Tuesday, September 16, 2014



Hypertension is the medical term for elevated blood pressure. This is a higher than normal pressure within the blood vessels as blood travels through it. High blood pressure in the short term does not cause any significant damage in the body and may even go unnoticed. However, prolonged elevation of the blood pressure can lead to a host of diseases affecting primarily the cardiovascular system and having secondary effects on almost every organ and system in the  body.

Normal and High Blood Pressure
The accurate definition of hypertension is the elevation of arterial blood pressure – pressure against the arterial walls. Pressure within the arteries ensures that there is sufficient force to propel oxygen-rich blood to all the tissues in the body. It also ensures that this force is transmitted through to the veins so that the oxygen-deficient blood can return back to the heart for re-oxygenation at the lungs.
The pressure at which the blood has to be maintained without causing damage to the blood vessels or body is commonly referred to as the normal blood pressure. A systolic pressure of 120 mm Hg and diastolic pressure of 80 mm Hg is considered as a normal blood pressure in adults (120/80 mm Hg). It can be slightly higher or lower and still remain within a normal range.
If it rises significantly above this then it is defined as hypertension according to the criteria below. If the blood pressure is significantly lower than the normal value then it is defined as hypotension (low blood pressure).
With regards to the actual pressure and values, the following criteria need to be present for a diagnosis of hypertension to be established.
a systolic pressure, which is the pressure in the blood vessels during contraction of the heart, exceeding 139 mm Hg.
a diastolic pressure, which is the pressure in the blood vessels while the heart is relaxing and the ventricles filling with blood, exceeding 89 mm Hg.
Ideally, three readings showing an elevated blood pressure of 140/90 mm Hg should be recorded in order for hypertension to be diagnosed.

Types of Hypertension

Hypertension can be broadly divided into benign and malignant.
Benign hypertension includes primary (essential) hypertension and secondary hypertension.
Primary hypertension is also known as essential hypertension or idiopathic hypertension. The exact cause is unknown although the disease mechanism has been established to a large degree and a variety of hypotheses exists as to why it occurs.
Secondary hypertension is a consequence of certain diseases.
Benign hypertension, primary or secondary, can lead to a host of complications over several years or even decades.
Malignant hypertension is also known as accelerated hypertension and accounts for  a minority of hypertension cases. It is a sudden and severe form of hypertension which if left untreated can lead to death within one or two years.
Although the cause of primary hypertension is not fully understood, its close link to obesity and often improvement after weight loss may suggest one or more of the following mechanisms :
1. Cardiac output increased as blood needs to be distributed to a larger body mass.
2. Vascular resistance caused by constriction of the arteries (vasoconstriction) as a result of sympathetic activity and possibly further contributed to by hormonal influence associated with increased fat stores.
3. Salt and water retention is due to greater reabsorption from the renal tubules (kidney) and normal mechanisms for water-electrolyte balance may be disrupted in obesity.

Primary hypertension may therefore be due to a combination of one of more of the factors above. A related concept that is important to understand is the renin-angiotensin system which may lead to vasoconstriction as well as salt and water reabsorption. This system exists to help the body stabilize the blood pressure in the event of a drop in pressure. However, in patients with primary hypertension, this system appears to be overactive. The effects of the renin-angiotensin system is to cause vascular resistance and increase salt and water resistance.

Explaining High Blood Pressure
The simplest way to explain the concept of hypertension is to consider the analogy of the garden hose or hose pipe. The water needs to exit the hose at a certain pressure which will allow it to reach its destination.  The force of the water spraying out at the end is proportional to the pressure within the pipe.
The more a faucet is opened, the higher the pressure of the water and faster the speed of the spraying water. This is related to the cardiac output component of blood pressure explained above.
If the pipe is wider, the pressure is reduced and the water exits at a slower speed. If the pipe is narrower, the pressure within the pipe is greater. This aspect is related to the increased vascular resistance (vasoconstriction).
If a larger than normal volume of water is pushed through a pipe, then the pressure increases just as is the case with water retention.
Benign hypertension, primary or secondary, can lead to a host of complications over several years or eve decades.

Medications For Hypertension

There are several types of drugs to treat hypertension and the use of each is dependent on the severity, duration and type of hypertension. Other underlying diseases also have to be taken into account when prescribing the most appropriate antihypertensive drug, even if the condition is not directly contributing to the raised blood pressure. Antihypertensive drugs work by either reducing the peripheral vascular resistance, cardiac output and/or fluid volume in the body.

The four main groups of antihypertensives based on different mechanisms of action. Hypertension medication may have different names depending on the class of drugs but fall into one or more of these categories  :
Angiotensin II modulators
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Renin inhibitors
Sympathetic (adrenergic) blockers
Centrally acting sympathetic blockers
Autonomic ganglion blockers
Sympathetic nerve terminal blockers
Adrenergic receptor blockers
Alpha blockers
Beta blockers
Thiazides and thiazide-like diuretics
Potassium-sparing diuretics
Loop diuretics
Calcium channel blockers (CCBs)
Vaso-selective blockers
Cardio-selective blockers
Potassium channel openers
Other antihypertensives

Angiotensin Converting Enzyme (ACE) Inhibitors
ACE inhibitors  inhibit formation of angiotensin II from angiotensin I. This includes drugs like captopril, enalapril, lisinopril, benazepril, quinapril, ramipril and perindopril.
ACE inhibitors reduce the constricting actions of angiotensin II on blood vessels and reduces the release of aldosterone. These two effects of reduced angiotensin II levels is primarily responsible for the blood pressure lowering action of ACE inhibitors. Bradykinin is a powerful dilator of blood vessels and it reduces peripheral vascular resistance. ACE inhibitors also inhibits break down of bradykinin and increases the levels of bradykinin. This also assists with lowering the the blood pressure.

ACE inhibitors are most useful in hypertensive patients with concomitant heart failure, diabetes mellitus, diabetic renal diseases (diabetic nephropathy), or hyperlipidemia and following a myocardial infarction (heart attack).
ACE inhibitors are not indicated in hypertensive patients with hypovolemia (low blood volume) as it can cause very low blood pressure (hypo. Use of ACE inhibitors in patients with narrowed renal arteries (renal stenosis) is not recommended as it can further damage the kidney. It is also contraindicated in pregnant women. Most common side effects of ACE inhibitors are a dry cough (due to increased levels of bradykinin) and hyperkalemia (increased levels of potassium of in blood).

Angiotensin II receptor blockers (ARBs)
Angiotensin II receptor blockers reduce blood pressure by blocking the actions of angiotensin II. This includes drugs like  losartan, valsartan, irbesartan, candesartan, telmisartan and olmesartan.
The efficacy, beneficial effects and side effect profile of angiotensin II receptor blockers are similar to that of ACE inhibitors. Unlike ACE inhibitors, the angiotensin II receptor blockers do not have any effect on bradykinin levels. This has resulted in minimal incidence of dry cough associated with angiotensin II receptor blockers.

Renin inhibitors
Renin inhibitor aliskiren decreases the conversion of angiotensin I to angiotensin II and is therefore useful in the treatment of hypertension. The side effects of rennin inhibitor are similar to that of ACE inhibitors.

Centrally Acting Sympathetic Blockers
Centrally acting sympathetic blockers reduce central sympathetic outflow and reduce norepinephrine release from adrenergic nerve endings. This includes drugs like clonidine and methyldopa.
These drugs are useful in treatment of hypertension. Clonidine is also öuse for treating symptoms of withdrawal from abused drugs and a prominent side effect of its use is sedation. Methyldopa is safe for use in pregnant women with hypertension.

Autonomic Ganglion Blockers
Autonomic ganglion blockers block the ganglionic nicotinic receptors of acetylcholine. These includes drugs like trimethaphan which causes a fall in blood pressure. It is also associated with a wide spread action not limited to cardiovascular system. These drugs are not regularly used for treatment of hypertension.

Sympathetic Nerve Terminal Blockers
Sympathetic nerve terminal blockers reduce sympathetic flow at the sympathetic nerve terminals by interfering with storage and release of noradrenaline. This includes drugs like reserpine and guanethedine.
It is effective in reducing blood pressure but is rarely used at present because of side effects. Reserpine is associated with toxicities like severe depression with suicidal thoughts and drug–induced Parkinsonism.

Adrenergic Receptor Blockers
Alpha blockers
Alpha blockers are effective in treatment of hypertension. This includes drugs like prazosin and terazosin. Alpha blockers are considered to be third-line agents in hypertension.
Alpha blockers reduce the blood pressure by preventing the normal alpha receptor (sympathetic) mediated blood vessel constriction. Alpha blockers also relieve the difficulty in passing urine in patients with prostate enlargement. Alpha blockers are thus ideal for older men with hypertension and prostate enlargement. The most prominent drawback of alpha blockers is the postural hypotension.

Beta blockers
Beta blockers are one of the most important groups of antihypertensive drugs. The group includes drugs like propranolol, atenolol, metoprolol, pindolol, bisoprolol and carvediolol.
Beta blockers reduce blood pressure by reducing the heart rate and its force of contraction. Some of the drugs among them (like atenolol and metoprolol) are very selective in its action on heart. Drugs like propranolol are not selective for heart and have some additional constricting action on bronchi. Beta blockers are useful in treatment of hypertension, cardiac arrhythmias and in controlling symptoms of hyperthyroidism. It is also useful in long term prophylaxis against ischemic heart disease (IHD).

Carvediolol has additional alpha blocking action and is also useful in conditions like heart failure. Use of other beta blockers in heart failure can worsen it. Beta blockers are generally not recommended in patients with concomitant bronchial asthma. It can interfere with awareness and recovery from hypoglycemia (low blood sugar levels) resulting from use of anti-diabetic medicines. Hence, its use in diabetic patients has to be done very cautiously. Beta blockers can also dangerously reduce heart rate in patients with heart block and when combined with other cardiac depressant drugs (like verapamil).

Thiazides and Thiazide-like Diuretics
Thiazide diuretics (like hydrochlorothiazide) are the most important antihypertensive diuretic group. Thiazide diuretics are usually used in combination with potassium-sparing diuretics like spironolactone.
Thiazides are known to cause hypokalemia (low potassium levels), which is countered or prevented with the use of potassium-sparing diuretics. Glucose intolerance and lipid level abnormalities are other common adverse effects of thiazides. It is used in mild to moderate primary hypertension. It is also of use in patients with concomitant mild heart failure.

Potassium-sparing Diuretics
Potassium-sparing diuretics (like spironolactone, eplerenone, amiloride etc) are used along with thiazides or loop diuretics. These drugs combinations act synergistically in lowering blood pressure and in reducing or preventing hypokalemia.

Loop Diuretics
Loop diuretics are less commonly used in long term management of hypertension and includes drugs like furosemide. It may be used along with potassium-sparing diuretics in management of severe hypertension along with other antihypertensive drugs. It may be also be used in patients with concomitant heart failure.

Calcium channel blockers (CCBs)
Calcium channel blockers are important group antihypertensive drugs. Some of the calcium channel blockers block the entry of calcium into vascular smooth muscle cells. This causes vasodilation due to relaxation of the vascular smooth muscle cells. These drugs are called vaso-selective calcium channel blockers.
Some of the CCBs inhibit the calcium channels in the cardiac muscle cells. This results in depression of cardiac functions and subsequent fall in blood pressure.

These are called cardio-selective calcium channel blockers.

Vasoselective calcium channel blockers
Vaso-selective CCBs include amlodipine, felodipine, isradipine, nicardipine, nimodipine and nifedipine. These drugs primarily reduce blood pressure by dilating the blood vessels. This group of drug is used in treatment of hypertension. Hypertensive patients with concomitant peripheral vascular diseases also benefit from vaso-selective CCBs.
Postural hypotension is a common side effect for these drugs. It can also cause increase in heart rate, flushing, edema, and sometimes precipitate cardiac pain (ischemic attack). This group of CCBs can be safely combined with other cardiac suppressant drugs like beta blockers and other drugs like diuretics.

Cardio-Selective Calcium Channel Blockers
Cardio-selective CCBs include verapamil and diltiazem. These drugs reduce blood pressure by suppressing the cardiac function. Heart rate and force of contraction of the heart is therefore also reduced.
This group of drug is used in treatment of hypertension, cardiac arrhythmias and angina pectoris. Heart rate can be dangerously reduced by these drugs occasionally as a side effect. Combining with other cardiac depressants like beta blockers is contraindicated. The group is also contraindicated in heart failure patients.

Nitrates have very potent dilating action on blood vessels but are not used for regular management of hypertension. Nitrates lower blood pressure very quickly and are preferred drugs in hypertensive emergencies (acute development of very high blood pressure). It can be administered intravenously for hypertensive emergencies. Important antihypertensive nitrates include sodium nitroprusside and nitroglycerine. Use of nitrates is associated with severe headache, sweating, palpitation and postural hypotension.

Potassium channel openers
Potassium channel openers like minoxidil produce blood pressure lowering effects by dilation of the blood vessels resulting from relaxation of the vascular smooth muscles. Potassium channel openers are less commonly used as antihypertensive drugs.
Minoxidil is more commonly used for treatment of male-pattern baldness. The use of these drugs as antihypertensive drugs is associated with hirsutism (abnormal facial hair growth in women), sweating, palpitations, and postural hypotension.

Others Antihypertensives
Several other drugs are known to have antihypertensive actions. Hydralazine, diazoxide, and fenoldapam are some of these other types of hypertensives. Hydralazine is available as tablets and for intravenous use. Hydralazine tablets are now rarely used for regular treatment of hypertension. The intravenous preparation is useful in hypertensive emergencies. Diazoxide and fenoldapam are also available as intravenous preparations for use in hypertensive emergencies.

Monday, February 17, 2014

Lupus Journal/Disease Activity Tracker

Please download, print, share my Comprehensive Lupus Journal/Disease Activity Tracker--it is very helpful to fill out and bring to Dr appts..even if you have not been diagnosed yet.


Pain: How To Help Your Doctor Help You

Speaking of Pain: How to Help Your Doctor Help You

Summary of a presentation at the Living with RA Workshop

Seth A. Waldman, MD
Director, Division of Pain Management, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

Rheumatoid arthritis is a systemic, inflammatory, autoimmune disorder. Inflammation causes redness, warmth, and swelling of the joints. Pain comes from the inflammation of the joints and tendons. Physicians seek to combat the inflammation at each phase of the immunologic process with:

Non-steroidal anti-inflammatory drugs (NSAIDs) to control inflammation and pain in general; and
Disease-modifying anti-rheumatic drugs (DMARDs) to combat the overactive cells and their history and to alter the natural history of RA, possibly even halting the development of joint damage.
It's important that the cause of any pain be identified, if possible. People with RA can have pain from many other causes, just as anyone without RA does, and those causes need to be identified and treated, in hopes of curing or controlling the problem without long-term pain medication.

Nonetheless, people with RA still may have chronic pain, as well as acute severe pain episodes, either due to flares or to post-surgical pain. However, pain is often under-reported by patients and/or trivialized as a symptom by physicians.

This is changing, because the Federal government now has a new standard of pain care. It requires physicians to ask patients what they are feeling and what medications they are using, and to do something about the pain - in the same way they check your vital signs (temperature, pulse, and blood pressure) and do something if the signs are abnormal.

Pain Management Programs

Further, major hospitals have been developing dedicated pain management programs. For example, here at the Hospital for Special Surgery we have an acute pain service, which is part of the Anesthesia Department. It includes nurses and anesthesiologists who see you for the first few days after surgery and then transition you to milder medicine that your physician takes care of or a stronger medicine that would be managed by a chronic pain physician. We also have a pain center that manages a lot of outpatients, many of whom have rheumatoid arthritis, who arrive by referral from their rheumatologist or surgeon.

The decision to refer to a pain management specialist has to do with the patient and the comfort level of the physician caring for the patient, based on the doctor's experience with these medications and perception about how the patient is doing. Pain management specialists tend to see patients whose pain has not improved and whose doctors have tried different approaches and can't figure out why the patient has not improved on the more commonly used medications.

Descriptions of Pain

Because pain is so subjective and varies so much from one person to another, it's important for you to be as specific as possible in describing your pain to your physician. Consider the following issues.

On a scale of 1 to 10, how much pain are you having - if 10 is the worst pain you've ever had?
What is the pattern of your pain - where does it arise and where does it spreads to?
What is the duration of your pain - how long does it last - and how often does it occur?
What does your pain feel like? This is very important because the words you use to describe your pain give your doctor clues on its cause as well as what drugs might help it.

Is it a deep aching, throbbing, gnawing or dragging pain? If so, it's probably what doctors call nocioceptive - nerve endings are being injured by some ongoing disorder, such as arthritis. For example, when a joint is being destroyed, the little nerve endings in the body sense that and send a normal pain message just as if it would if you cut your hand - a normal transmission of pain. Or you may have perioperative pain as you recuperate from joint surgery. These are normal, acute types of pain Nocioceptive pain tends to respond well to routine analgesics, such as NSAIDs and opioids that act in the brain.

On the other hand, is it burning, shooting, or tingling pain? If so, it's probably neuropathic pain - caused by abnormal processes that may persist after an injury or disease; nerves that constantly transmit pain become trained, through cellular changes, to transmit pain messages in the absence of an ongoing disorder. In such chronic pain, the symptoms become "imprinted" on your nervous system, which remembers what pain feels like and continues to send those messages, for example, beyond when your surgeon thinks you should be having pain post-operatively. Neuropathic pain responds to so-called adjuvant drugs that affect the brain's perception in unexplained ways. These include antidepressants and antiseizure drugs.

What has been the psychological impact of the pain on you - the degree of suffering - which can vary from the pain person to person from the same type of pain. This can help the physician determine the meaning of the pain for you and what additional treatments (beyond medication) might be useful, such as physical therapy and exercise programs, relaxation therapy and yoga, acupuncture, psychological support for depression or anxiety disorders, which are common in people who have chronic painful illnesses. All of these approaches should be considered in a comprehensive pain management program.

What medications you are taking and in what doses and for how long - and to what extent do they help the pain?
It can be useful to keep a pain diary for a week before seeing your doctor. Note when pain occurs, where it hurts, what it felt like, what you were doing when it hit, how severe it was on a 1 to 10 scale, and what you did to try to reduce the pain and the result of what you did.

Increasing Use of Opioids for Pain Management

After surgery, for acute pain management, some people receive intravenous morphine medication or anesthetic medications that make parts of the body numb. Historically, potent narcotic drugs, such as morphine and codeine, were reserved for people who were terminally ill. Doctors were loath to prescribe them for chronic pain management because of fears of addiction and side effects. However, that attitude has changed dramatically, especially among pain specialists, as these fears have proved unwarranted. These drugs are now used very widely for people who have so-called benign pain (to distinguish it from those who have malignant tumors).

Physicians are increasingly open to prescribing very strong medications when necessary and even maintaining people on those medications after the acute period, such as immediately post-surgery, has passed. Some people can tolerate very high levels of narcotic medications, although you don't want to be on those medications long-term if you can find relief from an alternative, and most people don't need to be on narcotics long-term.

The Range of Pain Medications

Most people can find some medication that they can tolerate and that gives them very good relief. However, your need for pain medication - and the type that gives you relief - may change over time. You need to have a plan for dealing with the different types of pain you have:

the chronic background pain that may be with you frequently or all the time, and
the acute severe pain that may arise - when you don't have time to wait for an appointment with your doctor in two weeks.
Your doctor should work with you to have a "plan b" - with medications to institute - when such acute severe pain arises. Here's the range of medications from which your doctor may choose:

Acetaminophen (Tylenol)
Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve); diclofenac (Voltaren), and others - with low-dose ones available over the counter and higher-dose ones available by prescription;

Adjuvant drugs, including: antidepressants such as amitriptyline (Elavil), paroxetine (Paxil) and venlaxafine (Effexor) and the SSRIs, such as fluoxitine (Prozac); anti-seizure drugs, such as gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin) and cloazepam (Klonopin); and some anti-hypertension drugs, such as clonidine (Catapres) - although these drugs require your doctor to be comfortable with "off-label" prescribing (using an FDA-approved drug for an indication other than that for which it has been approved;

Opioid-like drugs, such as tramadol (Ultram);
Weak opioids, such as codeine;
Strong opioids, such as morphine;
Controlled-release opioids, such as Oxycontin and MS Contin;
Long-acting opioids, such as skin patches containing fentanyl (Duragesic);
Invasive analgesia, infusing drugs through a tiny catheter inserted into the spinal space.


Saturday, November 30, 2013

Happy Holidays~How To Cope With Holiday Stress

Happy Holidays~ Living with a chronic illness can be extremely stressful during the holidays. I am posting an excellent article from The Hospital for Special Surgery, which has a spectacular Rheumatology Department.

Lupus and the Holiday Season: 
How to Cope with Stress

A summary of a presentation given to the SLE Workshop at HSS

Caroline Norris
M.S.W. Intern, Department of Social Work Programs
Hospital for Special Surgery
Stress is a normal part of life. Too much of it, however, can be taxing to the body. The holiday season is a time of additional stress for many people, and it can be even more challenging for people with lupus.
In this presentation to the SLE Workshop, Caroline Norris, M.S.W. Intern and SLE Workshop Coordinator, shared different ways to prevent stress during the holidays, as well as a series of relaxation techniques to alleviate and minimize the impact of stress.
Family relationships, finances, and the physical demands of the holiday season are all common triggers of stress. Holiday festivities mean spending additional time with family, which can heighten relationship issues for some people.
Another common holiday stress trigger is the additional expenses the season brings. There are more pressures to spend money during the holiday season. It can be very difficult to manage the costs of presents, food, and decorations, especially for people on a fixed income.
Ms. Norris also reminded the group of the significant physical demands the holiday season brings. Shopping, decorating, cooking, gift-wrapping, and going to parties can be exhausting.

Planning Ahead

A good way of preventing holiday stress is by planning ahead and prioritizing. This can include creating a schedule of all the different activities and tasks. Careful planning can eliminate the rush of last minute forgotten things to do, which can sap your energy.
Ns. Norris suggested that for people who struggle with fatigue it might be useful to include rest and relaxation in the holiday schedule. Conserving energy and making time for recovery will likely make participation in holiday activities much more enjoyable. This recovery time is also important in terms of pacing yourself and preventing yourself from “crashing”
Another good planning technique is creating a budget. There is so much pressure on people to spend, spend, spend. Planning ahead and creating a budget will eliminate overspending. It is also quite easy to forget that the holiday season is about “presence,” not presents.
Some money-saving tips that Ms. Norris suggested included setting a spending limit when exchanging gifts with loved ones. Another way to save money is to “gift” your talents. For example, if you happen to be low on funds, but you are a good cook, offer to prepare a meal for a busy family member or loved one. This is a great way to save money and simultaneously spend time with those you care about. Ms. Norris also reminded the group not to forget how much thoughtful cards and homemade gifts are always appreciated.
Another important part of planning ahead for the holiday season is to set realistic expectations. Trying to achieve perfection usually leaves little room for enjoyment. Unfortunately, many people have an expectation of the perfect holiday, which is usually something out a movie or television show. In real life, last minute things come up, people arrive late, decorations aren’t perfect, and dinner sometimes gets burned.
The best way for dealing with these unplanned events is to try and find the humor in them. The holiday party where the dog ate the dinner will more likely be remembered and laughed about later than the party where everything was perfect.


Ms. Norris shared with the group just how important communication is to surviving the holiday season when living with lupus. An important communication during the holiday season is “saying no.” It can be very difficult to turn down people’s invitations or requests, but sometimes saying yes isn’t the best thing to do.
When you have limited time and energy, participating in certain events or doing certain tasks can prevent you from doing what you really care about. The best way to say no is to do it respectfully and, if comfortable, to practice full disclosure.
Many people with lupus struggle with the unpredictable nature of the illness, they may be concerned about making plans or commitments and then having to back out. Ask the host of a party ahead of time if it will be problem if you have to back out at the last minute or if it would be all right if you left early.

Practicing the 4 A’s

In dealing with stress, Ms. Norris suggests practicing what is commonly known as the 4 A’s: Avoid, Alter, Accept and Adapt.
Avoid: Avoid the people and things that upset you or cause too much stress. One way of practicing avoidance is by saying no.
Alter: If you find that the normal holiday season routine is too fatiguing, alter your expectations. If loved ones aren’t respecting your needs, respectfully ask them to alter their behavior.
Accept: Acceptance is an important part of managing stress. During the holiday season, you may have to accept that you won’t be able to participate in all the activities you would like.
Adapt: One way of avoiding stress is to adapt. Living with lupus often means having to adapt one’s lifestyle or plans; this is true during the holiday season as well.
While the 4 A’s are excellent for managing the holiday season, they are also useful in managing the everyday struggles of a chronic condition like lupus.

Relaxation Techniques

Even with all the planning ahead, a certain amount of stress is unavoidable. Relaxation techniques are a good way of managing periods of increased stress. Regular use of such techniques may even lead to better health.
Breathing exercises are a good way of managing stress and, in general, they are a very useful method of symptom control or release. Ms. Norris led the SLE Workshop members in the “Letting Go of Tension Exercise” from the Relaxation and Stress Reduction Workbookby Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay.
Participants were asked to sit comfortably in their chair with their feet on the floor, and to close their eyes if they felt comfortable doing so. Then members were directed to breathe deeply into their abdomen, hold the breath in for a second and then to let it out. With each breath in, members said to themselves, “I am breathing in relaxation,” and as they exhaled, “I am breathing out tension.”
Another excellent relaxation technique that Ms. Norris discussed with the group was meditation. The practice of Mindfulness meditation has been very effective in the reduction of stress for people with arthritis and fibromyalgia.
The group also discussed visualization as a relaxation technique. Visualization is a way to use one’s imagination to relax by creating a safe and relaxing place in your mind. Lastly, Ms. Norris reminded the group of the benefits of listening to music and humor as ways of reducing holiday stress. The workshop concluded with many members sharing which music they listened to and how they used humor as a way to relax.

Learn more about the SLE Workshop, a free support and education group held monthly as HSS.

Some other excellent resources on Coping With Stress During The Holidays:

Sunday, July 7, 2013

What does it feel like to have lupus?

What Does It Feel Like To Have Lupus?

by Lupus and Me  
What does it feel like to have lupus/chronic illness? I get this question quite often, and I am sure you all do too. So here goes:

In reality, lupus has a different feeling every day.Sometimes it is joint pain and stiffness. Some days I am confused by simple tasks. Other times I can feel the heavy, pulsating beat of my heart, causing me to be dizzy, exhausted, and worried. My stomach is always upset. My digestive system is in a constant state of confusion. My skin itches and tingles and burns every day, all day long. My head pulsates and pounds, feeling as if it will explode. my mouth and nose are full of sores, making eating and drinking a task of torture. Sometimes I awake in streaks of blood from scratching in my sleep. And on really bad days, I feel all of these things at the same time.

Occasionally, I have difficulty breathing. It is almost as if my lungs can’t fill to capacity, and breathing itself causes excruciating pain. In my head, I ask…”Is it my heart? Do I have a clot?” Those are often very long nights. I ride it out untilit passes.

In a sentence…my body has forgotten how to mechanically run on its own. Each individual part is running independently of the others, in a type of mutiny. As the patient, I try to do my part by learning to adjust and following my doctor’s advice, although I have to say, a healthy amount of denial of my fate has helped me live my life to the fullest.

Along with the tangible comes the intangible, the parts of this disease that cannot be measured in a blood test, yet are very much a part of our lives. I am talking about the fatigue. It is debilitating. Do you remember the required obstacle course you were forced to navigate in gym class? Now imagine every day with an obstacle course laid out before you in the form of daily tasks. Only this time, when you finish it, you are required to repeat it again and again until you go to sleep that night. Or, imagine that the air surrounding your body is made of peanut butter--imagine the energy it would take to just walk--that is the type of fatigue I am talking about.

It is when every nerve ending in your body is pulsating with electrical charges, because it has worked overtime all day. And as ironic as it sounds, for some reason when it is time to retire for the night, your brain has disconnected the messages to your body that says it is time to sleep.

I feel, every day, that I have been given a test of survival. Despite the strength everyone says I have, the sorrow of the abandoned child lives on the surface, at the back of my throat, as a constant reminder of just how vulnerable I am. My world is different from everyone else’s. I am never on solid ground; it is always shifting beneath my feet.There is no cure for lupus. If the numbers become good, it doesn’t mean I am cured or had a misdiagnosis…it just means the wolf is caged, for only a brief period of time, and she will be back.


One of the worst symptoms I have had with lupus is a painful sensation in all the nerve endings of my body. It starts at my feet and slowly works its way systemically up, until every part of me, from my toes to the top of my scalp feels as if it is being stuck with needles, and battery acid is running through my bone marrow, bubbling to the surface of my skin in a cold fire. Sometimes I am convinced that somewhere in this vast world, is a replica doll of me being held in the hand of some unfortunate soul I have wronged. My body calls out in the darkness of night for me to listen. The simple act of wearing clothing is a painful endeavor worthy of any medieval torture device known to man. Kissing is out of the question, and hugging is merely a lost memory.

Lupus patients often refer to this disease as “The Wolf” because of its name. But it is also a perfect visual of the characteristics that this disease holds. As with Red Riding Hood, you are neve rcompletely out of the woods and safe. Everyday issues that most people have to address become magnified for us. With every slurred word…with every twinge of pain…with every rapid or slowed heart rate or indigestion, we wonder…is that the wolf lurking and licking at my heels? With the complexities of a disease that lives in all areas of my body, it is helpful for me to give it a face. But along with that face is also a sound, the sound of a Jack-in-the-Box: that constant, slow turning of the handle and that awful tune playing in your head. Even when you are receiving treatment and you start to feel better, your brain never lets go of the thought that the Jack-in-the-Box handle is still slowly turning, and eventually the wolf, dressed like a clown, will pop up again.

Every night when we lay our heads down to sleep, it is as if we are put adrift on a raft, uncertain of where we will be when we wake up. Every morning is different. The only thing that is certain is that things will change, no matter how good we feel. There is a constant state of uneasiness, that you realize is now your constant companion. And then we awaken and do it all again--every single day-- until a cure is found.


Thursday, July 4, 2013

Healthy Gut=Healthy You

Healthy Gut = Healthy You!

Reblogged from http://doccarnahan.blogspot.com/2013/01/healthy-gut-healthy-you.html
There is a microbial zoo living inside you, literally trillions of microscopic organisms―more than 10,000 different kinds of them―all co-existing with each other and you. 

In fact they outnumber you ten to one and ninety percent of the genetic material, (DNA and RNA) in your body is not yours, it belongs to the bacteria that is located mostly in your gut, but some also live on your skin and even in your nose. 

Exactly what those different life forms do has been the subject of some exciting research in recent years, and while a few of these organisms can sometimes wreak havoc with your system, the majority of these little "bugs" are good, helping you digest your food, stay protected from infections, and even keeping your immune system properly regulated to fend off autoimmune diseases like asthma, allergies, and diabetes. 

The community of microbes living on and in your body is unique to you – like your fingerprints – and is now being regarded as a key contributor to your overall health. 

More and more, science is finding that teeny tiny creatures living in your gut are there for a definite purpose. Known as your microbiome, about 100 trillion of these cells populate your body, particularly your intestines and other parts of your digestive system.

Although some of these bacteria can make you sick, the majority are good, and they work together as to aid your digestive system and keep you well. Beneficial bacteria, better known as probiotics, along with a host of other microorganisms, are so crucial to your health that researchers have compared them to "a newly recognized organ." We now know that your microflora influence your: 
  • Immune system function
  • Brain development, mental health, and memory
  • Obesity
  • Genetic expression 
  • Risk of diseases, including autoimmune disease, cancer, diabetes, and autism
According to the featured article in Time Magazine:
"Our surprisingly complex internal ecology has been a hot topic in medicine lately. Initiatives such as the Human Microbiome Project, an extension of the Human Genome Project, have been working tirelessly to probe potential links between the human microbiota and human health, and to construct strategies for manipulating the bacteria so that they work with us rather than against us.
...They've been linked to a range of nasty conditions, including obesity, arthritis, and high cholesterol. Now, two newer areas of research are pushing the field even further, looking at the possible gut bug link to a pair of very different conditions: autism and irritable bowel disease."
Most people, including many physicians, do not realize that 80 percent of your immune system is located in your digestive tract, making a healthy gut a major focal point in your efforts to achieve optimal health. In fact, the root of many health problems is related to an imbalance of intestinal bacteria.   

The beneficial bacteria in your gut has actually been found to help prevent allergies by training your immune system to distinguish between pathogens and non-harmful antigens and respond appropriately – and this may be one reason why they also appear so beneficial in conditions like allergies, asthma, and eczema

 Like it or not, the bugs in your gut have a lot to say about your health!  This is why I frequently test patients gut function for common complaints such as fatigue, migraines, mood disorders, depression, anxiety or insomnia, ecezma, allergies, asthma, autism, and even trouble with concentration & memory.  Getting the gut bugs back into proper balance is critical to your overall health and especially the health of your immune system.  The simplest way to jump start your overall health is pay attention to the gut...  Eliminate sugar and refined flours from your dietand add a high dose probiotic to you regimen.  You'll be well on your way to a happy and helpful intestinal "zoo"!