column logo Alithea Athans

I was diagnosed with cold agglutinin disease (CAD) over 2 years ago. It is a rare form of autoimmune hemolytic anemia. When I get sick, hemolysis begins, creating all kinds of symptoms that range from discomfort to a possible emergency.

I am considered to have primary CAD and my hemoglobin (HGB) often stays in the 10s. I am lucky in that way and hope I continue to stay this way for life or of course that it would spontaneously go into remission. This has happened to other CAD patients and in these situations, the thinking is that it was a virus that initially kicked it off and since resolved.

I have had symptoms for years unbeknownst to me related to CAD. It was only after I was diagnosed and reflected that I realized that my symptoms fell into the CAD category.

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Some of those symptoms are rapid heartbeat, a swooshing sound in the head, weakness in the arms and legs, fatigue, joint pain, and more. Occasionally, a new symptom will appear. The problem is that these are the typical symptoms that you may hear about if you happen to have a knowledgeable doctor, but it won’t be all of them. The great thing about the internet is it gives you the opportunity to speak with other people like you from around the world. It offers the opportunity to compare notes, and in a recent conversation, the consumption of alcohol came up.

This one rang home. Some discuss how drinking alcohol has such a negative effect on them that it sent them to the hospital to be treated. Others discussed how it gives them heart palpitations and makes them vomit or immediately nauseous.

I would never connect the 2 and that is why these conversations are so valuable. I used to be a casual drinker. I never had issues, then suddenly years ago I would get sick anytime I drank. I thought that it was because I couldn’t eat a meal and have a drink as anytime I went to dinner and had a drink, I would get insanely sick. After just a single drink my heart would start to race, I would get hot, and I would feel faint. It kept happening so eventually I would not drink and have a meal at the same time. I seemed to be okay but then it was any time I drank. So, I did the logical thing and stopped drinking.

At the time I wouldn’t have known that cold anything had a negative effect on me. The big question is whether the alcohol was cold or because it was both alcohol and cold. The obvious answer is the cold drink would have made me hemolyze and the rapid heart rate, dizziness, and overall feeling of being unwell could all have been attributed to CAD.

What about the alcohol alone, if it is room temperature, like Merlot? How could it hurt? I dug into it, and I did find some answers that make sense.

We all know that if alcohol is consumed quickly it makes us drunk, as we can only process an ounce of alcohol an hour. It’s also widely known that it can damage your liver and kidneys when one is a heavy drinker. Since I have not been a heavy drinker it never made sense as to why it suddenly affected me in a way that made me sick. I remember I asked my doctor at the time, and they didn’t know why either.

Fast forward to my diagnosis and now it all makes sense. It turns out alcohol affects the way our kidneys function. One of those effects is how it can filter blood. Our livers also filter our blood and alcohol also impacts the production of red blood cells in our bone marrow. Alcohol can even affect whether red blood cells mature.

In CAD, one of our major issues is that our bone marrow mistakes our red blood cells as foreign bodies and tags them for destruction before they can mature. Then our kidneys and liver amongst other organs are in a constant state of cleaning and filtering our dead red blood cells.

After reading all of this I finally have the answer I never knew I needed. I just assumed that one day my body decided that alcohol was too much for me and accepted it. It turns out that is true, but not for the reasons I thought.

Most doctors will tell you “everything in moderation,” but I feel like that may not apply when it comes to alcohol and CAD. Our organs are already working overtime and the alcohol just makes them work that much harder. Pushing for longevity abstinence just might be best.