Porphyria – my basic understanding … by Sylvia

I wanted to understand the basics of Porphyria to ensure the good health of my children, and my grandchildren, so I undertook to read as much as I could about the subject and make notes that pertained to myself and my family as I went along.  I have included my personal notes hereunder.  Please be aware that these are my own personal conclusions only.

In a nutshell

In a nutshell I have come to the following conclusions.

1.             I believe now, after doing my own personal research, that I should act more responsibly with this information by ensuring that I stress the Porphyria connection when undergoing medicals and also educate my two adult children regarding the implications to their health and the health of my grandchildren – non of us have been tested.

2.             I will spend a lot more time speaking about Porphyria with my doctors.

3.             I have been prescribed bio-identical hormones for 3 years now and I believe I should ask my doctor to re-evaluate my health and progress specifically with Porphyria in mind. 

4.             Both my children are allergic to sulpha drug antibiotics and suffer from random stomach pains, and my daughter, specifically suffers from IBS which may, or may not be symptoms.

5.             I did not gain much faith from my research regarding Porphyria testing.  It seems to be a lengthy, expensive, in many cases inconclusive business and as such I have decided to abstain from testing until such time as conclusive evidence is absolutely required. 

6.             I was very interested to note how important a balanced healthy lifestyle is in terms of avoiding mid-life onset of Porphyria.  Because of my possible genetic link to Porphyria I will avoid or be extra vigilant about the precursors such as stress, alcohol, crash dieting, low carbohydrate diets, avoiding unnecessary medications, toxic household cleaners and beauty products and being aware of and avoiding copper and brass jewellery. 

7.             From now on I will take a moment to look into the toilet to note the color of my urine and stools and remind my children to do the same J.

8.             I will find out what I need to know regarding what is needed to maintain a healthy liver.  I have never been able to tolerate alcohol and I find this fact interesting considering the fact that having a mother with Porphyria means I have a 50% chance of carrying the Porphyria gene.

9.             The Porphyria and mental health connection.  This is an interesting one, especially in view of the fact that I believe my mother may have suffered from anxiety for many years, yet, to my knowledge was never treated for it.  I find it interesting that I also have chronic anxiety which my doctor believes is due to reduced hormone levels.  I will mention this to my doctor when I next see him regarding my bio-identical hormone prescriptions.

10.            Lastly, to remain balanced about all of this.  Keep it in mind when visiting a doctor or when one of us gets ill, but otherwise to simply get on with a balanced life.

What is Porphyria?

It seems to me that Porphyria is basically a chemical imbalance that occurs in the blood. Not all porphyrias are genetic, and patients with liver disease can develop porphyria as a result of liver dysfunction.

What can cause a Porphyria attack?


An attack can be brought on by a number of things i.e.

·      The use of certain drugs especially barbiturates, sulfonamides (sulfa-drug antibiotics), anti-epileptic drugs, analgesics, sedatives, hypnotics, anesthetics, sex hormones especially estrogen and progesterone,

·      Alcohol – and I’m assuming this means the abuse of alcohol such as binge drinking or long term over-consumption

·      Stress

·      Illness

·      Dieting or sudden extreme changes in diet (especially the restriction of carbohydrates) or fasting for 10 hours or more.

·      An iron overload.

·      Hepatitis B or C.

Note:

It is not possible at this stage to say which drugs are definitely safe. We live in a society which tends to accept the idea of "a pill for every ill" but if you have a blood relative who has been diagnosed with Porphyria and have not been tested for Porphyria, you should avoid taking any drugs whether purchased in the pharmacy, over the counter, or given to you by your doctor, unless you have a serious condition which requires to be treated. Do not take drugs for trivial complaints. 

What aggravates Porphyria?

Low carbohydrate diets (skipped meals); intake of alcoholic beverages; medications, including sulfa drug antibiotics, barbiturates, estrogen, birth control pills; exposure to toxic chemicals.

Above factors, and skin symptoms made worse by exposure to sunlight. Copper or brass jewelry exacerbates the reaction.

What are the symptoms of a Porphyria?

Porphyria is very under-diagnosed as it can imitate a lot of other complaints.

The symptoms of Porphyria are nonspecific. This is why the diagnosis of Porphyria is often delayed or even missed altogether.  Symptoms may include one or more of the following:

·      Severe stomach pain or back pain.

·      Pain in limbs.

·      Chest pains.

·      Seizures, depression, or anxiety, or an increased heart rate. 

·      Constipation is frequently present, but diarrhea can also occur.

·      High blood pressure.

·      High fever.

·      Nausea.

·      Confused thoughts

·      Sensitivity to sunlight.

·      Blistered painful skin or gums that take a long time to heal.

·      Purple or discolored stools.

·      Discolored urine.

·      Discolored reddish color of teeth or nails.

·      Increased hair growth especially on forehead.

How is Porphyria diagnosed?

My understanding of Porphyria testing is that the number of tests available is very large, and the results among laboratories are not always reliable. Blood, urine, and stools can be tested.  Probably all 3 will be tested to make a final conclusion.  Urine and stool tests are considered secondary and are not considered conclusive on their own.  The best time to test for Porphyria is at the early stages of an acute attack.  At other times Porphyrins fluctuate and need to be tested for 24 hours.  If these tests are normal it does not exclude the possibility that you carry the gene. The stool test is mostly ordered to help distinguish which Porphyria is present.

Will my children have Porphyria? 


Whether you are male or female, any child of a Porphyric has a 50% chance of inheriting the gene.

Women with Porphyria

Women are at least three times more likely than men to experience an acute attack, due mostly to female hormones, particularly progesterone. This hormone is found in the combined oral contraceptive (the pill), as well as in hormone replacement therapy (HRT) which is frequently prescribed for post- menopausal women. Oral contraceptive and HRT preparations containing progesterone or related compounds (progesterones) should be avoided, if at all possible, by women with acute porphyria. 

Which drugs to avoid before testing for Porphyria?

            Aminosalicylic acid           

            Birth control pills

            Barbiturates

            Chloral hydrate

            Chlorpropamide

            Ethyl alcohol

            Griseofulvin

            Morphine

            Phenazopyridine

            Procaine

            Sulfonamides

What do Abnormal Results Mean?

Abnormal results may be due to:

            Liver cancer

            Hepatitis

            Lead poisoning

            Porphyria (several types)

What else do I need to know?

·      Patients with Porphyria should be monitored over their life for liver cancer. 

·      Most patients are healthy throughout adulthood until their Porphyria is triggered mid-life by toxic chemicals or drugs, an acute illness or worsening chronic condition, or a major dietary change.

·      The many noted links to mental illness suggests that maintaining a healthy balanced lifestyle is important.

More facts

·      The genetic predisposition for Porphyria could be as high as 1 in 500 in the population although active Porphyria may be as low as 1 in 10,000.

·      Based on the above estimated statistics, a GP could perhaps expect to meet a patient with Porphyria every five years and suspect or test a patient once per year.

·      Porphyria has been mistaken for: Guillain Barre, growing pains, Lupus, eczema, somatisation disorders, epilepsy, MS, dermatology, depression, appendicitis,Parkinson's and many, many more.