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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 11242
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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I am a 67 year old female, diagnosed and treated for ITP (low

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I am a 67 year old female, diagnosed and treated for ITP (low platelets) for 4 years. My platelet count at original diagnosis was 7,000. I went through a daily IV drip for five days, , but a good result was not achieved. I then started N-Plate injections which raised my platelet levels temporarily up to and beyond the normal range. Every four weeks I would drop low enough to need another injection. I had a splenectomy 2 years ago, but this also failed to achieve stability. Off and on I have received prednisone. My need for an injection is still at every 4 weeks. My counts have been as low as 3,000 lately. Other surgeries during the course of this ITP treatment, besides the splenectomy include gall bladder, incisinal hernia, laser eye treatment, and oral surgery. A side effect of the splenectomy was plueral effusion and pneumonia, for which I was hospitalized and 2 weeks in rehab. When my platelets are low, I bruise spontanesouly and have nose bleeds, just as I did before my diagnosis. Do you think there is any other treatment that may stabilize me or do I just reconcile to the fact that this is way I have to live the rest of my life? When my platelets drop as low as they do, I fear possibly bleeding to death. My funds are limited, but I hope there is something else that can be done. Thank you for your time.
Hello - I am classified as an EYE expert, but I may be able to provide you with some information.
It sounds as if you have had a difficult time with your ITP, despite several courses of steroids, N-Plate, and a splenectomy.
About 10 percent of adults with chronic ITP will fall into this refractory category. I know that it must be difficult for you to deal with this issue.
There are some other potential therapies that you can discuss with your hematologist, but they are both expensive and have side effects.
The first, called Rituximab, is an immunomodulator that may could give you some benefit. The other, is a relatively new medication called Promacta.
The rituximab has lots of side effects, most associated with the fact that it lowers your immune system. To be honest, I do not have much experience with Promacta. However, as it appears that you have tried several other therapies -- it may be worth a discussion to weigh the risks and benefits of these medications with your hematologist. Good luck!
Customer: replied 3 years ago.

Thank you for your response and the info provided. i will discuss this with my hematologist. I do not know why my question went to you as an eye specialist. I thought it would go to a hematologist. but thank you for your time and response. You have been helpful.

Is it possible for this to be referred to a hematologist without further charges? If it will cost more, please DO NOT forward.

Thank you again.

You are very welcome. I will see if this question can be transferred and I will get back to you.
Customer: replied 3 years ago.

Thank you. I'll await your response.

Hi. Dr Rick here. I completed an Internal medicine internship in NYC and have two decades of clinical experience.

No hematologists seem to be available at this time. I have reviewed the reply by the other expert and I must say that I agree with much that he has said.

However, it sounds like you have spent quite some time trying to find the best possible treatment for your ITP. I am sure that your previous doctors have thought of, and ruled out, all of the common and easily available treatment for your issue. Would you say this is a correct statement?

Well I think it might be time for you to take a very difficult, and bold, step to see if you can get some relief.

At this point I think the best thing for you to do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

I know that it is going to take significant effort on your part, but I believe that going to one of the "Medical Mecca's" is your best chance to – finally -- get to the bottom of what is going on.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 3 years ago.

Thank you for your response. I do appreciate your time. Your suggestion about the Mayo Clinic or other teaching institution was something I have considered, so i am glad to hear this suggestion come from you. Makes me feel I am not off base in possiblly pursuing this avenue.

I rate you and the other responding doctor as excellant service. Both of you have been very helpful!

Thank you again! Blessings to you both!

Thank you for the excellent rating...but for it to count you have to mash the button on your screen that says "excellent" :)

I hope you get answers to what is going on soon.

Take care.

Dr. Rick MD FACS
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 11242
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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