production and continued with weekly self-injections to help raise my hemoglobin. ln the winter of 2006, even the Procrit wasn’t working and my hemoglobin reached a low of 7 necessitating 2 units of transfused blood. Additionally, I was treated with 4 weekly infusions of Rituxan that raised my numbers only slightly and for a short duration. I should note that I had been ill several times in the fall and winter with various colds, a herpes outbreak, and other viral infections. There seemed to be a direct correlation between these illnesses and my lowered hemoglobin. By spring 2006, my doctor decided to re-treat me with another round of 4 weekly infusions of rituximab (Rituxan) and this time I had a more positive response to the drug. By summer, my hemoglobin rose to 14.2 and now 7 months later, remains mostly at 11+ with bi-weekly Procrit usage. I am still hemolyzing, but apparently compensating for the loss with sufficient red cell production. I continue to take approximately 2mgs of folic acid daily, exercise, keep warm, and try to eat healthily. Rituxan is a wonderful drug and can sometimes be more effective after the second or third round of treatments as it was in my case. Heretofore, corticosteroids and chemotherapies and immune suppressing drugs have been our only treatment options and all have side effects with the results being mostly temporary in nature. There are other single agent monoclonal antibodies in clinical trials. These are designed to target a specific site in the body with the goal of eliminating damage to the surrounding healthy tissue. This is good news for all of us. I have consulted with four hematologist/oncologists in the Miami area, and 3 in New York and all agree on the CAD diagnosis.
2010 UPDATE For 3 years following the Rituxan treatments. I continued to fare well using only 2 mg. of folic acid daily and weekly 10,000 unit, low-dose Procit. During the early Fall of 2009, my hemoglobin headed south due to a respiratory/sinus infection and the stoppage of the Procrit at the urging of my new New York Dr. Richard R. Furman who advised me of the FDA warnings of possible thrombosis. He also expressed concern that I wasn’t making enough reticulocytes-immature red cells. I had a CT scan of the pelvis, abdomen, chest, Bone Marrow Biopsy, Metabolic Profile, Coombs Direct and Indirect Tests and more. All ruled out Lymphoma. My HGB continued to drop until it reached 7.2. It was decided to treat again with Rituxan X 4 and also to do a Plasmapheresis to give me a better chance to respond to the Rituxan. Also, I received 2 units of blood to raise the HGB so I’d have more energy and be out of the danger zone. My numbers improved in the 9’s but after several weeks of watching and waiting, it was decided to retreat with Rituxan again between both my doctors, Dr. Michael A. Schwartz, Mt. Sinai Comprehensive Cancer Center, Miami Beach, Florida and Dr. Richard R. Furman, New York Presbyterian Hospital, Weill Cornell Medical Center, Hematology/Oncology, New York City. I have had to again use Procrit to avoid transfusion but stop when I reach a hemoglobin of 10 or higher. Presently, I am at 10 and on W & W (Watch and Wait) again. We are discussing what, if anything, should be done next, to try to put me in remission. There are new single agent monoclonal antibodies like Rituxan which are being considered at this time. Some have already been approved for use for Chronic Lymphocytic Leukemia, Waldenstrom Macroglobulinemia (an indolent form of Non-Hodgkins Lymphoma) and Lymphoma and Multiple Myeloma and are sometimes used in combination with other treatments. These could possibly be useful for CAD patients. To be continued.... Betty Usdan
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Graeme's story I am a keen yachtie and we had our Opening Day in September. I got a shock when I went to the toilet after sailing and saw that my urine looked like blood. My Doctor arranged for me to be seen at our local Hospital and they started doing tests to try to find out what was wrong. There were confusing symptoms as I had a very sore prostate at this time and I know I felt sure it was prostate cancer. I had difficulty believing that they couldn't find it. I also developed a very sore upper arm which stayed around for the next six months. I started keeping a Diary on
how I felt and an extract from a day about this time is: A month later I wrote: During this time I had many tests done at the Hospital...................and towards the end of November 2003, they told me I had Cold Agglutinin Disease. Over the next few months I was given some treatments to try to alleviate my problem. However none were effective and my condition deteriorated. My blood count fell to below 0.7 and I started needing blood transfusions. Initially these were at six week intervals, but by August 2004 I was down to two week intervals. It was then decided to give me Rituximab, and I am fine nearly three years later. My latest blood count is about 14.0, I can do most things, I still have to keep very warm or blood shows in my urine, but life is great! The cat's name is Bootie.
Update February 2010 Bootie is now a little larger, but lovely. I have just seen my Haematologist and he is extremely pleased with me. It is 5 1/2 years since he treated me with rituximab, and I have had no other treatment since, apart from one folic acid pill daily. At the time I was in extremely poor condition, and receiving blood transfusions every two weeks. My CAD is now in remission and I don't have any visible symptoms. Last weekend I capsized my small yacht and was in cold water for about 10 minutes. I had no after effects, and my HGB was 13.6 three days later. So am I cured? My haematologist doesn't know the answer to this, and wants me to visit him annually so that he can monitor my progress. I can't imagine that it will come back....but I don't know why it started in the first place so maybe it will......? On reading your stories I am very aware that I am very lucky, and that most of you struggle to cope with your CAD over many years. You are in my thoughts. Graeme Hore
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Bea’s Story In the winter of 1982, our family, consisting of my husband, my 13-year-old son, my 7-year-old son, and myself were tobogganing in Palos Hills, a suburb of Chicago. At the bottom of the run my son looked at me and said, “Mom, you’ve got dirt all over your face.” I knew that couldn’t be true – we were in the snow! So, off we went to the car and, sure enough, looking in the rearview mirror I could see what appeared to be purple vertical lines on my face. For whatever reason, I then looked at my feet and legs and they, too, had dark lines on them. My family physician sent me to a hematology specialist. Tests were done and I was sent home with the admonition of: “Don’t go out in the cold until we get the results of your tests.” I was found to have a positive “direct Coomb’s test and a positive antibody detection test.” My “cells were coated with complement components and the serum reacted with all red cells tested.” At that time I did not have a clue as to what that meant, but the diagnosis of cold agglutinin disease with autoimmune hemolytic anemia had been confirmed. I was fortunate enough to be diagnosed correctly immediately and did not have to endure other tests or a bone marrow biopsy. Being 37 years old at the time and never having heard the words “cold agglutinin” or knowing what that diagnosis would mean to me or my family, I felt very frightened. Additionally, finding out how rare this diagnosis was left me feeling extremely isolated. I had not heard of, nor did I know a single other person who had this rare diagnosis. I know (now) that I am one in a million (literally), but finding that out didn’t make me feel any better either! When I was diagnosed, my titer was quite high at 1:2048. Living in Chicago in the winter is quite a challenge when you have CAD. There were times when my blood counts dipped quite low and the fatigue became all encompassing. When outdoors, every exposed piece of skin had to be covered for it would become mottled. I found I had to use gloves to go into the freezer. I could not longer put my hands under cold water or even hold the garden hose. Down coats, down mittens, and boots, even when there was no snow, became the dress code. Remote starter for the car so I could go from a warm house to a warm car. Obtaining a handicapped parking placard so I could park close to entrances. All this and so much more became the “norm” in my life. Through all this I had a compassionate and caring doctor at Loyola Medical Center (Dr. Messmore) who watched over my counts (and me) and taught me how to set limitations for my physical well being. Fortunately, I have never had my counts dip to a place where I had to have any treatments. However, I was told about plasmapheresis and that a “chemo drug” could be used if that happened. I was also told that this could progress to a lymphoma or a myeloproliferative disease. Again, there was no one to talk with about these possible “scary” prognoses. My much-revered Dr. Messmore has since gone into retirement. He was replaced by Dr. Godwin who has since gone on to become the Director of the Cancer Center in Southern Illinois. And now, Dr. Barton has, very recently, replaced him. It has been 24 years since my diagnosis of CAD. I am now 61 years old (2006). I have “coped” with my diagnosis. It has profoundly changed my life. It has changed the way I live my life. It’s been an unseen presence every day in my life for all these 24 years. It is a “hidden” handicap. Because of my CAD I have had to enforce the Americans with Disabilities Act (ADA) at my place of employment because I could not work in the temperatures maintained in my workplace. Because of CAD I have had to endure the taunts of uninformed and ignorant people when I stepped from my car in winter after parking in the handicapped space and all they saw was someone who was not using a cane or a walker or was limping and they assumed I was not “handicapped.” Because of people’s ignorance about CAD, I have been asked, “Is this related to AIDS?” But, because of CAD I have learned: Tolerance and Understanding that things are not always what you see on the surface. Forgiveness of people’s ignorance. Patience and Perseverance in waiting for this Web Site and the support of people with a shared experience. That there is always Hope. Bea Paller
Laurie's
Story I had been to the doctor a month earlier and when I had my CBC run, I was a little low. The doc told me to take iron. I took the iron and continued to ski. I called them after seeing my white legs and told them that I could hear my heartbeat in my ears. She said that they couldn't get me in right away and I should go to minor emergency. I went and they took one look at me and told me that they would need to draw blood. The doc called me that night and told me to get to the store and take 1 mg of folic acid and stay warm and to see a hemotologist. Well, the only hemotologist here are in the Cancer clinics. I didn't know that until I walked in and it was such a shock. The doc tried cyclosporin on me...a cancer drug, and it didn't work. Then she sent me to a teaching hospital in Seattle. They took more blood. I was already at 7 on my hemoglobin and still they took more blood. They also did the CAT scan and bone marrow biopsy. All normal except the CAD. Their recommendation: Cytoxan....another chemo drug. Of course, it didn't work! It just made me loose my hair and feel awful. Then my doc decided to try the Rituxan. It brought my titer down to 1:256. It stayed that way for about a year. Then it popped back up to 1:1024 and has been that way since. The end of January I got the flu. It went to battle with the CAD
and I lost. I ended up in the hospital for my first transfusion.
My Hemoglobin had been around 10 and within 2 days, I was at 6. They
gave me 4 units of blood and the doc also gave me 2 shots of
Prednisone. I left the hospital with a hemoglobin of 12.1 and felt
great. While I was on the Prednisone, I didn't loose any blood.
Within a week, my hemoglobin was at 13.2. I felt wonderful!
Then I was weened off of the Prednisone and I started to loose blood
again. Prednisone is only suppose to maybe work for CAD with low
titers and high amptitude. Well...I have high titers....I don't
understand why it worked...I only know it did, but it's not a drug to stay
on for very long. March 2007...just finished 4 rounds of Rituxan. Found out today that my titers haven't changed. I'm still at 1:1024. I also lost a little vision after the 2nd round of Rituxan and went in for a check. They said that I have Narrow Angles which can lead to a glacoma attach from pressure on the optic nerve???? Anyway, they have to do a laser hole in each eye for drainage. The reason that I have to have it done now is because I am not suppose to have any antihistimines that can dilate your eyes because it can cause an attack. They give Prednisone and Benedrayl (an antihistamine) with each Rituxan treatment and the doc wants to do another 4 treatments in a month or so. June 2007....Life is good since the Rituxan treatments. Last week I had a blood draw and my hemoglobin was 13.6 and I wanted to dance. That's the highest it has been in 6 years. I feel great, and have lots of energy. The only thing that I have changed is that I quit drinking cold beverages....it was hard to give up, and I started taking 500mg of Vitamin B5. I think that I am going to try and ski this season. I'm only going to make a few runs and hopefully on a sunny day." Life goes on......
Update July 2010
I went to the doc about a month ago for my 6 month blood test. My CBC six
months ago was normal and my titer was 1:128. So, I wasn't expecting much
change. I had walked outside all winter without covering my head and
didn't have any symptoms. I very rarely have any symptoms with the titer
that low...it's only when it gets to the 1:1024 that the purple nose and
blood loss come into play. So, I went and had my CBC drawn and it came
back at 14.2. Highest it has ever been and very normal. Two days later,
they give me a call to tell me my titer is 1:8, which means that there was
no cold agglutinins in my system. I about fell over. The doctor called
me and said that my last round of Rituxin (March 2009) must have killed
the clone. He thinks it is gone and won't be back. I will still go for a
blood test in 6 months, but I will go on as if it is gone. Yeah!!! Laurie Riffle
Marilyn's Story I am presently (2007) a 48 year old female and I was officially diagnosed with Cold Agglutinins 3 years ago, but the doctors think I had it longer than that. I tested positive for Mycoplasma Pneumonia at the time also. I have done just fine for 3 years. My bone marrow has fully compensated me for the low grade hemolysis that my body goes thru. I have my blood counts done on a regular basis. At the time I was diagnosed my Hematologist wanted to be aggressive and try to reverse the Cold Agglutinins. I checked with several other Hematologists in California and decided not to do anything while my bone marrow was fully compensating me. I did not want to take steroids or immuran back in 2003. Then on March 1st, 2007 I came down with what my allergy doctor thought was a virus. I was home, sick for 5 days. The first 4 days I had a fever of 101.6 that would go down to 100.5 and then back up to 101.6.. continually.. on the fourth day on March 4th I noticed I was looking pretty pale.... and I couldn't keep my fever down so I contacted the doctor who told me to take Motrin ( do not take Motrin) which I did, quite a bit .. by day 5 march 5th, 2007 my palms were white and my heart was beating really fast and pretty weak. I ended up in the Emergency Room at 12:30am on March 6th, 2007. My hemoglobin was 4.8 and I was told I needed a transfusion...... I refused.. I thought they didn't keep my blood warm and they did the test wrong.. my RBC count was 1.7 and hematocrit was 13.. They called in a Hematologist that I had seen back in 2003..... She advised me that I needed a blood transfusion, I refused. She started me on Prednisone 50 mg a day...and my retic count was 0.06, that meant my bone marrow was not producing blood cells. They called in a Infectious Disease specialist... The both of them thought maybe I was exposed to something, or possible the heavy doses of Motrin which can cause aplastic anemia... (don't take Motrin) only Tylenol... Then they decided maybe I had (Parvo-virus b19) also called the (fifth disease). Usually kids get it. It gives them red cheeks and a rash on the trunk of their bodies.. It a simple virus for them.. but, People with auto-immune blood disorders... have major problems with this virus.. It tells the bone marrow to stop making red blood cells. They did a bone marrow test on me that showed I wasn't making any red blood cells. On the 2nd day when my doctor warned me that I could die and or have a heart attack and stroke. I agreed to the blood transfusion. I ended up having 2 of them, which they gave me with a blood warmer.. I then went on 5 days on IVIG.. which is Immuniglobins given by infusion for treating Parvo-virus b19.. They decided to treat me for the Parvo even thou the test results were not back yet. On the 4 th day of treatment my test results showed I had Parvo-virus b19. I was also given 4 Procit shots, one every 48 hours. I was in Intensive care for 9 days and on the chemo-ward for 3 days for a total of 12 days in the hospital. I was also given 1 dose of Rituxan on the chemo ward.. By the time I was discharged my hemoglobin had gone up to a 9.2 from a 4.9 and my hematocrit had gone to a 29 from a 13... and RBC was 3.2 from a 1.7..... my retic went up to 10.3 from 0.06 which showed my bone marrow was again making blood cells. It was the worst experience in my life... I had no idea that I could get this parvo-virus b19 that could kill me. I can never get Parvo again as my body will have anti-bodies for it. I am presently weaning myself off the steroids and am continuing my treatment of a total of (4 ) Rituxan treatments to try to reverse the cold agglutinin. My cold agglutinin counts are pretty high right now. My doctor here wanted me to stay on the steroids but the calif doctor advised me to wean off them. I have high cold agglutinin count and low warm agglutinin count... with a positive Coombs test... I have undergone 2 treatments on Rituxan with no side affects... I have 2 more to go.... The doctor has discussed with me the possibilities of doing up to 8 treatments..... I agreed to do 4 treatments and then we shall see what the results are. I had great doctors here in Vegas, who came up with the right diagnosis and saved my life. I wasn't the most co-operative patient. I questioned everything. The lab at the hospital continually made mistakes in not keeping my blood warm. They kept my room at 80 degrees to keep me warm.... I wanted to share this story. This is something that could affect other Cold Agglutinin patients..... The CDC -center of disease control has information on this virus... pretty informative.. 90 % of the senior population has already been exposed to it and have anti-bodies to it.. It can only create a crisis situation with someone who has an auto immune blood issue.. like Cold Agglutinin patients like us... I am on the upswing and feel pretty good.. It was a sur-real situation for me... I had to take a step back and let the doctors do all these things to me. My personality is such that I question everything and want to be fully informed. Due to my low blood count, my head was pretty foggy at the time of admission....... I had great support people ( my friends) who helped me thru my 12 days in the hospital. You have a great informative web site. I dont remember seeing this 3 years ago when I started doing research on my Cold Agglutinin disease. I will be glad to receive email with any questions, Marilyn Fishman
John Harm's story
His Cold Agglutinin Disease was first diagnosed as Raynaud's Syndrome in 1994. He tried to avoid the cold but he was still helping on his farm in Illinois so he was definitely out in some chilly weather. I'm not sure of what particular treatment he has had specifically for CAD other than the Rituxan, etc. for lymphoma. My mother has taken excellent care of Dad since his major heart attack in 1992. Now when he needs her the most, she has been stricken with ovarian cancer. I live in Georgia, they live in Illinois. My parents do not have email so I'm your email link! ...... Both my dad and mom are mentally sharp and had been physically active until these past months. It was helpful to read of the CADdys' treatments. Thank you for your interest in my dad's case----Diane Harms Mulkey
We were very sorry to hear that John died on 13th May 2009. Our deepest sympathy goes to Diane and her family. Personally, I was quite taken with the photo shown above which Diane sent us. For me it typifies the hospital or outpatient visits many of us have made. We sit in a comfortable chair, are connected to a blood warmer and get a transfusion. And the nurses always look after us...(Graeme)
Katherine's Story I'm 34 years old and
live on the northeast coast of England, one of the coldest places in the
country. I was diagnosed with cold agglutinin disease 4 years ago, 2003,
although I had been feeling poorly for the prior 12 years. I had had
periods of anaemia and no one seemed to be able to tell me what was wrong
with me. I experienced fatigue, muscle weakness, sore throats, and
Raynauds and was told I had M.E/Chronic Fatigue Syndrome. Ken Mascord's story
Hi there, my name is Ken
Mascord and I live in Sydney, Australia.
Ken Murton's story
I am Ken 73 years young, living near Worcester
England.
Marylin Porche's story My name is Marylin Porche. I am a 58 year old married mother of seven grown children ranging from 40 to 18. Until this past January I considered myself a very active healthy person who walked 3 miles a day five days a week, weather permitting. I ate healthy and worked in a school setting as a paraprofessional assisting teachers in a classroom. I have 14 grandchildren who all live within a 2-mile radius of our home. I started getting chest pains and had difficulty breathing when I exerted myself in January of 2007. I saw my family doctor who immediately had me see a cardiologist. I, of course, couldn’t pass the stress test and the blood work showed I was severely anemic. I was hospitalized for my first blood transfusion on Feb. 8. My HGB was 9.6 and Hct. 27. A hematologist was called in and they took many tests. The transfusion brought my levels up to 12.0/33.5. Six days later my counts had dropped back down (9.2/25.8). I was hospitalized for five days for observation while they treated me with salumedrol injections, took a battery of tests including CT scans and a bone marrow test. I was sent home on the 21st with my levels at (9.7/27.4) During this time I was very weak, jaundice, and was not very clear headed. I was on prednisone and not sleeping very good at night. Two days later I was back in the hospital for my second transfusion, (2 units) My count had dropped to (7.6 /20.9) Exactly one week later my counts had dropped back down to (6.8/18.8). At this point they gave me 3 units of blood which brought my counts to (11.6/30.8). I was beginning to think that I could only live with other people’s blood. By this time we had received a diagnosis of cold agglutinin/hemolytic anemia. They were warming my blood before transfusions and at my children’s request I was receiving directed donor blood. They were also premedicating me with Tylenol and Benadryl before all infusions because of the itching reactions I had gotten from previous infusions. Ten days later I was receiving my 4th transfusion. During this time I obtained a second opinion from a hematologist in New Orleans. He agreed that we should proceed with Rituxan treatments. We had been waiting for over a month for insurance approval. During the month of April I received four weekly Rituxan treatments with no reaction. My levels since the treatments have remained around (9.5/27). They fluctuate a little but I have not needed any further transfusions. It seems as though my body has adjusted and I can function at these levels. I have not returned to work yet, but I plan to in early August when school starts again. I have started walking again, though only 1-½ miles a day. I can maintain my housework though at a slower pace. At the beginning of June we repeated the CT scans and bone marrow. The scans showed no change and the preliminary results of the bone marrow were good. I am very thankful for this web site. After reading the stories of others, it reinforced what I had already begun to believe; that with a positive attitude I could live with this condition and still function in the world. I have faith that all will be well. Marylin Porche
Heather Orr's story May I introduce myself as Heather. I am an Australian aged 30 with a father (72 years) that was diagnosed “officially” with Cold Agglutinins Disease some 5 years ago, but it was only at Christmas 2006 that we really understood how serious it can be if not monitored! My father visited several doctors and specialists over the past 5 years at several major hospitals, and had a battery of tests undertaken and the results sent on to his (then) General Practitioner. The GP relayed to my father only the details “you need to take iron supplements, and keep warm in the cold, and come back for blood tests every few months”. So for five years, my mother (a retired trained nurse) and myself assumed only that he was iron-deficient and needed to have three-monthly blood checks with his GP. We didn’t know the true diagnoses by name at that time, or its implications. We kept asking that GP when he would do the blood tests, but he kept putting them off and off because of the time involved to do them in a general surgery. My father has a host of other medical problems as well as, not least of all several skin melanomas that had to be removed in day surgeries. In December 2006, I had booked a flight to New York to visit my boyfriend and his family for a few weeks. Those plans changed a few days before I was due to leave, when my father stumbled in the early hours of the morning from his bed, yellow as a banana skin from jaundice and barely conscious. My mother called an ambulance and they rushed him to hospital. He was soon admitted through the emergency ward and observed by a registrar, who diagnosed a Urinary Tract Infection. Because my father had an elevated temperature (39C), and was feverish, they removed his blankets and gave him cold water to keep his temperature down, as well as IV fluids and antibiotics to treat the urinary infection. They stuck him in a bed underneath a rotating fan. All bad moves. Unfortunately, we had no idea what my father’s true diagnosis was. When things didn’t improve and he started to go downhill even more, they transferred him to that same hospital’s aged care ward, where they undertook blood tests. They started to request more information from my mother and I, but we had so little to offer. We had never truly been properly informed. They kept him in the aged care ward that night, but by the time I went to leave at 8pm, he was shivering madly and complaining to me of being cold. When I asked the staff for more blankets, they told us it was the fever, and to not put too many blankets on him. I left him to go home to sleep, and went back first thing the next day. What hit me that day will stay with me for the rest of my life! I arrived with my mother to find his ward full of staff from the Medical Emergency Response Team (the team that gets called when the ‘red’ cardiac arrest button above a patient’s bed is triggered by ward staff). They had even assembled a photographic monitor above my father’s bed in the ward to take photos of his heart. I couldn’t see him from all the staff. When I covered my face in shock, I was sympathetically ushered out of the room. Tears are welling in my eyes even now as I recall that day 8 months ago. They still couldn’t tell us what was wrong, other than to relay a host of figures about my father’s extremely abnormal haemoglobin count, and to ask if that had been the case before. We knew he had had an abnormal blood count, but that was all. My mother gave the staff the contact details for the other hospital where my father had had the battery of tests years before, and they got in touch. It was that night, while my father was now declining in intensive care, that we were told the true diagnosis of Cold Agglutinins Disease. He required several blood transfusions that night, and had to be transferred to yet another hospital’s intensive care unit, as the hospital he was in didn’t have the critical care capabilities to attend to him (such as a specialist Haematology Unit). My mother drove in the back of the ambulance with him, and I took my car. I remember nothing of how I got there. It was after midnight only 24 hours after my father first stumbled up out of his bed at home, and we had been told to expect the worst. We were even asked whether my father and our family had ever considered life support. We were told that if the blood transfusions and other measures didn’t help, they may have to induce him into a coma to allow the body to heal, which is a type of life support. At the second hospital, they had my father hooked to IVs going into arteries in his leg because the regular way (through the arm) was not fast enough. They had him wrapped in bandages to keep him warm, and placed him in a special bed that had heating pads lining it. He then had foil insulation wrapped around his entire body (the type they usually reserve for mountaineers who get hypothermia). Being an Australian summer, the outside temperature was 39C. It was quite a juxtaposition. I couldn’t see my father without wearing a face mask or a special apron because his body just wouldn’t cope with any more infection. I felt so removed from him, and from my earlier plans. I had been through a whirlwind of emotions, from the excitement only three days before, looking forward to seeing my boyfriend, who I was in a long-distance relationship with and hadn’t seen in six months, and now to shock and anger because I knew so little of my father’s illness before now. The Haematologist my father went under at the second hospital was excellent. Although she had never come across a single case of CAD in her career, she knew what needed to be done. Thankfully, my father came out of intensive care within 3 days, but he went into a cardiology ward from there and spent his birthday, Christmas Day and New Year’s Eve in it. The episode of illness had left a strain on his heart and his pulse was hovering at times around 50b.p.m. Consequently, once he was over the infection, he was transferred to yet another hospital to have a pacemaker put in his heart. 8 months later, we are much more aware of his needs. The first thing we did was change GPs. Perhaps there are only a handful of medical professionals who come across this illness, but I can’t help thinking what might have been spared had we been able to tell the staff on arrival at the hospital that my father has CAD. Families and patients should and must be properly informed about the illness once a diagnosis is made. Waiting for a situation like ours to arise is too late. My father now never leaves the house without winter warmers (scarf, beanie and hat). People do occasionally laugh and it makes him self-conscious, and I do get angry because we went through so much and the have no idea why he is dressed in that way. But then I think life is so precious and I still have my father here eight months after I thought I may not. There are some good sides to every story, and mine is not without them. My boyfriend proposed to me last month, personally travelling here from the US to do so, and to ask my father’s ‘permission’ in person. All I want now is for my father to be well enough so that he just might be able to travel to the USA (NJ) next year in order to walk me down the aisle. Of course, it will have to be a summer wedding!!!!!!!!! I’ve given my father an incentive to keep wearing his warmers and staying well. I am glad there is now a support group like yours out there where there is information and understanding. We are also blessed from being in a warm climate like Australia, although my father is originally from Scotland, so moving here was the best thing he ever did! My father’s haematologist is keeping her eye on him and we have regular contact with a major hospital. Things are good for now, although I currently have the flu, so I can’t give my dad even a hug in fear of infecting him. Small things I used to take for granted I just can’t do anymore. I have printed some information off on Rituximab, which my family haven’t heard of. My father was treated with Prednisone for a short while, but he is off that now. I don’t know if being allergic to Penicillin (as he is), would rule him out, but I will take the literature to my father’s Dr incase it can be of interest. Not sure if the drug is available in Australia. Thank you for your time taking to read our story. Kind regards Heather Orr Update from Heather 28 Feb08: I thought I should pass onto you now that my father is back in hospital tonight after catching a chest infection from me. I feel terribly guilty that I passed it onto him. I picked it up from work (I teach) and it hit me hard enough, so I wasn’t surprised when dad started coughing and spluttering this morning. We took him straight to the hospital and he has had an ECG, blood tests, chest x-ray, cold agglutinins antibody test, enzyme test, you name it. We took him to Haematology (our local hospital has a specialty haematology unit……how lucky! That’s where he goes every month for routine tests). Anyway, his haematologist wasn’t there today and they directed us to emergency to have him seen by a doctor. They told me in haematology to make sure that the emergency nurse pages his haematologist, so I passed on their request, but the very new doctor in emergency didn’t call the haematologist and dad was in a bed under an air conditioner for four hours with only a sheet over him. When I asked for a couple of blankets to warm him and explained why (not that they didn’t already know that he had cold agglutinins!), the surly faced nurse clicked her teeth and complained. I blew my top eventually and left the emergency dept. and walked up to the haematology unit myself and demanded to speak to a Dr there. Better than that, they actually called dad’s haematologist who was driving her car and let me speak to her myself. Oh boy, did she see red!! She told me that she was so glad I had called her and said “good on you for defying everyone and having the courage to stand up to the nonsense”. Within the three minutes it took me to walk from the haematology unit back to emergency, she had already phoned through and ordered that my father be given warmed blankets and put out of the blow of the air conditioner. We got no apologies, but at least I put the surly nurse in her place (believe me I have nothing against nurses. My mother is one, and many of them today were excellent). But there’s one thing I’ve realised is how little medical staff are actually aware of this illness. I don’t mind ignorance, but I can’t stand indifference! Last time my father was sick, my father ended up in the ICU and I am determined that it won’t happen again if I can help it. I do feel especially bad because I put him there with my flu. I’m getting married in October and how I would love to have my father well enough to attend the wedding. I hope that other people who find themselves in my situation will do the same and hold their ground. A couple of warmed blankets might not seem much to a surly nurse, but it means so much to my father .........My father was released yesterday from the hospital. All my hard work paid off, because the Haematologist ordered my father two blood transfusions over the phone the first night he was in (his count had dropped to 80 from 92 the previous week). You know, had I not insisted they call her, she would not have known my father was there nor heard his blood test results and then been able to do what she did. My dad was admitted under a cardiologist who he didn’t see until the morning after he was admitted (i.e. he didn’t see a specialist at all until after he had had the blood transfusions), and even after 24 hours in the hospital, his past admission file (with all the details of his ICU experience last year) hadn’t been sent to his ward. He was feeling much better the following day, and the Haematologist came down to see my day in the ward. She shook my hand and told me how impressed she was with what I did. Email Betty if you want to contact Heather, and she will forward your letter
Nina Tartakoff's story Hi. I am Nina Tartakoff, a retired high school counselor, from Fairbanks, Alaska. I have had CAD since
about 1998. It took me a number of years before I was properly diagnosed.
It was actually by accident in 2000 that I finally found the proper
diagnosis. I had been to my GP and a dermatologist and no blood tests
showed anything abnormal and everyone was guessing why I was turning a
mottled purple all over when I went out skiing and for winter walks. I
have always been a very out-doorsy person throughout the seasons,
kayaking, hiking, skiing and biking. Fairbanks is not exactly a great
place for someone with CAD!! I hadn't been to the local health fair in a
few years but was having other blood work done yearly with my physicals. I
thought maybe something would show up that we were missing and went to the
Health Fair. Well, sure enough, the lab spotted the problem. I researched
the note on the bottom of the lab results by the technician and
immediately called my doctor with my diagnosis. She called a hematologist
in Seattle to see what tests to run to confirm my diagnosis. Sure enough
my titer was and still is 1:4096.
Ann Close's story I
am a retired school teacher, wife of Bill, mother of Will (37) and Janet
(33), grandmother of Caitlyn (6) and Julia (2). [2007] I
have osteoarthritis in both knees and was taking diclofen sodium for pain
relief. In a regular blood test in the spring of 2005, the My knees have gotten to the point that I am going in for surgery for a complete knee replacement. (September 2007) My hematologist is cautioning the orthopedic surgeon that I must be kept warm. The hematologist has ordered two units of warmed blood for me the day before surgery. I
really can say that I didn't realize how serious cold agglutinin disease
can be. I also did not realize that it is an autoimmune response
that kills red blood cells. I am glad for this web-site so I can
become better educated on this condition.
Eleanor Betz story I am a 71 year old retired teacher. A native New Yorker, I have been active all my life. I have 2 children, a daughter, Lisa, who lives nearby and has given us 3 wonderful granddaughters; and a son, Gregg, who lives in Budapest. My normal routine is to get up each morning and walk 3 miles. I take a weekly aerobics class and a weekly yoga class. I have always considered myself pretty healthy; no heart problems, low cholesterol, low blood pressure. The only prescribed medication I was on was Fosomax. I do have arthritis, carpal tunnel, and had a hip replacement 8 years ago. My first exposure to cold agglutinin was also 8 years ago. I was hospitalized for 3 weeks with pneumonia and severe anemia. I had numerous blood transfusions and after a week in the hospital, passing out on the bathroom floor, I was finally diagnosed with cold agglutinin disease. I had more blood transfusions (don't believe they ever warmed the blood) and told to keep warm. Upon my release from the hospital, was not given any info on the disease and thought it was a fluke. At the time, I was unable to find any info in medical books of on the internet and dismissed it from my mind. Two weeks ago, I developed a dry cough. Scheduled for carpal tunnel surgery, I went for pre-op testing. At the time, my chest was clear. The next day, I went walking and couldn't catch my breath. Upon returning home, I received a call from my internist, that my blood tests were abnormal. My CBC count was down to 10 and my white counts were up. Three days later, I was admitted to Long Island Jewish Hospital and received a liter of blood on Sunday nite. On Monday, my numbers were up slightly and on Tuesday, they were down again to 8.9. On Tuesday nite, I received 2 more liters of blood and on Wednesday, was put on prednisone. On Thursday nite, I received my first Rituxan treatment. On Thursday and Friday, my CBC was stable at 10 and 10.1 and I was released from the hospital. My numbers are now up and I am waiting for medical approval to have my next Rituxan treatment. Hopefully, that will happen at the hospital on Monday, Nov.5. Tomorrow, I am scheduled for a CT scan of my lower abdominal and pelvic areas. I have suffered with Raynaud's since I was a teenager and now know that it is part of this disease. I have been told by my hematologist that this is chronic and will be with me for the rest of my life. Luckily, we will be leaving for Florida after Thanksgiving and will avoid the cold weather here in NY. I am now in the process of getting together all my medical records from doctors and both hospital stays. I am so grateful to have found your website.I felt very alone and did not know where to go for information. It was also comforting to know that Rituxan seems to be the treatment of choice. When I first heard that I was going to have a chemo treatment, it freaked me out. I live in Valley Stream, New York most of the year; and Coconut Creek, Florida for the winter. Ellie Betz
Janice Frishkopf's story
My name is Janice and I am 60 years old. I live in Belmont Massachusetts
(a suburb of Boston) with my husband Larry, and our
Shetland Sheepdog, Heschy. I am a piano teacher, an artist, and I
love cooking and gardening. I have 2 children, 3 step children, and 1
grandson, born this past July (Solly - the piano player). I was diagnosed with Cold Agglutinin Disease in April of 2004. The months leading up to this were very difficult, involving the sickness and death of my father, and moving my mother (with dementia) up to Boston from New York. That autumn, my neighbor saw me leaving the house and told me that my cheeks and lips were dark purple. At the time, I was so busy with my mother's move into an assisted living home that I didn't pay much attention to it. As the weather got colder, I noticed that my hands were really starting to hurt, turning black, and were sometimes so cold that I couldn't move them. I thought that I had Raynaud's syndrome and made an appointment with a rheumatologist at Massachusetts General Hospital in Boston. He told me that I probably had Raynaud's but he needed to do blood tests to rule out anything else. That was when my nightmare began. My blood tests came back with reports of high levels of IgM antibodies, and my blood was coagulating before some of the tests could be completed. It was obvious after the 4th set of tests that I needed to see a hematologist. I am twice a breast cancer survivor, so the natural person for me to see was my oncology hematologist at MGH. In the next few months, I had scans which came up with nothing. I also had a bone marrow biopsy, showing no other cancer involvement. My diagnosis was then confirmed. My doctor called it ideopathic Cold Autoimmune Hemolytic Anemia. She told me that if I wasn't going to move to a warmer climate, I needed to figure out how to keep warm. My symptom was only cold sensitivity, not fatigue from loss of red blood cells. The treatment offered to me was Rituxan. Having experienced chemotherapy drugs, I was not going to take it. I really wanted a different doctor to handle this disease, so my oncologist had me see another hematologist at MGH. He was very impatient and not very helpful in answering my questions, telling me that Rituxan is the treatment and if I wasn't going to do it, he didn't want to see me again. He also told me that this could possibly develop into lymphoma. I then went to the anemia unit at Dana Farber Hospital. The doctor I met with was much kinder, gave me more time, but the treatment offered was the same. I came home feeling very discouraged. I then decided to see a homeopathic doctor. It was somewhat helpful mentally to do this, but after going for around four months, I stopped..
These are what my counts are now. They have not changed very much
since 2004. The titer is sometimes lower than this. Last year I finally found a hematologist at Massachusetts General Hospital who gives me the time I need and is very understanding and supportive. I see him twice a year for blood tests. And to talk. For me, the worse part of this disease is the limitation that it has placed on my life concerning my mobility and many of my interests. I am legally blind and am unable to drive. In the past, I walked to many places and also took public transportation. I can no longer stand outside to wait for the trolley in cold weather (now below about 55F), and it is very difficult to walk far in all of my layers of clothing, not to mention the comments I sometimes get. My husband and many friends help me, but I feel even more limited than I did before. Cooking and gardening have become quite challenging. My hands are always turning black and hurting but I will not give up these activities. On the positive side, I have made progress with my artwork, and last January I worked with a friend to design my first website. I would like to end by thanking everyone who has contributed to this site. Reading all of your stories has been extremely helpful to me. The isolation I have felt over the last few years has increased, but reading your stories has made me feel less alone. Janice Frishkopf
2008 starts here Cécile’s story I am 55; I live in Mayenne, a small town in western France; I am married with Didier and we have two girls and two grandsons. I work in a bank, full time. As far I can remember, I did anaemia because of a lack of iron in my youth, but my haemoglobin was round 14 in my twenties. Since a bronchitis end of 1999 the months leading to my first crisis were difficult –I was so tired! During the cold night of the 6th of March 2000, an acute pain in the chest and in the back awoke me suddenly, and I entered in local hospital. Only morphine could alleviate me. My haemoglobin was round 9, with less than 3 millions of red cells. I was pale, with jaundice, and weak. Some weeks later my illness was diagnosed Primary Chronic Cold Agglutinin Disease in Angers University Hospital where I had been transferred. No treatment was given, only folic acid daily and advice of protection against cold. I have never been transfused. Other episodes of such pains in the chest, in the back, including the arms led me till 2005 to hospital, with all the tests and check-ups, but doctors could not certify any direct relation with CAD, or with any other illness! I stopped working several periods of some months, because of my weakness. They were related with a decrease of my figures. In 2000 I tried Danatrol, without response, but side effects. In 2001 I tried Rituximab, efficient for 18 months; I was back at 13,5 and 4 millions! In 2004 one doctor wanted to put me again on Danatrol (inefficient for us) because of a lower price than Rituximab! In 2005 another doctor in Rennes University Hospital accepted to put me again on Rituximab; I had only a short response. Facing failure I accepted to take Interféron; my numbers fell to 8,2, and 2,6 millions! Another failure! At the moment, my numbers are between 10 and 11, with 2,9 red cells; I still work waiting for a retirement scheme to come. I am still haemolysing, but apparently compensating with my folic acid daily. I have also herpes outbreaks. I only fear driving 60 kilometres in winter for my job. I live under an oceanic climate, with frost and snow in winter however, and rains, fogs and humid winds more than I would like; so far I have only a slight livedo on my legs. I appreciate a lot a personal spa at home with hot water, as I don’t live in a warm country, to cope with my chronic tiredness, and lack of energy. Fortunately, one of my three doctors is very supporting and understanding, and ready to every initiative to help. From 2000 search on internet, contacts with doctors and patients (2 women in France, through a national association) could help me a lot. Congratulations to you all for your work, and thanks for the support you give us in the website to keep hope and to struggle. I give my address for any contact to help. Cécile POIRRIER-GUILMIN didier.poirrier-guilmin2@wanadoo.fr
Gloria's story I am a 66 year old female, born in Indiana, but lived most of my adult life in Southern California. Moved back to Indiana in 1994. During an annual physical in 2000, a hemoglobin of 10.8 was noted. My family doctor referred me to a hemotologist who started tests in May with a Coombs test positive for hemolytic anemia and an elevated titer of 1.256. By June hemo had risen to 11.8. Problems didn't surface until December, when hemo dropped to 8.8. Went up somewhat after taking prednisone, then dropped again. Started on cytoxin, and soon after hemo went to 3. Went directly from the doctor's office to the hospital for the first of two transfusions. After this, two shots of procrit, more blood tests at the Indiana Blood Center and Indiana University Hospital and agreement between the now three doctors of a CAD diagnosis. Since that time I have managed the CAD by staying warm. Two years after diagnosis we decided to spend January and February in Florida. My hemoglobin has consistently been in the 10's during the winter and 11 or 12 in the summer. In October of 2007 tried rituxan, four injections, but there was no improvement. We aren't going to Florida this year, but will spend a month in California. It isn't quite as warm there in February, but a lot warmer than Indiana. Gloria Storey
Inge's story Here are a few words about my last years. I am an 81 year old Danish woman, My husband died in 1998 after a long period of illness. In January 1999 I went for a small walk near my house north of Copenhagen, I returned after 15 minutes and got a chock. My face was totally black. My doctor had never heard such a story. She did send me to a specialist in interne medicine. He took at lot of blood tests and late May he had the result , CAD. He wanted a bone marrow test, but the hospital refused to take one, so he couldn’t find the cause. As I couldn’t enjoy the environment any more I moved to an apartment in Copenhagen. I then changed Hospital and doctor. Here they started a bone marrow test showing a Non Hodgkins lymfom. I was treated with Leukeran several times and one time with something I don’t remember the name of. None of them helped. In October 2002 they started a test of Mabthera in Denmark. It wasn’t accepted then in Denmark, but a doctor in Herlev wanted to try it on CAD. I agreed to join. The result was e better blood percent. All the other problems were still there. If it is a little cold ore windy my face, toes and fingers gets black and it is pain full in several hours. Normally I go home immediately, but if I stay out a little longer I get blood in the urine. It is really depressing. I have given up skiing with the family, walking in the forest, travelling North and worst of all playing golf. Sometimes I can play some holes in summertime, but I have also problems if it is too hot. In September 2007 my doctor heard about the research in Norway. So I started with Mabthera and Fludarabine. But I got a terrible infection and I couldn’t see myself all the summer near the Hospital , so we stopped the experiment. Last week we started with Mabthera again, 4 treatments are planned. This time my blood pressure fall and my temperature raised, but I will go on. It has been very interesting reading your website with all the stories. It has given me the idea to try a new treatment with Mabthera . It looks like it has helped some of your people. If you want more informations, please write me. Inge Andersen
Barbara's story
Hi everyone! My name is Barb Johnson. I am 42 years old. I am a Realtor in New Middletown, Ohio. I study Goshin Jutsu karate at the Crystal Dragon Family Martial Arts Center in Columbiana, Ohio. I believe that this is one of the reasons that I feel great. Karate keeps you (and your blood) moving and keeps your mind on full alert. Everyone there is fantastic too. If anyone is interested in taking karate, you may want to try Tai Chi. Tai Chi involves circular body movements and a lot of breathing. It is very relaxing. I first found out that there was something different about my blood when I was 16 years old and had been admitted to the hospital for Staph infection in my throat. Every time that my blood was drawn the nurse would come back in and tell me that they needed to redraw blood because the platelets clumped in the tube. I have had many surgeries; the blood work always needs redone. No actual problems with the surgery itself though. I have had 2 children and two miscarriages (probably because of the blood problems). Last year, Feb.14, 2007, I had a spinal fusion. After the spinal fusion I got really sick, I was anemic and was tired all the time. My pulse rate at rest was at 129 beats per minute. I also got an infection in my gallbladder and went to the E.R. on Feb. 23, 2007. I felt terrible. Over the next few months I was at the doctor’s office or hospital very often. My primary care physician sent me to a hematologist near us, Dr. Garg, to see if he could tell us why all of my blood work was off. What was supposed to be high was low, what was supposed to be low was high and my platelets were clumped. Dr. Garg was sure that he could get an accurate reading on my blood. But, even in a citrate tube, the platelets clumped. We could get counts on RBC and Hemoglobin; they were low, but not really bad. No counts usually show for platelets or white blood cells (Unless I am really sick, then white cells will be high. Platelet count must be done manually). Neither the titer test nor the thermal amplitude tests were done. There were a few other tests that Dr. Garg did and then he told me that I have CAD. He ruled out the other causes for the platelet clumping. I have had CAT scans of all of my organs; all are good except for a kidney stone. I recently went to another hematologist at UPMC Hillman Cancer Center in Pittsburgh, Dr. Bontempo. I told him what had happened and brought all of my blood work results with me for him to look at. He took 13 vials of blood and ran his own series of tests. I do have CAD, I also have lupus anticoagulant and the platelet clumping is due to the CAD. I have the following antibodies: Beta 2 Glycoprotein I, IgM and IgA. Also, Anticardiolipin IgG Ab and IgM Ab. Hexagonal Lipid Neutralization: positive.Cold agglutinin titer 1:160. ANA titer 1:160. There are a lot of other things in my blood that should not be there. Dr. Bontempo was telling me “You have all of these things and you don’t have any symptoms. You are an anomaly.” He said that we could get rid of the antibodies with chemotherapy, but that might trigger an autoimmune response and we would have to deal with the clumping issue and lupus anticoagulant. I believe that the right thing to do at this time is to leave it alone. I feel great! It is hard to believe that I have ninja antibodies inside my body. Barbara Johnson
Rod's story I have CAD. I am 72 years old as of yesterday and was told I had a problem with my blood during a routine physical about 20Yrs ago. Approx 10yrs ago, after an overnight kayak trip to an outer island with my youngest son which resulted in a 6hr return paddle in a minor storm, I became very tired, shivered uncontrollably and had very discolored extremities. The next day I was scheduled for another routine physical with the VA and realized then that something was amiss. The lab techs, after drawing blood for the third time with poor results, started to peek out the doorway at me. Consequently, I was give multiple tests to determine my problem and eliminate other possibilities. I continue to be monitored by the VA, a specialist in Portland, Me., and a specialist at Dana-Farber. I also continue to lead a fairly active lifestyle although I have had to give up skiing which has been my passion and major winter activity since age five. I still want to ski and am still able but the amount of clothes and gear needed and the possibility of getting stuck on a lift in the wind deters me. At least the kids enjoy the condo. Currently my numbers are typical, low RBC, Hemo, Crit and high Bili. My only intervention now is Folic Acid and my only recommendation from my Drs. is to move to a warmer climate. They say I am quite fortunate to be as healthy and active as I am. I certainly agree. Thanks again for your site. If my situation deteriorates, I and my Drs. will have a source of valuable information to depend on. Rod Coomer.
Mary Lou's story My name is Mary Lou Lydecker. I live in North Royalton, Ohio. The photo shows my family, and I am in the center.
I was 48 when I was first diagnosed with Cold Agglutinin Disease, and I am now 56. When I was first diagnosed in September 2000, I searched the web for a support group, but there was none. So when I recently stumbled upon this CAD support group site, I was thrilled. Finally, there would be a group of people who truly understood this bizarre disease and the complications that went along with it. Here is my story. (Sorry, it's long.) I was an elementary school music teacher in Strongsville, Ohio. It was late February 2000, and blistery cold in the Cleveland area. I had a cold and sore throat. The 5th/6th grade choir had just finished rehearsing. The choir met before school began, 7:30 am to 8:30 am, due to time limitations and conflicts during the regular school day. Since my next break wouldn't be until 12:30 or lunch time, I ran to the lady's room to "powder my nose," so to speak. When I turned around to flush the toilet, the bowl of water was a deep, dark red. Since I had undergone a full hysterectomy in 1993 and a cancerous but encapsulated lumpectomy in 1996, I panicked, thinking the worst. I told my principal and school secretary to please call a sub for my classes and I raced to my internist. Unfortunately, my doctor refused to see me even though I stressed to her nurse and assistant my need to see and talk to her. Instead, the nurse ran back and forth between me and the doctor acting like a middleman relaying my symptoms and questions to the doctor and then returning answers and a diagnosis to me!! The nurse told me that the doctor said that I had a bladder infection, that I shouldn't worry, and prescribed an antibiotic -- all of this without taking a urine specimen, blood test or seeing me!! I questioned this diagnosis and after another couple of "back and forths", a urine specimen was indeed ordered with a promise that the doctor would call me later that night with results and to see how I was. When the doctor didn't call me back by 10 pm that night, I called her emergency number. She called my fears "unfounded" and laughed at me for being so worried. I told her that I had never had a bladder infection, had no pain, and was indeed concerned about having something other than what she diagnosed and begged to see her. Instead, she told me that by the end of the next day, the blood should disappear and pain ease up. (HELLO!! DID YOU HEAR ME? I HAVE NO PAIN!) When I still had discolored urine two days later, she upped the milligrams of the antibiotic and told me to rest. I was out of school for two weeks and slept most of that time. Since I was an elementary music teacher, there were too many music programs to prepare with the children and I needed to return to work. So after two weeks, I went back to school and promised myself to change doctors over the summer. As luck would have it, a satellite campus of the Cleveland Clinic opened up in Strongsville that summer. I had no medical history papers with me when I walked into my first appointment in late August. As soon as the doctor saw me, and before I had a chance to say anything, he exclaimed that I was very jaundice and that he would order some blood tests. He mused that there were so many different blood tests, and that if these didn't show up something, he would order more. He knew nothing of my experience in February, but just by looking at me realized that something was causing my jaundice complexion. Within the same week, I ran out of my allergy medicine and needed a renewal prescription. Since I was a new patient, it was the Cleveland Clinic's policy that a doctor had to see a patient before writing any script. Another doctor in the practice saw me with my new Cleveland Clinic medical papers in hand. He immediately said that he concurred with his partner that I was indeed very jaundice and that he was ordering more blood tests. The next evening, a Friday, I received a call from this doctor stating that my hemoglobin number was a 6.8. He wanted me to come in the next day for another blood test to make sure that the number was correct. I asked if I could please come in on Monday before school since we had both a wedding in Columbus and an Ohio State football game in which our son was marching for the first time on Saturday. "OK," he said, "but, you must not dance or consume alcohol at the wedding. And please don't over do it." I noticed how cold I was all during the wedding. I just couldn't get warm. But the biggest hint that something might be wrong, came when I started climbing the stairs at the Ohio State stadium. I would climb about 5 stairs and have to stop to catch my breath. My husband was a nervous wreck trying to help me but also worrying that we'd miss our son's first "down the ramp" entrance in the Ohio State Band. Monday, I had my blood drawn at 7 am before going to school. At 9:30 pm that night, the phone rang. I was already in bed, exhausted from the weekend and the day of teaching. After taking the phone call, my husband gently woke me up saying that the phone call was from the Cleveland Clinic. My hemoglobin was dangerously low and we were to drive directly to the downtown Cleveland Clinic emergency room. The staff would be ready for me. The staff were amazed when I walked into the emergency room on my own and was talking lucidly. Since my hemoglobin was so low, attempts to draw blood were difficult. One set of nurses tried 9 times and were unsuccessful before the doctor on call was able to finally draw a vial full. I was told that my hemoglobin was a 4.8. I was admitted to the hospital. The long and the short -- I was diagnosed within 24 hours with cold agglutinin, thanks to Dr. Alan Lichtin, a hematology specialist at the Cleveland Clinic. He told me that cold agglutinin disease often either accompanies a cancer or a tumor, or is the result of a secondary viral infection that occurs due to an undiagnosed mono or pneumonia (hmm - February's real diagnosis??). After talking to me and watching my every movement closely, he decided to: 1) Not perform a transfusion since I appeared to be non-symptomatic and not in any apparent duress, 2) Send me home to recuperate as long as I promised not to do ANYTHING but rest, 3) Have me come in for tests every other day (bone marrow, MRI, HIV, X-rays, etc.) to rule out cancers and tumors, and 4) Continue to take blood tests to monitor my hemoglobin and other vitals. A transfusion and hospitalization could still take place if warranted. Thankfully, the tests showed no cancers or tumors. I was put on a high dose of prednizone, told to keep myself warm, to wear a hat and cover exposed skin if the temperature was below 65, to climb stairs once a day, and most of all, to rest. I was not allowed to go back to my teaching position until my hemoglobin was at least a 9.2. During this time, I craved ice drinks and ice cream. When my hemoglobin numbers weren't improving, and I assured my doctor that I was keeping myself warm on the outside, Dr. Lichtin quizzed me about my eating habits. After a lecture on the importance of warming the core as well as the outside of my body, I was told to stay away from all cold drinks and cold foods. Not surprisingly, the numbers began to rise. A secondary trigger to my disease is the common cold. My body cannot fight two fronts. As an elementary music teacher exposure to colds and other viruses are a daily occurrence, and so I found myself in and out of school with many cold agglutinin flare-ups. Dr. Lichtin and my family members all recommended applying for a disability retirement. In February 2002, I was granted a disability retirement from my teaching position. Since retiring, I have mostly been stable with my hemoglobin being around 10.6 - 11.4. I still catch the occasion cold and then my hemoglobin plummets. I can feel when this is happening, know what to look for, and call Dr. Lichtin immediately. Dr. Lichtin has told me that cold agglutinin disease can also precede a cancer or tumor and so he monitors me closely. I am to call him if I notice any changes in my body. So far, taking prednizone when I have an “episode”, keeping warm, and rest has worked the best for my condition. I also take 5 mg of folic acid each morning. I have not had any chemo treatments. The prednizone treatment tapers as my hemoglobin numbers rise. I'm usually off the medicine within 5 - 6 weeks. We have a sauna in our basement for those times when I feel chilled and the Cleveland winds and snow blow. I have several long wool or down coats, loads of hats, scarves, gloves and boots. I favor "cuddle duds" long underwear, and the layered look. (I often feel like a bag lady!) I've also rented condos in Florida for the past 7 years during January, February and March. My husband has two years until retiring from his teaching position. We just bought a condo in Ft. Myers, Fl. and are hoping to be snowbirds when he retires. Mary Lou Lydecker
Barbara's story My name is Barbara Southall, and we live in Burlington, Ontario, Canada. I am married to Paul, have 4 children, 6 grandchildren, another is expected in November and have 3 granddogs. I am 69 about to be 70 in November. December 2007 I felt pain around my mid section. I took medication with ibuprofen. Felt some relief. It was at Christmas so I pushed myself. By the Jan. 4 2008 I had severe chills, the starting of diarrhea and from there went down hill. On Jan 7, 2008 my family took me to the doctor. There was not a bed in the local Hospital. Went home, passed out, family called 911 and went to the hospital. Had various tests. The final diagnosis was anemia. The Cold Agglutinin Antibodies were present. With a hgb of 83 I went home. Had blood tests weekly, saw the hematologist on a regular basis. In May I decided to look up Cold Agglutinin on the Internet and was amazed to find your website. I immediately started the B5, tried to limit/eliminate ice cream, cold foods. My blood count went up, after the introducing of B5 until I indulged in the cold foods on vacation. For me I try to keep it simple and avoid any cold situations, cold foods like the plague, try to eat foods high in iron. Keep my body inner core warm. I always carry a jacket. I can tell when my hgb is low by the soreness in my knees and hips. I would be pleased to be contacted by anyone. Barbara Southall
Roberta's story My name is Roberta Franklin and I live in south Florida. I was 67 when I was diagnosed with cold agglutinins in December 2005. I was having acute bowel problems which I have had before and went to the ER in pain. I waited 6 hours before they brought me back to see a doctor. The ER doctor ordered blood tests among other things and my blood count was found to be dangerously low. They decided I should be admitted and the next day a hematologist was called and his partner Dr. Gersten was consulted. Before releasing me they gave me 2 units of blood. Dr. Gersten had encountered the disease before and was familiar with the standard treatments. I immediately made an appointment with Dr. Gersten who said I should have a bone marrow test to determine if I had Non Hodgkins Lymphoma. He did it in his office and luckily I do not have that. On December 8 and 29 I had Rituxan and VIncristine, a cancer drug and on Dec. 15 and 22 only Rituxan. Each treatment takes 4-5 hours But after 2 treatments my blood was so low 6.1 and I was feeling so bad that Dr. Gersten sent me from his office to the hospital for another transfusion. I had two units of blood which brought my blood up to 13 immediately. The doctor was amazed. I was told to take folic acid once a day, which I have continued taking. The Vincristine not only made me loose my hair but my singing voice. I went to a throat specialist who told me my vocal chords wouldn't close, therefore I could not sing any high notes. I went to a speech therapist who deals with singers and was told to do voice exercises for months. It took about 6 months for my vocal chords to become normal again. Very scary for a singer. At first I saw the doctor once a month, then 3, then 6 months, then a whole year. I was feeling well for approximately 2 years. I should never have waited a year and never will again. My symptoms returned and I had 4 treatments of Rituxan again in 2007, no Vincristine this time. My hemaglobin took months this time to reach 13 where it has stayed. Roberta Franklin
Joe's story Age 90 in 2008 I lived on Long Island, New York, for 64 years and retired with my wife Connie, now age 84, to Lake Hartwell Georgia in 1981. When I was 78, in 1996, my doctor discovered that my hemoglobin was down to 8.5. After many additional blood tests and a bone marrow biopsy, I was informed that I had CAD and was treated with Procrit shots. My hemoglobin gradually rose to 13.6 after I received 3 or 4 injections of 10,000 units, 3 x week.
Today, I lead a very full and active life playing golf at least 3 times a week. I shoot in the high 80's and low 90's. Also, I do a lot of swimming and boating and even ride my jet ski boat. I find having CAD is more of an inconvenience than a health issue. I’m still taking Procrit and my VA doctor, Dr Julian Jacobs MD, FACP, wants me to keep my hemoglobin in the range of 10.5 - 11.5. He believes that by keeping it at that level, as recommended by the FDA, there's less risk of a stroke or heart attack. I'm also taking Plavix, a blood thinner, since I have had some TIAs and possibly a mild stroke 10 years ago. I keep my house at 80 degrees (26 degrees to some of us) winter and summer and I'm never without sweaters and jackets whenever I travel or visit friends. It is amazing that of all the doctors’ patients, including those of at least 6 hematologists with whom I have spoken, I was the only one with CAD. That includes my VA hospital doctor in Atlanta who is a Professor of Medicine Emeritus for the Emory Medical School. I am very fortunate to have him as my blood doctor. I see him at least 4 times a year and spend at least an hour each time. He supplies me with the Procrit each month for a fee of only $8.00 co-pay. It sure helped being a World War ll veteran. After all these years I finally found a web site for people with CAD. I’m grateful now because I have a way of communicating with other CAD people and it’s a worthwhile effort even though I type with one finger. For the last 10 years, I thought I was the only one in the whole world with CAD. Joe Sergio
Steve's story
I
am 45 years old and live near Burlington, North Carolina. I grew up in
Central Pennsylvania on a cattle farm. I spent my winters feeding cattle,
breaking ice in the water toughs and used all my free time for hunting and
trapping. I graduated from Penn State I noticed about 13 years ago when I was returning to Pennsylvania to go deer hunting, my hands and feet were cold all the time. I thought that I had got adjusted to the warmer weather in eastern Maryland, and wasn’t tough enough to take the mountain’s chill anymore. That same year I joined the blood bank at work. The first time I gave blood, the blood coagulated in the bag. The phlebotomist’s told me the anti-coagulate in the bag must have been defective. About sixty days later I went back again to give blood. The same thing happened. I went back about three or four months later and the same thing happened. A few weeks later I received a call from a blood bank doctor advising me to go see my doctor. The only time I ever saw a doctor was for stitches or x-rays to see if broke anything on a few occasions and for tetanus shots for puncture wounds and cuts if it’s been more than seven years between shots. Other than that I didn’t need a doctor. I set up an appointment to see a doctor and she referred me to a hematologist. That’s when I spent the next year getting test after test to determine what I had. After Reynaud’s Syndrome was ruled out, I was diagnosed with CAD. The hematolgists advised me to stay warm, take an aspirin a day and stay warm. The next winter I couldn’t stay outside 2-3 hours at a time until I had to get in my truck, to the heat on, and warm up for 20 to 30 minutes. When I went to the gym to exercise I would have sweat pouring off me while I played racket ball, and at the same time my nose would be blue and my hands and arms would be getting numb. Went I lifted weights the cold steel would pull the heat out of my hands. I had to start wearing gloves. In spin and kick boxing classes my nose and cheeks would get blue. I did this for several years, but it got more painful, when it was real cold my hands, feet and face went completely numb, and on occasion I couldn’t talk because I could move my face muscles. If I got caught in a rainstorm in the winter while riding one of mules I would nearly freeze. When I would start thawing out, it felt like sand running through my hands and feet until they warmed up and the blood was flowing again. After I got warmed up I was back out in the cold to do it all over again. I went back to my hematologist and told her something had to be done because I couldn’t stay warm outside. I asked her for blood thinner and she told me blood thinner would not help. She advised me to wear warm clothes, stay out of the cold or move south. I asked her for a referral to John Hopkins. I figured someone up there could cure it.
Well I got another education, this time on steroids and prednisone. Anabolic steroids are used to build muscles not prednisone. Well after two winters of prednisone, that wasn’t going to help the CAD without the chance of screwing something else up in my body. This ole country boy is about as hard headed as the mules I ride and about as stubborn as one my hounds dogs when it’s time to quite hunting and head home but they want to keep these nose on the trail until they tree something. I was offered an opportunity to transfer to North Carolina and even get a promotion. Well nothing back in Maryland was holding me back, I was divorced twice, and had a huge falling with my girlfriend six months prior. So I sold my mules, my horse, most of my dogs, and headed south
.
I've been in North Carolina just over two years. The weather is warmer here. But I still get cold in the late fall and winter. If it’s below 60 degrees I can’t stay outside more than about 30 minutes. I don’t remember getting cold this easy. I’ve decided to give Rituxin another try. I had my first treatment yesterday. I think I’ve finally given up on being able to take the cold again. But I hope I can stand to be outside if it stays above 50 degrees. If not maybe south Texas might be an option in a few years. I discovered the CAD back in the spring. I read some of the stories. When I saw the picture of Miss Nina with the snow on the mountain and the ice in the water, I did email her and asked her a few questions. I figured if she can live in Alaska, I hope I can stay in North Carolina. I would love to talk to any of ya’ll about your experiences and or advice. Steve Hearne
Pamela's Story
Hi Graeme. Thank goodness I have found your
website. My name is Pamela Bedford and I currently live in Perth,
Australia. Your website is great, gives me encouragement, and I even print it out and take along with me to the doctors so that they also can understand CAD more. I have been in contact with Thio Gim here in Perth and he has been a tremendous help already. I am 56 years, and have just had to give up my job with the Agriculture Department as a Personal Assistant to the Director of Animal Biosecurity, a job I loved very much. I have my house on the market in suburban Perth and I am hopefully moving to Carnarvon up the north of Western Australia for warmer weather and where my sister lives. I have just had a cat scan, and now I have to have a Bone Marrow Biopsy so I am on that bumpy road that no doubt many of the CADdys have worn before me. My CAD was undiagnosed for many years and I thought I had chronic fatigue. The doctors told me it was all in my head, that I had had a bad divorce, that I was a single mum, depressed and so on. One day I went to the Doctor for some more tests, and the titre test came back a little out of range. The Doctor said not to worry and sent me back to work. Luckily for me, my boss was a very smart ex RAF lieutenant and demanded that I go back to another Doctor as she thought something was wrong and if the test says its out then it needs to be looked into. Thank God she did as the next Doctor I went to sent me off to a blood specialist and there it was........ CAD!! After all those years. I sat down and cried. I have now spoken with many people regarding CAD to try and get more awareness. People are amazed as to what has happened and just yesterday I was sharing information with the radiographer who was doing my cat scan. She had never heard of CAD, so she got a rather short lesson. She is from England and said you would have to dress in one of those inflatable suits to survive the cold. I laughed and said funny there is a picture that looks like that on the website. I am sure she will follow up herself also. I have lived in Auckland, so how on earth do you survive the cold in Christchurch Graeme?!!! Anyhow, after all that, I hope I can be part of the CAD group and keep in contact. Thio has been such an encouragement already and its so nice to share our good and bad stories and learn from each other. Pamela Bedford
2009 starts here Judith's Story Hi, my name is Judith Hubbard. I recently contacted Betty about starting a message board where those with CAD can communicate in a group forum. So, The CAD Chatter group was born. I am a 45 year old mother of two. I have been married 23 years to a great man, Brian. We have two grown children, and live outside the Fort Worth, Tx area. I was officially diagnosed with CAD in 1998. After reviewing my health records, symptoms go back to 1983. However, it was in the fall of 1998, when I got strep throat, that things really kicked into gear. The prior year I was told that my thyroid was shot and that I had mono. I had already received a fibromyalgia diagnosis five years before that. Okay, so it would seem that my immune system ain't so great! My official diagnosis was followed by two weeks in two different hospitals and a stroke, which messed up my vision for several months, and my entire left side is numb to this day. I have had 3 or 4 other "small" stroke events but their effects were minimal. Although my blood level was down to a 4.7 at the time of my stroke, I was not transfused as my bone marrow started to do its job. I used to pay closer attention to the numbers, but really don't anymore. I pretty much go by how I feel. I do have a daily medicine regime which addresses thyroid, fibromyalgia, peripheral neuropathy, Raynaud's and opthalmic migraines.
Other than the CAD, I try to enjoy life despite the limitations. I live in
A/C country, and it is hard to go anywhere without getting I was so happy to have finally see a website devoted to CAD. When I was first diagnosed there was nothing. I look forward to getting to know you all and hearing how you cope with this stuff as it seems to be a real roller-coaster ride for me. Judith Hubbard
Valérie's story
I am from France and have been
diagnosed with Waldenstrom's macroglobulinemia in 2005. I am interested in hearing from other patients or experts, who may have experience on this specific disease, and in appropriate treatment possibilities and results. In addition my mother has
very similar WM cancer.
She was diagnosed in 1999.
But I do not show the following symptoms:
As I am positive at direct coombs test results. That imply Fludarabine treatment is not recommended for me because of hemolytic risks. Treatment history and
results:
The next step for me should be chlorambucil. Thank you for your help. Best regards
Lael's story I am Lael Van Riper, 67, living on a farm in Montrose, Colorado. This high-country desert is less than two hours drive from three ski areas. Our valley has an arid climate, temperatures occasionally reaching highs above 100 or lows of below 0. For me CAD is as if I were putting together a jigsaw puzzle that has no picture to guide me. I don’t know how many pieces are in the puzzle, and someone gives me the pieces a few at a time over the years, occasionally throwing in pieces that belong to some other puzzle. The first piece of the puzzle I received over 50 years ago. My pediatrician told my mother that I should be protected from the cold. I had a marker in my blood that indicated I would be susceptible to cold and to arthritis. I have had restless leg syndrome since childhood. The NIH web site says, “People with low iron levels or anemia may be prone to developing RLS. Once iron levels or anemia is corrected, patients may see a reduction in symptoms". When I took the blood test to get married, I found that I test a false positive on the syphilis test. In my late 20’s I tried to become a blood donor. I was refused because of the false positive that I test and because as my blood cooled the red blood cells "clumped". In the early 90’s I began to spike high fevers, have hallucinations, then a day free of symptoms and back again. I grew more and more debilitated. I tested a high titer for rheumatoid arthritis and was treated for RA until the day I was put into intensive care. There, a bone marrow test revealed that my bone marrow had ceased producing red blood cells. A second doctor diagnosed the illness as Borellia, relapsing tick fever. (There is another strain of Borellia that causes Lyme Disease.) A round of tertracycline cured the disease, and my bone marrow resumed production. Sometime after that I was told that I had cold agglutinins that were causing my red blood cells to agglutinate when cooled. Since they were giving me few problems, I forgot about them. In 2005 I began to be fatigued, have plantar fasciitis (an inflammatory disease of an area in the foot that has a limited blood supply), eventually had heat exhaustion. When I finally saw my own physician, she took one look at me, declared I was severely anemic, and put me in the hospital. There, another bone marrow test revealed that I was not producing sufficient red or white blood cells. I was given four units of packed red blood cells. A distant lab looked at my blood and said I, almost certainly, had leukemia. My spleen was swollen and what red blood cells my bone marrow was producing were large and misshapen. By the time I got an appointment with an oncologist/hemotologist, my blood counts were rising. Two months later, well on my way to good health, no leukemia, the CDC finally let me know that I had West Nile Virus. I began at that time to have escalating problems with hands and feet during the winter, but I managed the problem, didn’t mention it to my doctor, and went on with normal life. From the summer of 2007 until December 2008 my doctors and I dealt with pain and spinal issues until lumbar fusion was scheduled. Meantime, I was having growing problems with CAD. Even in our home, heated to 70, my toes, fingers, nose would turn white then purple. Any exposure outdoors would add in ears, cheeks, mottled legs, and purple knees. I tried heated gloves and socks, wool socks, chemical heat packs, only receiving partial relief. In December as I lay waiting to be taken to the operating suite for the lumbar surgery, in rapid succession a nurse, the anesthesiologist, and the woman running the blood cleansing machine came in, read my chart, and said, “Cold agglutinins, I don’t know anything about them. I’d better go study up.” At that point my husband was ready to kidnap me, hospital gown and all, to get me away from these uninformed people. My surgeon reassured him that the operating suite would be heated higher than the normal cold temperature, that I would have warmed blankets on me at all times, that two units of blood were typed and cross matched and would be given warmed, and that the surgical staff was prepared for my case. The blood cleansing machine would not be used because there was no guarantee that the blood could be kept warm. Of the blood that runs through the machine, only red blood cells are returned to the body, the rest are eliminated. If the red blood cells agglutinated, that would mean that there would be nothing to return to the body. We made it as far as the operating theatre when the pathologist called down. My blood cells from the previous days test were hemolysing, and he did not feel that we had sufficient information on CAD to a risk a six-hour surgery. Surgery was cancelled until I saw a hematologist. The hematologist okayed the surgery without the blood cleansing machine and with a sufficient supply of typed and cross matched blood for transfusions and suggested that, long range, we consider moving to a warmer climate. The surgery in January was successful, used only five units of donor blood. Four days later I was released from the hospital having had countless blood tests, about a third of which had to be repeated because even with heat packs and heated blankets they did not make it to the lab before they agglutinated. Ten days later I had a second operation because I was not healing well and had a staph infection. This entailed four more units of blood, a wound vac pump attached to my spinal wound for five weeks, intravenous antibiotics 3 x daily for 7 weeks, and weekly blood tests at the hospital lab. The hematologist kept track of my blood tests, declared I was improving, and once again suggested that we consider moving to a warmer climate. To speed healing of my back I was supposed to be walking 1½ miles per day, impossible in Colorado winter weather with CAD. When I was in town I walked up and down the aisles of the supermarket, wound vac in the basket, PICC line in the arm, turning purple even in the heated store. Spring began to flirt with winter. The wound vac and PICC line were finally removed. I walked until…the pain in shoulders, arms, wrists and hands, once attributed to spinal problems, returned, accompanied by a full-body assault of pain in joints and muscles everywhere except the lower back. My GP sent me for—you guessed it—more blood tests. I thought the diagnosis would be rheumatoid arthritis, but I tested off the charts for lupus. I have now added a rheumatologist to my medical team. I still don’t know what the total picture of my puzzle will look like. The rheumatologist questioned the long-ago diagnosis of Borellia, asked me questions about conditions I have never heard of and some I had (pernicious anemia). There will be a change from Prednisone for pain to something with fewer side effects. Eventually, I may be sent to Mayo Clinic for further testing. I suspect my puzzle will never be finished, but some of the pieces are coming together. Both CAD and lupus are autoimmune diseases. Some people with lupus test a false positive on the syphilis test. Rituximab is a drug used for the treatment of both lupus and CAD, and, yes, we are trying to figure out if we can afford to be snowbirds, flying to a warmer climate in the winter and continuing to farm in gorgeous western Colorado in the summer. Lots of pieces, large puzzle, no big picture….
Peace and grace,
Ruth Ann's story My name is Ruth Ann Ryan and I live in Smithfield, Utah (I am 62 years old). Sue told me about the Cold Agglutinin Disease (CAD) Website and it is so nice to know that I’m not the only person in the world with CAD. Thanks again for responding. Sorry I’m so slow in getting back with you. (Life has been a little crazy.) I also have Waldenstrom Macroglobulinemia without the syndrome. I have known that I had CAD since Oct 2006. (I know now that I have had it much longer. In the past, when I would cross-county ski or would get cold, my hands and feet would get so cold I could hardly function and then they would start turning purple.) Back to 2006 - The Doctor did some tests and my “M spike” was very high so he sent me to a Cancer Doctor in our area. The Doctor did a bone marrow biopsy and it showed that I had something wrong, but the tests were inconclusive. The biopsy also said that I needed additional tests, but they were not done. Both of my Doctor’s said to get back with them if I started feeling ill, whatever that was. So I went along knowing that I had cold agglutinin disease and not knowing what the underlying cause was. Last year was full of all kinds of surprises. I am not sure if that had an effect on my disease acting up. In September I started feeling very tired and had a hard time functioning. On Oct 13, 2008, I received two units of blood. (Prior to the transfusion, when they drew blood they did not keep it warm so I had to go back again. It was also difficult to find a blood match, so I had to wait four days before the first transfusion.) They did heat the blood when I received the blood transfusion, thank goodness. My Doctor told me it may not last and that I may need an additional transfusion, but to always keep warm. I asked for additional information about CAD and he did not get back with me, so I contacted the Huntsman Cancer Center in Salt Lake City, Utah and made my own appointment. (I think they were interested in me because I had CAD and my condition was rare) My first appointment was Thursday Oct 23, 2008 and they did numerous blood tests. On Monday, October 26, I had to have a blood test at a Hospital close to where I live and my blood levels were lower so they had me come to Salt Lake. I had to go back again on Tuesday Oct 27, because they were concerned about me and they wanted a CT Scan as soon as possible. They had also forgot to draw enough blood on Monday, so they could find a match for a blood transfusion. In the afternoon after the CT-Scan I was having a hard time functioning and they were very concerned about my levels as they were still going down. Hematocrit - 20.8 and my Hemoglobin - 7.4. They admitted me in the Hospital and from there I got a final diagnosis and started treatments. Two units of blood, Rituxan and Cladribine. I received four treatments of Rituxan in November 2008. I am currently doing very well! I went to Doctor Gilbert, in Salt Lake on Thursday, July 16, and my levels are - Hemoglobin 12.9; Hematocrit - 35.0; Platelets 163. I have to go back again in three months, unless I start feeling ill. My main concern is that I don’t want this to happen again and I want to do whatever it takes to make sure it doesn’t. So I’m interested in what I need to do to stay healthy, and if there are any precursors to the disease. “Please let me know your secrets.” I lead a semi-active life style and I’m always doing something - from gardening, crafts, sewing and traveling to our cabin in WY, keeping up two houses and two yards and working full time. I’m not biking because I think I’ve gotten lazy. Please let me know what I need to do to stay healthy. Do I still have the disease? Is it always lurking in the back waiting to flair up again? Thanks,
Barbara's story I've been visiting your website for over a year now. My anemia was discovered on a routine CBC in June 2005. That winter I began exhibiting Raynaud's symptoms. It took the lab staff 3 hrs to type and crossmatch my blood prior to my first, and hopefully last, blood transfusion in Feb. 2006. The nurse informed me they'd encountered a "cold agglutinin", and she provided me with a printout explaining what it is. Back home, I searched the web to learn more about cold agglutins and came to believe I might have CAD. I was referred to a hematologist in April 2006 because my PCP believed I had a hemolytic anemia. The hematologist ran more bloodwork, but said it was not hemolytic. He started me on routine Procrit injections for 2 yrs. All that time he knew I had a "hard" agglutinin and sent me to the hospital lab for my CBCs since my blood plugged up the clinic's automated machine. More than once I mentioned CAD to him, but he insisted I didn't have it. In July 2008, I turned 65 and immediately changed health care plans and doctors. By August I'd been set up with a new hematologist who said I certainly do have CAD. My cold agglutinin titer was 1:20480. Monoclonal B-cells showed up in my blood and bone marrow. I was diagnosed with low-grade B-cell lymphoma and received the 4-wk round of Rituxan in Oct 2008. I had a good response to it and haven't needed Procrit injections since then. However, I and my hematologist were disappointed this week to see that my red cell count has dropped to the low end of normal, and my LDH is above normal. He showed me how my counts had slowly dropped since summer. I'll be going in for labwork monthly now and more often if I have symptoms. He promises not to let me get too anemic before ordering another round of Rituxan. My doctor also strongly encouraged me to start spending the winter months in Arizona. He emphasized that my efforts to stay warm aren't helping that much, and winter isn't even here yet. I've discussed this with my husband, and it would be hard to swing financially. Still, we might be able to find a way to spend at least a month there each year. I'm wondering if it's even worth looking into. Have your other readers (CADys) any specific ideas on good, affordable winter destinations? Thanks so much for this great website. I enjoy checking back now and again. My heart goes out to all the others who share this disease.
Sincerely
Don's Story I am 70 years old, retired and living in a golfing community near Providence Forge, Virginia. My CAD saga began in 1999 when my primary care physician noted that my hemoglobin count was low. He put me through a series on tests to determine the cause but nothing surfaced. At the same time I noted some physical symptoms that I now know is associated with my disease. However, at the time I did not realize the connection. These were nose and ears turning blue when exposed to cold weather and difficulty in getting back to my jogging regimen that after a hiatus of ten years or so I had determined to start again. I felt weak and unable to do more than a fast walk for a mile. I quit after about two months effort.
Finally, my primary care physician referred me to an oncologist who almost immediately recognized the symptoms. A bone marrow biopsy confirmed that I had a low grade lymphoma accompanied by cold agglutinins. He had me go through a couple of treatment of oral chemotherapy. (I'm sorry that I can't remember the name of the medicine used.) In any event, the treatments appeared to have no effect. A second bone marrow biopsy after the treatments showed that the lymphoma had increased slightly and that the cold agglutinins were still present.
At the time my hematocrit readings were in the low to mid-30's - Low but my life was not substantially affected. I learned to stay out of the cold and that I would be unable to participate in any significant physical activity. So it was determined to check my red blood cell levels every three months and monitor the situation... I was living in Northern Virginia at the time, working 8-10 hours a day, playing golf every weekend, and generally enjoying life. The only thing worth noting was that sometime in 2004-05 (I can't remember exactly) the machines used to measure hematocrit were unable to get a viable reading as the blood was clumping too quickly - even keeping it warm up to the time it was processed was inadequate. We adapted and began to measure red blood cell levels by the hemoglobin readings.
In 2004 my wife and I moved to our present home near Providence Forge and began looking for a good oncologist or hematologist in this area. We found a superb doctor at the Peninsula Cancer Institute in Williamsburg, Virginia who was well versed in the eclectic nature of my disease. After a few sessions we determined to continue the quarterly monitoring. This went well for a couple of years. But then increasing attacks of chronic sinusitis begin causing problems. Each time I suffered a sinus infection or other stress related condition my Hemoglobin count would crash to 6-7 levels. After each attack my blood levels came back up on their own once I had treatment (usually antibiotics) that alleviated the sinus attack or stress related issue - A radical prostectomy was one such incident and my blood levels were low until the catheter was removed. After a year of so of this my doctor, concerned about a massive drop, decided that I should undergo two years of Rituxan (Rituximab) treatments.
Things went along as usual - And the quarterly blood tests showed their usual ups and downs. About this same time my frequent sinus attacks were controlled by a daily dose of Allegra-D 24H and I felt good up until this last summer (2009).
This summer in late August after return from a trip abroad my hemoglobin count went down to 6 and didn't come back up on its own. I was about to begin my 4th and supposedly last series of Rituxan treatments in early September. In the interim, my doctor prescribed a massive dose of prednisone and wanted to see how the Rituxan and prednisone would work before considering other options. Unfortunately, this was the last time I would see this excellent doctor. He suffered a back incident in early Oct and has been out of action since.
His absence from the practice caused a bit of an upheaval to say the least. I was assigned to a new doctor who ordered a bone marrow biopsy and continued the prednisone - 100 mg per day. And I started the Rituxan treatments on 8 September. The bone marrow biopsy showed that my lymphoma was in remission but there was no doubt that my cold agglutinins disease remained in full force as my hemoglobin count hovered in the mid-6's. My doctor ordered a blood transfusion and in the period 22 Sept to 11 Nov I had five blood transfusions.
My doctor told me that while the Rituxan worked on the low-grade lymphoma it sometimes took a bit longer to work on the cold agglutinins anti-bodies. Essentially we were in a wait and see mode. This was extremely frustrating for me, particularly as it looked like I was in for a regimen of transfusions every couple of weeks... Under doctor's orders I was still taking prednisone although it appeared that I had "chronic CAD" and everything that I had read indicated that prednisone was not recommended. I had backed down to 60 mg per day. I was also taking folic acid, iron tabs, and B-12 shots (once a week). And had an iron transfusion as the doctor thought my iron reserves were low and wanted to bring them up.
I decided I needed a second opinion and arranged a visit to the Massey Cancer Center at VICE, Richmond, Virginia. My first appointment was on 18 November. The doctor that I saw there was extremely knowledgeable about CAD and associated diseases. And as it turned out the doctor that I had been assigned to at the Peninsula Cancer Institute had studied under him at VCU. Not only that but PCI is collaborating with Massey in a number of cases. I was added to that list.
More interestingly, a couple of days after the 11 Nov transfusion my hemoglobin count was 8.4. In the next two weeks it worked its way down to 7.7 then stabilized for about a week. On my last test on 16 Nov it had moved back up to 8.6. We're hoping this trend will continue. If it doesn't the doctor appears inclined to have me take another series of Rituxan treatments. No matter what happens he plans to have me take these in February but will move the series up if my blood levels don't continue to rise or begin to fall again. And with Massey doctor's concurrence I've backed totally off the prednisone.
I might also add that after spending more time exploring and reading the CAD website and about the same time I saw the doctor at Massey I decided to swear off cold drinks and ice cream. Prior to this I liked my drinks with lots of ice, liked to chew ice, loved ice cream, and dearly loved a nice, cold beer. Now I fairly rigidly follow a regimen of room temperature drinks and except for an occasional yogurt have no ice cream whatsoever. I have no idea whether this has triggered the upward movement of my red blood cell count but I'm not a great believer in coincidence. I asked both the doctor at Massey and at PCI whether they knew anything about cold drinks or ice affecting RBC levels for CAD sufferers. Neither did but both said it couldn't hurt.
As you can see the story is not complete. I'm hopeful that the upward trend will continue but there are still unanswered questions. Why did it fall so drastically in the first place? There was no sinus attack or other physical disorder that I could discern. Will Rituxan be a regular every six months?
In any event, like all of you I'm sure, I found the CAD website extremely helpful. If any of you have any comments, ideas, suggestions I'm all ears.
Regards, Don
2010 starts here
Jay's Story - as told by Barb My husband had been diagnosed with AIHA back in January of 2006. He has had six treatments of Rituxan. Prior to the last treatment his hemoglobin dropped to 8, so they gave him a blood transfusion in October. After that, his fingers started to pain him terribly. The doctor said it was because of the Cold Agglutinin.
Ended up in emergency where they gave him his sixth treatment of Rituxan and the doctor said Cytoxan would also help. Was in the hospital for six days in terrible pain with his fingers He received the Rituxan, but, unfortunately, his fingers on the right hand, the middle and ring finger and pinky turned a dark color with the ring finger tip turning black. It was diagnosed as gangrene.
He had three more treatments of Rituxan, ended up with the morphine patch for pain. Also had three more treatments of Cytoxan. In the meantime, he had to have his toe nails cut, so went to his foot doctor. This doctor had seen gangrene in toes, so he told us what he did was to prescribe nitro cream to be used on the wrist and joints of those fingers that were affected by the Cold Agglutin, which was what our doctor eventually said was causing the gangrene. He also had five more transfusions while in the hospital, but, fortunately these were warmed, which the first one wasn't, and I think is what caused the gangrene.
At this point, his one finger (the tip is dead) I started soaking it in Epson Salts. Our doctor has never seen this, so we are on our own with the treatment. He just wants to keep giving my husband Cytoxan, which I don't feel is helping much. I guess I'm just venting, don't know what else to do at this point.
His hemoglobin was 10.6 two weeks ago, before he got the last dose of Cytoxan. We go back on Monday to see our Oncologist. We actually went 11 months before we had to have Rituxan again, but the doctor panicked when his blood dropped to 8 which is when he ordered the "cold'" transfusion and when our bad troubles started. Don't know what your situation is at this point, but I do know that cold transfusions are a NO NO.
Have no idea what the doctor wants to do next. I feel he should leave well enough alone for awhile. Thanks for your beautiful support group.
Update 18 January 2010: Went to the doctor today and he feels that Jay should have at least two more doses of Cytoxan. I don't agree. His numbers are good, the cold agglutinin dropped to 2038 and the last Hgb was 11.7. Dr. feels that we are on the right track and we should do this since Jay tolerates it pretty well, thank God. Barb
Dennis's story I am a 72 year old male - first generation Greek descent.
Father had a kidney tumor and passed at the age of 79, Mother had nothing but arthritis and she died at the age of 94. My sister is a cancer survivor, still going strong at 83 but my brother succumbed to heart disease at 78. I hoping I'm blessed with my Mother's heart!
In December, 2004, I went to the hospital with pain on my left side just below the chest (later to be identified as being caused by shingles). Full torso scan, EKG and blood tests were taken - scan and EKG was normal - blood tests were not. Shingles were eventually cured but the blood tests eventually led me to a hematologist/oncologist (Dr. Paul Chung). Long story short: a year later after repeated blood testing and a bone marrow biopsy, I was diagnosed with CLL (Chronic Lymphocytic Lymphoma/Leukemia). I was told that this was a cancer that could last for many years until something more serious took over!
So, I did what any other computer nerd would do, I began tracking my blood tests on a spreadsheet which my oncologist found very helpful. Over the next couple of years my blood levels remained relatively stable - which meant there was no treatment protocol as yet - but we kept an eye on them on a three month interval. Since January 2006, my hemoglobin was slowly headed below 10.0 and I was found to have (CAD) Cold Agglutinin Disease (my body creates antibodies containing an enzyme [CD20] that destroy Red Blood Cells). I was sent for a million blood tests at Cooper University Hospital and consulted with Dr. Kanu Sharan.
Funny but serious side of this whole thing with the CAD is that I have to keep myself warm. It was suggested that I move to a warmer climate - well this year, there was no warm climate in the US, except of course Hawaii - so I stayed in New Jersey with the promise that I would do the best I could to keep myself warm. (CAD is exacerbated when outside temperature on your skin gets to below 70 F.)
When my blood levels got to 9.4, In November of 2009, I was given a transfusion and 4 chemo infusions of RITUXIN (each one week apart). The rituxin worked well, the chemo center at Southern Ocean County Hospital was a great place to get treatment and since than I have been relatively clean of CAD. I still have CLL, my Hemoglobin is hovering about 9.5. Because of the cold weather here in New Jersey I'm told that the CAD could return in three to six months. Currently I am on biweekly blood tests for another six weeks. Well - that's my story - so now we'll see.
Thanks for listening!
Dennis Fotopoulos
Judy's story My name is Judy Filipich. I am 72 years old and live in Murrysville,
PA. My story began eleven years ago when I told my doctor that I thought that I was anemic. He then wrote a prescription for a Hemoglobin and hematocrit level. The results came back showing that my hemoglobin level was down to eight. I then had my reticulocyte index tested which came out to a 6.6% meaning that my red blood cells last about twenty days, and normally they should last for one hundred twenty days. I didn’t have to go through a lot of tests to find out why I was anemic, since my primary care doctor figured it our right away. He referred me to an oncology hematologist who informed me that I might need a blood transfusion. He performed a bone marrow biopsy and luckily, it turned out to be normal. I was put on Procrit, and my hemoglobin level rose, so I didn’t need a transfusion. I see my hematologist every five or six weeks for blood work and a check up. I think that I developed this condition because of the stress experienced after my husband died. I was only fifty-five years old at the time.
I worked part time at Kaufmann’s department store. Because of the air conditioning, my fingers would turn white, seem to become frozen, and I would lose feeling in them. I would have to leave my work place and soak my hands in warm water. The air conditioning continued to bother me to the point where I was getting blood in my urine. At first it was thought that I had kidney stones, but that was ruled out. My doctor referred me to an urologist who performed a cystoscopy. He found everything to be normal, but performed a cystoscopy again just to be sure. I could no longer work in an air conditioned environment, so I had to retire.
I was very concerned to see all this blood in my urine. While I worked, the insurance I had then mailed the Procrit to me and I was able to give myself the shots that I needed once a week, but when I retired and am now on Medicare, I have to go the doctor’s office every one or two weeks, have a CBC done first, and if my hemoglobin count is under twelve, then I receive a shot. My blood has to be drawn from my arm since it is impossible to have it drawn from my finger. I have an appointment with my hematologist about every five weeks, and he does a lot of blood work.
For about a year and a half, I have been on Aranest, which is longer acting. I can go up to three weeks without a shot in the summer. Well, now, after having been on these medications for four years with Medicare, they now decided not to cover Aranest or Procrit, and there is no way I could pay for this myself. Aranest is about $2000 a shot. They pay if you have cancer up to a hemoglobin level of 10, but not at all for cold agglutinin disease. How can they pick and choose like this! I even went the Senator’s office for help, but they refused to believe that I had primary cold agglutinin disease even though I gave them permission to review my medical records. It didn’t do any good. They told me that since I am seeing an oncologist, that I must have cancer and that my doctor wasn’t using the right codes I felt like I was put out to pasture.
I then called the producer of this medication and was told that there is a foundation that helps those whose insurance does not cover it. I and my doctor’s office had to apply and be approved in order to receive this medication. It took a month for the approval to come through, and in the interim, I had to buy the medication on my own.
When preparing meals, I can’t cut chicken or vegetables from the refrigerator, without stopping to warm my hands in warm water. When shopping in the supermarket, I wear gloves and hand warmers, and still my hands become white and numb. When driving, I place my gloves on the heater vent to warm them up. I took a gardening course, and we had a class outside to learn how prune trees and shrubs. It was cold, and although the temperature was in the thirty’s my nose turned to a dark purple color. This even happens in a supermarket.
I love to garden and swim and am in very good health, except for this condition.
Judy Filipich
Chris’s story I am writing this worried about my husband Chris who was diagnosed with Cold Agglutinin Auto Immune Hemolytic Anemia about 6 years ago after feeling unwell decorating in November. His hands felt rubbery and he was passing blood and felt extremely tired. On visiting our GP he was admitted immediately to our local hospital in the Isle of Man ( Famous for the annual TT races and Manx tail less cats, situated in the Irish sea). After a week of tests, with us unsure of what was happening and fearing the worst, they sent him by plane to the UK to Liverpool Royal Hospital, our specialist for blood disorders in the north west of England. Here he was given extensive tests under different conditions and was found to be a healthy specimen for his age, he is now 64, but they found unexplained CAHAD with his hemoglobin levels extremely low but at least now we had a name for what was wrong. He was sent home and given a course of steroids and we made the plane journey back and forth each week with the steroids stepped up to a massive 12 a day plus folic acid, but no blood transfusions as yet. Yes his levels went up slightly for a while but he was like a manic hyperactive bunny who couldn't make rational decisions and was hell to live with. I trawled the internet for information as we felt so isolated because it is so rare. My husband we think is one of only two in the north west UK with it. We have been told this so many times like we are lottery winners….. if this is a lottery win we can do without it. Even the specialists are stumped on how to treat it here in the UK its so rare. So when I came across an article that stated that steroids did little to help in the long term I printed it out for my husband to read. He decided to take it with him on his next visit to the Royal. He was a bit nervous in showing to his doctor but she was more than glad to read it. So gradually the steroids where withdrawn over a number of months Thank God! Now he was started on a course of immune suppressants which helped lifting his levels to an expectable level and gradually our visits went from weekly to bi weekly then monthly to every two months to three. This was also helped by mild winters and warm summer weather. So gradually Chris eased himself off the immune suppressants to just what he felt was acceptable, as he, up until this illness, had never taken any medication in his life or indeed hardly visited our GP. The word paracetomal is alien to him. He was a fit man who worked outside in the building trade enjoyed the outdoor life and had travelled the world in his youth in the Merchant Navy, being ill wasn't the norm for Chris and knocked him for six as it meant a life change and early retirement. But he has always been a positive man who wont let things beat him and was determined to keep as active and as busy as he was able with his now limitations. Pushing himself and giving himself goals to achieve like last summer climbing Ben Nevis with our eldest son and astounding the doctors at the Royal that he had the energy to do it. This is Chris always positive. So we feel hurt by comments from friends and neighbors who think taking iron pills is the answer and when they see Chris on "good days" they think he is fully recovered, we wish. They look at us gob smacked when we say "No its for life" "Really" is the answer. For most people its a mouth full of a disease and how can you be walking around if its that bad. We had a winter sun holiday in January 09 to Egypt which proved sunshine is the tonic he needs as he felt energized, so I think after this years awfully long cold winter that will be what the doctor ordered for future winters to break it up a little and make him feel a little more like his old self again especially as we are now back to three weekly visits with his blood levels lower. He was shocked when they told him that it was 5.1 on his last visit, his consultant said " You shouldn't be standing!" So he was rushed for more painful tests, six phials where taken and they found his blood was "sticky" but his level had come up to 8.1, on his last visit three weeks earlier it was 7.1. Chris' body seems to have adjusted over the years to low levels so he is quite happy at 8.1 though of course feels the benefit when its higher. The highest its been is 12.3. We don't know how long he has had this disease, maybe years, as he remembers always feeling tired but just putting it down to hard work and adapting to it, which we think has put him in good stead now as it would knock someone else sideways. He is in bed now trying to get warm as its a very wet day outside, damp air seems to bring on his condition as does foggy weather along with extreme cold, with first his hands becoming purple speckled even with thermal gloves and now his feet are starting and he has the purple ears, nose etc on exposed areas. Has anyone the same problems as he has wearing glasses they get steamed up when he wears all the head gear. We would love to hear from anyone in the UK with this disorder particularly in our area.
Update May 2010 Not sure if they are satisfied with Chris's results or just a cost cutting measure as our health service is a massive hungry beast but anyway we have a hotline if we are at all worried. Chris seems to have adapted to his low levels and possibly may have had this condition far longer than diagnosed maybe from childhood so seems to be able to cope on half throttle. He is busy working on the outside of our house at the moment as the weather permits and actually puts healthy men to shame as he never stops till his condition prevents him. He has always been very positive and up beat and is more concerned about me half the time than himself. So to all the CAD sufferers out there be positive and try to live as normal a life that you can and make the most of the good days like Chris does.
Claire & Chris Morgan
Annegret's story
I was diagnosed with Hemolytic Anemia with Cold Agglutinin Syndrome in 1991. Since then, my hemoglobin has steadily declined. Right now it is stable around 8.4 to 8.6.
I have had treatment with Leukeran, have had infusions of Rituxan, the last one in August 2009 and had several Blood Transfusions, the last one in September 2009.
Having had several transfusions, my ferritin levels were close to 1000 and my doctor put me on Exjade. I took Exjade for 3 months and this lowered my ferritin levels to about 500. So right now, I don't have to take it. As a matter of fact, right now I am not taking any medication that is specifically for the CAD.
I go and have my blood checked once a month at this point.
Annegret Winsor
Marta's story
Me llamo Marta, tengo 55 años, vivo en Las Islas Canarias (España). En
el verano del año 2000, al salir del baño en la playa, mis piernas se
pusieron rojas y picaba mucho. Al año siguiente, cuando me bañaba en el
mar, la urticaria se extendió por todo el cuerpo. En
el año 2002 comenzó a hacerme daño el frío, mis pies se dormían y dolían
mucho, mis orejas, nariz y manos se volvían de color violáceo. Lo
comentaba a los médicos y no me daban una respuesta, así que continué con
mi vida normal pero sin ir a la playa y cuidándome del frío.
Durante estos años, en algunas ocasiones, mi orina era de color marrón. En
noviembre de 2008 me hice un análisis de rutina y se me aglutinaron los
glóbulos rojos, luego calentaron los tubos para colocar la sangre y
repitieron el examen.
Tenía la hemoglobina a 9, glóbulos rojos 2,900,000 y los glóbulos blancos:
2.500.
Criaglutininas reactivas a 4ºC: ( 1 /512) y a temperatura ambiente: ( 1 /
64), no reactivas a temperaturas superiores a 30º C. Mi
hematólogo me hizo un scanner y descartó cualquier otra enfermedad y
diagnosticó CAD. Tomo 5 miligramos de ácido fólico todos los días.
Consulté a tres hematólogos más y no saben lo que tengo. En
el verano del pasado año ( 2009) mi hemoglobina subió a 12.5 pero en enero
de 2010 bajó a 10.5. La
hemólisis continúa. Mi
tratamiento actual es ácido fólico y cuidarme del frío. Me
pregunto qué puedo hacer para tener unos valores normales. El clima de
Canarias es cálido. En invierno tenemos una media de 18ºC. Soy
profesora y no sé si el contacto con los virus que los niños llevan a
clase me perjudica. ¿Cree Ud que no debo trabajar? ¿Se
convertirá esta enfermedad en otra más grave como me dicen algunos médicos?
Mi
hematólogo dice que tengo Cad y que así seguirá siempre, ¿Que opina Ud? He
buscado en España algún caso de Cad y no he encontrado. Me puse en
contacto con el Centro de enfermedades raras en España (FEDER) y no
conocían a nadie. Por eso me llevé una gran alegría al encontrar esta
página web en EEUU.
Ahora sé que hay personas con esta patología. Me he sentido muy mal pues
los médicos no me entendían. Aún hoy algunos médicos no me creen.
Muchas gracias a Bea y Betty por contestarme tan rápidamente y ser tan
amables conmigo. He
resumido mi historia desde el año 2000. ¿Qué opina de todo esto?
GRACIAS
TRADUCCIÓN - TRANSLATION
My name is Marta, I have 55 years, living in the Canary Islands (Spain). In
the summer of 2000, out of the bath on the beach, my legs were red and
itched a lot. The following year, when I was bathing in the sea, the hives
are spread throughout the body. In
2002 he began to hurt me cold, my feet fell asleep and were very sore, my
ears, nose and hands turned purplish. He
said doctors and did not give me an answer, so I continued with my normal
life without going to the beach and watching over me from the cold.
During these years, sometimes my urine was brown. In
November 2008 I did a routine analysis and I agglutinated red blood cells,
then heated the blood tubing set and repeated the test. I
have hemoglobin was 9, and 2,900,000 red blood cells and white blood
cells: 2500.
Criaglutininas reactive at 4 °C: (1 / 512) and room temperatura: (1 / 64),
non-reactive at temperatures above 30 º C. My
hematologist gave me a scanner and ruled out any other disease and
diagnosed CAD. Volume 5 milligrams of folic acid every day. I
consulted three hematologists more and do not know what I have. In
the summer of last year(2009) my hemoglobin rose to 12.5.But in January
2010 fell to 10.5 The
hemolysis continues. My
current treatment is folic acid and take care of the cold. I
wonder what I can do to have normal values. The climate of the Canary
Islands is warm. In winter we average 18 º C. I am
a teacher and do not know if contact with the virus that children bring to
class hurts me. Do you believe that I should not work? Does
this become a more serious disease like some doctors tell me? My
hematologist says I have CAD and that this will continue forever, what is
your opinion? I
searched in Spain one case of CAD and have not found. I got in touch with
the Centre for rare diseases in Spain (FEDER) and did not know anyone. So
I took a great joy to find this website in the U.S.. Now
I know that some people with this condition. I felt very bad because the
doctors did not understand me. Even today some doctors do not believe me.
Thank you very much to Bea and Betty for answering so quickly and being so
kind to me. He
summed up my story since 2000. What do you think of this?
THANK YOU
Marta Loppery
Dorothy's story
How fortunate I was to find this webpage together with CADdy's
sharing their helpful stories.
I was dx'ed with Idiopathic Autoimmune Hemolytic
Anemia soon after I had four surgeries, four other invasive
procedures, anesthesia (of course), all kinds of pain medications
(ineffective) in '08 & '09. Now, currently, CAD was added with the
possibility of Lymphoma. Path report states that possible B cell Lymphomas
present - but words like "unclear", "may", & "not definitive" are
puzzling. A PET Scan has been suggested. So that is my state at the
moment.
I'm still in shock that I reached the age of 80 a couple of months ago. My
wonderful husband will be 90 in June and very healthy. We are active, have
a good diet (with a few "naughtys"), both are pilots, but no plane any
longer. (sigh)
Thank you for this list and all those who shared their stories.
Smile - your brain will think you're happy! :-)
Dorothy Ingerson
Jane's story
My mom first realized there was something wrong when she accidentally cut
her finger with a blade and instead of bloody red, the blood that oozed
out was a bit orange-y. Alarmed, we immediately went to Medical
City Hospital the following day for a CBC test and blood typing. We waited
for the results for hours, but they kept telling us they couldn't release
the results because it was being "rejected". Finally the head pathologist
suggested we go to Metropolitan Hospital because they were better equipped
to handle cases like this and so we went and they too had difficulty. They
had to run special tests to determine my mom's blood type. The head
medtech informed us that her blood was coagulating in room/cold
temperature and that she had Cold Agglutinin Disease.
Cold Agglutinin Disease is a condition where the antibodies attack red
blood cells in cold temperatures. The tech also said that if ever my mom
would need a transfusion they would have to use a blood warmer. After
going to several different hematologists, we finally settled on Dr. Torres
in Cardinal Santos Hospital. He put my mom on 40,000 units a week of
Procrit, an injectable medicine that stimulates the bone marrow to produce
red blood cells. After 2 shots my mom's hemoglobin rose to 8.9 from 8.6 -
a mere .3 but at least there was an improvement. As of now my mom is still
taking Procrit. This Thursday (sometime in May 2009) she will receive her
5th shot and if her hemoglobin reaches 10, she'll have clearance to travel
abroad to Hawaii for a "2nd" opinion from a hematologist.
UPDATE June 18 2010
Besides Procrit my mom has also tried taking prednisone and Imuran, as
prescribed by Dr. Narciso of St. Luke's Hospital, but with disappointing
results. Her hemoglobin which usually hovered at 8.2 to 9 while taking
Procrit dropped to 7.6 after a week of taking prednisone/Imuran so she had
to have a blood transfusion. After 2 units of blood, her hemoglobin rose
to 10.2 but this immediately dropped back down to the 7's after a week or
so which necessitated another 3 bags of blood. Again, her blood rose to
10.6 but dropped to 6.8 after another week. In addition to this, she
complained of weakness, fatigue, heaviness in the chest, and generally
just wasn't feeling as strong as she used to be. Finally, we decided to
stop the Imuran and wean her off the prednisone and go back to Dr.Torres to
start taking Procrit. This turned out to be a wise decision as the
steroids and Imuran just weren't doing her any good. Perhaps as a result
of the Imuran weakening her immune system, my mother also caught pneumonia
and had to be hospitalized and treated with IV antibiotics for 4 days and
at the same time be given 3 bags of blood which resulted in her hemoglobin
rising to 10.3 and now to 11.6 from taking Procrit.
As for life changes...no more extensive malling, staying inside cold air
conditioned rooms for too long. Even in hot weather she has to wear socks
to bed, and she can't go on a walk without her stopping to catch her
breath. The frequent visits to the hospital for injections and blood tests
also leaves her feeling drained and depressed at times because she doesn't
want to be pricked and prodded with needles anymore. and she has been to
so many doctors already.
So that is her story so far. I shall add more as more happens.
Jane's daughter
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My name
is Laurie and I am 51 years old. I live in Washington State and
would enjoy all of our 4 seasons if I could just go outside more than 4
months out of the year. I used to love to ski and that is how I
found out that I have CAD. I had been skiing and was really without
energy to walk up small inclines carrying my skiis. I came in on my
last run and took off my boots. My legs and feet were so ghostly white.
(2001)
lab reported a low hemoglobin count to my orthopedic doctor. They
called me to stop the anti-inflammatory medicine immediately and contact
my general practitioner to find the cause of the problem. After lots
of tests, I was sent to Dr. Jerome Bart, hematologist/oncologist for
Kelsey-Seybold in Houston. He was the one who diagnosed Cold
Agglutinin Hemolytic Anemia. He said my red blood cells clump
causing the anemia. He said cold aggravates the
condition and for me to wear a hat and gloves in the winter and take
folic acid every day He also said to come in every 3 months for blood
tests. I have done well since my diagnosis and continue to do my
normal home, church, and baby-sitting activities. I feel our warm
climate in 
