Annie,

without knowing the details of that specific patients, I can't comment of course. and you are right that in some patients ITP can be very hard to control (just like any other autoimmune disease).

although, we at least don't tell our patients that it is due to some "ill defined emotional problems" that neither them or their loved ones are aware of (sorry, couldn't help adding a bit of sarcasm).

ITP means immune/idiopathic thrombocytopenia. I believe that the elevated platelet count your friend had, was not the result of the illness per-se, but more likely due to inflamation/bleeding/iron deficiency, that can lead to increased platelets. probably, at that time the ITP was under control. in fact one possible treatment that is being considered in refractory ITP, is to mimic the situation caused by such stimuli, in order to increase the platelet prodction to overcome the increased destruction.

physicians are not always aware of the fact that patients can have more then one process going on, and that one pathological process can "normalize" the other.

I once had a patient with polycytemia, that I managed with periodical blood letting. at some point he seemed to "stabilize" and his Hgb. was near normal with no intervention. instead of being happy about it, I sent him for an emergent colonoscopy, because I realized that he has to be losing that blood somewhere.

or one of my patients with a long time anemia, was admitted to the hospital due to malaise and weakeness. she was discharged the next day, doing very well, and even her Hgb. was completely normal . when I saw her, I stopped the diuretics (started by her GP a few weeks earlier), as I realized that it made her dehydrated, on the verge of going into renal failure, and that was the cause of her "unexplained" weakness and malaise, and the "normalization" of her Hgb.

I am sure that there are occassional cases we all miss, because it is not always easy to think about everything. and that is why the patient and his family are so important, as our partners in alerting us to details we may have missed.

recently one of my patient's daughter picked up something that I have overlooked. being there with her father everyday (as opposed to me seeing him weekly, and not always recieving all the information from him).

and as I have been reading Kendra's posts, it seems that she picked up the connection between her treatment and the new diseases that she got, and fortunately her physician was ready to listen and act accordingly (as opposed to some neurologists I have encountered). possibly, it would have taken much longer had she not done that.

alice