Since you are experiencing a tight, squeezing pain in your left chest and shoulder, it is best to consult a cardiologist first for a comprehensive review of your tests to rule out any atypical issues. If your heart is completely cleared, a pulmonologist (lung specialist) or a gastroenterologist is the next best step, as issues like acid reflux or muscle strain can mimic this pain. Your medication, Azoran (azathioprine), can sometimes relate to acid reflux. Please discuss these symptoms with your primary doctor promptly for a safe, coordinated referral.

While medications like Mesacol (mesalamine) and Azoran (azathioprine) are excellent for keeping symptoms under control, there is currently no permanent medical cure for chronic colitis. However, deep, long-term remission is highly achievable. Advanced options like biologic therapies or targeted small molecules can help if your current treatment isn't fully working. In severe cases, surgical options can sometimes provide a permanent solution. Please don't lose heart?work closely with your gastroenterologist to tailor a plan that helps you feel your best.

Severe anemia with hemoglobin levels of 5 to 8 and joint pain require immediate medical evaluation. Long-term use of azathioprine (Azoran) is common for managing Crohn's disease, but it can sometimes affect your bone marrow and lower blood counts. It is very important that you do not adjust your doses of azathioprine or mesalamine (Mesacol) on your own, as this can trigger a disease flare. Please contact your gastroenterologist immediately. They will perform blood tests to determine the exact cause of your low blood counts and joint pain, and safely adjust your treatment plan to help you feel better.

For severe, active kidney inflammation, a stronger medication like cyclophosphamide (Endoxan) is generally preferred initially to quickly halt the damage, while azathioprine (Azoran) is typically used later to maintain recovery. Regarding plasma exchange, even at an advanced stage, it can still be very valuable. It works quickly to filter out harmful proteins causing the inflammation, potentially saving remaining kidney function. I highly recommend discussing these options closely with her nephrologist to tailor the best immediate plan for her.

Two miscarriages with SLE (systemic lupus erythematosus) can be emotionally difficult, but a future successful pregnancy may still be possible with careful planning and specialist care. Before trying to conceive, consult a rheumatologist and a high-risk pregnancy specialist. Your lupus should ideally be well controlled for several months before pregnancy, and your medicines should be reviewed for safety during pregnancy. Ask about testing for antiphospholipid antibodies and other possible causes of recurrent miscarriage. If antiphospholipid syndrome (an autoimmune disorder that increases the risk of blood clots) is confirmed, low-dose aspirin and heparin are commonly used during pregnancy. Since you experienced a miscarriage despite these medicines, your doctor should review the dose, timing, and response to treatment and check for other possible causes. Do not stop or change aspirin, heparin, or SLE medicines without medical advice.

Lichen planopilaris can be challenging, but there are other effective options. Since azathioprine (Azoran) isn't providing relief, your dermatologist might consider topical or injected corticosteroids directly into the scalp to calm the inflammation. Other alternatives include topical tacrolimus, or oral medications like hydroxychloroquine or doxycycline. Please schedule an appointment with your dermatologist to discuss these targeted options.