Not Feeding the Monster: Melanie Constuble's Life with Vasculitis
When Melanie was diagnosed with microscopic polyangiitis (MPA) in the summer of 2020, she was a year into a master’s program, living and working in the Annapolis, Maryland area, and planning the next phase of her federal career. Vasculitis was not on her radar—until a routine checkup changed everything.
“I really didn’t have symptoms,” she said. “I went in for a regular appointment in March of 2020, and my labs showed something was off.”
That “something” turned out to be her kidneys. Follow-up testing revealed significant inflammation, and within weeks Melanie had a diagnosis. “I was at LabCorp waiting for bloodwork when my nephrologist called me and said, ‘I think I know what this is,’” she recalled.
“At first, they couldn’t tell me if I was going to live,” she said bluntly. Her MPA involved her kidneys and caused anemia, making the situation especially serious.
Melanie was diagnosed by a multidisciplinary medical team that included her GP, rheumatologist Primal Bhatia, MD, and nephrologist Andrew Briglia, DO, in Maryland. They worked in collaboration with nephrologist Harpreet Singh, MD, in North Carolina, who now oversees most of her ongoing treatment.
“I knew I would have to leave the DC area eventually to set myself up for retirement,” she explained. “This just pushed it.”
She relocated to North Carolina for two reasons: to continue building toward 20 years of federal service, and to be closer to Duke University—home to a specialized vasculitis center. The move wasn’t easy. “I moved locations while getting treatment, changed jobs, and when I got to North Carolina, I also had pneumonia,” she said.
At Duke, her treatment plan changed. While her Maryland team recommended one year of Rituxan® followed by transplant medications, Duke took a longer view. “They said three years of Rituxan, and we put you in remission,” Melanie said. “I believe those three years gave my body time to bring the inflammation down.”
The approach worked. “I’ve finished with Rituxan,” she said. “That ended two years ago,” putting her in remission. “But I do go for monitoring every three to four months.”
Today, Melanie’s kidney function has significantly improved. “I told my nephrologist, ‘I want to live a long life, and I don’t want a transplant,’” she said. “So that’s our plan.”
Remission brought stability—but it also forced Melanie to confront how much her life had changed.
Redefining Strength
Now 47, Melanie lives in Raeford, North Carolina. She describes herself as an “extroverted introvert,” a “hard charger,” and an avid reader who prefers “something meaty” over beach reads. She loves cats, concerts, baseball, gardening, travel, weightlifting, and history—especially historic sites and antique shopping.
But vasculitis forced her to slow down in ways she never had before.
“Back in Maryland, I defined myself by work,” she said. “I was a great project manager. Now I need a less stressful job if I want to keep the antibodies in check. I’m having to reinvent myself.”
She added, “I used to eat challenges whole. Now I eat the elephant bite by bite.”
Treatment, Fatigue, and the Reality of Remission
Melanie’s primary treatment has been Rituxan, which she continues under close monitoring at Duke every three to four months. She tracks her kidney health weekly at home and has learned how her body responds to infusions.
“It takes about six weeks for me to feel normal again,” she said. “I felt sick after eating, so I started eating ginger. Reed’s Ginger Ale is superior. Canada Dry is next.”
She’s learned practical infusion wisdom along the way: carb loading, espresso the next day, packing food and blankets, and always asking for Benadryl® (pill form) instead of liquid. “Pack for a bear,” she advised. “Sometimes they won’t feed you.”
While remission has brought stability, it hasn’t erased the daily impact of vasculitis or its treatments. Prednisone saved her life—but left lasting effects.
“Fatigue is real. Every four to five weeks my body just says, ‘Done,’” she said. “I used to work out five days a week. Now I’m at three.”
She also deals with neuropathy symptoms, memory issues, acid reflux, and the long-term frustration of weight changes. “Prednisone saved my life,” she said, “but I hate being the size I am.”
Food, Identity, and Independence
Diet has become central to Melanie’s daily routine. Managing sodium and protein takes planning, creativity, and restraint.
“There is so much salt in everything,” she said. “I meal prep, cook from scratch, and I have one cheat meal a week. I want to live another 30 years.”
Social situations can be challenging. “I don’t want to punish people with my food issues,” she said. “Sometimes I feel like a burden.”
And yet, she finds joy in small victories—like discovering low-sodium pretzels she can salt herself. “I get thrilled when I find foods I can eat.”
Emotionally, Melanie has chosen not to let vasculitis define her. “I don’t feed the monster,” she said. “I won’t let my disease become my identity.”
She’s candid about how hard that choice can be, especially early on. Dating, hair loss, cognitive changes, and needing help all tested her independence. “Rest makes me feel weak,” she admitted. “But I’ve had to learn that rest is how I recharge.”
Looking Forward
Melanie’s support system is small, but meaningful. Friends have driven her to treatments. Her partner, Steve, has stood by her. She pays it forward by answering questions in online vasculitis communities.
Her hopes for the future are both personal and systemic: a long life, easier travel, more affordable treatments, better food options, and advances like CAR T-cell therapy.
“Why is chemo the only option?” she asked. “We have the technology. I’m willing to try new therapies.”
Her advice for newly diagnosed patients is direct and hard-earned: “Breathe. Advocate for yourself. Bring a notebook. Be the pain in the ass. Do not let this defeat you.”
And above all, she added, “You are more than this disease. Don’t let it take that from you.”