tag:blogger.com,1999:blog-43165261378663901502024-03-24T23:09:34.453-07:00Juju's LupusJulie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.comBlogger69125tag:blogger.com,1999:blog-4316526137866390150.post-2909952975242993172014-09-09T15:31:00.000-07:002014-09-09T15:31:26.738-07:00Learning how to not be "RASH"! My pemphigus/pemphigoid story-How skin falls apart: The pathology of autoimmune skin disease is
revealed at the nanoscale - UoB study of pemphigoid rashes discovered
new details of how autoantibodies destroy healthy cells in skin! <br /><br />This
information provides new insights into autoimmune mechanisms in general
and could help develop and screen treatments for patients suffering
from all autoimmune diseases, estimated to affect 5-10 percent of the
U.S. population.<br /><br />The study of pemphigoid rashes is of interest to people like me, who get these types of rashes-here's a pic of me with one-<a data-mce-href="http://www.buffalo.edu/news/releases/2014/09/013.html" href="http://www.buffalo.edu/news/releases/2014/09/013.html" target="_blank"><strong></strong></a><br />
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<dl class="wp-caption alignnone" data-mce-style="width: 670px" id="attachment_531" style="width: 670px;">
<dt class="wp-caption-dt"><a data-mce-href="http://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg" href="http://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg"><img alt="My Pemphigoid Rash" class="wp-image-531 size-large" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg?w=660" height="495" src="http://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg?w=660" width="660" /></a></dt>
<dd class="wp-caption-dd"><em>My Pemphigoid Rash</em></dd></dl>
</div>
It
hurt, felt like my skin was pulling, then it seeped clear white blood
cells. I could actually smell them! (Yuk, right?) It took quite a
while to heal completely. It took about 5 months to completely heal.
It did not leave any discolored skin. I used betamethazone to heal it. A
stronger type of steroid cream &/or a steroid shot right into the
rash would have probably healed it faster, but I didn't know that then.
I had this rash Feb 2013. It popped in right after a radiofrequency
ablation to my cervical spine for cervical spondylitis &
radiculopathy right at the shot site! Imagine that-Lupus stopping by to
say hello just because I had a shot there-(how nice....NOT! lol)<br />
I've
only had one pemphigoid type rash since, and it was a small one. Since
being treated for lupus with Cellcept (mycophenalate) my rashes
(discoid, pemphigoid, porphyria, urticaria) have all been minimal. Much
less severe!!! Of course now I stay in as much as possible, it's the
only real way to minimize the rashes. Don't go out during the day!<br />
Here's some info on Pemphigoid Rashes!<br />
<div class="large-12 columns entry-content__output non-vc-entry">
<h2>
Definition</h2>
Pemphigoid
is a group of subepidermal, blistering autoimmune diseases that
primarily affect the skin, especially the lower abdomen, groin, and
flexor surfaces of the extremities. Here, autoantibodies (anti-BPA-2 and
anti-BPA-1) are directed against the basal layer of the epidermis and
mucosa.<br />
The condition tends to persist for months or years with
periods of exacerbation and remission. Localized variants of the
condition have been reported, most often limited to the lower
extremities and usually affecting women.<br />
<h3>
Types</h3>
There are
two predominant types of pemphigoid: mucous membrane pemphigoid (MMP)
also called cicatricial pemphigoid, and bullous pemphigoid (BP) (g).
Pathogenesis and management are quite different for these conditions.
Scar formation in mucous membrane pemphigoid can lead to major
disability (g).<br />
<h4>
Pemphigoid gestationis</h4>
Pemphigoid
gestationis (PG) is a rare autoimmune bullous dermatosis of pregnancy.
The disease was originally named herpes gestationis on the basis of the
morphological herpetiform feature of the blisters, but this term is a
misnomer because PG is not related to or associated with any active or
prior herpes virus infection (h). PG typically manifests during late
pregnancy, with an abrupt onset of extremely pruritic urticarial papules
and blisters on the abdomen and trunk, but lesions may appear any time
during pregnancy, and dramatic flares can occur at or immediately after
delivery. PG usually resolves spontaneously within weeks to months after
delivery.<br />
<h3>
<em>Epidemiology</em></h3>
<h4>
Bullous Pemphigoid:</h4>
<ul>
<li>BP
is the most frequent blistering disease of the skin (and mucosa)
affecting typically the elderly (>65 years) (k), but can occur at any
age and in any race.</li>
<li>Overall incidence: ± 7-10 new cases per million inhabitants per year.</li>
<li>After the age of 70 incidence significantly increases.</li>
<li>Relative risk for patients > 90 y have a 300-fold higher than those < 60 y.</li>
<li>Women and men equally afflicted.</li>
<li>Precipitating
factors include trauma, burns, ionizing radiation, ultraviolet light,
and certain drugs such as neuroleptics and diuretics, particularly lasix
(furosemide), thiazides, and aldosterone antagonists.</li>
<li>Correlations between BP flare activity and recurrence of underlying cancer suggest such an association in some patients.</li>
<li>Even
without therapy, BP can be self-limited, resolving after a period of
many months to years, but is still a serious condition especially in the
elderly.</li>
<li>(j) 1-y survival probability may be as high as 88.96%
(standard error 5.21%), with a 95% confidence interval (75.6%, 94.2%)
but other analyses have documented 1 year mortalities of as much as
25-30% in moderate to severe pemphigus even on therapy (hh).</li>
<li><strong>Genetics</strong><ul>
<li>Genetic predisposition, but not hereditary</li>
</ul>
</li>
</ul>
<h4>
Pemphigoid Gestationis:</h4>
<ul>
<li>Is a condition of pregnancy (childbearing age women).</li>
<li>In the United States, PG has an estimated prevalence of 1 case in 50,000-60,000 pregnancies.</li>
<li>No
increase in fetal or maternal mortality has been demonstrated, although
a greater prevalence of premature and small-for-gestational-age (SGA)
babies is associated with PG.</li>
<li>Patients with PG have a higher
relative prevalence of other autoimmune diseases, including Hashimoto
thyroiditis, Graves disease, and pernicious anemia.</li>
</ul>
<h3>
Histology</h3>
The
earliest lesion of BP is a blister arising in the lamina lucida,
between the basal membrane of keratinocytes and the lamina densa. This
is associated with loss of anchoring filaments and hemidesmosomes.
Histologically, there is a superficial inflammatory cell infiltrate and a
subepidermal blister without necrotic keratinocytes. The infiltrate
consists of lymphocytes and histiocytes and is particularly rich in
eosinophils. There is no scarring.<br />
Approximately 70% to 80% of patients with active BP have circulating antibodies to one or more basement membrane zone antigens.<br />
<ul>
<li>Autoantibodies to BP180 (and BP230).</li>
<li>BP180 and BP230 are two components of hemidesmosomes, junctional adhesion complexes.</li>
<li>T cell autoreactive response to BP180 and BP230 regulate autoantibody production (l).</li>
<li>On
direct immunofluorescence, the antibodies are deposited in a thin
linear pattern; and on immune electron microscopy, they are present in
the lamina lucida. (By contrast, the antibodies to basement membrane
zone antigens that are present in cutaneous lupus erythematosus are
deposited in a granular pattern).</li>
</ul>
<h3>
Clinical Features</h3>
<h4>
Pemphigoid</h4>
Bullous
Pemphigoid (BP) is subepidermal blistering autoimmune disease primarily
affects the skin, especially the lower abdomen, groin, and flexor
surfaces of the extremities. Mucous membrane involvement is seen in
10%-40% of patients. The disease tends to persist for months or years
with periods of exacerbation and remission.<br />
The spectrum of
presentations is extremely broad (l), but typically there is an itchy
eruption with widespread blistering, and tense vesicles and bulla
(blisters), with clear fluid (can be hemorrhagic) on apparently normal
or slightly erythematous skin.<br />
Lesions normally appear on the
torso and flexures, particularly on the inner thighs. Blisters can range
in size from a few millimeters to several centimeters, and although.
pruritic, typically heal without scarring.<br />
Sometimes erosions and
crusting is seen. Also itchy bumps (papules) and crusts (plaques) can be
seen with an annular or figurate pattern. A characteristic feature is
that multiple bullae usually arise from large (palm-sized or larger),
irregular, urticarial plaques. (r) Mucosal (oral, ocular, genital)
involvement is also sometimes present, but ocular involvement, is rare.
(s) BP can be difficult to diagnose in its ‘non-blistering’ stage, when
just itchy, red, elevated patches are visible. Erosions are much less
common than in pemphigus, and the Nikolsky sign is negative.<br />
BP is
characterized by spontaneous remissions followed by flares in disease
activity that can persist for years. Even without therapy, BP is often
self-limited, resolving after a period of many months to years, but may
become very extensive.<br />
Localized variants of the disease have been
reported, most often limited to the lower extremities and usually
affecting women. One such variant, localized vulvar pemphigoid, reported
in girls aged 6 months to 8 years, presents with recurrent vulvar
vesicles and ulcerations that do not result in scarring (t)<br />
Bullous
pemphigoid is distinguished from other blistering skin diseases, such
as linear IgA dermatosis, epidermolysis bullosa acquisita, and
cicatricial pemphigoid, by the following 4 clinical items (it can also
be distinguished by biopsy and certain immunological tests) (u)<br />
<ul>
<li>Absence of atrophic scars;</li>
<li>Absence of head and neck involvement;</li>
<li>Relative absence of mucosal involvement.</li>
</ul>
<h4>
Mucous membrane pemphigoid</h4>
Mucous
membrane pemphigoid (MMP) is a chronic autoimmune disorder
characterized by blistering lesions that primarily affect the various
mucous membranes of the body, but also affects the skin (MMP is now the
preferred term for lesions only involving the mucosa) (v). It is also
known as Cicatricial Pemphigoid (CP), as it is often scarring.<br />
The
mucous membranes of the mouth and eyes are most often affected, but
those of the nose, throat, genitalia, and anus may also be affected. The
symptoms of MMP vary among affected individuals depending upon the
specific site(s) involved and the progression of the disease. Disease
onset is usually between 40 and 70 years and oral lesions are seen as
the initial manifestation of the disease in about two thirds of the
cases. Blistering lesions eventually heal, sometimes with scarring.
Progressive scarring may potentially lead to serious complications
affecting the eyes and throat.<br />
There is no racial or ethnic
predilection although most studies have demonstrated a female to male
ratio of approximately 2:1 (w). The diagnosis of MMP is mainly based on
history, clinical examination and biopsy of the lesions.</div>
<i>More on Pemphigoid Rashes from the Pemphigus & Pemphigoid Foundation <a data-mce-href="http://www.pemphigus.org/research/clinically-speaking/pemphigoid/" href="http://www.pemphigus.org/research/clinically-speaking/pemphigoid/" target="_blank"><strong>HERE!</strong></a></i><br />
<br data-mce-bogus="1" />
<a data-mce-href="http://www.buffalo.edu/news/releases/2014/09/013.html" href="http://www.buffalo.edu/news/releases/2014/09/013.html" target="_blank"><strong>MORE HERE</strong></a> from the University of Buffalo-Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com3tag:blogger.com,1999:blog-4316526137866390150.post-85904521211070487052014-08-29T11:29:00.000-07:002014-08-29T11:29:27.370-07:00Leave Your Ego At the Door & Join/Share at "The Lupus Channel"!<a data-mce-href="https://plus.google.com/b/110186023444879601555/communities/116172467635999599532?cfem=1" href="https://plus.google.com/b/110186023444879601555/communities/116172467635999599532?cfem=1" target="_blank" title="The Lupus Channel Google Community"><img alt="lupuschannelcommunity" class="alignnone size-medium wp-image-613" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/08/lupuschannelcommunity.jpg?w=300" height="155" src="http://butudontlooksick.files.wordpress.com/2014/08/lupuschannelcommunity.jpg?w=300" width="300" /></a><br />
<em><strong>Information is Power! </strong> </em><br />
My goal at <a data-mce-href="https://plus.google.com/b/110186023444879601555/communities/116172467635999599532?cfem=1" href="https://plus.google.com/b/110186023444879601555/communities/116172467635999599532?cfem=1" target="_blank"><strong>"The Lupus Channel"</strong></a> Google community is to share all things Autoimmune-<br />
Articles,
Info, Blogs, Events, Videos & Vlogs, Webinars, Pinterest Boards,
Support Groups, Research & Studies, etc on: Lupus Fibromyalgia
Sjogrens Scleroderma MCTD (mixed connective tissue disease & other
autoimmune conditions<br />
AND to help you connect to other people just
like YOU & Me who learn from each other everyday by sharing
experiences on how to most effectively manage our disease and have
quality of life! Nice to meet you & WELCOME! JJ<br />
A Special
Note to Advocates: Feel FREE to share your links to your groups, your
posts & your contact on "The Lupus Channel"-I left my ego at the
door- the objective is simply to reach the patients who need help! TY
so much! I look forward to your posts!<br />
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<hr />
<strong></strong>My
goal is to share all things Autoimmune-Articles, Info, Blogs, Events,
Videos & Vlogs, Webinars, Pinterest Boards, Support Groups, Research
& Studies, etc on:<br />
<ul>
<li>Lupus</li>
<li>Fibromyalgia</li>
<li>Sjogrens</li>
<li>Scleroderma</li>
<li>MCTD (mixed connective tissue disease</li>
<li> & other autoimmune conditions</li>
</ul>
<strong>And</strong>
to help you connect to other people just like YOU & Me who learn
from each other everyday by sharing experiences on how to most
effectively manage our disease and have quality of life!<br />
Nice to meet you! JJ<br />
ps. I make lupus music videos to help spread awareness so that we can get closer everyday to a cure! Here are my videos-<a data-mce-href="http://www.pinterest.com/jujubeee714/my-lupus-music-videos/" href="http://www.pinterest.com/jujubeee714/my-lupus-music-videos/"><strong> HERE!</strong></a><br />
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Your not alone with lupus or any autoimmune disease-there is tons of help out here! <a data-mce-href="https://plus.google.com/b/110186023444879601555/communities/116172467635999599532?cfem=1" href="https://plus.google.com/b/110186023444879601555/communities/116172467635999599532?cfem=1" target="_blank"><em><strong>Reach out TODAY!</strong></em></a>Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-89580480889283693232014-08-20T18:28:00.000-07:002014-08-20T18:28:02.556-07:00Rheums with a View: Rheumatologists Point of View at Patients Requesting Tests<a data-mce-href="http://butudontlooksick.files.wordpress.com/2014/08/meddiseasescartoon.jpg" href="http://butudontlooksick.files.wordpress.com/2014/08/meddiseasescartoon.jpg"><img alt="meddiseasescartoon" class="alignnone size-medium wp-image-580" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/08/meddiseasescartoon.jpg?w=300" height="300" src="http://butudontlooksick.files.wordpress.com/2014/08/meddiseasescartoon.jpg?w=300" width="300" /></a><br />
Article from "The Rheumatologist" official publication of the ACR<br />
by Matthew J. Koster, MD, & Kenneth J. Warrington, MD<br />
Case<br />
A
28-year-old woman presents for evaluation of exhaustion, widespread
myalgias and muscle spasms. In addition, she has numerous symptoms
spanning multiple organ systems, including paresthesia, atypical chest
pain and abdominal bloating. She has previously undergone evaluation at
other medical centers and by multiple subspecialists, and no specific
pathology or diagnosis has been established. She has difficulty
continuing her employment due to disabling symptoms. A comprehensive
evaluation for malignancy and infectious diseases has been unrevealing.
Neurological evaluation, including detailed physical examinations,
imaging of the brain, electromyography and testing for large- and
small-fiber neuropathy, has been negative. Extensive laboratory studies,
autoimmune serologies and radiographic imaging studies are
unremarkable.<br />
You review the history and conduct a comprehensive
physical examination and find no abnormalities, except for widespread
muscle tenderness without weakness. The patient is not reassured by the
negative evaluation and is concerned that a progressive autoimmune
disorder is being missed. Additional evaluation is pursued, including
magnetic resonance imaging (MRI) of proximal muscles, which is negative.
The patient requests further testing, including a muscle biopsy. Her
request conflicts with your recommendation that the diagnostic
evaluation has been completed and your plan to pursue symptomatic
management for fibromyalgia.<br />
Dilemma<br />
As access to medical
information expands, patients increasingly present to clinical
encounters with specific preconceptions regarding their possible
diagnosis and requests for testing and interventions. Medical literacy,
if applied appropriately, can lead to patient education and empowerment,
and can improve shared decision making. However, if the information
obtained is of questionable accuracy, incomplete, misinterpreted or
outdated, such requests and expectations can lead to challenging
clinical encounters, especially when the patient’s preconceptions differ
from the physician’s assessment.<br />
How should physicians approach
patient requests for testing deemed unnecessary or even contraindicated
in a manner that respects patient preferences, upholds a physician’s
integrity and maintains a strong physician–patient relationship?<br />
Discussion<br />
On
the surface, the patient’s request in the above scenario may seem
morally innocuous; however, it has complex ethical undertones involving
patient autonomy, physician professionalism, knowledge asymmetry,
medical uncertainty and defensive medicine.<br />
Should additional testing be performed in this patient?<br />
The
patient in this clinical scenario has fibromyalgia. Comprehensive
examination and testing have already been performed to rule out other
conditions for the cause of pain, one of the criteria for the diagnosis
of this condition.1 Muscle biopsy studies show there are no specific
changes conclusive for fibromyalgia.2 Additional testing in the
evaluation of such patients should be prompted primarily by clinical
suspicion and objective physical findings. Excessive and repeated
testing may have a negative effect on the patient’s well-being and
encourage medicalization.3 In the absence of findings concerning for
inflammatory myopathy, muscular dystrophy or metabolic muscle disease,
muscle biopsy would not be indicated and, thus, can be considered
medically unnecessary in this case.<br />
Matthew Koster<br />
Matthew Koster<br />
What are positive & negative rights?<br />
When
patient requests conflict with a physician’s concept of acceptable
practice, it’s important to examine the distinction between positive and
negative rights.4 When considering medical encounters, most ethicists
focus on patient autonomy in terms of negative rights—that is, the right
to decline a treatment or test.<br />
The American Medical Association
Code of Ethics states the patient has the right to make decisions
regarding the healthcare that is recommended by his or her physician.
Accordingly, patients may accept or refuse any recommended medical
treatment.5 The emphasis of informed consent promotes appropriate
barriers to prevent patients from receiving care or interventions that
are contrary to their desires or beliefs. Respect for patient autonomy,
however, also governs positive rights—the right that something be done.
Much less guidance is provided to physicians in this regard. If
physicians are to respect patient autonomy by way of positive rights,
how are physicians ever justified in denying a patient’s request?<br />
According
to the ACP Ethics Manual, the patient–physician relationship entails
special obligations for the physician to serve the patient’s interest
because of the specialized knowledge that physicians possess, the
confidential nature of the relationship, and the imbalance of power
between patient and physician.6<br />
In this case scenario, the
patient’s autonomous decision conflicts with the physician’s
professional duty to look out for the patient’s best interests and
welfare (i.e., beneficence). Therefore, we must carefully consider the
balance between respecting the patient’s right to share in the medical
decision making and the physician’s responsibility to avoid patient harm
(i.e., nonmaleficence). This patient is so worried about having an
autoimmune disease that her quality of life is compromised. When
patients request diagnostic studies that are not indicated, physicians
should first seek to understand the reason for the request. Then, the
physician should educate the patient about his or her rationale for not
recommending the test based on the physician’s specific knowledge and
medical expertise for which the patient is seeking counsel.<br />
When
the risk of harm to the patient significantly exceeds the potential
diagnostic utility of an intervention, the physician has to keep in
focus one of the principal precepts of bioethics: primum non nocere
(first, do no harm).<br />
Kenneth Warrington<br />
Kenneth Warrington<br />
What
if, despite education of medical necessity & risk-benefit ratio of
intervention, the patient continues to insist on the nonindicated
intervention?<br />
If the principles of patient autonomy, beneficence
and nonmaleficence were the only factors being weighed in such
encounters, physicians may convince themselves that acquiescence to
patient requests can be justified on grounds that reduction of anxiety
alone may tip the risk-benefit scale toward intervention.<br />
However,
in the current case, it seems doubtful that another negative test would
be the end of her requests. In addition, it is increasingly apparent in
our current healthcare environment that medically unnecessary testing
cannot be sustained, and the ethical tenet of distributive justice must
also be considered. The principle of distributive justice implies that
healthcare resources should be distributed fairly in society. Therefore,
although an additional laboratory test, imaging study or procedure may
seem insignificant, when magnified on a national scale, the economic
cost of these “inconsequential” decisions becomes large. It is not
unethical to withhold nonindicated treatment, and one of the reasons is
the pursuit of distributive justice.<br />
We must carefully consider
the balance between respecting the patient’s right to share in the
medical decision making & the physician’s responsibility to avoid
patient harm.<br />
But what if I decline a test & miss something diagnosable?<br />
Societal,
legal and professional pressures add to physicians’ fear of missing a
diagnosis. This is compounded in disorders when symptoms are purely
subjective. When dealing with medical uncertainty associated with vague
or subjective symptoms, physicians may agree to patient requests that do
not present undue risk to the patient. However, the testing should be
rational, medically justified and part of a comprehensive,
well-documented management plan.<br />
Back to the Patient<br />
A
critical goal of this patient’s physician is to reassure her that there
is not an underlying disease being missed. The assumption in this
encounter is that the patient feels information that can be obtained
from a biopsy is more convincing than the physician’s clinical judgment
regarding her diagnosis.<br />
Additional investigation into the
patient’s request reveals some important information: A friend was
recently diagnosed with polymyositis, and she is concerned she may have
this as well. After review of her current workup, education about
fibromyalgia and its differences from autoimmune disorders, as well as
the risk of the procedure compared with the expected benefit, the
patient ultimately agrees a muscle biopsy is not required. Although she
is still apprehensive about her diagnosis, she agrees to initiate a
treatment plan with the reassurance that she will have ongoing
monitoring for any changes in symptoms and reevaluation as
necessary—plans that can only be implemented in the context of a strong
physician–patient relationship.<br />
Have you had an experience in
which patients requested tests or treatment that you felt was not
indicated? How did you handle the request? If you have comments or
questions about this case, or if you have a case that you’d like to see
in Ethics Forum, e-mail us at klosavio@wiley.com.<br />
Matthew J. Koster, MD, is a second-year rheumatology fellow at Mayo Clinic, Rochester, Minn.<br />
Kenneth
J. Warrington, MD, is an associate professor of medicine and practice
chair of rheumatology at Mayo Clinic, Rochester, Minn. He is a member of
the ACR’s Committee on Ethics and Conflict of Interest.<br />
Acknowledgment<br />
The authors thank Dr. Robert H. Shmerling, MD, for his critical review of the manuscript.<br />
References<br />
Wolfe
F, Clauw DJ, Fitzcharles M-A, et al. The American College of
Rheumatology preliminary diagnostic criteria for fibromyalgia and
measurement of symptom severity. Arthritis Care Res. 2010
May;62(5):600–610.<br />
Bengtsson A. The muscle in fibromyalgia. Rheumatology. 2002 Jul;41(7):721–724.<br />
Fitzcharles
M-A, Ste-Marie PA, Goldenberg DL, et al. Canadian Pain Society and
Canadian Rheumatology Association recommendations for rational care of
persons with fibromyalgia. A summary report. J Rheum. 2013
Aug;40(8):1388–1393.<br />
Beauchamp TL, Childress JF. Principles in Bioethics. New York: Oxford University Press. 1979:50.<br />
AMA Council on Ethical and Judicial Affairs. Code of Medical Ethics of the American Medical Association, 2012–2013.<br />
Snyder
L. American College of Physicians Ethics, Professionalism, and Human
Rights Committee. American College of Physicians Ethics Manual, 6th Ed.
Ann Intern Med. 2012 Jan 3;156(1 Pt 2):73–104.<br />
http://www.the-rheumatologist.org/details/article/6480961/Patient_Test_Requests_Pose_Challenges_for_Rheumatologists.htmlJulie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-3367985981316014442014-08-04T17:10:00.003-07:002014-08-04T17:10:34.940-07:00The Inflammation connected to the Hamstring..The Hamstring connected to the Tendon..& that’s the way of the Lupus!<div class="mceTemp">
<dl class="wp-caption alignnone" id="attachment_569" style="width: 310px;">
<dt class="wp-caption-dt"><a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/08/myleg.jpg" href="https://butudontlooksick.files.wordpress.com/2014/08/myleg.jpg"><img alt="myleg" class="wp-image-569 size-medium" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/08/myleg.jpg?w=300" height="225" src="http://butudontlooksick.files.wordpress.com/2014/08/myleg.jpg?w=300" width="300" /></a></dt>
<dd class="wp-caption-dd">hamstring tendonitis from lupus-inflammation</dd></dl>
</div>
So-there
it is. Tendonitis in the hamstring. NO, I did not fall even though
YES, I am a klutz. And NO, I did not get punched! (except by lupus)<br />
<br data-mce-bogus="1" />
I
woke up a couple days ago and Surprise- OWWWWWWWWWWWWWWWWWWWWWWWWW!
It's hot, swollen and yes, painful. It's a pulling type of pain, from
around my calfs up to my lower thighs and back of my leg. My doc is
scheduling a cortisone shot which will deflate the inflammation and the
pain asap. I'm also taking steroids and anti-inflammatories. It
helps. Alot. Ice is indicated for inflammation as well.<br />
I
tried to get a selfie of this but ended up tangled and unbalanced like
you get playing Twister! Finally got hubbie to snap a photo-it even
shocks ME & it's on my body!<br />
So for those who question what
kind of inflammation mixed connective tissue disease causes- tendonitis
is just one of em! Lupus is a mixed connective tissue disease-and our
bodies are made of this material-so it's all up for lupus damage grabs,
lol. Two days of bedrest and a few shots isn't so bad-<br />
<br data-mce-bogus="1" />
<span color="#AC193D" data-mce-style="color: #ac193d; font-family: Times New Roman; font-size: large;" face="Times New Roman" size="4" style="color: #ac193d; font-family: Times New Roman; font-size: medium;"><b><span color="#8C0095" data-mce-style="color: #8c0095;" style="color: #8c0095;"><i>"Housebound is no worse than earthbound it's what you make of it."</i></span></b></span><br />
<hr />
Here's some more info on hamstring tendonitis & lupus connective tissue damage from <a data-mce-href="http://www.medicinenet.com/connective_tissue_disease/article.htm" href="http://www.medicinenet.com/connective_tissue_disease/article.htm" target="_blank">Medicine Net</a>:<br />
<br />
Connective
tissue diseases are actually a group of medical diseases. A connective
tissue disease is any disease that has the connective tissues of the
body as a primary target of pathology. The connective tissues are the
structural portions of our body that essentially hold the cells of the
body together. These tissues form a framework, or matrix, for the body.
The connective tissues are composed of two major structural protein
molecules, collagen and elastin. There are many different types of
collagen protein that vary in amount in each of the body's tissues.
Elastin has the capability of stretching and returning to its original
length -- like a spring or rubber band. Elastin is the major component
of ligaments (tissues that attach bone to bone) and skin. In patients
with connective tissue diseases, it is common for collagen and elastin
to become injured by inflammation.<br />
Many connective tissue diseases
feature abnormal immune system activity with inflammation in tissues as
a result of an immune system that is directed against one's own body
tissues (autoimmunity).<br />
<br />
Diseases in which inflammation or <a data-mce-href="http://www.medicinenet.com/weakness/symptoms.htm" href="http://www.medicinenet.com/weakness/symptoms.htm" rel="sym">weakness</a>
of collagen tends to occur are also referred to as collagen diseases.
Collagen vascular disease is a somewhat antiquated term used to describe
diseases of the connective tissues that typically include diseases that
can be (but are not necessarily) associated with blood vessel
abnormalities.<br />
<br data-mce-bogus="1" />
<br data-mce-bogus="1" />
<br data-mce-bogus="1" />Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-79448080994650828192014-06-02T17:59:00.000-07:002014-06-08T12:16:09.637-07:00SUN is out, Wind in My Face; Absolutely Awful! ~Life Above Zero~<br />
<span data-mce-style="font-size: large; color: #ac193d; font-family: Times New Roman;" style="color: #ac193d; font-family: Times New Roman; font-size: medium;"><b><span data-mce-style="color: #8c0095;" style="color: #8c0095;"><i><a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/lupusgrumpycat.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/lupusgrumpycat.jpg"><img alt="lupusgrumpycat" class="alignnone wp-image-519" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/lupusgrumpycat.jpg?w=300" height="379" src="http://butudontlooksick.files.wordpress.com/2014/06/lupusgrumpycat.jpg?w=300" width="453" /></a></i></span></b></span><br />
<span data-mce-style="font-size: large; color: #ff99cc; font-family: Times New Roman;" style="color: #ff99cc; font-family: Times New Roman; font-size: medium;"><b><i>Not only vampires go out at night-LUPUS patients do too!</i></b></span><br />
While
these things are true-UV Hypersensitivity is prevalent with Systemic
Lupus Erythematosus - it doesn't have to mean ISOLATION in this day
& age!<br />
With lupus, our bodies aren't just "allergic" to itself
(white blood cells attacking healthy tissue by mistake causing central
nervous system damage, kidney damage, skin damage including hives, solar
urticaria, discoid, pemphigoid, and cutaneous porphyria rashes, lesions
& vasculitis, inflammation around the heart-pericarditis, around
the lungs-pleurisy, blood disorders (clotting issues and anemia), nerve
damage and a myriad of other symptoms and conditions. So what do you
do? You manage. You CONFORM!<br /><br />I can tell you what I do-<br />
My
windows have double black-out drapes. I go out mostly at night only.
After many years of neutragena helioplex 360 and 120 proof
sunscreen-rashes and lupus flares anyway-I discovered the true way to be
less sick is to just plain STAY INSIDE. In the dark. No UV lights, no
sun at all. Is it isolating? I don't think so thanks to modern
technology-but that's me-it's all in how you see it. <span data-mce-style="font-size: large; color: #ff99cc; font-family: Times New Roman;" style="color: #ff99cc; font-family: Times New Roman; font-size: medium;"><b><i>"Housebound is no worse than earthbound it's what you make of it."</i></b></span><br />
Here's some of my rashes from UV-if you had these I'm sure you'd come to the same conclusion!<br />
<a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/discoid-rash-400x400.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/discoid-rash-400x400.jpg"><img alt="discoid-rash-400x400" class="alignnone size-medium wp-image-539" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/discoid-rash-400x400.jpg?w=300" height="300" src="http://butudontlooksick.files.wordpress.com/2014/06/discoid-rash-400x400.jpg?w=300" width="300" /></a> <a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/malarrash-copy.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/malarrash-copy.jpg"><img alt="malarrash - Copy" class="alignnone size-medium wp-image-538" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/malarrash-copy.jpg?w=300" height="244" src="http://butudontlooksick.files.wordpress.com/2014/06/malarrash-copy.jpg?w=300" width="300" /></a> <a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg"><img alt="IMG_20130130_164207(4)" class="alignnone size-medium wp-image-531" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg?w=300" height="225" src="http://butudontlooksick.files.wordpress.com/2014/06/img_20130130_1642074.jpg?w=300" width="300" /></a> <a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/headrash1.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/headrash1.jpg"><img alt="headrash1" class="alignnone size-medium wp-image-525" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/headrash1.jpg?w=300" height="225" src="http://butudontlooksick.files.wordpress.com/2014/06/headrash1.jpg?w=300" width="300" /></a> <a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/juliefacerash.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/juliefacerash.jpg"><img alt="juliefacerash" class="alignnone size-medium wp-image-522" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/juliefacerash.jpg?w=300" height="225" src="http://butudontlooksick.files.wordpress.com/2014/06/juliefacerash.jpg?w=300" width="300" /></a> <a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/vasculitislegs.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/vasculitislegs.jpg"><img alt="vasculitislegs" class="alignnone size-full wp-image-521" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/vasculitislegs.jpg" height="204" src="http://butudontlooksick.files.wordpress.com/2014/06/vasculitislegs.jpg" width="247" /></a> <a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/vascularlesion.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/vascularlesion.jpg"><img alt="vascularlesion" class="alignnone wp-image-520" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/vascularlesion.jpg" height="208" src="http://butudontlooksick.files.wordpress.com/2014/06/vascularlesion.jpg" width="359" /></a> <a data-mce-href="http://butudontlooksick.files.wordpress.com/2013/03/june2013rash.jpg" href="http://butudontlooksick.files.wordpress.com/2013/03/june2013rash.jpg"><img alt="june2013rash" class="alignnone size-medium wp-image-369" data-mce-src="http://butudontlooksick.files.wordpress.com/2013/03/june2013rash.jpg?w=289" height="300" src="http://butudontlooksick.files.wordpress.com/2013/03/june2013rash.jpg?w=289" width="289" /></a><a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/julieshingles1.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/julieshingles1.jpg"><img alt="julieshingles1" class="alignnone size-medium wp-image-535" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/julieshingles1.jpg?w=300" height="225" src="http://butudontlooksick.files.wordpress.com/2014/06/julieshingles1.jpg?w=300" width="300" /></a><br />
That would drive ya inside-yes? LOL..And my point? It doesn't have to BE isolating or feel isolating..<br />
The
internet has given us many advances-immediate chat, visuals like skype,
and the ability to find info, give info, and reach out without having
to take one step outside into that debilitating sun. I can watch my
son's chorus concert from bed, talk to people on the other side of the
world-make appointments, talk to doctors and do relatively anything but
reach out and touch someone! So isolating? No-it's the opposite for
people like me!!! It's FREEING! And I'm thankful for it everyday!
Even after a small TIA June 2012-I was relatively a "head in a bed"
while I recouped...but I was happy and I was anything but bored or
isolated! So again-Housebound is what you make of it! Is a wheelchair a
good or a bad thing? Ask someone who is in one? It's a great thing!
It's mobility! Just a different way-and so what!<br />
On a personal
note - I enjoy watching reality shows-specifically shows about
Alaska-the last frontier. Why- I wonder? Because we LUPUS patients
share something with these people-we are isolated. We are literally in
the dark most of the time. Plus of course-they are exciting! There's
gold miners, hunters, and people who are solely responsible for their
own food and water sources-and live in the most extreme of
circumstances. And they succeed. They flourish. They give us HOPE.
They tell us that life is precious-and to be lived- There is a woman
you might have all seen-Susan Aikens on a National Geographic show
called "Life Below Zero", who owns and manages a remote fueling station
near the Arctic Circle-she is alone 8 months of the year. She is the
strongest, toughest woman I have ever seen. She was attacked by a bear,
left for dead, sewed up her own head, hunts for food and braves
temperatures so freezing- she doesn't just persevere-she flourishes. I
designed the pic of Sue & Alaska to say Thank You for the
Inspiration!<br />
<a data-mce-href="https://butudontlooksick.files.wordpress.com/2014/06/lighthousesusanaikens.jpg" href="https://butudontlooksick.files.wordpress.com/2014/06/lighthousesusanaikens.jpg"><img alt="lighthousesusanaikens" class="alignnone wp-image-540" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/06/lighthousesusanaikens.jpg?w=300" height="403" src="http://butudontlooksick.files.wordpress.com/2014/06/lighthousesusanaikens.jpg?w=300" width="403" /></a><br />
Pic of Susan Aikens from "Life Below Zero" on National Geographic channel<br />
Susan
said that she knows due to her remoteness and the difficulty especially
in winter for planes and helicopters to reach her that she and people
like her understand that if something happens, if they get hurt-that
there is always the chance that noone will come and they will die out
there. People with chronic illness know the same fear. It is freeing
to accept what might happen-what could happen-it takes the fear out of
it! Still-I think Susan has another message-one she might not even
realize-<br />
When Susan Aikens was asked why she is alright to stay
out there in remote Alaska alone and be isolated so much of the year-she
said it is because when she was little all she wanted to be was a
lighthouse keeper. Well-she IS a lighthouse keeper. She's a beacon of
what life without fear means for those with chronic illness. She's an
inspiration.<br />
<div class="copy-paste-block">
"We are told to let our
light shine, and if it does, we won't need to tell anybody it does.
Lighthouses don't fire cannons to call attention to their shining- they
just shine"., Dwight L Moody</div>
<div class="copy-paste-block">
<br /></div>
<div class="copy-paste-block">
<br /></div>
<div class="copy-paste-block">
<br /></div>
<div class="copy-paste-block">
<em>from Wiki on Solar Urticaria:</em></div>
<div class="copy-paste-block">
<b>Solar urticaria</b> (SU) is a rare condition in which exposure to ultraviolet or <a class="mw-redirect" data-mce-href="http://en.wikipedia.org/wiki/Ultraviolet_radiation" href="http://en.wikipedia.org/wiki/Ultraviolet_radiation" title="Ultraviolet radiation">UV radiation</a>, or sometimes even <a data-mce-href="http://en.wikipedia.org/wiki/Visible_spectrum" href="http://en.wikipedia.org/wiki/Visible_spectrum" title="Visible spectrum">visible light</a>, induces a case of <a data-mce-href="http://en.wikipedia.org/wiki/Urticaria" href="http://en.wikipedia.org/wiki/Urticaria" title="Urticaria">urticaria</a> or hives that can appear in both covered and uncovered areas of the skin.<sup class="reference" id="cite_ref-Dermnetnz_1-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Dermnetnz-1" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Dermnetnz-1">[1]</a></sup><sup class="reference" id="cite_ref-covered_2-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-covered-2" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-covered-2">[2]</a></sup> It is classified as a type of <a data-mce-href="http://en.wikipedia.org/wiki/Physical_urticaria" href="http://en.wikipedia.org/wiki/Physical_urticaria" title="Physical urticaria">physical urticaria</a>.<sup class="reference" id="cite_ref-3"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-3" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-3">[3]</a></sup>
The classification of disease types is somewhat controversial. One
classification system distinguished various types of SU based on the <a data-mce-href="http://en.wikipedia.org/wiki/Wavelength" href="http://en.wikipedia.org/wiki/Wavelength" title="Wavelength">wavelength</a> of the radiation that causes the breakout; another classification system is based on the type of <a data-mce-href="http://en.wikipedia.org/wiki/Allergen" href="http://en.wikipedia.org/wiki/Allergen" title="Allergen">allergen</a> that initiates a breakout.<sup class="reference" id="cite_ref-Clinical_4-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Clinical-4" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Clinical-4">[4]</a></sup><sup class="reference" id="cite_ref-pathogenesis_5-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-pathogenesis-5" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-pathogenesis-5">[5]</a></sup><br />
The agent in the human body responsible for the reaction to radiation, known as the photoallergen, has not yet been identified.<sup class="reference" id="cite_ref-Photodermatology_6-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Photodermatology-6" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Photodermatology-6">[6]</a></sup>
The disease itself can be difficult to diagnose properly because it is
so similar to other dermatological disorders, such as polymorphic light
eruption or <a data-mce-href="http://en.wikipedia.org/wiki/Polymorphous_light_eruption" href="http://en.wikipedia.org/wiki/Polymorphous_light_eruption" title="Polymorphous light eruption">PMLE</a>.<sup class="reference" id="cite_ref-allergic_7-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-allergic-7" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-allergic-7">[7]</a></sup>
The most helpful test is a diagnostic phototest, a specialized test
which confirms the presence of an abnormal sunburn reaction. Once
recognized, treatment of the disease commonly involves the
administration of <a class="mw-redirect" data-mce-href="http://en.wikipedia.org/wiki/Antihistamines" href="http://en.wikipedia.org/wiki/Antihistamines" title="Antihistamines">antihistamines</a>, and <a data-mce-href="http://en.wikipedia.org/wiki/Desensitization_%28medicine%29" href="http://en.wikipedia.org/wiki/Desensitization_%28medicine%29" title="Desensitization (medicine)">desensitization</a> treatments such as <a class="mw-redirect" data-mce-href="http://en.wikipedia.org/wiki/Phototherapy" href="http://en.wikipedia.org/wiki/Phototherapy" title="Phototherapy">phototherapy</a>.<sup class="reference" id="cite_ref-Dermnetnz_1-1"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Dermnetnz-1" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Dermnetnz-1">[1]</a></sup> In more extreme cases, the use of <a class="mw-redirect" data-mce-href="http://en.wikipedia.org/wiki/Immunosuppressive_drugs" href="http://en.wikipedia.org/wiki/Immunosuppressive_drugs" title="Immunosuppressive drugs">immunosuppressive drugs</a> and even <a data-mce-href="http://en.wikipedia.org/wiki/Plasmapheresis" href="http://en.wikipedia.org/wiki/Plasmapheresis" title="Plasmapheresis">plasmapheresis</a> may be considered.<sup class="reference" id="cite_ref-urticaria.org.uk_8-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-urticaria.org.uk-8" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-urticaria.org.uk-8">[8]</a></sup><br />
The
initial discovery of the disease is credited to P. Merklen in 1904, but
it did not have a name until the suggestion of "solar urticaria" was
given by Duke in 1923.<sup class="reference" id="cite_ref-Photodermatology_6-1"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Photodermatology-6" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-Photodermatology-6">[6]</a></sup><sup class="reference" id="cite_ref-pediatric_9-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-pediatric-9" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-pediatric-9">[9]</a></sup>
However, their research contributed to the study of this uncommon
disease. More than one hundred cases have been reported in the past
century.<sup class="reference" id="cite_ref-vitro_10-0"><a data-mce-href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-vitro-10" href="http://en.wikipedia.org/wiki/Solar_urticaria#cite_note-vitro-10">[10]</a></sup></div>
<div class="copy-paste-block">
from the Lupus Foundation of America on Lupus Rashes:</div>
<div class="copy-paste-block">
Approximately
two-thirds of people with lupus will develop some type of skin disease,
called cutaneous lupus erythematosus. Skin disease in lupus can cause
rashes or sores (lesions), most of which will appear on sun-exposed
areas such as the face, ears, neck, arms, and legs.<br />
<blockquote>
40-70
percent of people with lupus will find that their disease is made worse
by exposure to ultraviolet (UV) rays from sunlight or artificial light.</blockquote>
A
dermatologist, a physician who specializes in caring for the skin,
should treat lupus skin rashes and lesions. He or she will usually
examine tissue under a microscope to determine whether a lesion or rash
is due to cutaneous lupus: taking the tissue sample is called a biopsy.<br />
<h2>
<strong>The Forms of Cutaneous Lupus</strong></h2>
Lupus skin disease can occur in one of three forms:<br />
<ol>
<li>Chronic cutaneous (discoid) lupus</li>
<li>Subacute cutaneous lupus</li>
<li>Acute cutaneous lupus.</li>
</ol>
<strong>Chronic cutaneous lupus (discoid lupus)</strong> appears
as disk-shaped, round lesions. The sores usually appear on the scalp
and face but sometimes they will occur on other parts of the body as
well.<br />
<blockquote>
Approximately 10 percent of people with discoid
lupus later develop lupus in other organ systems, but these people
probably already had systemic lupus with the skin rash as the first
symptom.</blockquote>
Discoid lupus lesions are often red, scaly,
and thick. Usually they do not hurt or itch. Over time, these lesions
can produce scarring and skin discoloration (darkly colored and/or
lightly colored areas). Discoid lesions that occur on the scalp may
cause the hair to fall out. If the lesions form scars when they heal,
the hair loss may be permanent.<br />
Cancer can develop in discoid
lesions that have existed for a long time. It’s important to speak with
your doctor about any changes in the appearance of these lesions.<br />
Discoid lupus lesions can be very photosensitive so preventive measures are important:<br />
<ul>
<li>Avoid being out in the sunlight between the hours of 10 a.m. and 4 p.m.</li>
<li>Use plenty of sunscreen when you are outdoors</li>
<li>Wear sun-protective clothing and broad-brimmed hats</li>
<li>Limit the amount of time spent under indoor fluorescent lights</li>
</ul>
<strong>Subacute cutaneous lesions</strong>
may appear as areas of red scaly skin with distinct edges or as red,
ring-shaped lesions. The lesions occur most commonly on the sun-exposed
areas of the arms, shoulders, neck, and body. The lesions usually do not
itch or scar, but they can become discolored. Subacute cutaneous
lesions are also photosensitive so preventive measures should be taken
when spending time outdoors or under fluorescent lights.<br />
<strong>Acute cutaneous lupus</strong>
lesions occur when your systemic lupus is active. The most typical form
of acute cutaneous lupus is a malar rash–flattened areas of red skin on
the face that resemble a sunburn. When the rash appears on both cheeks
and across the bridge of the nose in the shape of a butterfly, it is
known as the "butterfly rash." However, the rash can also appear on
arms, legs, and body. These lesions tend to be very photosensitive. They
typically do not produce scarring, although changes in skin color may
occur.<br />
<h2>
<strong>Other Skin Problems</strong></h2>
There are several other conditions that can occur with lupus:<br />
<strong>Calcinosis</strong>
is caused by a buildup of calcium deposits under the skin. These
deposits can be painful, and may leak a white liquid. Calcinosis can
develop from a reaction to steroid injections or as a result of kidney
failure.<br />
<strong>Cutaneous vasculitis lesions</strong> occur when
inflammation damages the blood vessels in the skin. The lesions
typically appear as small, red-purple spots and bumps on the lower legs;
occasionally, larger knots (nodules) and ulcers can develop. Vasculitis
lesions can also appear in the form of raised sores or as small red or
purple lines or spots in the fingernail folds or on the tips of the
fingers. In some cases, cutaneous vasculitis can result in significant
damage to skin tissue. Areas of dead skin can appear as sores or small
black spots at the ends of the fingers or around the fingernails and
toes, causing gangrene (death of soft tissues due to loss of blood
supply).<br />
<strong>Hair loss</strong> can occur for other reasons
besides scarring on the scalp. Severe systemic lupus may cause a
temporary pattern of hair loss that is then replaced by new hair growth.
A severe lupus flare can result in fragile hair that breaks easily.
Such broken hairs at the edge of the scalp give a characteristic ragged
appearance termed "lupus hair."<br />
<strong>Raynaud’s phenomenon</strong>
is a condition in which the blood vessels in the hands and/or feet go
into spasm, causing restricted blood flow. Lupus-related Raynaud’s
usually results from inflammation of nerves or blood vessels and most
often happens in cold temperatures, causing the tips of the fingers or
toes to turn red, white, or blue. Pain, numbness, or tingling may also
occur. People with Raynaud’s phenomenon should try to avoid cold
conditions, and, if necessary, should wear gloves or mittens and thick
socks when in an air-conditioned area.<br />
<strong>Livedo reticularis</strong> and <strong>palmar erythema</strong>
are caused by abnormal rates of blood flow through the capillaries and
small arteries. A bluish, lacelike mottling will appear beneath the
skin, especially on the legs, giving a "fishnet" appearance. Like
Raynaud’s phenomenon, these conditions tend to be worse in cold weather.<br />
<strong>Mucosal ulcerations</strong>
are sores in the mouth or nose or, less often, in lining of vaginal
tissue. These ulcers can be caused by both cutaneous lupus and systemic
lupus. It is important to differentiate lupus ulcers from herpes lesions
or cold sores, which may be brought on by the use of immunosuppressive
drugs. Lupus ulcers are usually painless and signs of inflammation will
show up in the biopsy.<br />
<strong>Petechiae </strong>(pah-TEE-kee-eye)
are tiny red spots on the skin, especially on the lower legs, that
result from low numbers of platelet in the blood, a condition called
thrombocytopenia. Although thrombocytopenia is common in lupus, serious
bleeding as a result of the low number of platelets usually does not
occur.<br />
<h2>
<strong>Treating Cutaneous Lupus </strong></h2>
The
medications used to treat lupus-related skin conditions depends on the
form of cutaneous lupus. The most common treatments are topical
ointments, such as steroid cream or gel. In some cases liquid steroids
will be injected directly into the lesions.<br />
A new class of drugs,
called topical immunomodulators, can treat serious skin conditions
without the side effects found in corticosteroids: tacrolimus ointment
(Protopic®) and pimecrolimus cream (Elidel®) have been shown to suppress
the activity of the immune system in the skin, including the butterfly
rash, subacute cutaneous lupus, and possibly even discoid lupus lesions.<br />
In
addition, thalidomide (Thalomid®) has been increasingly accepted as a
treatment for the types of lupus that affect the skin; it has been shown
to greatly improve cutaneous lupus that has not responded to other
treatments.<br />
<h3>
Preventative Treatments</h3>
<ul>
<li>Avoidance/protection from sunlight and artificial ultraviolet light</li>
<li>Seek shade</li>
<li>Sunscreens -- physical and chemical</li>
</ul>
<h3>
Local/Topical Treatments</h3>
<ul>
<li>Corticosteroid creams, ointments, gels, solutions, lotions, sprays, foams</li>
<li>Calcineurin inhibitors<ul>
<li>tacrolimus ointment (Protopic®)</li>
<li>pimecrolimus cream (Elidel®)</li>
</ul>
</li>
</ul>
<h3>
Systemic Treatments for Mild to Moderate Disease</h3>
<ul>
<li>Corticosteroids -- short term</li>
<li>Antimalarials<ul>
<li>hydroxychloroquine (Plaquenil®)</li>
<li>chloroquine (Aralen®)</li>
<li>quinacrine (available from compounding pharmacies only)</li>
</ul>
</li>
<li>Retinoids</li>
<li>synthetic forms of vitamin A—isotretinoin (Accutane®), acitretin (Soriatane®)</li>
<li>diaminodiphenylsulfone (Dapsone®)</li>
<li>Sulfones</li>
</ul>
<h3>
Systemic Treatments for Severe Disease</h3>
<ul>
<li>Corticosteroids -- long term</li>
<li>Gold<ul>
<li>oral—auronofin (Ridura®)</li>
<li>intramuscular—gold sodium thiomaleate (Myochrisine®)</li>
</ul>
</li>
<li>Thalidomide (Thalomid®)</li>
<li>Methotrexate</li>
<li>Azathioprine (Imuran®)</li>
<li>Mycophenolate mofetil (CellCept®)</li>
<li>Biologics</li>
<li>efalizumab (Raptiva®)</li>
</ul>
<span data-mce-style="text-decoration: underline;" style="text-decoration: underline;">It should be noted that most of the above treatments are not approved by the Food and Drug Administration for cutaneous lupus.</span><br />
<em>The Lupus Foundation of America would like to thank Richard Sontheimer, MD, for this information.</em><br />
<em>Medically reviewed on July 12, 2013</em></div>
<br />
<br />
Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com2tag:blogger.com,1999:blog-4316526137866390150.post-46597153956067683042014-04-03T17:51:00.000-07:002017-06-30T17:34:01.852-07:00Get the SKIN-EEEE on Scleroderma!<a href="http://butudontlooksick.files.wordpress.com/2014/04/juliesclerocompare.jpg"><img alt="Image" class="size-full wp-image" src="http://butudontlooksick.files.wordpress.com/2014/04/juliesclerocompare.jpg?w=650" id="i-506" /></a><br />
<strong>Scleroderma=Sclera=hardening</strong><br />
There are two types, diffuse or skin. My scleroderma is limited to
my skin. I’m VERY lucky! (even if I don’t look it in the middle pic,
lol) You may have to click on the pic to get a close up of it so you
can really tell how thick and “pulled” the skin is. Yes, it was
painful. It took about two weeks to go “down” and get back to normal. I
used steroid cream to heal and prednisone. It was the worse rash of
it’s kind on my face I ever had. The pic on the right shows the
hardening and peeling fingertips common in Scleroderma-called
“scleroderma fingers”.<br />
<br />
Here’s some more info on Scleroderma from <a href="http://www.scleroderma.org/site/PageNavigator/patients_whatis.html#.Uz4AsldnDOc" target="_blank" title="the Scleroderma Foundation">Scleroderma.org</a>:<br />
Scleroderma, or systemic sclerosis, is a chronic connective tissue
disease generally classified as one of the autoimmune rheumatic
diseases.<br />
<br />
The word “scleroderma” comes from two Greek words: “sclero” meaning
hard, and “derma” meaning skin. Hardening of the skin is one of the most
visible manifestations of the disease. The disease has been called
“progressive systemic sclerosis,” but the use of that term has been
discouraged since it has been found that scleroderma is not necessarily
progressive. The disease varies from patient-to-patient.<br />
<br />
<strong>What scleroderma is not</strong><br />
Scleroderma is not contagious, infectious, cancerous or malignant.<br />
<strong>How serious is scleroderma?</strong><br />
Any chronic disease can be serious. The symptoms of scleroderma vary
greatly for each person, and the effects of scleroderma can range from
very mild to life threatening. The seriousness will depend on the parts
of the body, which are affected, and the extent to which they are
affected. A mild case can become more serious if not properly treated.
Prompt and proper diagnosis and treatment by qualified physicians may
minimize the symptoms of scleroderma and lessen the chance for
irreversible damage.<br />
<br />
<strong>How is scleroderma diagnosed?</strong><br />
The diagnostic process may require consultation with rheumatologists
(arthritis specialists), and/or dermatologists (skin specialists) and
require blood studies and numerous other specialized tests depending
upon which organs are affected.<br />
<br />
<strong>Who develops scleroderma, and when?</strong><br />
It’s estimated that about 300,000 Americans have scleroderma. About one
third of those people have the systemic form of scleroderma. Since
scleroderma presents with symptoms similar to other autoimmune diseases,
diagnosis is difficult. There may be many misdiagnosed or undiagnosed
cases.<br />
Localized scleroderma is more common in children, whereas systemic
scleroderma is more common in adults. Overall, female patients outnumber
male patients about 4-to-1. Factors other than a person’s gender, such
as race and ethnic background, may influence the risk of getting
scleroderma, the age of onset, and the pattern or severity of internal
organ involvement. The reasons for this are not clear. Although
scleroderma is not directly inherited, some scientists feel there is a
slight predisposition to it in families with a history of rheumatic
diseases.<br />
<br />
However, scleroderma can develop in every age group from infants to
the elderly, but its onset is most frequent between the ages of 25 to
55. When doctors say “usually” or “for the most part,” the reader should
understand that variations frequently occur. Many patients get alarmed
when they read medical information that seems to contradict their own
experiences, and conclude that what has happened to them is not supposed
to happen. There are many exceptions to the rules in scleroderma,
perhaps more so than in other diseases. Each case is different, and
information should be discussed with your own doctor.<br />
<br />
<strong>What causes scleroderma?</strong><br />
The exact cause or causes of scleroderma are still unknown, but
scientists and medical researchers are working hard to make those
determinations. It is known that scleroderma involves an overproduction
of collagen.<br />
<br />
<strong>Is scleroderma genetic?</strong><br />
Most patients do not have any relatives with scleroderma and their
children do not get scleroderma. Research indicates that there is a
susceptibility gene, which raises the likelihood of getting scleroderma,
but by itself does not cause the disease.<br />
<br />
<strong>What is the treatment for scleroderma?</strong><br />
Currently, there is no cure for scleroderma, but there are many
treatments available to help particular symptoms. For instance,
heartburn can be controlled by medications called proton pump inhibitors
PPIs) or medicine to improve the motion of the bowel. Some treatments
are directed at decreasing the activity of the immune system. Some
people with mild disease may not need medication at all and occasionally
people can go off treatment when their scleroderma is no longer active.
Because there is so much variation from one person to another, there is
great variation in the treatments prescribed.<br />
<hr />
<h2>
<a href="https://www.blogger.com/null" name="types"></a>Types of Scleroderma</h2>
There are two major classifications of scleroderma: localized
scleroderma and systemic sclerosis (SSc). Other forms or
subclassifications, each with its own characteristics and prognosis, may
be identified through future research.<br />
<img align="middle" alt="types of scleroderma chart" border="0" src="http://www.scleroderma.org/images/content/pagebuilder/types-scleroderma-chart.jpg" height="319" style="display: block; margin-left: auto; margin-right: auto;" width="600" /><br />
<strong><a href="https://www.blogger.com/null" name="localized"></a>Localized Scleroderma</strong> The
changes, which occur in localized scleroderma, are usually found in only
a few places on the skin or muscles, and rarely spread elsewhere.
Generally, localized scleroderma is relatively mild. The internal organs
are usually not affected, and persons with localized scleroderma rarely
develop systemic scleroderma. Some laboratory abnormalities commonly
seen in systemic scleroderma are frequently absent in the localized
form.<br />
<strong>Morphea</strong> is a form of localized scleroderma
characterized by waxy patches on the skin of varying sizes, shapes and
color. The skin under the patches may thicken. The patches may enlarge
or shrink, and often may disappear spontaneously. Morphea usually
appears between the ages of 20 and 50, but is often seen in young
children.<br />
<strong>Linear scleroderma</strong> is a form of localized
scleroderma which frequently starts as a streak or line of hardened,
waxy skin on an arm or leg or on the forehead. Sometimes it forms a long
crease on the head or neck, referred to as <strong>en coup de sabre</strong>
because it resembles a saber or sword wound. Linear scleroderma tends
to involve deeper layers of the skin as well as the surface layers, and
sometimes affects the motion of the joints, which lie underneath. Linear
scleroderma usually develops in childhood. In children, the growth of
involved limbs may be affected.<br />
<strong><a href="https://www.blogger.com/null" name="systemic"></a>Systemic scleroderma (systemic sclerosis)</strong>
The changes occurring in systemic scleroderma may affect the connective
tissue in many parts of the body. Systemic scleroderma can involve the
skin, esophagus, gastrointestinal tract (stomach and bowels), lungs,
kidneys, heart and other internal organs. It can also affect blood
vessels, muscles and joints. The tissues of involved organs become hard
and fibrous, causing them to function less efficiently. The term <strong>systemic sclerosis</strong>
indicates that “sclerosis” (hardening) may occur in the internal
systems of the body. There are two major recognized patterns that the
illness can take – diffuse or limited disease. In <strong>diffuse scleroderma</strong>,
skin thickening occurs more rapidly and involves more skin areas than
in limited disease. In addition, people with diffuse scleroderma have a
higher risk of developing “sclerosis” or fibrous hardening of the
internal organs.<br />
About 50 percent of patients have a slower and more benign illness called <strong>limited scleroderma</strong>.
In limited scleroderma, skin thickening is less widespread, typically
confined to the fingers, hands and face, and develops slowly over years.
Although internal problems occur, they are less frequent and tend to be
less severe than in diffuse scleroderma, and are usually delayed in
onset for several years. However, persons with limited scleroderma, and
occasionally those with diffuse scleroderma,<br />
can develop pulmonary hypertension, a condition in which the lung’s
blood vessels become narrow, leading to impaired blood flow through the
lungs resulting in shortness of breath.<br />
Limited scleroderma is sometimes called CREST syndrome. CREST stands for the initial letters of five common features:<br />
<ul>
<li>Calcinosis</li>
<li>Raynaud Phenomenon</li>
<li>Esophageal dysfunction</li>
<li>Sclerodactyly</li>
<li>Telangiectasia</li>
</ul>
To further complicate the terminology, some people with diffuse
disease will go on to develop calcinosis and telangiectasias so that
they also have the features of CREST.<br />
Although most patients can be classified as having diffuse or limited
disease, different people may have different symptoms and different
combination of symptoms of the illness.Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com2tag:blogger.com,1999:blog-4316526137866390150.post-84683585712534937532014-01-29T19:26:00.000-08:002017-06-30T17:33:00.108-07:00Urticarial Vasculitis-It's a lupus thing!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEht7mpisxmU5FKnYV8D-8rPnpFPMF6u58RpCFWhQEstJ8nbhtNn1MANXUJHnXiYth-1CqY7JITYJfKiXagNM_ATnEwoER0jIObP3aRbCdVOTD_-fTARKa4va58fYY7hXkSZkATJnaToBP0/s1600/juliesclero.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEht7mpisxmU5FKnYV8D-8rPnpFPMF6u58RpCFWhQEstJ8nbhtNn1MANXUJHnXiYth-1CqY7JITYJfKiXagNM_ATnEwoER0jIObP3aRbCdVOTD_-fTARKa4va58fYY7hXkSZkATJnaToBP0/s320/juliesclero.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQEhZiStFrT9THtKWzSq5FjvkCdq7tip5pMMCbnthaOucd3Z6ctJ20SQBCmOfxHXQJEYt7PykAcFqRHgOU86ofJqp_C9uJ8WDAz4MnQAzX22T92FXpn8pWnpLqEotHOAD12sigvgEivXs/s1600/juliearm.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="576" data-original-width="1024" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQEhZiStFrT9THtKWzSq5FjvkCdq7tip5pMMCbnthaOucd3Z6ctJ20SQBCmOfxHXQJEYt7PykAcFqRHgOU86ofJqp_C9uJ8WDAz4MnQAzX22T92FXpn8pWnpLqEotHOAD12sigvgEivXs/s320/juliearm.jpg" width="320" /></a></div>
It's
a little difficult to see in the pic-but I tried to capture not the
rash or hives on top of the skin but the bumps underneath the skin. My
blood vessels were so inflammed I could follow them up and down my
arms-and feel the muscles and nerves of my ulnar and carpal neuropathy
being pulled.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP1wtSI_G-NyXnunXpXRt8WdpLwK_hVJmYx8Q-6QjAQuZwHJyZlFdkRxDVTLhAnO8hwMa6K7nmgtNgqQ5o9CDgViUExW5Hnh2_xOyzUYtzgxqOb3_4ShjFW8KdzVLuCSzOycQVN5XZjTM/s1600/juliepemphigusrash.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="194" data-original-width="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP1wtSI_G-NyXnunXpXRt8WdpLwK_hVJmYx8Q-6QjAQuZwHJyZlFdkRxDVTLhAnO8hwMa6K7nmgtNgqQ5o9CDgViUExW5Hnh2_xOyzUYtzgxqOb3_4ShjFW8KdzVLuCSzOycQVN5XZjTM/s1600/juliepemphigusrash.jpg" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhDf5lRr1M5LJGXHL8d9n2yv7ZXkooIUp_5BVjANlG3tOUL3MMGRu-YoLJoYG22lgNH7pxBWSfDVo0WA1C5Ws8uYZ0Z6JunM3GDewjcqQFza-WAkzzkAlAwPqev9XvilaviAZcO2Z6Kh8/s1600/juliearms.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="540" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhDf5lRr1M5LJGXHL8d9n2yv7ZXkooIUp_5BVjANlG3tOUL3MMGRu-YoLJoYG22lgNH7pxBWSfDVo0WA1C5Ws8uYZ0Z6JunM3GDewjcqQFza-WAkzzkAlAwPqev9XvilaviAZcO2Z6Kh8/s320/juliearms.jpg" width="180" /></a></div>
<br />
The
actual term is urticarial vasculitis. It's a hypersensitivity vascular
reaction to the UV or the sun-of which many people with lupus have
sensitivities with. When mine gets bad-it causes this reaction. I call
it a mini-flare-it usually takes about a week to come all the way down,
and yes, it ITCHES and yes, it's painful. While I usually have it on
my arms, I have had it on my chest and face as well. Here's my chest,
only slightly reactive, but still very hot, swollen and itchy: <a data-mce-href="http://butudontlooksick.files.wordpress.com/2014/01/juliearm4.jpg" href="http://butudontlooksick.files.wordpress.com/2014/01/juliearm4.jpg"><img alt="Image" class="size-full wp-image" data-filename="juliearm4.jpg" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/01/juliearm4.jpg?w=650" src="http://butudontlooksick.files.wordpress.com/2014/01/juliearm4.jpg?w=650" id="i-494" /></a><br />
The
discolorations you see on my chest are from previous urticaria rashes,
lupus rashes, discoid rashes, lesions and pemphigoid rashes. Here's
some info on urticarial vasculitis from medscape:<br />
Urticarial
vasculitis is an eruption of erythematous wheals that clinically
resemble urticaria but histologically show changes of <a data-mce-href="http://emedicine.medscape.com/article/333891-overview" href="http://emedicine.medscape.com/article/333891-overview" target="_self">leukocytoclastic vasculitis</a>.<sup><a href="https://www.blogger.com/null">[1, 2] </a></sup>Urticarial
vasculitis may be divided into normocomplementemic and
hypocomplementemic variants. Both subsets can be associated with
systemic symptoms (eg, <a data-mce-href="http://emedicine.medscape.com/article/135208-overview" href="http://emedicine.medscape.com/article/135208-overview" target="_self">angioedema</a>, arthralgias, abdominal or chest pain, fever, pulmonary disease, renal disease, episcleritis, uveitis, and <a data-mce-href="http://emedicine.medscape.com/article/331197-overview" href="http://emedicine.medscape.com/article/331197-overview" target="_self">Raynaud phenomenon</a>).<br />
<br />
The hypocomplementemic form more often is associated with systemic
symptoms and has been linked to connective-tissue disease (ie, <a data-mce-href="http://emedicine.medscape.com/article/332244-overview" href="http://emedicine.medscape.com/article/332244-overview" target="_self">systemic lupus erythematosus</a> [SLE]).<br />
<div>
<br />
Patients
with urticarial vasculitis present with an urticarial eruption, often
accompanied by a painful or burning sensation. Lesions are generalized
wheals or erythematous plaques, occasionally with central clearing,
lasting for more than 24 hours in a fixed location (in contrast to
urticaria, which resolves in minutes to hours or migrates continually).
Petechiae may be noted within the lesions, and they may resolve with
ecchymoses or postinflammatory hyperpigmentation. Patients may have
photosensitivity, lymphadenopathy, arthralgia, angioedema (40%), fever,
abdominal pain, dyspnea, and pleural and pericardial effusions.<sup><a href="https://www.blogger.com/null">[4] </a></sup>Most cases of urticarial vasculitis are idiopathic.<br />
The primary causes of urticarial vasculitis are as follows:<br />
<ul>
<li><div>
Drug
induced, such as ACE inhibitors, penicillin, sulfonamides, fluoxetine,
cimetidine, diltiazem, thiazides, potassium iodide, non-steroid
inflammatory drugs, and glatiramer acetate.<sup><a href="https://www.blogger.com/null">[9] </a></sup></div>
</li>
<li><div>
Rheumatic disease, such as SLE and <a data-mce-href="http://emedicine.medscape.com/article/332125-overview" href="http://emedicine.medscape.com/article/332125-overview" target="_self">Sjögren syndrome</a>:
Urticarial vasculitis has also been reported with immunoglobulin A and
immunoglobulin M monoclonal gammopathies, mixed cryoglobulins, and
hematologic and solid malignancies.<sup><a href="https://www.blogger.com/null">[10] </a></sup></div>
</li>
<li><div>
Viral disease, such as <a data-mce-href="http://emedicine.medscape.com/article/177632-overview" href="http://emedicine.medscape.com/article/177632-overview" target="_self">hepatitis B</a>, <a data-mce-href="http://emedicine.medscape.com/article/177792-overview" href="http://emedicine.medscape.com/article/177792-overview" target="_self">hepatitis C</a>,<sup><a href="https://www.blogger.com/null">[11] </a></sup>and <a data-mce-href="http://emedicine.medscape.com/article/222040-overview" href="http://emedicine.medscape.com/article/222040-overview" target="_self">infectious mononucleosis</a></div>
</li>
</ul>
Urticarial vasculitis is divided into hypocomplementemic and normocomplementemic categories, as follows<sup><a href="https://www.blogger.com/null">[12] </a></sup>:<br />
<ul>
<li><div>
Hypocomplementemia
often is associated with a systemic condition, such as SLE (in which
>50% of patients have hypocomplementemia).<sup><a href="https://www.blogger.com/null">[3] </a></sup>In
addition, as many as 71% of patients with hypocomplementemic urticarial
vasculitis have a positive antinuclear antibody titer but do not fulfill
the American Rheumatism Association criteria for SLE.<sup><a href="https://www.blogger.com/null">[5] </a></sup>Some
authors have suggested evaluation of hypocomplementemic urticarial
vasculitis for immunoglobulin G antibodies to C1q. Individuals with
these antibodies have a higher incidence of angioedema, ocular
inflammation, glomerulonephritis, and obstructive pulmonary disease.</div>
</li>
<li><div>
Normocomplementemic vasculitis can be associated with connective-tissue disease but at a much lower rate.</div>
</li>
</ul>
</div>
Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-62559538856579157662014-01-18T16:06:00.000-08:002014-01-18T16:06:09.753-08:00What's Phenomenal about Raynaud's Phenomenon?<a data-mce-href="http://butudontlooksick.files.wordpress.com/2014/01/juliehandsnew.jpg" href="http://butudontlooksick.files.wordpress.com/2014/01/juliehandsnew.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="juliehandsnew" class="size-medium wp-image-478 alignleft" data-mce-src="http://butudontlooksick.files.wordpress.com/2014/01/juliehandsnew.jpg?w=168" height="300" src="http://butudontlooksick.files.wordpress.com/2014/01/juliehandsnew.jpg?w=168" title="" width="168" /></a>It's winter,
it's cold and that means people with autoimmune conditions can have an
increase in symptoms, like joint pain, arthritis inflammation and
raynaud's syndrome to name a few.<br />
Raynauds is when small arteries
that provide blood to your skin, narrow. This can cause trouble in
circulation. In some people, it can turn your fingertips blue, purple or
even white. Raynaud's can be minor-like in mine (pic) or so complicated
it can cause amputations to be needed.<br />
Raynaud's is more than
cold hands-it can be very difficult to get your hands or feet to warm up
after a flare. Preventative care is to layer up in clothes and wear
nice warm socks and gloves.<br />
Treatment according to Mayo.com:<br /> Medications<br />
Depending
on the cause of your symptoms, medications may help treat Raynaud's. To
widen (dilate) blood vessels and promote circulation, your doctor may
prescribe:<br />
Calcium channel blockers. These drugs relax and open up
small blood vessels in your hands and feet. They decrease the frequency
and severity of attacks in most people with Raynaud's. These drugs can
also help heal skin ulcers on your fingers or toes. Examples include
nifedipine (Adalat CC, Afeditab CR, Procardia), amlodipine (Norvasc) and
felodipine (Plendil).<br /> Alpha blockers. Some people find relief with
drugs called alpha blockers, which counteract the actions of
norepinephrine, a hormone that constricts blood vessels. Examples
include prazosin (Minipress) and doxazosin (Cardura).<br /> Vasodilators.
Some doctors prescribe a vasodilator — a drug that relaxes blood vessels
— such as nitroglycerin cream to your fingers to help heal skin ulcers.
Your doctor may also prescribe vasodilator drugs that are commonly used
to treat other conditions, but may effectively relieve the symptoms of
Raynaud's. These drugs include the high blood pressure drug losartan
(Cozaar), the erectile dysfunction medication sildenafil (Viagra,
Revatio), the antidepressant medication fluoxetine (Prozac, Sarafem),
and a class of medication called prostaglandins.Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-10765569284654128232013-10-25T16:49:00.000-07:002017-06-30T17:34:31.288-07:00The Nerve of THIS NERVE-Failed Amputation-Going for Round 3!<img alt="The #NERVE of THIS NERVE; #Amputation Failed! Not giving up!" class="size-full" data-mce-src="http://butudontlooksick.files.wordpress.com/2013/10/toetwo.jpg" src="http://butudontlooksick.files.wordpress.com/2013/10/toetwo.jpg" /><br />
Yesterday
I saw my surgeon-the amputation was a fail. The darn median nerve
continues to curse my days and sleep. It went five days nonstop. Doc
gave me no less than EIGHT lidocaine shots yesterday to shut it down. By
the time he was done I couldn't feel any part of my right foot EXCEPT
THE NERVE PAIN. I mean, it practically defies nature. The other
possibility according to the million dollar nerve conduction equipment
is that there are severely damaged small to medium fiber peripheral
nerves in the skin that was used to close up the amputation.<br />
<br />
Anyway,
THIS IS WAR (as my BIL used to say)<br />
<br />
End of story is I'm going in
for another surgery. I'll let you know when it is. He's cutting the
median nerve in two new places and ripping out the skin used to cover up
where the toe is amputated and stretching what's left to use. He may
have to graft later if it doesn't take and I get a wound problem. Ah,
another risk I'm willing to take-wound problems. Like I said, "THIS IS
WAR" and I'm not backin down until this nerve is gone for good.<br />
<br />
I
know what your thinking but I'm actually very lucky to have a surgeon
willing to go thrice trying to help me. This is his last suggestion,
after that-he is outta ideas. You've got to remember I am a complicated
case with circulating immune complexes causing inflammation in my blood
vessels that press on nerves and damage them. This is my particular
present from lupus.<br />
So.......that's whats happening. :)Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-29593534146799201212013-09-17T17:33:00.000-07:002017-06-30T17:36:31.060-07:00Toe Amputated-Goodbye Neuroma! Hello Successful SSDI Hearing! Goodbye Lidocaine Overdose!<br />
<br />
<header class="entry-header"><br /><div class="comments-link">
<a href="http://butudontlooksick.wordpress.com/2013/09/15/toe-amputated-goodbye-neuroma-hello-successful-ssdi-hearing-goodbye-lidocaine-overdose/#respond" title="Comment on Toe Amputated-Goodbye Neuroma! Hello Successful SSDI Hearing! Goodbye Lidocaine Overdose!"><span class="no-reply"></span></a></div>
So much has happened! I’ll break it up in Parts. Part 1-toe
amputation. Part 2- I WON at my disability appeal hearing for SSDI.
Part 3-My favorite pain doc accidentally hit my vein with lidocaine and I
became UNRESPONSIVE! </header><header class="entry-header"> </header><span style="color: yellow;"><b>PART 1 – TOE AMPUTATION</b></span><br />
A week ago I had my 4th toe right foot amputated. It’s still wrapped
up. I have a little phantom pain-but not too much and I think it’s
just the nerve remembering-soon to forget. I had it done in the
hospital in the early afternoon and was home by 4pm!<br />
I’ll take a pic of what my foot looks like as soon as I have the bandage wrap taken off. Here is my right foot-bandage on.<br />
<div class="wp-caption alignnone" id="attachment_433" style="width: 310px;">
<a href="http://butudontlooksick.files.wordpress.com/2013/09/dsc00522.jpg"><img alt="4th toe right foot amputation for neuroma" class="size-medium wp-image-433" src="http://butudontlooksick.files.wordpress.com/2013/09/dsc00522.jpg?w=300&h=225" height="225" width="300" /></a><br />
<div class="wp-caption-text">
A little bit about Neuroma’s from feetmd.com: 4th toe right foot amputation for neuroma</div>
</div>
<div class="wp-caption alignnone" id="attachment_446" style="width: 310px;">
<a href="http://butudontlooksick.files.wordpress.com/2013/09/julietoeone.jpg"><img alt="amputated toe" class="size-medium wp-image-446" src="http://butudontlooksick.files.wordpress.com/2013/09/julietoeone.jpg?w=300&h=240" height="240" width="300" /></a><br />
<div class="wp-caption-text">
amputated toe</div>
</div>
<a href="http://butudontlooksick.files.wordpress.com/2013/09/julietoetwo.jpg"><img alt="julietoetwo" class="alignnone size-medium wp-image-447" src="http://butudontlooksick.files.wordpress.com/2013/09/julietoetwo.jpg?w=300&h=240" height="240" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/09/julietoethree.jpg"><img alt="julietoethree" class="alignnone size-medium wp-image-448" src="http://butudontlooksick.files.wordpress.com/2013/09/julietoethree.jpg?w=300&h=240" height="240" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/09/julietoefour.jpg"><img alt="julietoefour" class="alignnone size-medium wp-image-449" src="http://butudontlooksick.files.wordpress.com/2013/09/julietoefour.jpg?w=271&h=300" height="300" width="271" /></a><br />
<div id="stcpDiv">
<h2 id="mortons_neuroma">
Morton’s Neuroma</h2>
In the foot, there are the long bones (metatarsals) and thin nerves
running between them. The nerves split in a Y-shape when they reach the
toes. If the metatarsals move abnormally, they can pinch the nerve
between them, which causes inflammation and, eventually, permanent nerve
damage. Morton’s neuroma is the most common of this type and affects
the nerve between the third and fourth toes.<br />
<h3>
<a href="http://www.feetmd.com/foot-ankle-conditions/nerve-problems-pathology/mortons-neuroma" title="Morton’s Neuroma">Click here to read more about Morton’s Neuroma»</a></h3>
<h2 id="other_neuromas">
Other Neuromas</h2>
A neuroma is a painful swelling of a nerve, usually in the ball or
heel of the foot. Neuromas may occur after a nerve has been injured,
either from a traumatic wound or from damage suffered during surgery.
Symptoms include sporadic pain; burning, tingling or numbness of one or
more toes; and a popping sensation when walking. Pain is often soothed
by taking weight off the foot or by massaging the area.<br />
<h2 id="tarsal_tunnel">
Tarsal Tunnel Syndrome</h2>
Tarsal tunnel syndrome is a condition classified by chronic pain in
the ankle, foot and toes caused by abnormal pressure on nerve roots. It
is similar to carpal tunnel syndrome in the wrist and hand, but is not
as common. The specific cause of tarsal tunnel syndrome is not known,
but it can be a result of inflamed tissues around the tibial nerve,
injury or other conditions that may affect the area.<br />
<br />
The main symptom of tarsal tunnel syndrome is tingling or burning pain
while standing or walking that starts in the ankle and spreads to the
toes. Pain is usually relieved during rest. Doctors diagnose this
condition by trying to induce the tingling sensation when tapping the
nerve.<br />
Treatment for tarsal tunnel syndrome depends on the cause of the pain
but can include anti-inflammatory medication, orthotics, corticosteroid
injections or surgery. Surgery is usually used as a last resort to
relieve pressure on the nerve.<br />
<br />
<span style="color: yellow;"><i><b>I had a failed median neurectomy
July 12th and this amputation was a last resort for intractable nerve
pain. I’m 52, married 23 years and perfectly willing to take the risk
of surgery if it means less pain. Having several painful conditions,
lupus, spondyloarthritis, recurring sacroillitis, osteoarthritis, PN,
carpal, tarpal and ulnar neuropathy-this toe was the camel that broke
the camel’s back. That is why I decided on the total solution. Also
between surgeries I have to go off my lupus meds-and THAT is very
difficult. I have experienced a low grade fever almost every day, tons
of mouth and nose sores, fatigue, muscle and joint pain, worsening
anemia, etc. This was my third surgery this year. I am very positive I
made a good choice FOR ME.</b></i> <img alt=":)" class="wp-smiley" src="http://s0.wp.com/wp-includes/images/smilies/icon_smile.gif?m=1129645325g" /> </span></div>
<div>
<br />
<span style="color: orange;"><span style="text-decoration: underline;"><b>PART 2: I WON AT MY SSDI APPEAL HEARING!</b></span></span></div>
After just over three years I had my day in court for social security
disability. I WON my case. I had a wonderful lawyer who did a
tip-top job of organizing and preparing my medical files which were over
two feet high, lol! I’m still in shock! I will talk more about this
in another post where I hope I can be helpful for other people like me
with lupus who are applying for disability.<br />
<br />
Here’s the short list: One thing is to keep all your medical
records. Have a good repore with your doctors, especially your
rheumatologist and GP, neurologist if they are a big part of your case,
etc. Prepare them that you are coming to the end of your working
days-and hopefully get their support. Enough to have them fill out
paperwork for your lawyer or to write you a letter describing your
inability to work and why.<br />
<br />
If you worked and had to stop-get a letter from your previous
employers. Hopefully this letter will reflect that due to no fault of
your own you had to stop working-that your condition symptoms, doctor
appointments and medication side effects all effected your ability to
work but that while you did work you were an exemplory employee! This
is very beneficial to your case.<br />
Of course, find a lawyer who specializes in social security
disability, hopefully one that has been doing this type of work for many
years-a local attorney is always better because they have dealt with
the particular judges that you will be seeing should your case go to a
hearing. Any lawyer you do find should work on contingency-with about a
25 to 33% of your backpay reward as a fee. There is a cap at $6000, so
no worries there. If a lawyer wants to charge you upfront I would look
around for another.<br />
<br />
<div>
<span style="text-decoration: underline;"><span style="color: cyan; text-decoration: underline;"><b>PART 3-MY FAVORITE PAIN DOC HIT A VEIN BY ACCIDENT WITH LIDOCAINE DURING A PROCEDURE! BIG OOPS!</b></span></span><br />
<span style="text-decoration: underline;"><span style="color: cyan; text-decoration: underline;"><b><br /></b></span></span></div>
I was considered unresponsive! First let me say that I adore this
doctor-he has given me back quality of life with radiofrequency
ablations, cortisone and alcohol shots, and nerve blocks in addition to
effective pain management medications.<br />
<br />
I have all procedures in office and without sedation. I’m good about
that. My theory is if your there for dealing with pain, you can make
it through the procedures without being knocked out. That said, this
accident KNOCKED ME OUT COLD!<br />
<br />
I woke up in a recovery chair confused and bewildered to say the
least. One of the nurses handed me my purse and coffee cup, which I
dumped and spilled all over my lap in a dazed state. They slid the
thingy off my finger and said I was done and to go up front and wait for
my scripts. Huh? I was really out of it. I knew I was asleep but not
why..really strange feeling.<br />
<br />
As I wobbled down the hallway I looked back and my doctor half jogged
towards me. He said he accidentally got a blood vessel with the
lidocaine. I had no idea what that meant but it didn’t sound good. I
asked the one question that mattered. I said, “AM I OK?” He said
“YES”, so I continued my wobble down the hall to check out and make my
next appointment. Really dazed…<br />
<br />
Long story short when I got home I noticed I had bandages around my
wrist and that both arms were black and blue. My right wrist was black
and blue-looked a little like dirt, and my left wrist where the bandage
had been was bruised also but with puncture marks both on the wrist and
then up by the inside of my elbows.<br />
<br />
My husband called the docs office after this fiasco to find out
exactly what happened. They told him (they read it off the docs
report) that I was unresponsive and that he accidentally injected the
lidocaine into a vein. I still don’t know what that means exactly. I
know I was unconscious since the last thing I heard was “Julie, your
doing great-almost done” and then I WOKE UP in a chair. Huh? Was I
unresponsive other than unconscious? Did my heart stop? Did my
breathing stop? And WHAT DID THEY INJECT that they made all these holes
in me?<br />
<br />
Why did they not explain to me when I woke up, etc. I was expecting a
call back from my doc but he had a nurse call. I wasn’t happy about
that. She tried to make it sound like it was all normal and no big
deal. SHE wasn’t the one UNRESPONSIVE. I told her I want to know what
happened exactly. She spent her time defending why the nurses around me
when I woke up didn’t know any better since they deal with people who
are sedated waking up all the time. I recanted with the fact THAT I WAS
NOT SEDATED EVER DURING A PROCEDURE, so it certainly wasn’t normal for
me!!!!!!!<br />
<div>
Here is a pic of my wrists when I got home: <a href="http://butudontlooksick.files.wordpress.com/2013/09/dsc00510.jpg"><img alt="DSC00510" class="alignnone size-medium wp-image-439" src="http://butudontlooksick.files.wordpress.com/2013/09/dsc00510.jpg?w=300&h=225" height="225" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/09/dsc00514.jpg"><img alt="DSC00514" class="alignnone size-medium wp-image-438" src="http://butudontlooksick.files.wordpress.com/2013/09/dsc00514.jpg?w=300&h=225" height="225" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/09/dsc00515.jpg"><img alt="DSC00515" class="alignnone size-medium wp-image-437" src="http://butudontlooksick.files.wordpress.com/2013/09/dsc00515.jpg?w=300&h=225" height="225" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/09/dsc00516.jpg"><img alt="DSC00516" class="alignnone size-medium wp-image-436" src="http://butudontlooksick.files.wordpress.com/2013/09/dsc00516.jpg?w=300&h=225" height="225" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/09/dsc00517.jpg"><img alt="DSC00517" class="alignnone size-medium wp-image-435" src="http://butudontlooksick.files.wordpress.com/2013/09/dsc00517.jpg?w=300&h=225" height="225" width="300" /></a></div>
<div>
Thanks for listening! I read that lidocaine injections
accidentally in veins can cause strokes, arrested breathing, severe
hypertension, heart attacks, YIKES!<br />
<br /></div>
<div>
<i><b>About Lidocaine Accidental Intravascular Overdose from epilepsy.com</b></i>:</div>
<div>
Lidocaine hydrochloride has proconvulsant and anticonvulsant effects,
with CNS effects related to blood concentrations. Low doses (2–3 mg/kg)
can terminate <a href="http://professionals.epilepsy.com/page/local_lidocaine.html">status epilepticus</a>.<br />
<br />
With increasing blood levels, CNS symptoms and signs of toxicity
occur, from perioral numbness, lightheadedness, dizziness, tinnitus, and
fine tremors to generalized seizures and coma. In animals, lidocaine
produces <a href="http://professionals.epilepsy.com/page/local_lidocaine.html">epileptiform</a> activity that is limited to the amygdala and hippocampus.<a href="http://professionals.epilepsy.com/page/procedures_ref.html#86">86</a><br />
Lidocaine doses that are commonly used for local anesthesia can cause
CNS toxicity if they are inadvertently administered intravenously. For
example, when administering epidural anesthesia, total doses of 5–8
mg/kg are commonly injected into the epidural space.<a href="http://professionals.epilepsy.com/page/procedures_ref.html#84">84</a> Accidental intravascular injection of this dose can cause epileptic seizures.<br />
<br />
In addition to direct intravascular injection and immediate toxicity,
systemic lidocaine levels can rise to toxic levels by rapid systemic
absorption from the area of injection. This can occur 10 to 20 minutes
after injection. Anesthesiologists often add 5 mg/mL of epinephrine to
the local anesthetic to decrease systemic absorption and peak serum
lidocaine levels. When a regional anesthesia block is successful, early
reinjection of local anesthesia can cause toxicity (including seizures),
because peak absorption of the first injection occurs while additional
medication is injected.<br />
Efforts should be made to deliver minimum amounts of lidocaine to the
lower respiratory tract in airway anesthesia (e.g., for bronchoscopy),
because its pharmacokinetics at that site are similar to those with
intravenous administration.<a href="http://professionals.epilepsy.com/page/procedures_ref.html#87">87</a><br />
<br />
High doses of lidocaine cause sedation. Increasing the arterial
partial pressure of carbon dioxide (PaCO2) decreases the dose of
lidocaine needed to produce a generalized electrical seizure.<a href="http://professionals.epilepsy.com/page/procedures_ref.html#88">88</a>
Higher PaCO2 levels increase cerebral blood flow, thus increasing the
amount of anesthetic reaching the brain, and may directly excite the
amygdala. In contrast to the usual pattern, in which <a href="http://professionals.epilepsy.com/page/local_lidocaine.html">hyperventilation</a>
activates seizure activity, hyperventilation may prevent seizures from
occurring in patients with lidocaine overdose by decreasing cerebral
blood flow.<br />
<br />
Lidocaine is injected intravenously to provide local anesthesia
(intravenous regional anesthesia or Bier blocks). In this technique,
after an extremity is exsanguinated, and the blood supply is arrested by
a tourniquet, lidocaine is injected into a vein to provide anesthesia.
Doses of lidocaine up to 3 mg/kg of 0.5% solution without preservatives
or epinephrine are used. Premature tourniquet release (less than 20
minutes) can result in high systemic lidocaine levels and possible
seizure activity. Release after 20 minutes can also be associated with
toxicity. Some physicians cycle the deflation of the tourniquet with an
intermittent inflation-deflation-inflation cycle in an attempt to
decrease rapid absorption of lidocaine from the extremity.<br />
<br />
Seizures induced by lidocaine can be terminated with barbiturates.<br />
Etidocaine hydrochloride, a long-acting derivative of lidocaine, as
well as mepivacaine and prilocaine hydrochloride, share common
pharmacologic properties with lidocaine hydrochloride.<br />
Adapted from: Najjar S, Devinsky O, Rosenberg AD, et al. Procedures
in epilepsy patients. In: Ettinger AB and Devinsky O, eds. Managing
epilepsy and co-existing disorders. Boston: Butterworth-Heinemann;
2002;499–513. With permission from Elsevier (<a href="http://www.elsevier.com/" target="new">www.elsevier.com</a>).<br />
Reviewed and revised April 2004 by Steven C. Schachter, MD,<i> epilepsy.com </i>Editorial Board.<br />
This conversation is from ExpertLaw.com about the exact subject of a lidocaine overdose by vein during a pain procedure:</div>
<div>
<ol id="posts" start="1">
<li id="post_522814">
<div>
<div>
<h2>
Lidocaine Reaction</h2>
<div>
<div id="post_message_522814">
<blockquote>
Yesterday I received lidocaine as a local anesthetic
while getting a steriod epidural for bulging disc problems in lower
spine. During procedure I began to have a severe allergic reaction that
required I be taken by ambulance from the clinic to the ER. I was
released after 4 hours of observation (and benedryl), but still not
feeling very well today.<br />
The ER doc (not me) raised the possibility of an overdose, but said
he asked the doctor who adminstered the lidocaine who said I got the
right dose. I suppose there is also the chance the lidocaine was
injected directly into a vein by mistake.<br />
How do I figure out what happened and if there is any fault here? I’m
clearly not allergic to lidocaine or the steriod at normal levels since
I’ve received both many times before.</blockquote>
</div>
</div>
</div>
</div>
</li>
<li id="post_522872">
<div>
<div>
<h2>
<img alt="Default" src="http://www.expertlaw.com/forums/images/icons/icon1.png" title="Default" /> Re: Lidocaine Reaction</h2>
<div>
<div id="post_message_522872">
<blockquote>
What kind of severe allergic reaction? Cardiac or itching/swelling?<br />
You could always get a copy of your medical record since the
procedure, your reaction, and the fact that they had to call an
ambulance should be documented.</blockquote>
</div>
</div>
</div>
</div>
</li>
<li id="post_522897">
<div>
<div>
<h2>
<img alt="Default" src="http://www.expertlaw.com/forums/images/icons/icon1.png" title="Default" /> Re: Lidocaine Reaction</h2>
<div>
<div id="post_message_522897">
<blockquote>
Thank you for your response.<br />
The reaction began on the table as really bad hot flash and nausea
after the lidocaine injection. The doctor told me to hold on while he
finished the ESI. It got worse when I got up.<br />
After moving to a chair post-procedure, symptoms of strong dull pain
in chest/upper body and difficulty breathing began, and continued to get
worse. Doctor initially said this was “normal” and would go away in 10
minutes or so. My BP was high and O2 level was low (based on the finger
clamp thing?). When it didn’t go away, I was moved to a laying position,
and after another 10 minutes, the uncontrollable, severe shaking
started. I think that’s when they called an ambulance and took me to the
hospital.<br />
In the ambulance they gave me a IV dose of benedryl. I also had tingling/itchy hands and blotchy skin.<br />
After getting to hospital, shaking and chest pain stopped and breathing seemed to return to normal.<br />
Also, isn’t the fact that they are billing my insurance company for the ambulance documentation enough that I needed that?</blockquote>
</div>
</div>
</div>
</div>
</li>
<li id="post_522905">
<div>
<div>
<h2>
<img alt="Default" src="http://www.expertlaw.com/forums/images/icons/icon1.png" title="Default" /> Re: Lidocaine Reaction</h2>
<div>
<div id="post_message_522905">
<blockquote>
First, the informed consent you signed before the
procedure listed the side effects/risks of the epidural, as well as the
medications given during the procedure.<br />
The fact that you did not have a previous reaction to Lidocaine
doesn’t mean you’ll never have a reaction to it. It also does not mean
the reaction you had was necessarily caused by Lidocaine.<br />
The ambulance company billing your insurance is not he kind of
documentation you need. You’ll need a copy of the office notes from the
procedure, which should contain notation of your reaction and the fact
that 911 was necessary. You’ll also need a copy of the hospital ER
record.</blockquote>
</div>
</div>
</div>
</div>
</li>
<li id="post_522953">
<div>
<div>
<h2>
<img alt="Default" src="http://www.expertlaw.com/forums/images/icons/icon1.png" title="Default" /> Re: Lidocaine Reaction</h2>
<div>
<div id="post_message_522953">
<blockquote>
Thanks. I guess one final question, and I don’t mean this
to sound cavalier. If I signed the informed consent assuming all
responsibility and risks, why do I “need” a copy of anything at this
point?</blockquote>
</div>
</div>
</div>
</div>
</li>
<li id="post_523018">
<div>
<div>
<h2>
<img alt="Default" src="http://www.expertlaw.com/forums/images/icons/icon1.png" title="Default" /> Re: Lidocaine Reaction</h2>
<div>
<div id="post_message_523018">
<blockquote>
You originally asked:<br />
<div>
<div>
<div>
How do I figure out what happened and if there is any fault here?</div>
</div>
</div>
The answer <i><b>may</b></i> be in your medical record.</blockquote>
</div>
</div>
</div>
</div>
<div>
<div>
<div>
Thanks. I guess one final question, and I don’t mean this to sound
cavalier. If I signed the informed consent assuming all responsibility
and risks, why do I “need” a copy of anything at this point?</div>
</div>
</div>
</li>
<li id="post_523025">
<div>
<div>
<div>
<div id="post_message_523025">
<blockquote>
you don’t assume all responsibility nor waive all rights
to seek redress. You signed consent based on known risks and
complications. That doesn’t mean if a doctor is negligent you have no
redress available (not suggesting there were in this case, simply as
explanation of what would not be waived by your consent form)</blockquote>
<blockquote>
THANKS FOR LISTENING EVERYONE! ((((((((HUGS)))))))) Julie</blockquote>
</div>
</div>
</div>
</div>
</li>
</ol>
</div>
Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-33680598126679219602013-08-08T14:31:00.000-07:002017-06-30T17:37:36.620-07:00Reactive Arthritis-WHAT? “React THIS-Arthritis”!For me it took 3 bouts of sacroillitis (one was VERY bad-oy vay-
couldn't walk, sleep, lay) that comes accompanied with it's pal uveitis
and pinkeye. <br />
<br />
My rheumatologist calls with the results of my
genetic testing-the gene HLA-B27 locked up the dx after the MRI of lower
lumbar and si joint showed inflammation only and no bone fusing-had
there been bone fusing a diagnosis of anklylosing spondylitis would have
been appropriate. Thank goodness it wasn't that-well isn't so far- My
grandmother had AS and she was in great pain and hunched over. She
also had undiagnosed lupus, which attacked her nerves, blood and skin
the most-just like ME. <br />
<br />
The pain radiating
on one side above my butt and under lower back-now known as the si
joint is warm to the touch, swollen looking and varies in intensity when
it acts up and is painful. At it's worst I would not hesitate to
clobber ya for getting in touching distance, lol. Sometimes it's one
side, sometimes its both and last December, the worst flare I ever had
with it, it was both, it also included the pelvic area and I could not
MOVE without pain. Its horrendous. It comes with uveitis and/or
pinkeye. And what the two have to do with each other, BEATS ME! But
here's the idea the doctors have:<br />
<br />
<h3>
Fast facts</h3>
<ul>
<li>Reactive arthritis can affect the heels, toes, fingers, low back, and joints, especially of the knees or ankles.</li>
<li>The
infection that causes reactive arthritis usually presents (shows up) as
diarrhea or as a sexually transmitted disease. But, it can have no
symptoms (called asymptomatic).</li>
<li>Though it often goes away on its own, reactive arthritis can be prolonged and severe enough to require seeing a specialist.</li>
</ul>
<div>
My eyes with uveitis and scleritis. Not fun.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjF1xk-fVo2UafdTMaYwn8DUe-vnrjt2HRtXs9uJYB8TWSAHW_g2OOm0IKkkd6Khtw1cLPBHh9CgmTulWW3ozY4hDglzkpmfg0XV8U2f02u1LnKbfKzEgF2J26a8AJXSaf79HkpVfkR2D8/s1600/julieeyes.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjF1xk-fVo2UafdTMaYwn8DUe-vnrjt2HRtXs9uJYB8TWSAHW_g2OOm0IKkkd6Khtw1cLPBHh9CgmTulWW3ozY4hDglzkpmfg0XV8U2f02u1LnKbfKzEgF2J26a8AJXSaf79HkpVfkR2D8/s320/julieeyes.jpg" width="240" /></a></div>
<br /></div>
<h3>
What is reactive arthritis?</h3>
Reactive
arthritis is a painful form of inflammatory arthritis (joint disease
due to inflammation). It occurs in reaction to an infection by certain
bacteria. Most often, these bacteria are in the genitals (Chlamydia
trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and
Yersinia). Chlamydia most often transmits by sex. It often has no
symptoms, but can cause a pus-like or watery discharge from the
genitals. The bowel bacteria can cause diarrhea.<br />
Reactive arthritis can have any or all of these features:<br />
<ul>
<li>Pain and swelling of certain joints, often the knees and/or ankles</li>
<li>Swelling and pain at the heels</li>
<li>Extensive swelling of the toes or fingers</li>
<li>Persistent low back pain, which tends to be worse at night or in the morning</li>
</ul>
Some
patients with this type of arthritis also have eye redness and
irritation. Still other signs and symptoms include burning with
urination and a rash on the palms or the soles of the feet.<br />
<h3>
What causes reactive arthritis?</h3>
The bacteria induce (cause) arthritis by distorting your body's defense against infections, as well as your genetic environment.<br />
How
exactly each of these factors plays a role in the disease likely varies
from patient to patient. This is a focus of research.<br />
<h3>
Who gets reactive arthritis?</h3>
The
bacteria that cause reactive arthritis are very common. In theory,
anyone who becomes infected with these germs might develop reactive
arthritis. Yet very few people with bacterial diarrhea actually go on to
have serious reactive arthritis. <br />
<b>Musculoskeletal</b><br />
Signs and symptoms that affect your bones and muscles may include:<br />
<ul>
<li>Joint pain, usually in your knees, ankles and feet</li>
<li>Heel pain</li>
<li>Pain and swelling at the back of your ankle</li>
<li>Swollen toes or fingers, which may look like sausages</li>
<li>Pain in your low back or buttocks</li>
</ul>
<b>Reproductive and urinary<br /> </b>Possible signs and symptoms of your reproductive and urinary systems include:<br />
<ul>
<li>Pain or burning during urination</li>
<li>Increased frequency of urination</li>
<li>Inflammation of the prostate gland (prostatitis)</li>
<li>Inflammation of the cervix (cervicitis)</li>
</ul>
<b>Eyes, mouth and skin<br /> </b>Signs and symptoms that affect your eyes, mouth and skin may include:<br />
<ul>
<li>Eye inflammation (conjunctivitis)</li>
<li>Inflammation of your inner eye (uveitis)</li>
<li>Mouth ulcers</li>
<li>Skin rashes</li>
</ul>
Reactive
arthritis develops in reaction to an infection in another part of your
body, often in your intestines, genitals or urinary tract. You may not
be aware of the triggering infection because it may cause only mild
symptoms or none at all.<br />
Numerous bacteria can cause reactive arthritis. The most common ones include:<br />
<ul>
<li>Chlamydia</li>
<li>Salmonella</li>
<li>Shigella</li>
<li>Yersinia</li>
<li>Campylobacter</li>
</ul>
Reactive
arthritis isn't contagious. However, the bacteria that cause it can be
transmitted sexually or in contaminated food. But only a few of the
people who are exposed to these bacteria develop reactive arthritis.<br />
Also called Reiter's Syndrome-here is more info:<br />
<a data-mce-href="https://www.mayoclinic.com/health/reactive-arthritis/DS00486" href="https://www.mayoclinic.com/health/reactive-arthritis/DS00486" target="_blank" title="Reactive Arthritis from Mayo Clinic">https://www.mayoclinic.com/health/reactive-arthritis/DS00486</a><br />
<a data-mce-href="http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Reactive_Arthritis/" href="http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Reactive_Arthritis/" target="_blank" title="Reactive Arthritis from ACR">http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Reactive_Arthritis/</a><br />
<br data-mce-bogus="1" />
Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com1tag:blogger.com,1999:blog-4316526137866390150.post-36071083914511747892013-07-23T08:23:00.001-07:002017-06-30T17:37:59.196-07:00for·ti·tude<h3>
/ˈfôrtiˌto͞od/</h3>
<div>
Noun</div>
Courage in pain or adversity: “she endured her illness with great fortitude”.<br />
<br />
<span style="color: #ac193d; font-family: "calibri"; font-size: medium;"><b>I
was writing an email to my father and out popped the word “fortitude”.
“Wish I had the fortitude” I wrote. I know what it means but I looked
it up anyway. Its definition pops out AT ME. (see above) And I can’t
help thinking it’s not a coincidence. I’m not enduring my illness with
any for·ti·tude at all and I should be. I am more of an unorganized
mess-lately hit with that dreaded brain fog forgetting what I’m doing
and what I’m saying, names, places, faces, details. Not enough of a
help to <b>my family</b>. I need to step up higher. <b>My husband</b> is tired. <b>My son</b> needs my help. </b></span><br />
<br />
Disability hearing is coming up in September. The board of education
kicked back my dismissed Sallie Mae school loans because my GP is a
DO. Go figure. Alot going on and alot coming up. My foot surgery
seems failed and I will likely need two more, one to kill the other side
of the nerve and one to take the toe. The familiar pain has returned
along with my unsettledness & has run off with my for·ti·tude.<br />
Tomorrow is another day. Tally Ho!Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-86171033439795466252013-07-21T00:07:00.002-07:002017-06-30T17:40:06.746-07:00The EYES have it! Uveitis, that is!<br />
<header class="entry-header">
ps. Does the inflammation highway ever run out of track? I don’t
think so! Todays stop boys and girls will be recurring anterior
uveitis. You-vee itis? Me-vee-itis? We all you-me-itis!
</header>This is my second round of pretty bad uveitis-bad enough for the men
in white to give me an iv of steroids and a shot in the eyes of the
same. YES, I said a Shot In The Eyes.<br />
My last bout-December 2012 came accompanied with sacroiliitis, alias
inflammatory arthritis, alias “are you kidding me” kind of pain. So far
it’s starting about the same. While uveitis can come to the
inflammation party on its own-there are alot of conditions that also can
cause it. In my case docs just blamed the L-Word although my
grandmother had ankylosing spondylitis-and she may have set a genetic
trap for me. lol. There’s a genetic marker-it is called HLA-B27 tissue
type and testing is appropriate if you have both sacroiliitis and
chronic recurring <em>anterior uveitis</em>.<br />
Here’s what to look for in the inflammation of the eye: <a href="http://butudontlooksick.files.wordpress.com/2013/07/uveitispic.jpg"><img alt="uveitispic" class="alignnone size-medium wp-image-392" src="http://butudontlooksick.files.wordpress.com/2013/07/uveitispic.jpg?w=300&h=194" height="194" width="300" /></a><br />
And here’s my eyes: <a href="http://butudontlooksick.files.wordpress.com/2013/07/juliejuly.jpg"><img alt="juliejuly" class="alignnone size-medium wp-image-393" src="http://butudontlooksick.files.wordpress.com/2013/07/juliejuly.jpg?w=300&h=225" height="225" width="300" /></a> <a href="http://butudontlooksick.files.wordpress.com/2013/07/juliemalarjuly2013.jpg"><img alt="'juliemalarjuly2013" class="alignnone size-medium wp-image-396" src="http://butudontlooksick.files.wordpress.com/2013/07/juliemalarjuly2013.jpg?w=300&h=240" height="240" width="300" /></a><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2OyS5N0OA7hAsTsYXHyePVuFYWcKothQKeSHh1Wn7JXCEcdHkt0OaZnINYUyhhdkRWG6d00fLBq8rPfYeDHaj48G7CVAOged3mubxC8WyyMmKI_jRqxO9P0CXErkQm1E8VoQVqWkLFNo/s1600/julieeyes.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2OyS5N0OA7hAsTsYXHyePVuFYWcKothQKeSHh1Wn7JXCEcdHkt0OaZnINYUyhhdkRWG6d00fLBq8rPfYeDHaj48G7CVAOged3mubxC8WyyMmKI_jRqxO9P0CXErkQm1E8VoQVqWkLFNo/s320/julieeyes.jpg" width="240" /></a></div>
<br />
Of course the uveitis highjacked a malar rash and low grade fever on
it’s way to rain on my surgery recovery parade. Just when I thought it
was safe to start dibbling and dabbling with projects and posts. It’s
getting better now by leaps and bounds thanks to the evil but wonderful
prednisone and steroid drops. All the white floaters are gone (I CAN
SEE AGAIN) and the pressure and inflammatory pain is down! Yippeee! I
don’t know about you-but lupus might be the great imitator-however I am
the great procrastinator-and that trumps lupus. <img alt=";)" class="wp-smiley" src="http://s1.wp.com/wp-includes/images/smilies/icon_wink.gif?m=1129645325g" /> <br />
Here is some info about Uveitis (there is more than one kind) and
also while playing around I found a new medicine in trial stages for eye
inflammation. This is potentially sight-saving. And
unfortunately-once lupus stops at the door of the eyes, it comes back
often to the party.<br />
From Mayo.com:<br />
The signs, symptoms and characteristics of uveitis include:<br />
<ul>
<li>Eye redness</li>
<li>Eye pain</li>
<li>Light sensitivity</li>
<li>Blurred vision</li>
<li>Dark, floating spots in your field of vision (floaters)</li>
<li>Decreased vision</li>
<li>Whitish area (hypopyon) inside the eye in front of the lower part of the colored area of the eye (iris)</li>
</ul>
The site of uveitis varies and is described by where in the eye it occurs.<br />
<ul>
<li>Anterior uveitis affects the front of your eye (also called iritis).</li>
<li>Posterior uveitis affects the back of your eye (also called choroiditis).</li>
<li>Intermediary uveitis affects the ciliary body (also called cyclitis).</li>
<li>Panuveitis occurs when all layers of the uvea are inflamed.</li>
</ul>
In any of these conditions, the jelly-like material in the center of
your eye (vitreous) can also become inflamed and infiltrated with
inflammatory cells.<br />
Symptoms may occur suddenly and get worse quickly, though in some
cases, symptoms develop gradually. Symptoms may be noticeable in one or
both eyes.<br />
<strong>When to see a doctor</strong><br />
Contact your doctor if you think you may have symptoms of uveitis. Your
doctor may refer you to an eye specialist (ophthalmologist). If you’re
having significant eye pain and new vision problems, seek prompt medical
attention.<br />
If uveitis is caused by an underlying condition, treatment will focus
on that specific condition. The goal of treatment is to reduce the
inflammation in your eye.<br />
Treatment of uveitis may include:<br />
<ul>
<li><strong>Anti-inflammatory medication.</strong> Your doctor may
prescribe anti-inflammatory medication, such as a corticosteroid, to
treat your uveitis. This medication may be given as eyedrops. Or, you
may be given corticosteroid pills or an injection into the eye. For
people with difficult-to-treat posterior uveitis, a device that’s
implanted in your eye may be an option. This device slowly releases
corticosteroid medication into your eye for about 2 1/2 years.</li>
<li><strong>Antibiotic or antiviral medication.</strong> If uveitis is
caused by an infection, antibiotics, antiviral medications or other
medicines may be given with or without corticosteroids to bring the
infection under control.</li>
<li><strong>Immunosuppressive or cell-destroying (cytotoxic) medication.</strong>
Immunosuppressive or cytotoxic agents may be necessary if your uveitis
doesn’t respond well to corticosteroids or becomes severe enough to
threaten your vision.</li>
<li><strong>Surgery.</strong> Vitrectomy — surgery to remove some of the
jelly-like material in your eye (vitreous) — may be necessary both for
diagnosis and management of your uveitis. A small sample of the vitreous
can help identify a specific cause of eye inflammation, such as a
virus, bacterium or lymphoma. The procedure may also be used to remove
developing scar tissue in the vitreous.</li>
</ul>
The part of your eye affected by uveitis — either the front
(anterior) or back (posterior) of the uvea — may determine how quickly
your eye heals. Uveitis affecting the back of your eye tends to heal
more slowly than uveitis in the front of the eye. Severe inflammation
takes longer to clear up than mild inflammation does.<br />
Uveitis can come back. Make an appointment with your doctor if any of your symptoms reappear after successful treatment.<br />
<br />
<h1 id="headline">
<strong>Eye Disease: Preliminary Findings On Uveitis Drug</strong></h1>
<a href="http://www.sciencedaily.com/releases/2012/08/120822100809.htm" target="_blank" title="Link to Clinical Trials for NEW Uveitis Medication!">Aug.
22, 2012 — Shree Kurup, M.D., director of research in the ophthalmology
department at Wake Forest Baptist Medical Center, will present the
preliminary findings of a Phase 3 clinical trial on a new drug for the
treatment of uveitis, a serious inflammatory condition of the uvea, the
middle layer of the eye that provides most of the blood supply to the
retina.</a><br />
<a href="http://www.sciencedaily.com/releases/2012/08/120822100809.htm" target="_blank" title="Link to Clinical Trials for NEW Uveitis Medication!">Link to Clinical Trials for NEW uveitis medication! </a>Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-23421255040581323602013-07-15T12:42:00.000-07:002013-07-15T12:42:13.151-07:00L for LUPUS, N for Neurectomy & No More Pain??<a data-mce-href="http://butudontlooksick.files.wordpress.com/2013/07/juliehospital.jpg" href="http://butudontlooksick.files.wordpress.com/2013/07/juliehospital.jpg"><img alt="juliehospital" class="alignnone size-medium wp-image-387" data-mce-src="http://butudontlooksick.files.wordpress.com/2013/07/juliehospital.jpg?w=300" height="258" src="http://butudontlooksick.files.wordpress.com/2013/07/juliehospital.jpg?w=300" width="300" /></a>I
had what is called a median nerve neurectomy. My orthopedic surgeon
snipped the median nerve in my right foot that leads to the bottom of
the fourth toe (on the left side of the toe) with the hopes and
intentions of killing the nerve dead! That toe has certainly been the
bane of my existence for the last five years. Sometimes something so
small can turn into something so big and painful. They call it a
Morton's Neuroma. Likely mine was caused by inflammation in the
connective tissue of my feet-plantar fasciitis. At one time my PF was
so bad I couldn't walk. Cortisone shots right into the plantar gave me
back my mobility but the shots into that toe and median nerve stopped
working and the zapping and stinging and sharp pains continued. <br />
<br data-mce-bogus="1" />
I
was lucky. I found an orthopedic surgeon that specializes in FEET. He
went in through the top of the foot and snipped the median nerve right
down the middle to the back of the fourth toe right foot. Here's a
better explanation of what a Morton's Neuroma is and a short video
animation I found.<br />
Lupus is different in
every patient. Mine likes to attack my peripheral and cranial nerves,
skin and blood. This is just one example of what lupus can do.<br />
<br data-mce-bogus="1" />
<em>From myfootshop.com: </em><br />
<div align="left">
Morton's
Neuroma is a painful condition of the forefoot that is caused by the
entrapment of the common intermetatarsal nerve as it passes through the
forefoot to the toes. This condition was first described by Dr. Morton, a
Viennese physician, in 1876. The most common location for Morton's
neuroma is between the third and fourth toes. The second most common
location is between the second and third toes.</div>
<div align="left">
<br /></div>
<div align="left">
To
help understand this condition a bit better, let's break down the word
neuroma into its' root form. Neuro relates to the nervous system and in
this case, we are describing a portion of the peripheral nervous system.
The suffix 'oma' is the Latin term that defines a tumor or swelling
that is of primary origin. Put the terms together and what is described
is a tumor or swelling of a peripheral nerve. Interestingly, a Morton's
neuroma is not truly a tumor, but more accurately, a nerve entrapment.
Although the term neuroma is somewhat inaccurate in describing this
condition, the term neuroma is still used today to describe this unique
nerve entrapment. Other terms may be used to describe Morton's
neuroma. These terms include intermetatarsal neuroma, Morton's
metatarsalgia, Morton's neuralgia, plantar neuroma, intermetatarsal
perineural fibroma or intermetatarsal nerve entrapment. </div>
<div align="left">
<br /></div>
<div align="left">
What
causes Morton's Neuroma? Why does the intermetatarsal nerve become
entrapped? Clinicians and surgeons recognize a number of factors that
may aggravate Morton's neuroma, but the primary cause of Morton's
neuroma remains elusive. Shoes that are tight in the forefoot will
contribute to the symptoms of Morton's Neuroma by binding the forefoot
and compressing the common intermetatarsal nerve. High heels will also
act to increase the ground reactive forces. Ground reactive force is the
amount of force generated as the foot pushes against a fixed surface
like the floor. With high heels, the amount and focus of ground reactive
force increases since weight bearing is focused in a smaller area (just
the forefoot). A higher heel also puts the common intermetatarsal nerve
under tension, making it more prone to injury. Activities such as
squatting will increase the ground reactive force applied to the plantar
foot and aggravate the symptoms of Morton's neuroma. And finally,
clinician also agree that hypermobility of the forefoot can contribute
to the formation of Morton's neuroma.</div>
<div align="left">
<br /></div>
<div align="left">
<span data-mce-style="font-size: large;" style="font-size: medium;">Treatment of Morton's neuroma</span></div>
<div align="left">
It's
interesting to note that until the early 1990's, we treated Morton's
neuroma in same way as described by Dr. Morton some 100 years ago. But
over the past ten years, our understanding and treatment of neuromas has
changed dramatically. Our understanding of Morton's neuroma as an
entrapment and not a tumor can be attributed to the work of Steve
Barrett, DPM. Dr. Barrett was the first to take a critical look at
Morton's neuroma and describe it as an entrapment rather than a tumor.</div>
<div align="left">
<br /></div>
<div align="left">
What
Dr. Barrett recognized was that the common intermetatarsal nerve is
sometimes prone to becoming entrapped as it passes beneath the
intermetatarsal ligament. This was a new concept for us in light of the
fact that we had considered Morton's neuroma a tumor. In fact, Dr.
Barrett's findings enabled us to recognize Morton's Neuroma to be
similar to other nerve entrapments such as carpal tunnel syndrome or
tarsal tunnel syndrome. Subsequently, the treatment of Morton's Neuroma
has been slowly changing over the last ten years as the result of a new
endoscopic surgical procedure first described by Dr. Barrett.</div>
<div align="left">
<br /></div>
<div align="left">
Diagnostic
testing to evaluate Morton's neuroma includes plain x-rays, diagnostic
ultrasound and MRI. Plain x-rays are not actually used to visualize the
nerve, but are use rather to screen for bone and joint pathology
adjacent to the nerve. Metatarsal fractures, Freiberg's infraction and
osteoarthritis are common conditions that can influence the behavior of
Morton's neuroma and need to be evaluated with x-ray.</div>
<div align="left">
<br /></div>
<div align="left">
Several
authors have suggested that the efficacy of MRI and ultrasound as
diagnostic tools are comparable when evaluating patients for Morton's
neuroma. Diagnostic ultrasound is significantly less expensive and much
more readily available compared to MRI. Kankanala et. al described a
91.48% pre-op predictive value for diagnostic ultrasound when screening
for Morton's neuroma.</div>
<div align="left">
<br /></div>
<div align="left">
Conservative care of Morton's
neuroma can be quite successful. 70% or more of new Morton's neuroma
patients respond to simple changes in shoes such as a wider toe box.
Shoe padding can also help treat Morton's neuroma. <a data-mce-href="http://www.myfootshop.com/detail.asp?ProductID=729" href="http://www.myfootshop.com/detail.asp?ProductID=729">Metatarsal pads</a>
are an important tool for patients with Morton's neuroma symptoms. A
metatarsal pad is a small lift that is positioned in the shoe just
proximal (behind) the weight bearing surface of the metatarsal bones. A
metatarsal pad lifts and separates the metatarsal bones thereby
decreasing the pressure on the intermetatarsal nerve. Some <a data-mce-href="http://www.myfootshop.com/detail.asp?ProductID=797" href="http://www.myfootshop.com/detail.asp?ProductID=797">prefabricated arch supports</a>
come with a metatarsal pad already seated in the correct position.
Using inserts with a metatarsal pad is sometimes the easier way to use a
met pad because they can be easily moved from shoe to shoe. Also, by
using an <a data-mce-href="http://www.myfootshop.com/SearchResults_simple.asp?Method=pKeyword&Value=pedag" href="http://www.myfootshop.com/SearchResults_simple.asp?Method=pKeyword&Value=pedag">insert with a fixed metatarsal pad</a>, the position of the met pad is always in the correct location.</div>
<div align="left">
<br /></div>
<div align="left">
Other
non-surgical methods of treating Morton's neuroma include injectable
cortisone and chemical sclerosis of the intermetatarsal nerve. Cortisone
has been used successfully for years in treating Morton's neuroma.
Although the use of cortisone does not actually treat or change the
entrapment of the intermetatarsal nerve, cortisone can decrease
inflammation and swelling of the nerve, resulting in a decrease in pain.
Care should be exercised when using cortisone injections noting that
excessive cortisone injections can thin the plantar fat pad of the foot.</div>
<div align="left">
<br /></div>
<div align="left">
Sclerosis
of the nerve (also called chemical neuro-ablation or chemical
neurolysis) can be performed in the office using a number of different
solutions, most commonly dilute (4%) alcohol. Multiple sclerosing
injections are used to destroy the contents of the peripheral nerve. A
series of injections are employed, each injection separated by a period
of 7-10 days. The total number of injections may vary from 3 to 7. The
success rates of injectable sclerosing solutions have been reported to
be as high as 60-90%. Chemical neurolysis is also a great tool for
failed neuroma surgeries where a stump neuroma has formed.</div>
<div align="left">
<br /></div>
<div align="left">
The
intent of chemical neurolysis is to destroy the internal contents while
preserving the external sheath of the nerve. This would be a bit like
removing the copper wire in an electrical wire while preserving the
plastic outer insulation or cover of the wire. The reason that this is
important is due to the fact that peripheral nerve will regenerate over
time. With the nerve sheath intact, regeneration of the nerve is
possible in a controlled manner utilizing the existing sheath. By
contrast, removal of the nerve by surgery results in the nerve
regenerating and the formation of a mass of scar tissue called a stump
neuroma. Knowing that peripheral nerve may regenerate also means that
sclerosing injections may need to be repeated at some point in the
future. The percentage of repeat sclerosing injections varies but is
overall quite low.</div>
<div align="left">
<br /></div>
<div align="left">
Another new technique used to
treat Morton's neuroma is called cryogenic neuroablation. Cryo surgery
is surgery that uses extremely cold instrumentation to selectively
destroy tissue. Cryosurgery has been used commonly to destroy
superficial skin lesions such as warts and moles. The technique uses
what is referred to as the Joule-Thompson effect. The Joule-Thompson
effect occurs when a gas is passed through an area where it may expand.
As the gas expands, it cools to approximately -70 degrees centigrade .
In the case of cryogenic neuroablation, the expansion of the gas is
controlled in a 5.5 mm probe that freezes and subsequently destroys the
nerve tissue.</div>
<div align="left">
<br /></div>
<div align="left">
In the cryogenic ablation study carried
out by Drs. Caporusso, Fallet and Savoy-Moore, thirty one neuromas were
treated in 20 patients. All procedures were performed in an office
setting. The procedure used a small amount of local anesthetic to numb
the skin to allow the passage of a 12-gauge cannula through the skin. A
nerve stimulator was passed through the cannula to locate the nerve.
Once the position of the nerve was established, two three minute freeze
sessions were utilized to destroy the nerve tissue. A sterile dressing
was applied to the site and the patient was dismissed without the need
for pain medication. The study cites a 65% success rate.</div>
<div align="left">
<br /></div>
<div align="left">
Dr.
Morton's original treatment plan as described in 1876 included changes
in shoes, multiple injections of cortisone and if necessary, complete
excision of the common intermetatarsal nerve. We've mentioned before
that Morton's neuroma is a nerve entrapment much like carpal tunnel. Now
let's see if we can apply Dr. Morton's treatment plan to any other
nerve entrapment such as carpal tunnel syndrome. Perhaps we'd splint the
wrist, try some injectable cortisone, but completely excise the nerve?
No way. But that's what's been done for the past 100 years for Morton's
Neuroma. Post-op complications were common and included thinning of the
plantar fat pad and loss of sensation in the 3rd and 4th toes.</div>
<div align="left">
<br /></div>
<div align="left">
The
introduction of Dr. Barrett's EDIN procedure has revolutionized the
treatment of Morton's Neuroma and really represents the first unique
contribution to treating this condition in over 100 years. The EDIN
procedure stands for endoscopic decompression of the common
intermetatarsal nerve. Interestingly enough, Steve describes first
thinking about this procedure as he watched another surgeon perform an
endoscopic carpal tunnel surgery. Steve recognized the problem to be the
ligament and not the nerve. The EDIN procedure selectively releases the
ligament and leaves the nerve intact.</div>
<div align="left">
<br /></div>
<div align="left">
The EDIN
procedure provides us with a new alternative. In the past we knew that
the traditional surgery used to treat Morton's Neuroma, called a
neurectomy, was destructive and carried with it a number of post-op
complications. Therefore, we would tend to use excessive amounts of
cortisone to avoid surgery. The EDIN procedure provides a new
alternative using non-invasive endoscopic techniques that usually return
patients to activities much sooner than the traditional surgery. And,
what I find most helpful is the fact that it enables us to use less
cortisone, thereby avoiding fat pad atrophy. The question remains; was
the common complication of fat pad atrophy due to the neurectomy itself
or did it result from the overuse of cortisone? The EDIN procedure shows
none of the traditional post-op complications that were so commonly
seen in the neurectomy, therefore we can assume that fat pad atrophy was
in part due to overuse of cortisone.</div>
<div align="left">
The EDIN
procedure has been used for at least ten years and has shown promising
results. It can be technically challenging for some who are not familiar
with endoscopic techniques. As with other surgical procedures there are
pros, cons and possible complication that need to be discussed
thoroughly with your physician prior to surgery. The following pictures
show the technique used to perform an EDIN procedure. Image 1 shows
pre-operative markings identifying the 3rd and 4th metatarsal heads.
Image 2 shows placement of the cannula through an interdigital incision.
The cannula is much like a small 4mm drinking straw with a slot cut in
one side. The slot or open side of the cannula is placed adjacent to the
intermetatarsal ligament. The cannula passes from between the toes to a
second incision on the plantar aspect of the foot just proximal to the
weight bearing surface. The endoscope and knife are used within the
slotted cannula to identify and transect the intermetatarsal ligament.
Image 3 show the use of a blunt probe without the cannula to verify a
complete release of the intermetatarsal ligament. In the bottom of image
3, a metatarsal spreader can be seen. The spreader is used to separate
the 3rd and 4th metatarsals subsequently putting pressure on the
intermetatarsal ligament. The procedure takes about 20 minutes and is
completed in a hospital or surgery center. Local anesthesia with
sedation is used. Patients return to regular shoes in two days with just
a band-aid on the incisions.</div>
<div align="left">
<a data-mce-href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN1_mod.jpg" href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN1_mod.jpg"> <img alt="EDIN_procedure_for_Morton's_neuroma_image1" border="2" data-mce-src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN1_mod_small.jpg" src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN1_mod_small.jpg" /></a> <a data-mce-href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN2_mod.jpg" href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN2_mod.jpg"> <img alt="EDIN_procedure_for_Morton's_neuroma_image2" border="2" data-mce-src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN2_mod_small.jpg" src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN2_mod_small.jpg" /></a> <a data-mce-href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN3_mod.jpg" href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN3_mod.jpg"> <img alt="EDIN_procedure_for_Morton's_neuroma_image3" border="2" data-mce-src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN3_mod_small.jpg" src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN3_mod_small.jpg" /></a> <a data-mce-href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN_scope_mod.jpg" href="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN_scope_mod.jpg"> <img alt="EDIN_procedure_for_Morton's_neuroma_image4" border="2" data-mce-src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN_scope_mod_small.jpg" src="http://www.myfootshop.com/images/medical/Surgery/EDIN/EDIN_scope_mod_small.jpg" /></a></div>
<div align="left">
Traditional
neurectomy, or removal of the nerve for the treatment of Morton's
neuroma, is used less often due to the success of sclerosing injections
and the EDIN procedure. Neurectomy can be performed from a dorsal or
plantar approach. The advantage of a dorsal approach is that patients
are able to walk immediately following the surgery. The disadvantage of
the dorsal approach is that it requires more dissections and possible
tissue trauma. The plantar approach results in less tissue trauma but
requires that patients are non-weight bearing on the surgery foot for 3
weeks post-op. Traditional neurectomy for the treatment of Morton's
neuroma is performed on an out-patient basis at a surgery center or
hospital using a local or general anesthetic. The procedure is
completed in less than 30 minutes.</div>
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from youtube: <a data-mce-href="http://iframewidth=560height=315src=//www.youtube.com/embed/tEreq6F3EoYframeborder=0allowfullscreen/iframe" href="http://iframewidth=560height=315src=//www.youtube.com/embed/tEreq6F3EoYframeborder=0allowfullscreen/iframe"><img class="mceItemMedia mceItemIframe" data-mce-json="{'video':{},'params':{'src':'//www.youtube.com/embed/tEreq6F3EoY','frameborder':'0','allowfullscreen':''},'hspace':null,'vspace':null,'align':null,'bgcolor':null}" height="315" src="http://butudontlooksick.wordpress.com/wp-includes/js/tinymce/themes/advanced/img/trans.gif" width="560" /></a></div>
Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-57322879884261525662013-06-27T22:58:00.003-07:002013-06-27T22:59:15.094-07:00Lupus Rash is Back!<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-yiF7dnxEe2I/Uc0mAfL9lsI/AAAAAAAAA14/XuwRS5dE4ww/s640/juliehealingjune2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://4.bp.blogspot.com/-yiF7dnxEe2I/Uc0mAfL9lsI/AAAAAAAAA14/XuwRS5dE4ww/s320/juliehealingjune2013.jpg" width="320" /></a></div>
Ouch! Itchy Lupus Rash! Just another lupus rash-this one on my chest. This rash is a necrotizing type, deep endometrial lesion. I use betamethazone cream to heal. This type of lupus rash typically takes about a week to 10 days to heal and leaves skin discoloration. You can check out my rashes page for more rashes-different kinds. All from lupus. ;) <br />
<br />Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-91360419327354414122013-06-15T14:50:00.000-07:002013-06-15T14:50:22.067-07:00The Calm Before the Storm-Amputating my bad TOE with Lupus<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-ZCh9tJLUPks/UbzhZmNlmMI/AAAAAAAAA0c/lLzINfvosq8/s1600/calm+before+storm.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-ZCh9tJLUPks/UbzhZmNlmMI/AAAAAAAAA0c/lLzINfvosq8/s1600/calm+before+storm.jpg" /></a></div>
The toe must go!<br />
<br />
I finally found a surgeon (orthopedic) to go in and obliterate my
neuroma under the 4th toe right foot. He suspects its a stump neuroma
with a damaged/entrapped nerve. I have given him permission to cut the
nerve, remove the nerve and if necessary amputate the toe!<br />
<br />
What do I need that toe for anyway? It’s the thorn in my side, the
cause of a massive amount of pain (it comes in flares). I’m the lion
with the thorn and he is going to remove the thorn. I am so so
thrilled! Yipppppeeeeeeee!<br />
<br />
The bad side: Once again I’m off my lupus meds, no cellcept, no
meloxicam or plaquenil or of course prednisone. Ouch. Here comes the
joint and muscle pain. The afternoon low grade fevers, the queasiness.
It’s worth it though.<br />
<br />
I know many people with lupus have nerve problems. Here’s some info
about neuromas, specifically Morton’s neuroma which is usually located
between the 3rd and 4th digit on toes. If you have one-you KNOW how
exquisite the pain can get. It’s a thousand papercuts, a sharp knife
slice over and over.<br />
<br />
From Mayo.com:<br />
Morton’s neuroma is a painful condition that affects the ball of your
foot, most commonly the area between your third and fourth toes.
Morton’s neuroma may feel as if you are standing on a pebble in your
shoe or on a fold in your sock.<br />
<br />
Morton’s neuroma involves a thickening of the tissue around one of
the nerves leading to your toes. This can cause a sharp, burning pain in
the ball of your foot. Your toes also may sting, burn or feel numb. <br />
Typically, there’s no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:<br />
<br />
A feeling as if you’re standing on a pebble in your shoe<br />
A burning pain in the ball of your foot that may radiate into your toes<br />
Tingling or numbness in your toes<br />
When to see a doctor<br />
It’s best not to ignore any foot pain that lasts longer than a few days.
See your doctor if you experience a burning pain in the ball of your
foot that’s not improving, despite changing your footwear and modifying
activities that may cause stress to your foot.<br />
<br />
Morton’s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.<br />
<br />
Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first.<br />
<br />
Therapy<br />
Arch supports and foot pads fit inside your shoe and help reduce
pressure on the nerve. These can be purchased over-the-counter, or your
doctor may prescribe a custom-made, individually designed shoe insert —
molded to fit the exact contours of your foot.<br />
<br />
Surgical and other procedures<br />
If conservative treatments haven’t helped, your doctor might suggest:<br />
Injections. Some people are helped by the injection of steroids into the painful area.<br />
Decompression surgery. In some cases, surgeons can relieve the
pressure on the nerve by cutting nearby structures, such as the ligament
that binds together some of the bones in the front of the foot.<br />
Removal of the nerve. Surgical removal of the growth may be
necessary if other treatments fail to provide pain relief. Although
surgery is usually successful, the procedure can result in permanent
numbness in the affected toes.Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-59323648438845222752013-06-12T01:32:00.000-07:002017-06-30T17:39:19.303-07:00Stripped of Dignity and Pain Medication from a Dumb PALetter To My Pain Management Doctor,<br />
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<br />
They took me away in what seemed like heavy chains<br />
They clinked and dragged along the hard floor while my heart fluttered and sank<br />
Go and don’t come back I heard..it rang in my ears while my heart jumped in shock<br />
Your doctor is dismissing you because there aren’t enough drugs in your system.<br />
I forgot that the bottle said “take as needed”<br />
I forgot I was without my other meds by their mistake<br />
I forgot it all.<br />
I didn’t see what the paper said, the words floated in jumbled up clouds<br />
While my heart sank to the floor<br />
And all I could hear was the chains dragging me down<br />
He pushed the paper to my face and thrust the pen at me<br />
Saying your doctor said to sign here..<br />
All I could see was a blur and I could not get my eyes to focus on the paper<br />
All I could hear was your doctor wants you discharged and you did not
take the pills as prescribed. Someone signed the page with a
bewildered look, it was me. Usually so “with it”, so “on the ball”. No
more. He took my dignity in an instant.<br />
<br />
And it came pouring back to me..he asked me if I wanted to hurt someone<br />
He asked me if I was beaten at home or in danger when the only danger
I felt was this chair, this room spinning around, out of focus, sign
the paper he said, sign the paper. My heart hit the floor. My tears
blocked my view. I didn’t even see the words on the paper but I didn’t
want him to know how hard I tried to read them but could not. I could
not see the words.<br />
<br />
He stripped me of my dignity. Does it matter I’d been there 8 long
years or that I love my doctor, respected him and felt nothing but
gratitude for the life he gave to me with his treatments. He really
told this PA, this fake doctor to discharge me? No, couldn’t be, my
heart hit the floor while my eyes welled up. In one foul, mean spirited
swoop he stripped me of my dignity.<br />
<br />
In the distance I heard the pharmacists voices calling me a drug
addict, while the room spinned and the paper blurred. I heard all my
other doctors follow in a long line call me an addict too and heard all
of them say, please leave, your doctor is dismissing you. My heart hit
the floor. I heard the chains dragging.<br />
He stripped me of my heart and I can hear my dignity in chains drag across the endless floor.Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com6tag:blogger.com,1999:blog-4316526137866390150.post-82805299530427105712013-05-26T16:24:00.000-07:002017-06-30T17:40:42.082-07:00Learning to move on from where I am and not from where I was!I couldn’t pick up where I left off before my last bout with the sun and sun caused illness.<br />
Slowly moving in and out of social networks, commenting, reading
emails, making and keeping doctor appointments, getting out and all in
all joining in my own life as a contributor and not a spectator takes
all my energy and thought processes. Catching up is too hard so I’m
learning to just move on, click the like button on fb on new posts and
put recent sicknesses that stopped me in their tracks behind me. This
will be my only mention of it and I’m keeping it light.<br />
<br />
I had what they called a hypersensitive vasculitis facial attack from
the sun (UV). I wasn’t just down for the count, I was blasted into an
oblivion of pain like even I haven’t experienced in quite a long time.
My face and arm itched from the inside and burned as if my blood was
boiling from the inside. After the hives disappeared and the bleeding
stopped my face on and under my lupus malar rash became HOT and
SWOLLEN. I looked like someone punched me. My nerves and every layer
of skin were on fire. I went 3 days until it dissipated enough with
steroids that I could talk without searing pain. A tonage of
anti-inflammatories and 60mg of the dreaded prednisone later the
swelling went down and the burning under my skin subsided. I NEVER EVER
AGAIN want to go through this. I’m guessing the appearance of the
newly summerized hot Arizona sun and UV in the danger levels
precipitated the attack. Right now I think I’d like to just stay inside
the rest of my life. But I won’t. Who would?<br />
<a href="http://butudontlooksick.files.wordpress.com/2013/05/juliesunmay20131.jpg"><img alt="juliesunmay2013" class="alignnone size-medium wp-image-285" src="http://butudontlooksick.files.wordpress.com/2013/05/juliesunmay20131.jpg?w=262&h=222" height="222" width="262" /></a><br />
Here’s a little info on <b>hypersensitive vasculitis</b> from <a href="http://emedicine.medscape.com/article/1083719-overview" target="_blank" title="medscape.com">medscape.com</a>:<br />
<br />
Hypersensitivity vasculitis, which is usually represented
histopathologically as leukocytoclastic vasculitis, is a term commonly
used to denote a small vessel vasculitis. Many possible causes or
associations exist for hypersensitivity vasculitis, but a cause or an
associated disorder is not found in as many as 50% of patients.<br />
Hypersensitivity vasculitis (a form of small vessel vasculitis) may
manifest clinically as cutaneous disease only or it may manifest as skin
disease with involvement of other organs. The internal organs most
commonly affected in hypersensitivity vasculitis are the joints,
gastrointestinal tract, and the kidneys. The prognosis for
hypersensitivity vasculitis is good when no internal involvement is
clinically present. Hypersensitivity vasculitis may be acute and
self-limited, recurrent or chronic.<br />
<br />
Patients with hypersensitivity vasculitis of their skin may report
itching, a burning sensation, or pain, or they may have asymptomatic
lesions. Vasculitis of the skin may occur in the absence of any
detectable systemic disease. Vasculitis may occur in conjunction with
collagen-vascular disorders, paraproteinemia, ingestants (drugs or
foods), infections, or malignancy (rare).<br />
<br />
I’m prone to severe sun reactions, pemphigoid rashes, porphyric
reactions, discoid rashes, hives, necrotizing lesions, livedo
reticularis, small spot vasculitis, reynauds, but this is something
different. This is cellular pain (like cellulitis) that effects you
down to the core. It’s horrific. I assure you this autoimmune reaction
is not a sunburn. I wish it was. Boy do I.<br />
<br />
My body is recovering. My mind is fine. I’m not picking up where I
left off anymore. I’m moving on. Life is too short and too precious.
HUGS!Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-57839675172823399862013-05-08T23:27:00.000-07:002013-05-08T23:29:02.842-07:00Over the river & thru the woods to my daughter's wedding I go....WoW! Our beautiful independent 22yr old daughter is getting married! I spent half the day today packing and the other half resting with an on again-off again 99.9 low grade fever: AKA, Lupus's calling card. Somehow I made it through the packing of clothes, making of sandwiches for the road trip, etc.<br />
<br />I let lupus steal from me the Lupus Walk, which I could not attend, but nothing was stopping me from traveling to see my daughter get married. :) Wish me luck!!!<br />
<br />For anyone else who is traveling with chronic illness, here are some great tips!<br />
<br />From the Lupus Foundation of America:<br />
Traveling<br />
<br />If you are a person who enjoys traveling, you may be worried that those days are over because you have lupus. After all, the stress of travel is just the opposite of what someone with lupus needs when seeking rest and recreation! <br />
<br />But travel can be made easier. Airports today have wheelchairs, motorized transporters, and attendants to help you if you have difficulty walking or carrying luggage. Wheelchairs may also be available at museums and other public institutions. If you have joint pain or any difficulty walking, you should not hesitate to ask for these services, even if you might not regularly ask for any kind of help at home or work. You may also want to look into renting a motorized scooter or wheelchair for the duration of your trip.<br />
<br />Advance airline check-in, including printing out the boarding pass, is another stress-saving technique, and can be done on most airline Websites within 24 hours of takeoff. Some airlines allow passengers to choose a seat in advance as well, whether online or through an agent. Planning a trip in advance greatly increases the chances of getting a seat with extended leg room. Taking a mild sleeping pill can help you rest on long flights. Whether traveling by car, bus, train, or plane, it is important to get up, stretch, and walk around during a long trip, to improve blood circulation.<br />
<br />You should make arrangements to have your prescribed medications available when you are traveling, either by taking your medicines with you, or by carrying prescription orders that can be filled at a pharmacy at your final destination. Medicine can be sent ahead to a hotel or residence, or can be packed in luggage. But because mail can be misplaced and checked bags can be damaged, delayed, or lost, it’s always a good idea to pack at least a two-day supply of medicine in your carry-on luggage. In those instances, it’s important that medications are in their original, marked containers to avoid unnecessary questions and possible confiscation. If the original, labeled medication containers are not available, carry a doctor’s note confirming that the prescriptions are for you. Keep all medication containers together in a clear zip-lock bag to make things easier at security checkpoints.<br />
<br />When making hotel accommodations, you may want to request a room that conforms to ADA standards, such as grab bars for the bathtub, wider access for the shower, elevated toilet seats, and less furniture to allow for wheelchair access.<br />
<br />There are alternatives to air travel and hotel stays. Ocean cruises offer a chance to relax and travel, with a room whenever a nap is needed, readily available medical care, and choices of meal times. Some cruises also are wheelchair- and scooter-accessible. Short bus trips or train rides to areas of interest also offer comfort for travelers. Even local events and day trips can provide the enrichment of traveling without going far from home.<br />
<br />When vacationing, try not to over-schedule your days with too many events, and make sure you set aside time for rest -- just as you do at home.<br />
<br />
<br />
<br />
<br />
<br />
<a href="http://butudontlooksick.files.wordpress.com/2013/05/130508-231233.jpg"><img src="http://butudontlooksick.files.wordpress.com/2013/05/130508-231233.jpg?w=487" /></a>Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-49541684633205901322013-04-23T17:25:00.001-07:002013-04-23T17:33:37.302-07:00Is it Shingles or one of my Cutaneous Porphyria rashes?<div class="separator" style="clear: both; text-align: center;">
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<br />
It's ITCHY AS HECK!<br />
It's HOT HOT HOT and inflammed.<br />
It "pocked up" in a day<br />
It followed a nerve path<br />
It happened after a cold sore attack<br />
Was in the sun & have LUPUS & Cutaneous Porphyria<br />
<br />
What do YOU think?<br />
I need to plan a viral test WHEN I get this rash. Did I mention it was ITCHY?<br />
<br />
To Explain the photosensitive process in the skin, I have systemic
lupus and with that circulating immune complexes in my blood that do the
actual damage to tissue and skin. Here is an explanation of that
hypersensitve process: Not all my rashes are necrotizing, but many are.<br />
from http://en.wikipedia.org/wiki/Type_III_hypersensitivity<br />
<b>Type III hypersensitivity</b>
occurs when antigen-antibody complexes that are not adequately cleared
by innate immune cells accumulate, giving rise to an inflammatory
response and attraction of leukocytes.<br />
<h2>
Presentation</h2>
Type
III hypersensitivity occurs when there is little antigen and an excess
of antibody, leading to small immune complexes being formed that do not
fix complement and are not cleared from the circulation. It is
characterized by solvent antigens that are not bound to cell surfaces
(which is the case in <a data-mce-href="http://en.wikipedia.org/wiki/Type_II_hypersensitivity" href="http://en.wikipedia.org/wiki/Type_II_hypersensitivity" title="Type II hypersensitivity">type II hypersensitivity</a>). When these antigens bind antibodies, <a data-mce-href="http://en.wikipedia.org/wiki/Immune_complex" href="http://en.wikipedia.org/wiki/Immune_complex" title="Immune complex">immune complexes</a> of different sizes form.<sup id="cite_ref-urlHypersensitivity_reactions_1-0"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-urlHypersensitivity_reactions-1" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-urlHypersensitivity_reactions-1">[1]</a></sup>
Large complexes can be cleared by macrophages but macrophages have
difficulty in the disposal of small immune complexes. These immune
complexes insert themselves into small blood vessels, joints, and <a data-mce-href="http://en.wikipedia.org/wiki/Glomerulus" href="http://en.wikipedia.org/wiki/Glomerulus" title="Glomerulus">glomeruli</a>,
causing symptoms. Unlike the free variant, a small immune complex bound
to sites of deposition (like blood vessel walls) are far more capable
of interacting with complement; these medium-sized complexes, formed in
the slight excess of antigen, are viewed as being highly pathogenic.<sup id="cite_ref-2"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-2" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-2">[2]</a></sup><br />
Such depositions in tissues often induce an inflammatory response,<sup id="cite_ref-urlChapter_19_3-0"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-urlChapter_19-3" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-urlChapter_19-3">[3]</a></sup>
and can cause damage wherever they precipitate. The cause of damage is
as a result of the action of cleaved complement anaphylotoxins C3a and
C5a, which, respectively, mediate the induction of granule release from
mast cells (from which histamine can cause <a data-mce-href="http://en.wikipedia.org/wiki/Urticaria" href="http://en.wikipedia.org/wiki/Urticaria" title="Urticaria">urticaria</a>),
and recruitment of inflammatory cells into the tissue (mainly those
with lysosomal action, leading to tissue damage through frustrated
phagocytosis by <a data-mce-href="http://en.wikipedia.org/wiki/Neutrophil" href="http://en.wikipedia.org/wiki/Neutrophil" title="Neutrophil">PMNs</a> and <a data-mce-href="http://en.wikipedia.org/wiki/Macrophage" href="http://en.wikipedia.org/wiki/Macrophage" title="Macrophage">macrophages</a>).<sup id="cite_ref-Parham_2009_389_4-0"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Parham_2009_389-4" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Parham_2009_389-4">[4]</a></sup><br />
The
reaction can take hours, days, or even weeks to develop, depending on
whether or not there is immunlogic memory of the precipitating antigen.
Typically, clinical features emerge a week following initial antigen
challenge, when the deposited immune complexes can precipitate an
inflammatory response. Because of the nature of the antibody
aggregation, tissues that are associated with blood filtration at
considerable osmotic and hydrostatic gradient (e.g. sites of urinary and
synovial fluid formation, kidney glomeruli and joint tissues
respectively) bear the brunt of the damage. Hence, <a data-mce-href="http://en.wikipedia.org/wiki/Vasculitis" href="http://en.wikipedia.org/wiki/Vasculitis" title="Vasculitis">vasculitis</a>, <a data-mce-href="http://en.wikipedia.org/wiki/Glomerulonephritis" href="http://en.wikipedia.org/wiki/Glomerulonephritis" title="Glomerulonephritis">glomerulonephritis</a> and <a data-mce-href="http://en.wikipedia.org/wiki/Arthritis" href="http://en.wikipedia.org/wiki/Arthritis" title="Arthritis">arthritis</a> are commonly-associated conditions as a result of type III hypersensitivity responses<sup id="cite_ref-Kumar_2010_204.E2.80.93205_5-0"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Kumar_2010_204.E2.80.93205-5" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Kumar_2010_204.E2.80.93205-5">[5]</a></sup>).<br />
As
observed under methods of histopathology, acute necrotizing vasculitis
within the affected tissues is observed concomitant to neutrophilic
infiltration, along with notable eosinophilic deposition (<a data-mce-href="http://en.wikipedia.org/wiki/Fibrinoid_necrosis" href="http://en.wikipedia.org/wiki/Fibrinoid_necrosis" title="Fibrinoid necrosis">fibrinoid necrosis</a>). Often, immunofluorescence microscopy can be used to visualize the immune complexes <sup id="cite_ref-Kumar_2010_204.E2.80.93205_5-1"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Kumar_2010_204.E2.80.93205-5" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Kumar_2010_204.E2.80.93205-5">[5]</a></sup>). Skin response to a hypersensitivity of this type is referred to as an <a data-mce-href="http://en.wikipedia.org/wiki/Arthus_reaction" href="http://en.wikipedia.org/wiki/Arthus_reaction" title="Arthus reaction">Arthus reaction</a>,
and is characterized by local erythema and some induration. Platelet
aggregation, especially in microvasculature, can cause localized clot
formation, leading to blotchy hemorrhages. This typifies the response to
injection of foreign antigen sufficient to lead to the condition of <a data-mce-href="http://en.wikipedia.org/wiki/Serum_sickness" href="http://en.wikipedia.org/wiki/Serum_sickness" title="Serum sickness">serum sickness</a>.<sup id="cite_ref-Parham_2009_389_4-1"><a data-mce-href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Parham_2009_389-4" href="http://en.wikipedia.org/wiki/Type_III_hypersensitivity#cite_note-Parham_2009_389-4">[4]</a></sup>Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-55701037820555330592013-04-08T14:49:00.004-07:002013-04-08T14:49:51.283-07:003 More Weeks Left - HELP!!!!<a data-mce-href="http://butudontlooksick.files.wordpress.com/2013/04/lfa-logo.jpg" href="http://butudontlooksick.files.wordpress.com/2013/04/lfa-logo.jpg"><img alt="lfa logo" class="alignnone size-full wp-image-218" data-mce-src="http://butudontlooksick.files.wordpress.com/2013/04/lfa-logo.jpg" height="87" src="http://butudontlooksick.files.wordpress.com/2013/04/lfa-logo.jpg" width="126" /></a> 3 More Weeks Left - HELP!<br />
Only
3 more weeks and I'm SO CLOSE to goal of raising $500 !!!!! I have
$385, so if I had 25 of my friends donate just $5 I would make it!!!!
PLEASE HELP!!<br />
I was unable to walk two years ago at the last one,
but nothing is stopping me THIS TIME!!!!! Please donate to Lupus
Foundation of America to help find a cure for those of us living with
lupus. Do it for the many young women afflicted by this disease and not
for me. They have their whole lives ahead of them only to be taken away
and foreshadowed by a lifetime of pain and unknowing what will happen
when their body turns against itself next.<br /> Thank YOU! Big HUGS! Love Julie<br />
To chip in...<br /> <a data-mce-href="http://lupus.donorpages.com/Arizona2013/JuJuLupusWalk/" href="http://lupus.donorpages.com/Arizona2013/JuJuLupusWalk/" rel="nofollow nofollow" target="_blank">http://lupus.donorpages.com/Arizona2013/JuJuLupusWalk/</a><br />
LUPUS
is a chronic, autoimmune disease that can damage any part of the body
(skin, joints, and/or organs inside the body). Chronic means that the
signs and symptoms tend to last longer than six weeks and often for many
years. In lupus, something goes wrong with your immune system, which is
the part of the body that fights off viruses, bacteria, and germs
("foreign invaders," like the flu). Normally our immune system produces
proteins called antibodies that protect the body from these invaders.
Autoimmune means your immune system cannot tell the difference between
these foreign invaders and your body’s healthy tissues ("auto" means
"self") and creates autoantibodies that attack and destroy healthy
tissue. These autoantibodies cause inflammation, pain, and damage in
various parts of the body.Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-45428572849380224212013-04-05T18:49:00.000-07:002013-04-05T18:50:57.438-07:00The NERVE of LUPUS!LUPUS Neuropathies, I’ve wondered what IS the cause? Is it destruction to the myelin sheath? Is it the same as in diabetic neuropathy? Is it from inflammation in blood vessels or nerves or both?<br />
<br />
<a href="http://butudontlooksick.files.wordpress.com/2013/04/pns-dermatomes.jpg"><img src="http://butudontlooksick.files.wordpress.com/2013/04/pns-dermatomes.jpg?w=487" /></a>Try asking a doctor that question..lupies-ask your rheumatologists..they are not quick to “go there”, although statistics are that 20% of all patients with systemic lupus (SLE) have neuropathy and of those 20% , only 4% have cranial neuropathies. I’d be hip to hearing YOUR stories and responses from your rheumatologists on the subject, so feel free to comment!<br />
<br />
Those statistics IMO are right on the money! I’ve met many patients with lupus online, and about a quarter of them have neuropathy and out of those in the 3 years I’ve been online hanging out in support groups, I have met just about one dozen of us with lupus and trigeminal neuralgia, geniculate neuralgia, temporal arteritis, etc. I try to share information I find on medical sites at my other site here: <a href="http://lupuscranialneuropathies.blogspot.com/">http://lupuscranialneuropathies.blogspot.com/</a> .<br />
<br />
Here is a good explanation of the process from Lupus International:<br />
<br />
<br />
A variety of pathological processes may be involved in CNS lupus. The blood supply to a particular part of the brain can be disrupted due to autoimmune vasculitis (blood vessel inflammation), or clots formed as a result of antiphospholipid antibodies, or emboli that travel from a cardiac source. In some lupus patients, the thickness of their blood is increased causing hyperviscosity and this may disrupt blood flow. Anti-neuronal antibodies also may be produced in some lupus patients; these can have direct effects on the cells of the brain (neurons) and alter their function. The choroid plexus, a part of the brain that is the source of cerebrospinal fluid (CSF- a fluid bathing brain and spinal cord) may be involved thus causing diffuse problems. Several cytokines such as interleukin-1, interleukin-6 and interferon-γ are increased in CNS lupus and these have a direct effect on the neurons and can interfere with their function. Abnormalities of the hormones produced in the hypothalamus, pituitary and adrenal glands (the HPA axis) are common in lupus due to the disease itself as well as the effects of steroids and these abnormalities can cause some of the CNS disturbances lupus.<br />
<br />
<br />
In addition, a number of secondary factors lead to the manifestations of CNS lupus such as infection (lupus patients are more prone to certain types of infections), medications (several drugs such as corticosteroids have significant CNS toxicity), hypertension, electrolyte imbalances, uremia (renal failure), thyroid disease, atherosclerotic strokes, and subdural hematomas. The concomitant presence of fibromyalgia in lupus patients is associated with an increase in functional neurological problems such as anxiety and cognitive dysfunction.<br />
<br />
I have both peripheral and cranial (brainstem) neuropathies with myoclonic seizures. I take anti-seizure meds (tegretol) that help control them. Trigeminal neuralgia is considered to be the most painful condition known to man. There is no cure for nerve damage.<br />
<br />
The LFA has some of the best information on lupus and neuropathy. From <a href="http://www.lfa.org/">http://www.lfa.org</a>:<br />
The Nervous System<br />
<br />
Lupus is an autoimmune disease that can affect almost any part of your body, including your joints, skin, kidneys, heart, lungs, or blood. Lupus can also affect the nervous system and brain. There are several terms doctors use to describe this: neuropsychiatric lupus (NP-SLE), neurocognitive dysfunction, or central nervous system lupus (CNS lupus). Your nervous system has three parts, any of which may be affected by lupus. <br />
The central nervous system (CNS) consists of the brain and the spinal cord. <br />
The peripheral nervous system (PNS) is a network of nerves that connects the brain and spinal cord to the rest of the body, and gives skin and muscles the signals needed for sensation and movement. <br />
The autonomic nervous system (ANS) allows communication between spinal and peripheral nerves and the brain and internal organs, and controls functions like breathing, blood flow, and heart rate. <br />
<br />
People with lupus can experience a number of complications when their nervous system is affected. The symptoms may come on suddenly or may come and go, but they will vary depending upon the location and extent of the tissue injury. These symptoms also can be present in other diseases, so diagnosing lupus-related nervous system disorders is often difficult.<br />
<br />
Neurologists are the physicians who specialize in the nervous system. They may rely on a number of diagnostic tools to determine whether lupus is involved in your cognitive problems: <br />
x-rays <br />
brain scans (magnetic resonance imaging (MRI) and computed tomography (CT) <br />
electroencephalograms (to capture the electrical pattern of brain activity) <br />
spinal tap (to examine fluid in the spinal column) <br />
<br />
Behavioral and cognitive tests may also be done to find out if your memory or other mental abilities have been affected.<br />
<br />
Depending on the symptoms, a variety of medications are available to treat lupus-related nervous system disorders, including non-steroidal anti-inflammatory drugs, antimalarials, and steroids. Your response to treatment may be rapid or gradual over several months. For many people with lupus, nervous system involvement is completely reversible.<br />
<a href="http://butudontlooksick.files.wordpress.com/2013/04/cranial-nerves.jpg"><img src="http://butudontlooksick.files.wordpress.com/2013/04/cranial-nerves.jpg?w=426" /></a>Central Nervous System (CNS)<br />
<br />
When lupus affects your central nervous system, many symptoms may occur, including: <br />
headaches <br />
confusion <br />
fatigue <br />
depression <br />
seizures <br />
strokes <br />
vision problems <br />
mood swings <br />
difficulty concentrating <br />
<br />
Drugs used to treat lupus can cause side effects that are similar to the symptoms of CNS lupus. If you have symptoms of CNS lupus you should consult a neurologist who can determine which symptoms are side effects of medication and which are due to lupus. The drugs most known for causing symptoms like those of CNS lupus are: <br />
Non-steroidal anti-inflammatory drugs (NSAIDs) – may cause headache, dizziness, confusion, and in rare instances, meningitis-like symptoms <br />
Antimalarials – in very high doses (not usually given for lupus) may cause manic behavior, seizures, psychosis <br />
Corticosteroids – may cause agitation, confusion, mood swings, psychosis, depression <br />
Anti-hypertensive medications – may cause depression or loss of sex drive <br />
<br />
A serious form of lupus called CNS vasculitis may occur when there is inflammation of the blood vessels of the brain. Characterized by high fevers, seizures, psychosis, and meningitis-like stiffness of the neck, CNS vasculitis is the most dangerous form of lupus involving the nervous system and usually requires hospitalization and high doses of corticosteroids to suppress the inflammation.<br />
Peripheral Nervous System (PNS)<br />
<br />
The nerves of your peripheral nervous system control your motor responses and sensation, so symptoms of numbness or tingling, or inability to move a part of your body, may be the result of lupus affecting these nerves. Known as peripheral neuropathies, symptoms of PNS nerve damage are caused by inflammation of the nerves or by compression of the nerves due to swelling in the tissue around them. The types of symptoms you might experience include: <br />
vision problems <br />
facial pain <br />
ringing in the ears <br />
dizziness <br />
drooping of an eyelid <br />
carpel tunnel syndrome <br />
Autonomic Nervous System (ANS)<br />
<br />
The autonomic nervous system regulates many of your body’s functions that happen almost automatically: heart rate, blood pressure, feeling hot or cold, bladder and bowel functions, release of adrenalin, breathing, sweating, and muscle movement. Lupus can cause these nerve signals to be overactive, which can lead to a wide range of symptoms: <br />
numbness <br />
burning <br />
tingling <br />
mental confusion <br />
headaches <br />
gastrointestinal problems such as nausea, vomiting, constipation, or diarrhea <br />
<br />
Raynaud’s phenomenon<br />
<br />
Raynaud’s phenomenon is a condition of ANS involvement caused by inflammation of nerves or blood vessels. Blood vessels in your hands and feet go into spasm and restrict blood flow, usually as a reaction to cold temperatures, with the tips of the fingers or toes turning red, white, or blue. Raynaud’s can also cause pain, numbness, or tingling in fingers and/or toes. People who have Raynaud’s phenomenon are advised to avoid cold conditions when possible, and may have to wear gloves or mittens when in air-conditioned surroundings.<br />
<br />
Livedo reticularis and palmar erythema are two other skin disorders that may affect you if you have autonomic nerve damage. Both of these conditions can cause a bluish, lacelike mottling under your skin, especially on your legs, giving your skin a “fishnet” look.<br />
<br />
Cognitive Dysfunction<br />
<br />
As many as half of all people with lupus describe feelings of confusion, fatigue, memory loss, and difficulty expressing their thoughts. This collection of symptoms is termed cognitive dysfunction, although many people call it “lupus fog.”<br />
<br />
Cognitive dysfunction most often affects people with mild to moderately active lupus. The causes of these symptoms, and the reasons that the symptoms tend to come and go, are not known. Living with cognitive dysfunction can be very frustrating. However, you can learn to improve your concentration and lessen confusion and memory loss with a variety of coping skills, including puzzles, games, biofeedback, using a daily appointment calendar, and balancing daily activities to reduce stress.<br />
<br />
Lupus Headache<br />
<br />
Compared with the general population, people with lupus may be twice as likely to experience migraine-like lupus headaches, commonly known as lupus headaches. The features of lupus headaches are similar to migraines and may be seen more often in people who also have Raynaud’s phenomenon. However, headaches can also be caused by vasculitis, a symptom of active lupus due to inflammation of the blood vessels. If you are experiencing headaches that are not improved by an over-the-counter headache medication, be sure to tell your doctor.Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-36276947685987539202013-04-03T12:25:00.003-07:002013-04-03T12:33:32.740-07:00LUPUS from the Bowels<!--[if gte mso 9]><xml>
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<b><i><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">& Inflammatory Arthritis
& Sacroiliitis</span></i></b><br />
<br />
From the bowels means just what it sounds like, a little TMI here, but it's part of some our experiences with lupus. Do you have Inflammatory bowel syndrome? Not quite the same as IBS (irritable bowel syndrome) but a PITA just the same! (LOL - PITA, get it?)<br />
<br />
Some of the symptoms are constipation, inability to empty your bowels, bloating, gas, nausea and diarrhea. If you do, and you have lupus like I do it can lead to inflammatory arthritis! I did not know this and I am on my second terrible bout of the beast. I've been living on promethazine for nausea for many years. <br />
<br />
<br />
Perhaps because I also have interstitial cystitis also and a 8mm slipped vertebrae at L4/L5 picking up some inflammatory arthritis in the si joint was a perfect storm. <br />
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<a href="http://2.bp.blogspot.com/-BbUxqWrjPYQ/UVyBfUYMBxI/AAAAAAAAAx4/WoxvfKpO1N0/s1600/digestivetractpic.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://2.bp.blogspot.com/-BbUxqWrjPYQ/UVyBfUYMBxI/AAAAAAAAAx4/WoxvfKpO1N0/s320/digestivetractpic.gif" width="219" /></a></div>
I'll tell ya (and you can look at my earlier blogs from Dec during my worst ever attack of sacroillitis-it is P A I N FU L!!!!!! I couldn't walk without help, get up or down, sleep on either side, was hot to the touch above my buttocks, my stomach was upset, my pelvis hurt, my legs ached. It's just awful! My grandmother who had undiagnosed lupus and RA had ankylosing spondylitis and it was so severe she was hunchbacked. My poor grandmother, us ungrateful grandkids nicknamed her the Buzzard, how AWFUL! I'm sorry Grandma (looking up at heaven)...<br />
<br />
I found some great info on sacroillitis and inflammatory arthritis caused by inflammation from bowel dysfunction-which is common in lupus!<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> </span>Here it is from: <a href="http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/inflammatory-bowel-disease.html">http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/inflammatory-bowel-disease.html</a><br />
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Basics of inflammatory bowel disease<br />
<br />
Arthritis means inflammation of joints. Inflammation is a body process that can
result in pain swelling warmth redness and stiffness. Sometimes inflammation
can also affect the bowel. When it does that process is called inflammatory
bowel disease (IBD). IBD is actually two separate diseases: Crohn's disease and
ulcerative colitis.</div>
<div class="MsoNormal">
Prognosis<br />
<br />
With proper treatment most people who have these diseases can lead full active
lives. Usually the inflammation of joints in IBD lasts only a short time and
does not cause permanent deformity. With the bowel symptoms under control
through medication and diet the outlook for the joints is excellent. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Incidence</div>
<div class="MsoNormal">
Both men and women are affected equally. The arthritis of
IBD can appear at any age but is most common between the ages of 25 and 45. </div>
<div class="MsoNormal">
Joint inflammation begins most often when the colon (the
large intestine) is involved in the disease process. In adults the arthritis is
usually most active when the bowel disease is active. Indeed the amount of
bowel disease usually influences the severity of the arthritis. In children the
arthritis is not as often associated with increased bowel disease activity.</div>
<div class="MsoNormal">
Symptoms </div>
<div class="MsoNormal">
<i>Ulcerative colitis</i></div>
<div class="MsoNormal">
Ulcerative colitis produces inflammation and breakdown along
the lining of the colon (see figure 1). Inflammation usually begins in the
rectum and extends up the colon. Symptoms may include rectal bleeding abdominal
cramping weight loss and fever. </div>
<div class="MsoNormal">
The bowel symptoms often occur before the symptoms of
arthritis. When ulcerative colitis is present the arthritis is most likely to
occur if there is severe bleeding or if the area around the anus is inflamed.
When only the rectum is involved the chance of getting arthritis is less. </div>
<div class="MsoNormal">
Most of the time the arthritis flares (becomes worse) when
the bowel symptoms flare. An exception is during the first episode of arthritis
which can come at any time. One or more joints may be affected and the symptoms
often move from joint to joint. The hips knees and ankles are involved most
often although any joint may be affected. The joints may be very painful red
and hot but these symptoms usually do not result in permanent damage. </div>
<div class="MsoNormal">
About one-fourth of people with IBD who develop arthritis
have a skin rash on the lower legs frequently seen when the arthritis flares.
One characteristic rash usually consists of small reddish lumps which are very
painful to the touch. This skin condition is called erythema nodosum. </div>
<div class="MsoNormal">
People with ulcerative colitis can develop another form of
arthritis called <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/AnkylosingSpondylitis.aspx">ankylosing
spondylitis</a> which involves inflammation of the spine. It usually begins
around the sacroiliac joints at the bottom of the back (see figure 2). Symptoms
of spondylitis generally do not accompany bowel symptoms in ulcerative colitis.
If just the sacroiliac joints are inflamed the symptoms are fairly mild. When
the spine is affected however it may be quite painful and even disabling. This
can result in stiffness or rigidity.</div>
<div class="MsoNormal">
<i>Crohn's disease</i></div>
<div class="MsoNormal">
Crohn's disease usually involves either the colon or the
ileum the lower small intestine. It may affect both or any part of the
digestive tract from the mouth to the rectum. The inflammation involves all
layers of the intestinal wall and may lead to scarring and narrowing of the
bowel. Fever weight loss and loss of appetite are common symptoms of Crohn's
disease. </div>
<div class="MsoNormal">
The arthritis of Crohn's disease can occur before after or
at the same time as the bowel symptoms. As with ulcerative colitis the large
joints such as the knees and ankles are generally affected though not
necessarily on both sides of the body and back pain can result from <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/AnkylosingSpondylitis.aspx">ankylosing
spondylitis</a>.</div>
<div class="MsoNormal">
Causes </div>
<div class="MsoNormal">
The cause of inflammatory bowel disease is not known. <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/ResearchonArthritis.aspx">Research</a>
suggests that the immune system the body's natural defense against foreign
invaders is somehow altered in people with these conditions. Researchers
believe that the chronic (long-lasting) inflammation present in the intestines
of persons with both forms of IBD damages the bowel. This may permit bacteria
to enter the damaged bowel wall and circulate through the bloodstream. The
body's reaction to this bacteria may then cause problems in other areas of the
body. The most common is inflammation of the joints. Other problems include
skin sores inflammation of the eyes and certain types of liver disease. </div>
<div class="MsoNormal">
Diagnosis</div>
<div class="MsoNormal">
The history taken by the doctor is the most important part
of the diagnosis. Certain information--such as the way the arthritis began the
specific joints involved and the relationship between joint and bowel
symptoms--is very helpful for diagnosis. The appearance of the joints their
range of motion and pain or tenderness during the physical examination are also
important. Usually X-rays of the joints are normal unless the joints of the
spine are affected. Then damage is visible in X-rays. A blood test for the
presence of a substance called HLA-B27 in the blood cells is sometimes helpful
in diagnosing ankylosing spondylitis. This substance is an inherited factor
present in a much higher frequency among people who have IBD and spondylitis
than in the normal population.</div>
<div class="MsoNormal">
Treatment Usually these conditions are treated with
medication exercise and sometimes surgery. </div>
<div class="MsoNormal">
Health care team</div>
<div class="MsoNormal">
A gastroenterologist (specialist in diseases of the
digestive tract) is usually the doctor who directs treatment but an arthritis
or skin specialist may be needed as well. </div>
<div class="MsoNormal">
Diet</div>
<div class="MsoNormal">
Your doctor may give you a special diet to help control your
bowel disease. If so follow it carefully. Control of your bowel disease may
also help your arthritis. Many diets are advertised as arthritis
"cures." There is no known diet that can cure arthritis caused by
IBD.</div>
<div class="MsoNormal">
Exercise and therapy</div>
<div class="MsoNormal">
Your doctor or physical therapist will probably design a
program of <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/ExerciseandArthritis.aspx">exercises</a>
for you to follow every day. Proper exercise helps to reduce stiffness maintain
joint motion and strengthen the muscles around the joints. Maintaining the
range of motion of affected joints is important in order to prevent or reduce
deformity caused by lack of use. If you have <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/AnkylosingSpondylitis.aspx">ankylosing
spondylitis</a> range of motion exercises of the spine are of benefit. Deep
breathing exercises are emphasized because motion of the ribs may eventually be
restricted as the disease moves up the spine. If you smoke you should stop in
order to help prevent breathing complications. </div>
<div class="MsoNormal">
If you find exercising to be painful take a warm shower or
bath before you exercise. This should lessen the pain and stiffness. Begin the
exercises slowly and plan them for the times of the day when you have the least
pain. </div>
<div class="MsoNormal">
Good posture is essential for the person with ankylosing
spondylitis and IBD. The spine should be kept as straight as possible at all
times. Avoid sitting for prolonged periods of time. Sleep on your stomach or
back on a firm mattress. If you need to use a pillow under your head only use a
thin one or one that fits the hollow of your neck. Avoid pillows under your
knees. Keep your body as straight as you can. Avoid lying in a curled position.
</div>
<div class="MsoNormal">
Medications</div>
<div class="MsoNormal">
Several <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/FrequentlyAskedQuestionsaboutArthritis.aspx">medications</a>
may be helpful in controlling arthritis and IBD. Sulfasalazine is a very useful
sulfa drug. The other medications fall into certain groups of drugs: <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/CorticosteroidsforArthritis.aspx">corticosteroids</a>,
immunosuppressives and <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/AspirinandRelatedDrugsNSAIDs.aspx">nonsteroidal
anti-inflammatory drugs (NSAIDs)</a>. </div>
<div class="MsoNormal">
Sulfasalazine (Azulfidine) helps to control both the bowel
disease and the symptoms of arthritis. It is usually started at a low dose to
lessen possible side effects and then increased if needed. The most common side
effects are nausea and headaches. The nausea may be controlled by taking the
drug with food or by using the enteric-coated form of the drug. (This form is specially
designed to dissolve in the bowel not in the stomach.) </div>
<div class="MsoNormal">
Sulfasalazine can usually be taken safely for a long time.
Some people however develop an allergy to sulfasalazine in the form of a rash
and fever. Giving the drug in frequent very small doses may enable the person
to tolerate the drug without producing a rash or other reaction. When
sulfasalazine cannot be taken due to side effects or allergy olsalazine
(Dipentum) or mesalamine (Asacol) may be taken but these drugs have not been
shown to be effective against arthritis. </div>
<div class="MsoNormal">
<a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/CorticosteroidsforArthritis.aspx">Corticosteroids</a>
are similar to cortisone a hormone produced by the body. They are strong
anti-inflammatory drugs which can help both the symptoms of the bowel and the
joints. They are used only when the symptoms are severe because they may
produce serious side effects when taken for a long time. These side effects
include thinning of bones (<a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/Osteoporosis.aspx">osteoporosis</a>)
cataracts reduced resistance to infection diabetes obesity and high blood pressure.
</div>
<div class="MsoNormal">
Be sure to discuss the possible side effects with your
doctor before taking corticosteroids. Most of the side effects decrease and
eventually go away as the dosage is reduced and stopped. Once you begin taking
these drugs however never stop or change the dosage on your own. </div>
<div class="MsoNormal">
Immunosuppressives such as azathioprine (Imuran) are used on
occasion for arthritis and Crohn's disease. By suppressing the immune system
they reduce inflammation. The most common side effect of these medications is a
decrease in white blood cells which can cause an increased risk of infections.
Other side effects of these medications may include fever rash vomiting hair
loss and liver toxicity. Immunosuppressives therefore are used with caution. </div>
<div class="MsoNormal">
<a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/AspirinandRelatedDrugsNSAIDs.aspx">Nonsteroidal
anti-inflammatory drugs (NSAIDs)</a> such as ibuprofen are helpful in
controlling the pain swelling and stiffness of inflamed joints. To work
effectively they must be taken every day during the arthritis episode. </div>
<div class="MsoNormal">
NSAIDs may produce nausea indigestion and heart burn. In
addition they may cause bleeding from the stomach and make the underlying bowel
disease worse so they are used with caution in IBD. These side effects can
usually be decreased if the drug is taken with food fluid or an antacid. </div>
<div class="MsoNormal">
Surgery</div>
<div class="MsoNormal">
Surgical removal of the diseased bowel is usually a
permanent cure for ulcerative colitis. This <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/BasicsofSurgeryforArthritis.aspx">surgery</a>
also puts an end to any arthritis that may be present unless the arthritis
involves the spine. <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/AnkylosingSpondylitis.aspx">Ankylosing
spondylitis</a> may last even after removal of the diseased colon. </div>
<div class="MsoNormal">
Crohn's disease does not respond as well to surgery.
Surgical removal of the diseased bowel may be necessary but it does not cure
Crohn's disease. Thus symptoms of arthritis may recur when and if bowel
symptoms reappear. </div>
<div class="MsoNormal">
Strategies for coping</div>
<div class="MsoNormal">
Living with arthritis and IBD can be very difficult at
times. In addition to pain and discomfort you may have to deal with changes in
your appearance or in your leisure time activities. These changes may leave you
sad depressed or angry. Relaxation techniques are coping skills that can help
you relieve <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/ManagingArthritisPain.aspx">pain</a>
and <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/StressandArthritis.aspx">stress</a>
and adjust to the changes in your life. </div>
<div class="MsoNormal">
It helps to talk about your feelings with <a href="http://www.orthop.washington.edu/PatientCare/OurServices/Arthritis/Articles/Familiesandarthritis.aspx">family,
members</a> friends or someone else who has arthritis and IBD. Ask your doctor
about educational programs materials or support groups for people who have
arthritis as well as their families. </div>
<div class="MsoNormal">
Resources</div>
<div class="MsoNormal">
Another source of help is the <a href="http://www.ccfa.org/" target="_blank">Crohn's and Colitis Foundation of America
Inc. (CCFA)</a>. It provides educational materials and programs for people who
have IBD. To locate the chapter nearest you contact the CCFA at info@ccfa.org
write to them at 386 Park Avenue South 17th Floor New York NY 10016-8804 or
call toll-free (800) 932-2423. </div>
<div class="MsoNormal">
Credits</div>
<div class="MsoNormal">
Some of this material may also be available in an <a href="http://www.arthritis.org/" target="_blank">Arthritis
Foundation</a> brochure. Contact the Washington/Alaska Chapter Helpline: (800)
542-0295. If dialing from outside of WA and AK contact the National Helpline:
(800) 283-7800.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
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<![endif]-->Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-54505575939353891522013-04-02T00:37:00.001-07:002013-04-03T10:01:03.949-07:00"Ya Give Me FEVER"!!!!<b><u>Lupus Fevers.</u></b> Low Grade. For me it's the ole
99.9. Usually for me they are the telltale sign of an incoming lupus
flare. "INCOMING!" Watch Out!!! lol. I usually get
the low grade fevers at the same time each afternoon, but not this time.
This time they pop in for a visit anytime during the day or night. They
are tiredsome. They are exhausting and uncomfortable. They are a
real drag. <br />
<br />
I'm not surprised I have something going on. Discoid rashes, vascular
rashes and lesions, hives and other cutaneous manifestions are normal for me on
an everyday basis, so I don't consider those a lupus flare. A lupus flare
is defined as any onslaught of symptoms not usually experienced that indicate
an increase in disease activity. For me, I had my first when I was
diagnosed with lupus in March 2010 with lupus nephritis (my kidneys are in
remission btw!!!) and I lost 40 pounds without trying, I experienced malaise,
or just a huge under the weather feeling. <br />
<br />
Second flare I also lost a large amount of weight, again with the malaise
and this time required a blood transfusion and was dx'd with hemalytic anemia
(with my lupus-a sidedish, lol).<o:p></o:p><br />
<br />
This time I think it's just a small flare, no real malaise (yet), a minor
bout of sacroillitis, no weight loss (poo), a major discoid rash on my neck and
upper back and a tonage of mouth and nose sores. I think my superhuman
lupus healing powers have done their job, I healed like a champ after surgery,
but those superhuman lupus powers don't know when to stop, so their still
going...attacking my own body a bit. Hence the fevers.<br />
<br />
Solution: We all know the drill. The
dreaded/beloved/hated/dreaded/thank goodness for it/ prednisone.
Steroids. That shot to the immune system that says "Shut the heck up
already!!!!". I'm sure the fevers will end shortly. :)
HUGS, Julie<br />
<br />
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sometimes have a low-grade fever related to the disease. Fever is sometimes a
first sign of the disease.</span></div>
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<span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><a href="http://www.niams.nih.gov/Health_Info/Lupus/Lupus_Guide/chppis8.asp"><span style="color: yellow;">From National Institute of Arthritis:</span></a> </span></div>
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<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Patient
Information Sheet #8, Fever and Lupus</span></b></div>
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<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br />
Fever is often a part of lupus. For some people with lupus, an intermittent
(coming and going) or continuous low-grade fever may be normal. Other people,
especially those taking large doses of aspirin, nonsteroidal antiinflammatory
drugs (NSAIDs), or corticosteroids, may not have fever at all because these
drugs may mask a fever.</span></b></div>
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If you have lupus, you may be more vulnerable to certain infections than other
people who don’t have lupus. In addition, you may be more prone to infection if
you are taking any immunosuppressive drugs for your lupus. Be alert to a
temperature that is new or higher than normal for you, because it could be a
sign of a developing infection or a lupus flare.</span></b></div>
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Caring for Yourself </span></b></div>
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<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Take
your temperature at least once a day (or more often if needed) to determine
what a “normal” temperature is for you. </span></b></div>
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<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Take
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<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Call
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<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Even if
you don’t have a fever, don’t hesitate to call your doctor if you do not feel
well in any way, particularly if you are taking aspirin, NSAIDs, or a
corticosteroid. Signs of infection other than a fever include unusual pain,
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<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Talk to
your doctor about immunization against pneumococcal pneumonia and the flu. </span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Practice
good personal hygiene. </span></b></div>
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<b><span style="color: yellow; font-family: "Abadi MT Condensed Extra Bold","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Avoid
large crowds and people who are sick.</span></b></div>
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<![endif]--><o:p></o:p>Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0tag:blogger.com,1999:blog-4316526137866390150.post-54495944742836718132013-03-22T22:32:00.000-07:002013-03-22T22:39:41.850-07:00Use & Research of Adult Stem Cells To Repair Organs in LUPUS<h5 data-ft="{"type":1,"tn":"K"}">
<span class="userContent">Lupus is a tenacious autoimmune disease, affecting about 1.4 million
people in the U.S. Considered a high risk disease for mortality and
organ damage, a recent study has discovered that fat-derived stem cells
can restore lupus to normal body functions. </span></h5>
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<span class="userContent">Really KOOL! This affects ONLY adult stem
cells. I recently had cervical spinal surgery using stem cells for disc
material. We are currently waiting to see if they REGENERATE my
discs. Here is an article about research using adult stem cells to
treat LUPUS, an autoimmune condition where the body attacks it's own
cells. Many of us with lupus have organ damage-to be able to restore
normal functions..well it's AMAZING!</span> </h5>
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<a href="http://www.digitaljournal.com/article/311616" target="_blank">http://www.digitaljournal.com/</a><wbr></wbr><a href="http://www.digitaljournal.com/article/311616" target="_blank">LINK To Article On Stem Cell Treatment For LUPUS</a></h5>
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Julie Johttp://www.blogger.com/profile/04052180639238272441noreply@blogger.com0