3474. The 57-year-old vet has autoimmune disease!!!

April 3, 2019

"Auto-immune disease!!!" the vet's wife WhatsApp to me the diagnosis of the specialists who had the reports of blood tests, urine tests, ultrasounds, radiographs,  and MRI scan of the neck vertebra.

"Why do you say he has auto-immune disease?" I know this diagnosis  is not good for a longevity as the vet is only 57 years old.

"The dsDNA (DNA) antigen  is 28 meaning it is 2+ when it should be 0-5 i.e. negative", the wife replied. "Also the ASO (Anti-Streptolysin O) titre is very high at  477 when the normal is less than 200".

ASO is an antibody made by people to eliminate the the Streptooccus bacteria infecting them. The increase in ASO titres in the blood can cause damage to the heart and joints as well as other organs like the brain and skin. These antibodies attack mainly human antigens (mainly collagen). The husband recently suffered a very painful left neck pain and had stopped operating on many dogs daily over the past 20 years as he has a thriving practice.

Hence the vet's wife diagnosis of her husband suffering from auto-immune disease now.
"Your husband is not suffering from auto-immune disease," I explained that when the ASO titres are very high, it indicates exposure to Streptococcal bacteria. However it does not indicate disease if there are no clinical signs. A high ASO titre may be a false negative as false negatives rates are 20-30%. Hence a dsDNA antigen test needs to be done. If the DNA antigen is positive, it means that her husband has a recent Streptococcal bacterial infection, provided he has no rheumatoid fever or kidney disease (glomerulitis).

The husband's blood test showed normal blood urea and creatinine, phosphorus and sodium, normal thyroid stimulating hormone level, normal RA (Rheumatoid Factor). Urine test was normal with no proteinuria, bacteria, leucocytes and epithelial cells.

The ESR (Erythrocyte Sedimentation Rate)  is high at 16 (2-6). This is due to his suffering from hypochromic microcytic anaemia suspected to be thalassemia, a genetic blood disorder he has had inherited.

The X-rays showed a calcified lump in the lung and must be monitored for lung cancer.
The abdominal ultrasound showed a renal cyst.

The tumour marker test showed EBV Capsid Ag IgA AbIF positive, but EBV Early Ag IgA Ab IF negative. The vet has to monitor these values by repeating the test, the  as ear, nose and throat cancer is  common in Asian Chinese.  

Solutions:

1.  The vet loved surgeries and had hunched over the patient for long periods of time on a low operating table instead of one with hydraulic movement to elevate to his height. Bone fracture repairs in stray dogs knocked down by vehicles are common in his practice and such surgeries take a longer time to operate.

1.1. Physiotherapy relieves the pain and numbness in the left shoulder but is not a cure.
1.2. Invest in an operating table with hydraulic system. 
1.3  Best to stop operating. 
1.4. Stop texting for long periods of time

2.    The MRI scan of the cervical vertebra shows osteophytes and degenerative disc lesions at C3/4, C5/6, C6/7. The  disc spaces are narrowed. "The C6/7 space is severely narrowed," I said to the husband. "If you do not change your life-style (e.g  hunching on long operating table, texting, computer gaming for long hours, typing on low tables), you will be tetraplegic (paralysed from the neck downwards).  

3. Neurobion and folic acid for thalassemia. Good nutritious diet.

4. Penicillin for a year according to the Specialists to get rid of the Streptococcal bacteria in his blood. 

5. Be hygienic as regards treatment of diseased stray dogs, using gloves, masks and washing hands.

The specialist had given his opinion of a possible auto-immune disease but the wife took this to mean the husband already has it. Hence she WhatsApp message --- "Auto-immune disease !!!". The high ASO titres have to be taken seriously as it can lead to auto-immune disease of the heart and joints.