"In order to write about life, first you must live it." ~ Ernest Hemingway

Category: autoimmune disease (Page 4 of 19)

Sjögren’s and Interstitial Cystitis

Several years ago, in 2012, I began to have some issues that confused the heck out of me. I was having some urinary symptoms such as feeling like I had to go all the time, lower pelvic pain, and oftentimes feeling like I could not quite empty my bladder. These symptoms would wax and wane and were episodic in nature. I would go to the doctor and often, I would get treated for a urinary tract infection (UTI), even though my urine sample was always negative. However the symptoms I was experiencing seemed like they were classic UTI symptoms.

Around the time of my wedding in Spring 2013, the symptoms were acting up, but it was the months between my wedding and honeymoon that were the worse. The pain was relentless and had actually become crippling at times, I constantly felt like I had to urinate. During this time I saw a urologist in western Massachusetts. I had found some information in The Sjögren’s Book by Daniel Wallace which pointed to the suspicion that my symptoms may be related to something called Interstitial Cystitis (IC). The doctor’s appointment was a nightmare. He insisted that this was not the issue and furthermore, IC is not at all related to Sjögren’s syndrome.

Well, things were getting worse by the week and I realized that I couldn’t go back to that doctor and I needed help. I did my own research and ended up in the urology clinic at Lahey Clinic in Burlington, Massachusetts. These doctors were top notch in the urology world and by the end of the first visit, they told me I likely had IC. As an aside, I highly recommend Lahey Clinic and this was also a perfect example of how important it is to advocate for your own health care. They put me on a bladder medication and had me radically change my diet to avoid foods with high acid content, as that can make IC much worse. I got no relief from the medication and minimal relief from the diet.

One month before my honeymoon, they brought me to the operating room and did a procedure called a hydrodistention with cystoscopy. Typically, you can see an indication of IC during this procedure and although the doctor did not necessarily see what he was looking for in terms of diseased areas, they went ahead and did the hydrodistension part of the procedure to flush away any inflammatory cells that may be present.

I did unbelievably well with the procedure and my symptoms disappeared. Since that procedure in August 2013, I have had a few very minor pain flare-ups with my bladder, but I can always correlate it with an increase in acid in my diet. As soon as I fix that, I am good. I am firmly convinced that  the Lahey Clinic they did was what got me on the road to recovery and since then, I have tried to be very vocal about the possibility of having IC with Sjögren’s so that more Sjögren’s patients like me don’t suffer more than they need to. Especially since that first urologist I saw was so uneducated and uninformed.

I was delighted to open up the February 2015 Moisture Seekers newsletter last week to see an article about Interstitial Cystitis. Because the article is so well done, I am going to reprint it below for your information:

Intersitial Cystitis (also known as IC) is a chronic bladder condition that usually consists of recurring pelvic pain, pressure, or discomfort in the bladder and pelvic region, urinary frequency (needing to go often) and urgency (a strong need to go). IC also can be referred to as painful bladder syndrome (PBS) and chronic pelvic pain (CPP). The exact cause is unknown, but researchers have identified different factors that may contribute to the development of the condition.

About 25% of IC pateints have a definite or probably diagnosis of Sjögren’s and as many as 14% of Sjögren’s patients are estimated to have IC.

Some things you can do to control your IC include:

1. Avoid or limit foods and beverages that may irritate the bladder, including coffee, tea, soda, alcohol, citrus juices, and cranberry juice. For some, spicy foods may be a problem as well as foods and beverages containing artificial sweeteners.

2. Apply heat or cold over the bladder or between the legs to alleviate some pain.

3. Modify or stop Kegal exercises which may make pelvic floor muscles even tighter.

4. Avoid tight clothing to prevent further irritatiion and restricted blood flow to the pelvic region.

5. Treat constipation.

6. Develop healthy sleep habits as sleep is crucial for pain control.

7. Adjust fluid intake. Increase or decrease depending on your situation.

8. Retrain your bladder by learning to urinate on a set schedule and not when your bladder tells you.

9. Find healthy ways to manage your stress since it may make IC symptoms worse.

10. Find, in advance, the locations of restrooms along your route when traveling.

11. Get active! The health of the bladder depends on good blood flow to the area and having flexible and strong muscles around your bladder and other pelvic organs to protect and support them.

12. Quit smoking. Cigarettes may irritate the bladder and worsen the pelvic and bladder pain.

13. Take a trial and error approach to treatment as no one treatment works for everyone. A combination of treatments is often necessary to get your IC under control.

14. Track how your symptoms change with treatment and speak with your healthcare provider if you think a therapy is not working.

Visit the Interstitial Cystitis Association website at www.ichelp.org for the most up-to-date and accurate information about IC and to find knowledgeable healthcare providers.

******Reprinted from The Moisture Seekers, Volume 33, Issue 2, February 2015.*****

The Courage of Illness

Yesterday, my husband and I attended the Greater Boston SSF Support Group at Tufts. The February meeting is always unique every year because it is the one meeting a year in which we have round table discussions, instead of a guest speaker lecture. What happens is that different topics that people are interested in are submitted to the moderator. There are three separate sessions during the two hour meeting and in each session there is anywhere from six-nine different table topics. Each support group member goes to the table that has a topic they are interested in discussing with other members. It is a great way to learn and discuss topics that are of interest and are unique to each group member.

This year I facilitated two of the three sessions. One was on the topic on using low-dose naltrexone as a treatment for Sjögren’s and the other was on the use of alternative medicine in Sjögren’s. My husband and I also attended a session on complications from Sjögren’s and he attended a session on his own about being a caregiver of someone with Sjögren’s.

Both my husband and I recognized the many faces of those who have attended the group before, but it was very noticeable to both of us that there were a lot of new faces as well. As we spoke with people, we realized that that there were quite a few people who were newly diagnosed and I particularly noticed that there were more younger people than usual. Younger being defined as younger than being in their 30’s.

The ride to the support group takes at least an hour and a half on a good day and the day of this meeting, I was definitely not feeling my best. I was in more pain than usual, more tired than usual, and basically just sick of Sjögren’s; and the ridiculous winter weather we have been having as of late in Massachusetts. But I knew people were counting on me to facilitate these group discussions and I also had help getting there, so off we went.

As someone who has written a book on Sjögren’s, writes a blog, has had the illness for quite a few years now, and does a lot of research, I often get approached a lot during these support group meetings by people asking for advice or asking questions. I will be honest, I love this because for me, it makes all the hell I have been through have meaning because I can then use my experience to help others. It can be a little overwhelming though on days when I am not feeling well. Not because I don’t want to help or anything like that, but because it is harder for me to focus and pay attention. I’m sure many of you can relate to how that feels.

The low-dose naltrexone session I facilitated went well, but the alternative medicine session was incredible. I originally had estimated, according to the sign up sheet, that about six-seven people would be attending that session. The session ended up consisting of twenty-three people. After handing out information on a variety of alternative treatments, I had each group member talk briefly about their experiences, if any, with alternative medicine.. It actually surprised me how many people were using different alternative medicine treatments. Some of the most common treatments used were diet (specifically gluten-free and dairy-free), oil pulling (this surprised me, I thought I was the only one who did it), acupuncture, and turmeric. There was some really good discussion and sharing of ideas; an ideal outcome for a session like this.

Because I interacted with so many different people during this particular support group, I heard more personal experiences than I usually do during a meeting. As I have been thinking about the meeting since yesterday, there has been a common theme that keeps emerging in my mind. And that is how much we, as Sjögren’s patients, go through on a day to day basis. And the amount of courage it takes to live with this crap day after day, week in and week out. I’m not just talking about the path to diagnosis, which as we know, is usually a nightmare in itself. But rather, the amount of care we need to provide ourselves in order to manage our symptoms each and every day.

For me personally, a lot goes into existing in this illness stricken body day after day and I think that I often take that fact for granted, mostly because I feel like I cannot always dwell on how difficult it is or I will spiral into a massive depression. I also think that a lot of what I do to manage my illness becomes routine at times and I also take that for granted because well, its my life and its what I have to do. Just the steps that I have to take every day to prevent complications as a result of the dry eyes and dry mouth is time-consuming. Seriously, think about what the average non-Sjögren’s person does to care for their eyes and mouth every day. Most people I know brush their teeth twice a day and maybe floss once or twice a day. See a dentist every six-twelve months or so. Some non-Sjögren’s people have to put in and remove contact lenses every day or keep track of their eyeglasses.

For those of us with Sjögren’s, it is so much different: meticulous oral care such as frequent brushing, flossing, oil pulling, saliva substitutes as often as every hour, more frequent dental visits, special oral rinses, managing dry lips, dealing with swallowing issues from the lack of saliva, increased cavities, eye drops every thirsty minutes to an hour, warm eye compresses several times a day, waking up during the night from the discomfort of dry eyes and dry mouth, using and caring for a humidifier, trying to avoid dry environments, the list goes on and on.

And that is just our eyes and mouth. As we know, for most of us, that is just the tip of the iceberg. It doesn’t include the management of pain, fatigue, and other organ complications with our lungs, heart, nervous system, digestive system, kidneys, bladder, etc. etc.

When I did a rough estimate of the amount of time per day I spend on managing this illness (including but not limited to: medications, treatments, physical therapy, diet management, phone calls, medical appointments, etc.), I realized that the average amount of time I currently spend managing my Sjögren’s is three hours A DAY! And that is when things are relatively stable.

As I think about that and about all these patients yesterday, one word comes to my mind and that is:

COURAGE.

Guys, this illness business is not easy. One of the definitions of courage is: strength in the face of pain and grief. This courage we exhibit is something I needed to be reminded of recently, by people who understand what it takes to live with this illness. It takes an incredible amount of courage to wake up every single morning and know what we have to face…

The special care our bodies need.
The pain.
The stress of modifying our day to meet our physical, emotional, and spiritual needs.
The grief over what we have lost.
Finding treatments to manage an incurable illness.
Dealing with a medical system that at its best, is broken.
Facing the possibilities of long-term complications and even death.

People who don’t know better or don’t understand this invisible illness, they may say you are lazy, or weak, or making it all up. But friends, I know better. YOU know better. You are warriors. Each and every one of you. Despite the odds being stacked against you, you rally on. You go to work, or you educate others from the confines of your home. You tell your story. You care for your children and your parents. You volunteer to help those less fortunate. You rescue abandoned animals.

I have heard your stories.
You all exemplify courage.

Don’t let anyone ever convince you otherwise.
Own your strength.

Nutrition and Sjögren’s

I posted on the Facebook page for this blog recently about a visit I made to a nutritionist. I had won, at an auction for the SSF (or rather, my husband won for me), a one hour consult with Tara Mardigan, MS, MPH, RD. She is a nutritionist in Boston, MA and also serves on the Sjögren’s Syndrome Foundation’s Medical and Scientific Advisory Board. Some of my readers asked if I would post the information about that visit and this is what today’s entry is all about.

Anybody who follows my blog know that I feel very strongly that diet and nutrition play a huge part in dealing with autoimmune illnesses and is a very underutilized treatment option for all patients. I was running into a few issues with my nutrition lately, mostly because I was freaking out over what I was “supposed” to do. Since my diagnosis, I have been vegetarian, gluten and dairy-free, Paleo, and on the Autoimmune Protocol. I have had significant relief at times with the gluten and dairy-free, as well as the Paleo. However Paleo was causing me some other problems physically, so I had to loosen up on that. The Autoimmune Protocol didn’t seem to do me much good except make it so that I became a recluse in my house because I couldn’t eat anywhere else.

I have some emotional issues around food as well, many of which have improved over the past few years, but still come back to haunt me when my stress level is high. This most notably happens when I am stressed out over medical issues. I definitely have an addiction issue around sugar, processed foods, fast foods, etc. So going in all these different directions with my diet was really just making these issues worse over the past six months. I wanted to eat to fuel and heal my body, but it felt like the more restrictions I imposed on myself, the worse my eating habits would get after a while.

I was curious to see what an actual nutritionist had to say about it all, so off to Boston I went. Honestly, I am in Boston so much, I should just move there! The visit went well and the following is the recommendations she made to me in regards to my diet. Please remember, these suggestions are for me; most likely, you will have different needs so these suggestions should not be considered appropriate for everyone. That being said, I think a lot of the suggestions are just a good way to eat for all of us:

* Aim for a bigger, more balanced breakfast.

* Aim for balance at mealtime using the Five Fingers Chart. This chart states that at every meal, you should strive to eat one serving from each of the following groups: fruit/vegetable; carbohydrate, protein, healthy fat, and fluid. You can eat more than one serving of vegetables/fruits (except for starchy veggies and dried fruit). The more color, the better. Choose smaller portions for tropical fruits.

* Aim for a Powerful Plate at dinnertime. Choose the Healthy Eating Plate on days you exercise (50% vegetables/fruits, 25% carbohydrates, 25% protein) and the Less Active Plate on days you don’t exercise or have a very light day (75% vegetables/fruits, 25% protein). Adjust the amount of carbohydrates you take in based on your activity level. Less active, less carbs.

* Count corn, winter squash, parsnips, peas, and potatoes as carbohydrates, not as vegetables.

* Fruit with skin: 1 medium-large piece or 1 cup (berries, apples, pears, grapes, plums, nectarines,oranges, grapefruit.

* Fruit without skin: 1 small banana or 1/2 up (any tropical fruit)

* Consider a high powered blender such as Vitamix or Blendtec to support your efforts and increasing fruits and vegetables (significantly) in smoothies will be a great anti-inflammatory nutrition strategy.

*Try adding an intentional healthy snack between breakfast and lunch and/or lunch and dinner if you have a gap of more than 3-4 hours between. Fruit with 0.25 cup of nuts or unsalted pumpkin seeds or sunflower seeds is a great choice here. You are looking for fiber, a small amount of healthy fat and/or protein.

*Consider trying some non-gluten free options from fresh-made sources. Refer to FODMAP grocery list for some digestive-friendly choices (not necessarily gluten-free).

* Try fresh cut vegetables, such as cucumbers or carrots with red wine or white vinegar as a crunchy nighttime snack that’s sodium-free and low in calories.

* Consider the “One Bowl” method for nighttime or mindless snacking. You can eat whatever you want (healthy or unhealthy) but you’ll first stop and put the food into a bowl. Don’t judge the food or the amount, but take a minute to pause. This is a mindful eating strategy and may help you gradually make intentional choices that help nourish. This is a difficult strategy but if you’re able to stick with it, it will help you lose weight because you’ll eat less and choose more healthful options. The book that inspired this idea is One Bowl by Don Gerrard.

* Be verbal when eating out. Ask for extra vegetables, prepared without butter or sauces. Ask for a side of pasta or skip it. Skip the bread. Avoid shiny and battered foods. Get open-faced sandwiches. Have the burrito bowl with a small spoonful of rice. Skip or split appetizers and desserts. Choose fish instead of meat. Ask for lemon wedges to add flavor.

* When dressing your salad, use fresh lemons and a small amount of olive oil. If you want creamy dressing, ask for it on the side and use a small amount.

* Continue with consistent (but gradual) hydration throughout the day with water.

* Great job with exercise. Continue with walking and yoga and hopefully you will be able to gradually get back into running again.

Whew! I know that’s a lot of information, but I thought it was important enough to share with all of you. I had the appointment right before Christmas. I did read the One Bowl book she mentioned and started to implement a few of the suggestions, but Christmas eating really threw me off. I did try some non-GMO bread with gluten in it. I found that in small amounts (and I mean SMALL), I could tolerate it, but larger amounts seem to be a problem. I found this out when I dropped my gluten and dairy restriction for several weeks around Christmas. I also developed a lot of digestive issues when I ate a lot of gluten and dairy, issues that I have never had before. I am currently on the last day of a 10 day detox/cleanse which was my own doing; it was NOT a recommendation of the nutritionist. I will be blogging about that tomorrow or Monday. My plan for the few days following the detox is to ease back into eating normally again and then go full steam ahead with the nutritionist’s suggestions.

One of the big things that this visit made me realize and understand is that despite all the different “diets” and eating plans out there that claim to cure or help your autoimmune illness, in the end, it may just come down to great nutrition on a consistent basis for many people. I am not saying that the Autoimmune Protocol or eliminating gluten may not help your symptoms; I know many people who find relief eliminating different food groups, such as with me and gluten. However, I think that for me, the answer may be more in eating whole foods in balance with each other, minus the gluten and dairy I need to limit, as well as limiting processed foods, soy, alcohol, refined sugar, etc. So basically, just eating healthy!

Please feel free to comment below on what nutrition strategies you have implemented to help your autoimmune illness, or even just your general health.

Low Dose Naltrexone Update

I happened to notice that my posts on low dose naltrexone (LDN) get a ton of traffic, maybe even the most traffic out of any other topic. I am relatively certain that the reason for this is because more and more patients and medical providers are learning about all the potential benefits of this under recognized medication.

I have written about LDN a few times in the past and lately, I have also been getting some e-mails asking where I am at with it. So I figured an update, even a brief one, was in order.

I am currently taking 2 mg of LDN every morning. If you have followed by other LDN posts, you will know that this is my third and final attempt at making LDN work for me. I have definitely had benefits from it in the past, but the insomnia issue negated any positive effects I was getting from it in terms of fatigue and pain.

I got up to 2 mg over the past several months and I think that is a critical reason why I am doing so well with it this time around. I am taking it in the morning. There are so many different opinions amongst the “experts” as to whether morning dosing is therapeutic at all. And honestly, I don’t feel the need to get into that debate. What I do know is that it has helped my pain and fatigue and that is good enough for me. If insomnia is a big issue for you with LDN, I encourage you to try morning dosing.

That being said, my goal is to try and switch it to evening dosing to see if it makes any difference in my symptoms. Since my sleep has been great lately, I will probably do that soon. I am also planning on increasing the dosage to 3 mg at some point. I am waiting on that because I want my body to take its time adjusting to the 2 mg and I want to try switching it to the evening. I also just got more thyroid better regulated and I know that a dose change will likely mess with that. Sometimes its good to just go with the flow.

I don’t have ANY side effects at this point with this current dose. While it has improved some of my symptoms, I still have a long way to go and I will see what happens with the changes mentioned above.

If this is the first you are hearing of LDN, I encourage you to do some research and talk to your doctor. Most medical providers have not heard of it and they require some information. This medication has very low risk of side effects associated with it and I think it is worth your while to investigate it further as a possible treatment for yourself.

Book Review: As My Body Attacks Itself

In December , I was approached via e-mail  by a woman, Kelly Morgan Dempewolf, PhD, with Sjögren’s syndrome, who asked if she could send me a free copy of her book (that is my disclaimer by the way) As My Body Attacks Itself, in order for me to do a book review on this blog.

This self-published work, which is 192 pages, is a memoir describing her experience with Sjögren’s syndrome. As a patient who published her own book on the illness, of course I was instantly intrigued as to what she had to say in this book. Here is the  book description taken from the back cover of the paperback:

“50 million Americans suffer with an autoimmune disease and countless more deal with chronic pain, fatigue, and illness. These diseases are often invisible, yet they touch every part of a person’s life and of the lives of the people they love.

This book is an honest, raw look at the thoughts, concerns, fears, and struggles as Kelly deals with Sjögren’s syndrome (the second most common autoimmune disease). The story isn’t just about Sjögren’s, or even just autoimmune disease. It’s for everyone impacted by chronic disease of any kind.

Kelly’s hope is that patients will find solace and validation; friends and family will gain understanding and the abilities to empathize, communicate and support loved ones; and medical professionals will gain understanding and ability.”

The book is divided into 41 plus chapters and reads similar to a person’s journal or even an online blog. Each chapter is divided into different topics and these range from topics like disease envy and pain medication to others like brain fog and parenting. Each chapter is written from her perspective and details, quite elaborately, her journey and experiences with each of these issues or events. If you are someone who has Sjögren’s syndrome, I am certain that you will read parts of yourself, and your experiences, while traveling through this book.

Because this book is a story about a personal journey, I don’t think it is possible to fairly review the book beyond that because in doing so, a reviewer would be judging another person’s very real and very painful experience battling an often misunderstood and little-known illness. And I feel that nobody has the right to really do that.

Rather, I think it is important for you to read the book yourself and see what comfort you may be able to find in reading a story about a brave woman going through a struggle similar to the one you, or your loved one, may be going through right now. You can find Kelly’s book on Amazon by clicking HERE.

Happy reading!

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