Am considering switching hematologists and looking for resources to help find a "better" one. So far the only resources I can find are generic "find a doc" tools where nearly "everyone" treats ITP.

I really like my hematologist, for example, when was the last time a doctor called and didn't turf it out to a nurse or NP? But I suspect that she likely sees a small # of ITP patients and focuses more on the oncology side of her "business". Therefore I don't feel she always speaks with great confidence on next steps, full range of treatment options, etc.

So I would like to find someone who sees relatively "many" ITP patients and can therefore speak relatively confidently from experience on various treatment options. I know there aren't many ITPers to begin with and no one can speak 100% confidentially where the immune system is involved.

Bottom line: looking for a hematologist whose sub-specialty is adult ITP/platelet disorders and really "gets it".

Thanks!

Well, a bit of controversy in this older thread. The original post is totally believable. In fact I've had better results than these. Increase of over 400,000 in 4 days of pills. Of course, I don't know what dosage the original poster used on her daughter. 

Now, papaya leaf extract has shown signs of killing cancer cells, but that's not what we're talking here. We are talking a relatively simple thing. Raising platelets. If  the platelets raise then that's it, the platelets raised. It is so easy, with blood tests, to see how the papaya leaf extract works. So easy. 

And from my point of view, don't say well my numbers went up from 70 to 85, so I think it worked. If I am any indication, its a lot more powerful than that! Of course, I probably shouldn't say that. If that's your results that's your results, but a small increase in dose might show you something more. Of course, everyone has to judge for themselves how much they want to take.

 So yes, the complicated thing is finding a maintenance dose, but how many drugs do you want to take as a maintenance dose? This is why I found papaya leaf extract, because I wanted a maintenance dose with a supplement that I felt could give me a maintenance dose, and head off the second line defense drugs, that were going to be next.

Now, this supplement has full power to be the safety net drug for me, too, like I said earlier. I can increase my platelets at home the same as if I gave myself ivig and platelets at the same time. But of course, I can't give myself ivig and platelets, and lets not talk about the cost of that treatment.

I too wonder about the tea method. Will the boiling  point improve digestion? Will it weaken the effect? I may explore these questions at a later date. I thought of opening up the pills and doing this last time, but since I'm still working on a maintenance dose, I don't want to complicate, at this time. I mostly hear the tea tastes terrible. That's the other problem with the tea.

Wow! I would have thought the count would be single figures. 

Nosebleeds for 10 months would seem to be chronic Itp. Then there's CTP, which nobody talks about on here. That is cyclic thrombocytopenia. I guess we can all hope for Itp. CTP has wild platelet fluctuations for no reason.

I think/ wonder about her a lot.  I know I miss her posts.

Sandi was/is the best responder/thread starter on here. She lists a higher-end-of-normal count of platelets as her last number. She sometimes stated that she felt more comfortable with somewhat lower numbers. Anybody know if she is ok? I know she's been off for 6 years. She is dearly missed.

Here is more on this drug:  pmc.ncbi.nlm.nih.gov/articles/PMC9807464/

Seems like I'm seeing some effects of this drug lowering platelets listed elsewhere... I guess sometimes these factors can be independent, not that I understand why.

 Papaya leaf extract works (I know, I know I'm mr. papaya leaf extract, but it absolutely works for me), and guess what, it does this while supposedly Strengthening the immune system. I'm thinking maybe the papaya leaf extract is more on the side of Rituximab in what it does, except that it strengthens the immune system. I only have experience with ivig, platelets, and dexamethasone. Rituximab would probably have been my next try, but it didn't happen. Of course, I would look into the TPO test, given what was recently posted on here, if I had to go to the hard stuff.

But, its kind of mind boggling why anyone wouldn't want to know what papaya leaf extract will do to THEIR platelets. I don't see papaya leaf extract as like the other natural treatments. Oh, I suppose people will say that the pills are not regulated... 

There is really no long term commitment. If you combine with dexamethasone, you will probably see a difference with one pill a day. I saw this happen once, so its not exactly proven, in my case. By itself (no dex, no nothing), one pill won't do it. I know 4 will, for me. Once every 4 days or 5 days. Conversely, when I take 4 pills 4 days in a row (only when my numbers are low), my platelets go up 10 fold. So you know immediately. So why in the world wouldn't you want to know. Of course, I have to say be a bit cautious at first, but you can learn pretty immediately if you have the same power of papaya leaf extract that I do., as long as you don't expect results by itself on low dose. Just the way things have worked out, I never tried 2 pills or 3 pills at once. One 500 mg pill a day doesn't cut it for me, although 4 pills, then skip the next 3 days does work, for me. There is no easier treatment option than this. Of course, you need constant blood tests (every 2 weeks or less) to get to the bottom of it. 

So, you can look at it this way, too. If you test with papaya leaf extract and it works, you at least know you have a backup, if for some reason you don't want to use it as a maintenance "drug". I personally wanted a maintenance drug that would have fewer side effects. Of course remission would be nice. Do I really want to be dealing with this schedule of papaya leaf extract "forever" (of course, how do I know there won't be remission)? 

I mean, its not like the drugs that we're looking at are any great choice! EVERYTHING is hit and miss. Results AND side effects.

I do not sell supplements like papaya leaf extract, and will not even tell which exact product I have been using. I don't think that it matters. I just have ITP, and it would have been helpful to me if someone was saying this stuff before. Fortunately just a little trial and error has gotten me this far in 7 months. So, I'm thankful I had the wherewithal, and thankful for the power of papaya leaf extract, and of course thankful for the blood tests.

Sorry, this is in general treatment, but the segue is the strengthening of the immune system. I don't see a problem with papaya leaf extract going head-to-head with the hard stuff. If it works it works. It absolutely belongs, if it works for others like it does for me. Unfortunately, I have no odds on this, but there have been studies... How do you think I found it?

Asking people with fluctuating platelets numbers, do you notice that the monocytes go high when the platelets go high? Mine do. I believe it is showing the immune response, to fight the platelets. I guess the body thinks that high platelets is a disease to fight (or any platelets is a disease to fight, unfortunately). 

I wonder if this (monocytes going up with platelets going up) may not happen when your problem is production. But then, maybe you don't have the wild fluctuations in platelets, so wouldn't be as noticeable for you, anyway.

Can this be a way of determining the actual individual (your own personal) reasons for low platelets, personally wondering... Of course, it would be nice if when the platelets go low, that the lower count of monocytes would leave them alone, but that does not seem to be happening, either. The platelets still do bottom out.

Now here's something of interest. If you fight itp with papaya leaf extract, you get the benefit of fighting diabetes! Maybe having Itp will actually indirectly help me. And look at the toxicity. It would take over 3000 mg PER kg body weight to kill a mouse. That would be like me taking seven 60-capsule bottles at once of the 500 mg pills.

[color=var(--body-link-color)]fikkia.unair.ac.id/en/research/manfaat-daun-pepaya-sebagai-obat-antidiabetes/#:~:text=In%20addition%2C%20the%20active%20substance,activity%20against%20alloxan%2Dinduced%20mice [/color]  .

All about insurance with these drugs I guess. Before thinking of promacta or Nplate, you might want to take a TPO test, from what I've read here... If you have normal TPO, you don't need Promacta or Nplate. I believe then it would be Retuximab or natural like Papaya leaf extract. Not a doctor, but I play one for myself. So far, I'm avoiding any big drug questions, although insurance did have to endure the initial hospital stay unfortunately. Of course, I was blindsided with an ultra-low platelet count before I could research. Now, the only insurance costs are the constant blood tests.

As I've said elsewhere, papaya leaf extract works for me, no doubt. I've been working on a maintenance dose, and its hard to find (meaning that it takes a lot of time to find the right dose--the product is easy to find). It either is too much or not enough. Now, I am trying 4 500mg pills at a time, but only once every 5 days. Will see how that goes...

I said earlier that papaya leaf extract may have let me down, unless my count might have gotten really low. Well, I expect that is what happened, because second "pulse" of papaya leaf extract brought my number from 41 to 465 in one week. It just works, for me. I'm guessing its not the production of platelets that is a problem for me, but who knows. This will keep people out of the hospital, or generally keep people from the other drugs, if said people are like me. The leaves are still a bit a of a challenge digestively speaking, so not without their problems.

If your hematologist can't see you he could at least order a CBC to check your counts!!!
I find it interesting that you are a nursing student but he treats you differently.
You like him, he's friendly but it doesn't sound like he is taking your concern & anxiety
seriously - that wouldn't sit well with me!  If you are not happy with how he is treating
you (feeling overlooked) then you might want another hematologist, but if you are fine with him then stick with him.

Yes anxiety & stress has been known to bring down platelets of some patients!    I am
so very sorry about the loss of your precious dog!!   

Good luck and do keep us posted on how you are doing.  

The chewable papaya complex is pretty easy to google it seems. It has papaya but not papaya leaf. It has bromelain which is supposed to be more anti-platelet so, that is not so great. But, the results for the original poster sound good. Maybe papaya leaf extract would be a better choice. It would be great to get results without the leaves, though. Anybody else get results from papaya without the leaves?

"I like my hematologist, he is local and very friendly. However, my actual appointments with him only lasted around 10 minutes. I bring up concerns about my anxiety impacting these drops, but nothing comes of it. I am wondering if others have had similar experiences and I should consider a second opinion, or if this may just be the ride that I am in for."

As far as your last paragraph goes, it's good that your doctor is friendly. He is really just going by your numbers. He probably just figures your anxiety is not something that he can do anything about, and he might just think that you are just pointing out your situation, but not actually looking for an answer to it. If he did give an answer, it might be "talk to your primary about it". 

Yes, people do list stress as a wildcard for platelet drop.

This could be informative:  pdsa.org/discussion-group/5-newly-diagnosed-a-frequently-asked-questions/31306-nplate-information

Promacta I see is like Nplate, both helping production of platelets. You could ask for the TPO test.

So, if you had steroids handy, you could avoid the hospital, right? I guess you need steroids handy, for one thing.

Hi there! 

I am new here and also somewhat new to ITP. I was first diagnosed back in August, so going on 7 months now. I was 21 when I was first diagnosed, and am now 22 in my last semester of college.

When I was first diagnosed in early August 2024, I received an invasive dental procedure that gave me asymptomatic strep, which is the believed instigator for all of this at the moment. I noticed petechiae/bruising and after a few days of no improvement, went to the ER. I was at 15,000. I was given a consult with an outpatient hematology Dr. and was started on prednisone and antibiotics. By late August, I was admitted for 4 days following my levels dropping down to 0. I had no infection this time around, but had just lost my dog and was very emotionally vulnerable (always my assumption for the drop).

Following this, I was started on Promacta (Eltrombopag) 25 mg while still weaning off my prednisone. Ultimately it took me 5 months to get off my Prednisone due to headaches and side effects.

I seem to respond very well to steroids in these events and bounce back up to the consistent 300,000s. But when my levels drop they drop fast and sudden. In January 2025 there were more petechiae and bruising with a level of 66,000. In February 2025 I was admitted for a night at 19,000. And as I currently am writing this in March 2025 I have petechiae and am getting ready to pack up and head to the ER since my hematologist cannot see me.

I am currently on Promacta 50mg tablets once per day. 

My current issue is that I am feeling frustrated and overlooked as a patient. I am a nursing student in my very last semester, so I understand how this process works to an extent and I do not expect a permanent 'solution' or something that will work perfectly. I am just wondering if I should seek a second opinion?

I like my hematologist, he is local and very friendly. However, my actual appointments with him only lasted around 10 minutes. I bring up concerns about my anxiety impacting these drops, but nothing comes of it. I am wondering if others have had similar experiences and I should consider a second opinion, or if this may just be the ride that I am in for.

Nice to find a helpful community!

How do you guys cover the costs of drugs like promacta? Nplate? I've been reading up on deductible accumulators (universal co-pay program payments don't count towards your deductible or out-of-pocket-max) and I'm scared I won't be able to afford treatment when I get an insurance plan (I'm on medicaid now). Do insurance plans on the ACA marketplace have deductible accumulator policies?

How much do you spend per year on prescriptions for this condition. 

My daughter was diagnosed in Aug of last year that she has ITP. We were told she has had it since 2020. We have noticed that when her platelets drop a migraine is one of her symptoms. Is this something that happens with others? 

We did talk and he does think it's intriguing. If anyone else is using Samsung Health i'd be happy to share my analysis notes with them once i get the data parsed. (I am trying to determine if there were previous signals correlated or uncorrelated with platelet drops before the watch started reporting to me HRV overnight.)

Hi Judi,
Your idea is plausible but unproven, so consider tracking it with your Samsung watch alongside platelet counts and discussing it with Dr. Kasthuri as a potential early warning tool.

Hi Susie,
You could ask your hematologist if delaying treatment and monitoring your platelet counts is safe instead of starting Dexamethasone.

Hi Coasterdon,
You should consider asking your doctor for a complete blood count soon to monitor your platelet levels, given the past fluctuations and enlarged spleen, rather than waiting until July for the hematologist.

Its difficult, but if you are feeling unusually tired, that is a clue. I just now, with my latest CBC, thought my platelets would be high, but admittedly was feeling like they are low. Well,...they ARE low... Seems like the papaya leaf extract let me down a bit this time, unless my platelet number got lower than I realized, before I had the latest round of pills... And therefore is taking more to bump it back up... Disease of questions...

One thing that I do is speed typing as a hobby. My typing has not been going too well, for me, so that is a clue also. So, if you want to know how you're doing, your wpm might help you to get an idea. Just not the same fluidity. So if you happen to have a hobby that deals with numbers and quickness, that could help. I suppose any video game. Speed typing is like a practical video game.

Hi MommaBear
Sorry to hear your story.
In my opinion, switching to Nplate or Avatrombopag is a great idea if you don't have a medical contradiction. I assume you have good insurance that covers your IVIGs so getting this covered should be possible.

Regarding your concern about ditching prednisone, from what I remember +80% of patients on these meds do so. The few still needing to take pred will usually take less than 5mg as both medications have a great synergy.

P.S: I am just changing care team ...

Yes, my hematologist is also curious whether heart rate variability might be a signal of platelet dropping (not a cause). I hope to find something that might be a useful signal of platelets dropping under 30k before petechiae show up.

Margaret, I agree 89k is a good count!  And that is with a 1/2 dose of your mycophenolate.   Good to hear it has been used 20-30 years without problems!   Let us know when you have another CBC!

Strange reaction your Mom had with #2 Shingrex!   I have that, without the rash, since having Shingles May 2024 - no rash but the post-pain.  Seriously, Shingles is the pits!!

Talk care!
Melinda

So it’s been a few months and my Wife’s numbers have increased above 200 and held, so we dropped down to Doptelet 40mg 3x per week and 20mg 4x per week.

She dropped down to lower 100s, but then started rising again to where her last reading was approximately 190. 

It has now been three weeks since that last reading. After that appointment, we decided to start taking Black Raspberey powder to try and attack inflammation from yet another angle.

Hoping to come down on the Doptelet again, but just very grateful to actually have a life again…huge difference from that whole first year.