I suspect that there is a chemical poisoning in the family

for mom to have kidney failure and daughter to have an autoimmune issue

M-Margaret

 Assoc Press - update 1/28/06:

Slutskaya shrugs off misfortune on, off ice

Russian handles illness, sick mom, poor finishes with smile every time

Russian figure skater Irina Slutskaya performs her trademark move, a double Biellmann, earlier this month. Slutskaya will be the favorite to win gold at the Winter Olympics.

Irina Slutskaya was terrified.

Always so healthy and vibrant, she was in and out of the hospital for weeks. Doctors poked and prodded her, trying first to explain the mysterious fever that came and went, then to treat the heart condition causing it.

Hearing there was something wrong with her heart was scary enough. Fearing she might never skate again, well, that she simply couldn’t bear.

 “When you’re No. 1, and after you get sick, that was really a hard moment for me,” the Russian says now. “But I always knew that I could skate again.”

Less than three years later, Slutskaya’s story is a triumph of the human spirit as much as the body. Not only is she skating again, she’s better than ever. Almost unbeatable since her return, she’s the defending world champion and the overwhelming — not to mention sentimental — favorite for gold at the Turin Olympics.

She’s been nominated to carry Russia’s flag in the opening ceremony, and on Thursday she was honored by the president of the Russian Olympic Committee and minister of sport as the best athlete in the sports-mad country.

“I’m so excited for this time,” she says, the joy in her voice carrying all the way from Moscow. “I’m so happy, I just want to go there and do my best.”

Courage is a word used too loosely to describe athletes or their performances these days. Someone plays on a gimpy ankle or single-handedly carries his team in the fourth quarter, and it’s deemed heroic.

Those feats are minor compared to how Slutskaya has handled her ordeals.

She had the makings of skating’s next big thing when she became the first Russian woman to win the European title in 1996. She was dazzling technically, doing difficult jump combinations with ease and contorting her body into the most beautiful shapes for spins. Her trademark was a double Biellmann, where she reaches back with both hands, grabs the blade of one skate and pulls it straight over her head, then does the same thing with the other skate.

And oh, the star potential. With cherubic, apple-red cheeks, short hair that evoked memories of Dorothy Hamill, and a quick, bright smile, fans were automatically drawn to Slutskaya when she was on the ice. She was funny and charming, too, cracking jokes at news conferences and showing a joy that’s a rarity when a sport becomes a job.

“I just love to skate,” she said, laughing. “I like to be on the ice. I like when people look at me. That’s why I’m skating.”

After struggling to find consistency — she was left off the 1999 world championships team after her fourth-place finish at the Russian national championships — Slutskaya revived her career with a silver medal in Salt Lake City and her first world title a month later.

But happiness always seems to come with a price for her.

Slutskaya’s mother, Natalia, has kidney disease, and she was so sick in 2003 that Slutskaya skipped the world championships. Natalia already has had one transplant, but it failed and she is now back on the waiting list. She undergoes dialysis three days a week in the meantime, and it’s often her only child who drives her back and forth.

“I’m always on the telephone with her. I’m always in contact with her several times a day,” Slutskaya says. “Of course, I’m worried when I’m not home with her.”

Natalia was well enough that her daughter came to the United States in the spring of 2003 to skate with the Champions on Ice tour. When Slutskaya returned to Russia, though, she had a cough and high fever that came and went without any regularity.

She tried to keep skating, but the fever persisted and her mother told her to stop. After a few days of rest, the fever went away, but it came back whenever Slutskaya tried to skate again. She finally went to a doctor, who did X-rays and blood tests and discovered that the sac around her heart was inflamed.

When she was told her heart was enlarged, Slutskaya responded, “Of course. I am a sportsman.”

But it was far more serious. She was off the ice from mid-July to late September 2003. Given the OK to skate again, her energy was so low she couldn’t get back into her normal training schedule. Doctors soon discovered she also was suffering from vasculitis, an inflammation of blood vessels that can cause major vascular organs to deteriorate.

Through it all, Slutskaya never complained. No one would have begrudged her if she’d whined or sat down for a good pout every once in a while. But pouting and whining are words that don’t exist in her vocabulary — in Russian or in English.

She returned to competition at the 2004 worlds, and her ninth-place finish was her worst ever. But she beamed as if she’d won the title, thrilled to be back on the ice.

“We can’t decide our lives,” she says, simply. “That’s my life and I need to go through it.”

http://www.msnbc.msn.com/id/11049867/

#2 Cont - Getting healthy: http://www.msnbc.msn.com/id/11049867/page/2/

WHAT YOU NEED TO KNOW ABOUT VASCULITIS

What is vasculitis?
Vasculitis is a general term that refers to the inflammation of blood vessels. When blood vessels become inflamed, they can only react in limited ways. They may become weakened, stretch and increase in size, or become narrow – even to the point of closing off entirely.

What are the consequences of vasculitis?
In an extreme situation, when a segment of a blood vessel becomes weakened, it may then stretch and bulge (called an “aneurysm”). The wall of the blood vessel can become so weak that it ruptures and bleeds. Fortunately, this is a very rare event.

If a blood vessel becomes inflamed and narrowed, blood supply to that area may be partially or completely eliminated. If collateral blood vessels (thought of as alternate routes of blood supply) are not available in sufficient quantity to carry the blood to such sites, the tissue supplied by the affected blood vessels will die. This is called infarction.

Because vasculitis can occur in any part of the body, any tissue or organ can be at risk.

Who is affected by vasculitis?
Vasculitis can affect people of all ages from childhood to adulthood. There are some types of vasculitis that occur in certain age groups more than others.

What are the causes of vasculitis?
Vasculitis may occur secondary to an identified underlying disease or trigger. Occasionally, an allergic reaction to a medicine may trigger vasculitis. Vasculitis can sometimes develop in conjunction with an infection. Usually in these cases, the infection causes an abnormal response in the person’s immune system, damaging the blood vessels. Viral hepatitis (a type of liver infection), is a specific infection that can be associated with vasculitis. Vasculitis may also be related to other diseases of the immune system that the patient had for months or years. For example, vasculitis could be a complication of rheumatoid arthritis, systemic lupus erythematosus, or Sjögren’s syndrome.

In many cases though, the causes of vasculitis are not known. These diseases are collectively sometimes referred to under the broad heading of primary forms of vasculitis. In such settings, the appearance and location of the vasculitis often behaves in a distinct way allowing it to be diagnosed as a unique type of vasculitis and is given a specific name.

What are the types of primary vasculitis? There are many types of primary vasculitis including disease entities such as Wegener’s granulomatosis, microscopic polyangiitis, Henoch-Schönlein purpura, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu’s arteritis, and Behçet’s disease. Some are named after doctors (Wegener, Takayasu, Kawasaki) who were among those to provide the best original descriptions of the illness or are named based on features seen on biopsies (giant cell arteritis, angiitis, arteritis nodosa) of affected tissues or blood vessels. Although most of these are systemic (or generalized) vasculitides where the vasculitis may affect many organ systems at the same time, they often differ a great deal among each other. Some of the primary systemic vasculitic diseases may be quite mild and require little or even no treatment. Other forms may be severe, affecting critical organs and, if left untreated, may lead to death within days or months. Some forms of primary vasculitis may be restricted in their location to certain organs (these are called isolated forms of vasculitis). Examples include vasculitis that only occurs either in the skin, eye, brain (isolated CNS vasculitis) or certain internal organs.

What are the symptoms of vasculitis?
Because any organ system may be involved, an enormous number of symptoms are possible. If the skin is involved, there may be a rash. If nerves suffer loss of blood supply, there may initially be an abnormal sensation followed by a loss of sensation. Vasculitis in the brain may cause a stroke, or in the heart may result in a heart attack. Kidney inflammation usually is not associated with symptoms and is detected by the doctor by examination of the urine. This is important to recognize as inflammation in the kidneys can lead to kidney failure unless promptly detected.

Sometimes the symptoms are nonspecific. When inflammation is present in the body, we tend to respond in ways that tell us that we are not well, but those responses may not be unique to vasculitis at all. For example, along with the symptoms mentioned previously, a person with vasculitis may also have a fever or experience loss of appetite, weight loss and loss of energy.

How is vasculitis treated?
Treatment depends entirely upon the diagnosis, the organs that are affected, and the severity of the vasculitis. When vasculitis represents an allergic reaction, it may be “self limiting,” or will go away on its own and not require treatment. There are other instances also where minimal to no treatment is required and the person can be closely observed.

In instances where critical organs such as the lungs, brain or kidneys are involved, the outlook is less positive and aggressive and timely treatment is necessary. For most forms of systemic vasculitis, treatment generally includes corticosteroid medications (prednisone is the most commonly prescribed). For some forms of vasculitis, treatment must also include another immunosuppressive medication used in combination with the prednisone. Some of these medications are chemotherapy agents like those used to treat cancer, but are given in doses considerably lower than people with cancer may receive. The goal of this type of chemotherapy is to suppress the abnormal immune response that has led to blood vessel damage.

What is the outlook for people with vasculitis?
The outlook for a person who has vasculitis will vary with the type of vasculitis that is present, what organs are being affected, how severe the vasculitis is, and how the person responds to treatment. Knowing the type of vasculitis allows the doctor to predict the likelihood of illness severity and outcome.

Prior to the time of available treatment, people with severe vasculitis may have had anticipated survival of only weeks to months. However, today with proper treatment, normal life spans are possible. The success of therapy is related to prompt diagnosis, aggressive treatment and careful follow-up to be sure that side effects from medications do not develop.

Once vasculitis is under control (often referred to as “remission”), medications may be cautiously withdrawn, with the hope that the patient will sustain a long remission, independent of treatment. Because some forms of vasculitis can recur (referred to as a “relapse”) after a period of remission, it is very important for patients with vasculitis to remain under the care of a knowledgeable physician.

The Cleveland Clinic  |  Contact Us  |   December 6, 2005

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