This time, we tested some key immune markers that hadn't been tested in nearly two years, namely immunoglobulin (IgG) subclasses, and (a more indirect indication of immune health) candida antibodies.
As I've written about before, over the last two years I have gradually increased my "baseline" health. The improvements have been moderate, but certainly noticeable. It's definitely something more than just "getting used to it," although that is a factor too. The improvements have been nothing world-beating, but then again, I would consider it a victory even if I managed to hold steady and not slide backwards. I read about so many of my fellow patients who describe a long, slow slide backwards into poorer and poorer health, and I think that any patient who can at least maintain their baseline should be relatively happy. A slight improvement, like mine, is something to be celebrated.
At the same time, I've been looking for some indication in my blood test results to explain why I've been feeling a little better lately. I continue to be disappointed.
I first had my IgG subclasses tested back in April, 2012--over two years ago. While subclasses 1, 2 and 4 were in the normal ranges, subclass 3 was low (12, with a reference range of 22-178 mg/dL). Now two years later I had it tested again, after years of immune modulating supplements, probiotics, optimal Vitamin D3 levels, and a number of other treatments designed to boost or modulate my immune system, like Equilibrant, ImmunoStim, and others. My new results: 12 again.
Dr. W states that my three other IgG subclasses are also low, although technically not out of range. In each case, the numbers are in the lower third of the reference range, but this is nothing that would strike me as alarming. Those numbers also remained about the same from 2 years ago.
My Candida antibodies have actually gone back up (that's bad) after going down for a while... While candida isn't a direct measure of immune health, candida overgrowth is a solid indicator of a weak immune system. Candida overgrowth simply doesn't occur in people with healthy immune systems.
I used to test my Candida antibodies much more frequently, but my doctor stopped once it became clear that I had a good anti-Candida diet in place and I was also taking daily oral Nystanin for a while. Here are my results from late 2011 and early 2012, alongside my recent results in bold. The test measures three types of antibodies for a complete picture (IgG, IgA, and IgM). Anything 1.0 or over is considered "out of range" on the high side:
Dec. '11 Feb. '12 Apr. '12 May, '14
IgG 1.3 1.2 1.2 1.7
IgA 3.7 3.3 2.6 3.1
IgM 1.4 1.3 1.2 1.0
On the other hand, IgG antibodies for Candida are higher than they've ever been, including when I was in my acute phase. IgG and IgM antibodies, I believe, are found in the blood. You don't want to see those numbers go up because that could mean candida is becoming systemic. Candida overgrowth in the gut is one thing, but real problems begin when it becomes systemic and enters the blood stream in significant amounts. It is not overly encouraging that IgM antibodies continue to drop, as those antibodies are usually most present in an early infection and one would expect them to wane as a long-term infection continues. (Source).
I will be trying a month-long course of Diflucan to try to stop the Candida. Unlike Nystatin, Diflucan can actually clear candida from the blood, not just the digestive tract. The downside is that it is harsh on the liver and must be used sparingly and under close medical supervision.
These results are just a little frustrating because I have been pretty damned disciplined about my diet and taking probiotics. I would have expected better results. There's not much else I can do (Diflucan is not a permanent solution), and feeling like you don't have any control over a bad situation is the worst feeling of all. (I know, "welcome to ME/CFS," right?)
While not exactly related to immune function, I was shocked that my glucose tested high at 102 (range 65-99). I was fasting on the morning of the test, and I have been a saint about sticking to my Paleo diet. Genetically I tend to have high blood sugar, but again, I don't know what else I can do to control this. I know there are blood sugar lowering medicines, but I don't want to add another pharmaceutical.
Blood ammonia levels were also high 50 umol/L (normal range < or = 47). High ammonia levels is a problem according to Dr. Yasko and her methylation protocol. Now I have to take a couple steps back in that protocol as well.
It's not that I haven't seen any progress in these or previous blood test results. Results like vitamin D3, thyroid, and testosterone levels have been brought back to close-to-optimal levels. And perhaps this explains my slight improvement. But honestly, I won't be happy unless/until I see improvement in my immune system. Like many, I believe that immune dysfunction is at the heart of ME/CFS.
While I know better, sometimes I had allowed myself to imagine that these slight improvements meant I would slowly climb out of this hole and get better and not have to worry about if I'll be able to play with my daughters and go on vacations and continue to work, etc.
As Dr. W says, once you have Candida overgrowth, it is a life-long battle. "It's a nasty, lifelong companion" he always says. The same may be true for my ME/CFS in general. In the best circumstances, you can manage it and hopefully stave off a backward slide and maybe even improve some, but I'm not sure that actually correcting one's immune system to the point of being "cured" is in the cards.
How do we reconcile that with those occasional articles that claim a certain percentage of ME/CFS patients "recover?" (Example) I think the answer is that the surveys that produce those results have different ideas of what it means to "recover" than I do. Probably many of them would already consider me "recovered" because I am more functional than average ME/CFS patient. I can do things.
But I certainly don't consider myself recovered, or even close to it. So that's the rub: a realistic goal for me is to seek to be as healthy as I possibly can, but not to have expectations of ever being able to be carefree about my health again. The daily frustrations and unpredictability of this disease will always be there in one sense or another. The threat of a major relapse will perpetually be my shadow. My task is to carve out as happy of a life as I can within those parameters.
The "realities" that I'm writing about here are not new to me. I've known them for a long time and have probably written about them before in this blog. But I find that I sometimes need to reset my expectations. My blog is called Quixotic because I have a tendency to stay optimistic even in the face of information that tells me I shouldn't be. That's fine, but my challenge is to keep that spirit while at the same time understanding the situation accurately on an intellectual level. With ME/CFS, and many other diseases no doubt, there's so often a conflict between the spirit and the intellect. True peace of mind comes when we find a way to balance the two.