Ducks in a Row

So, I met with my hematologist for my semi-annual exam last week. Platelets were at 73, which both he and I feel fine about. However, given the fact that sometimes my platelets will drop from the seventies to the thirties with little warning, and the fact that I've had some unsafely low-platelet occurrences within the last few months, we spent a fair amount of time talking about second-line treatments. (where steroids are considered first-line treatments).

The way I've researched it, there are basically four different potentially effective options at this point. They are:

1-Continue treating with Dexamethasone as platelets drop
2-Rituxin--an infusion chemotherapy medication that has been proven effective in some cases
3-Spleen removal surgery (splenectomy)
4-A fairly new class of kind of medications called Thrombopoietin Receptor Agonists or TPOs

I don't want to take the time or energy to go into all the ins and outs of the different options here, but there are benefits and drawbacks to each one.

In my case, my doctor and I have rejected (for now) options 2 and 4, and we are focusing on options 1 and 3.

We're considering option one because we have already seen that, while it wreaks havoc on my emotional health while I'm doing it, Dexamethasone has proven to be quite effective at restoring my platelet levels, so while neither of us are committed to it as a life-long course, we both do have a bit of a "don't fix what's not broken" mentality as it relates to this option.

We are considering option 2 because studies have shown that splenectomies tend to have a higher rate of success in treating ITP when the patient is around age 45 or younger, and whose platelet levels respond well to steroid treatment. I meet both of those criteria.

So, right now, we're "lining up our ducks" for a possible splenectomy. This week I've received pre-splenectomy immunizations, mainly pneumonia and meningitis, because apparently those are diseases that are more easily contracted and more difficult to fight off when one doesn't have a spleen. Also, my doctor (who practices about an hour away from me) is speaking with his colleagues to get a recommendation for a surgeon that practices at my local hospital and would be skilled at a splenectomy.

Once our "ducks are in a row" regarding all of this, if my levels do tank at some point, we'll have the option of deciding if we want to stay with steroids or move on to splenectomy. I really like the thought of getting all this groundwork done now, in the calm of good health, rather than later, in the heat and stress of super-thin blood.

In other news, I started taking papaya leaf capsules. I don't know that they will help, but I found an economical source for the capsules on amazon, and I thought I'd give them a try. My doctor is fine with it, and it seems, a little curious as to whether or not it will make any difference.