Basic Lupus Treatment and Steroids

Many of us would be surprised at the amount we already know about lupus that the average consumer does not. For example, often we know what our ANAs and ESRs are. We know to compare them with previous ones and we might understand why they might be elevated. For example, often we follow our ESR (erythrocyte sedimentation rate) as a measure of inflammation in our bodies. Well, if it is elevated, it means that there is inflammation SOME WHERE IN THE BODY. More specifically, we might compare our ANAs.

We’ve learned over the years, that treatment for the symptoms of lupus involves treating the inflammation that causes those symptoms. That’s the reason doctors often suggest NSAIDs (non-steroidal anti-inflammatory drugs) like “Aleve” or ibuprofen.

Oftentimes, NSAIDs are adequate to control pain as they decrease inflammation which causes the pain. But, sometimes NSAIDs are not adequate. So, pain is managed temporarily with the steroid, prednisone. Sometimes, a dosepak is prescribed, a burst of an oral steroid followed by decreasing doses of that same steroid for 5 or 6 days.

Steroids should always be withdrawn slowly; we all know that. But do you know why? We might experience symptoms of the withdrawal (weakness, fatigue, body aches, joint pain).

The main reason for weaning from steroids slowly is because the adrenal glands already produce a steroid, cortisol. When you started taking oral exogenous (from an outside source) steroids, the body began to slow down it’s production of them over 2-3 weeks. As time passed, your body became completely dependent on oral steroids as endogenous  (produced from within the body) stops.

When the exogenous steroids are to be stopped and steroid therapy reintroduced, it is important to slowly taper the amount of steroids that you take because it ‘time’ for the adrenals to ‘kick back in’ with their production of cortisol, so exogenous steroids have to be slowly withdrawn. Why? Because cortisol is the steroid responsible for the ‘fight or flight’ response that our body mounts to stress, so something called adrenal insufficiency or adrenal crisis can result. We must be able to engage the fight or flight response, so it is important, very important that steroid tapers be followed exactly as your doctor orders. retrieved from the www: 9/19/2016

What is Pulmonary Hypertension?

We’ve talked about some ways in which lupus can affect the heart: its inflammation can cause pericarditis; a painful inflammation of the lining around the heart, lupus patients are at an increased risk for development of Coronary Artery Disease, dyslipidema and many other heart-related problems.

Pulmonary Hypertension is not to be confused with high blood pressure, the systemic type in which your doctor measures your blood pressure with a cuff around your arm. For the purposes of this discussion, we speak of PULMONARY hypertension, or HIGH BLOOD PRESSURE IN THE LUNGS and treatment for it involves sophisticated treatment by subspecialists- after a through diagnostic workup. The World Health Organization has chosen to classify 5 types of Pulmonary Hypertension into Groups:

Group 1. Pulmonary Arterial Hypertension-the Pulmonary Artery becomes narrowed, so the pressure inside this artery becomes high.

Group 2. Pulmonary Hypertension due to left heart disease. This is often seen when stiff LEFT-SIDED HEART vessels don’t completely relax. A good example might be one which is caused by left ventricular diastolic dysfunction.

Group 3. Pulmonary Hypertension due to lung disease- the diseases here include COPD, mainly empyhsema and chronic bronchitis, as well as any disease that leads to scarring of the lungs, like pulmonary fibrosis and sleep-disordered breathing. In this instance (sleep-disordered breathing) CPAP for Obstructive Sleep Apnea is necessary.

Group 4. Pulmonary Hypertension due to blood clots in the lungs: this is sometimes called Chronic Thromboembolic Pulmonary Hypertension and in it, (blood clots) form within the lungs causing pulmonary hypertension by blocking the flow of blood through the pulmonary arteries., not only raising the blood pressure in the pulmonary artery, but since blood flow is blocked, more clots form.

Group 5. blood and other rare disorders that result in Pulmonary Hypertension-or Chronic Thromboembolic Pulmonary Hypertension. For an unknown reason, blood clots form in the lungs and in addidtion to the formation of clots which create more clots, these clots increase the pressure inside the pulmonary arteries.

The diagnosis of Pulmonary Hyptertension is often one made during a work-up of shortness of breath. Shortness of breath can have multiple causes and unless diagnosed and treated by subspecialists early, the shortness of breath of Pulmonary Hypertension  can have a poor outcome.

The unknown

Surgery to replace my hip was called off. Was it because I was chicken? No. I was advised against surgery at the time because of a risk to my lungs and heart. Does that mean that I am forever at high risk for any surgery?

High risk. I don’t like the sound. You mean, one of these times, I might not ‘wake up?’ Now, there’s a humbling thought and a reason to examine my own mortality. I have Shrinking Lung Syndrome (sometimes known as Vanishing Lung Syndrome) from lupus or from Sjogren’s Syndrome (it is a rare pulmonary effect of either) and I experience severe shortness of breath with next to no exertion. However, upon measuring my oxygen saturation at the time, the result is usually normal, @ 98%-99%.

That’s why supplemental oxygen didn’t help. However, that was the past and I just wonder about the present.  A recent sleep study monitored oxygen all night long. We’ve tried inhalers: So far, none have worked.  So the next step/treatment.

The shortness of breath is now much more involved as it takes on a life of it’s own. Walking is limited to 10-20 yards before it becomes so severe that I need to rest. The shortness and breath, along with weakness, makes it next to impossible to walk without use of a cane.  My balance, issues are getting worse everyday. Hardly the way I wanted to spend the ‘golden years!’

Having not much more than time on my hands, I write here or at my other blog, annies analysis, frequently. My rheumatologist has prescribed several medications, and a diary of my journey with these can be found in TREATMENT CHRONICLES. Come, join me on my journey!

The Bionic Woman?


Replacements of most joints are becoming commonplace, but some are replaced more often than others; and the hip joint is very likely the most frequently replaced joint. The following is an image of a normal hip:

normal hipNotice that the bone marrow has a blood supply, (the blood supply to the bone marrow is represented by the area with the red dots on the graph), ‘ball’ and ‘socket’ created by the ‘head’ or top of the femur and the acetabulum of the pelvis.

Over the course of years, the cartilage  can wear thin. When the cartilage doesn’t provide the cushion that it used to provide, pain results, and this pain can be quite severe and not always relieved by medication. You may have heard people use the term, ‘bone on bone’ referring to the bone in the ball rubbing against each other of the ball and socket. each. It may now look a bit more like:

Untitled 3

You can see on the patient’s same side that there is an accumulation of dead bone cells. These cells cause much of the pain: how? Bone cells are like any other cell in the body, they must rid themselves of debris and toxic wastes. This is the goal of one procedure commonly used to relieve symptoms: core decompression.

If pain from osteonecrosis still exists despite complete non-weight bearing status, ice, elevation and physical therapy with tylenol and nonsteroidal antinflammatories (NSAIDs) like ibuprofen and naproxyn, a surgical option is sometimes indicated. One of those surgical options is the total joint replacement, a THR.

anntated_THRIn the diagram to the left are the components of the hip prosthesis which are inserted by the surgeon to create a new joint.

The femoral stem is inserted into the thigh bone and bypasses any osteonecrosis or osteoarthritis which may be present.

The femoral head component has at it’s end a shiny metallic (titanium) piece which inserts into a plastic cup or liner. This liner fits into the acetabular component and doubles as cartilage to further protect the new joint.

This surgery has saved many from a lifetime of pain and if it works on me in a week, I’ll be free of hip pain for the first time in many years and one step closer to THE BIONIC WOMAN!

Internet Medicine: Should I consult ‘Dr. Google’?

What did we do before the Internet? A search can answer many of life’s questions; All well and good when you want to know the bus schedule, what’s playing at the cinema, or where to find the best sushi restaurant in a new town.

But, there are times, when, the Internet is not the best first source of information. When it comes to medical conditions, typing symptoms into a search engine will return so many wild and far-fetched results that you can easily scare yourself silly.

Many of us turn to Internet research for information on unexplained aches or pains. With quick answers readily available via the devices we all carry, it would be strange not to. It’s not necessarily a bad thing. Just so long as we keep a sense of perspective, and don’t allow the alarming ailments described in the search results to convince us we have barely moments to live.

Here are some tips to help get and maintain vital perspective:

Choose Accurate Reliable Sites

Peer lead, forum based sites are not the best bet because even though they have a lot of information, a good part of that information may not be applicable to you. While it’s interesting to read people’s experiences with symptoms similar to yours, the problem is that similar symptoms are present in many diverse conditions. For instance, the symptoms caused by bad indigestion can mimic heart attack pain. It takes years of training and some sophisticated monitoring equipment to make an accurate diagnosis. There are two danger points:

  • Your condition may be serious but the forum discussions you’re reading lead you into a false sense of security,
  • Your condition is not serious, with symptoms easily treated by over-the-counter medications, but from what you read you’re convinced a trip to the ER is urgently needed.

Without medical training, it’s practically impossible to make the right judgment call when you have new symptoms. Research and analysis into the accuracy of medical information found on the Internet has revealed that blogs and websites run by individuals are the least reliable, with between 25 and 30% accuracy.

Sites such as those with domains ending in .gov, .org or .state are the most reliable but still they aren’t 100% foolproof. Advice you find there is really only relevant to you it if you have been diagnosed with the disease, a proper, official diagnosis by a doctor.

Even if the information is accurate, a second problem with Internet research is that you might come across unfamiliar medical terms or jargon, leading to further research that can also provoke unnecessary concern.

Doing research on the Internet about a condition is best left until after you have been diagnosed with that condition. You doctor may have a much harder time finding out the cause of your symptoms, if you have a preconceived notion about what might be wrong.

Internet research is most useful after a diagnosis. When you know exactly what the problem is, the Internet can help you to research and understand complex medical issues. It can empower you to ask your doctors the right questions and help you play a more proactive role in your treatment and recovery.

Following diagnosis, what a useful as a tool to help you reach other patients with similar conditions through support groups!

Internet Research Do’s and Don’ts

Because we are not going to stop looking on the Internet to help us understand medical conditions or find out possible causes for symptoms, bear in mind these tips when consulting Dr. Google:

What Not to Do

  • Don’t believe everything you read on blogs.
  • Don’t trust hyped-up marketing copy. Advertisements on websites are sometimes hard to spot since they are often cleverly placed to appear like part of the text. If something looks like a miracle cure or sounds too good to be true, (it probably is). Ignore it and move on.
  • Don’t self-diagnose. Look at everything you read as possible background information rather than solid fact that applies to you personally. A diagnosis that you can trust only comes from your doctor.
  • Don’t assume that medical conditions always cause the same symptoms. Having some symptoms of a serious disease usually doesn’t mean that you have the disease, because individuals are different in showing the symptoms of their disease.
  • Don’t self medicate using information that you got from the Internet.

What You Should Do

  • Do your research at reputable, reliable organization or government websites.
  • Double-check all the facts, especially those found on individual or blog sites.
  • Use common sense, and don’t allow information you find on the Internet to scare you into rash actions.
  • Always see a doctor for diagnosis, and check with medical specialists or consultants before following online advice.

The Internet is a very useful tool and it can teach us many things. But, it can’t replace years of medical training that your doctor has and, as such, it should never be relied on or trusted when it comes to something as important as your health.

This does NOT mean that you should never use the Internet for medical advice, but you should use it with common sense and use the Internet to clarify information. Then, you ought to ask your doctor if what you read, could be true.


This post was written by Dr. Aaron Braun, Medical Director at SignatureCare Emergency Center.


General Anesthesia and Lupus

Surgery and Lupus

People who suffer from lupus face a great deal of unique health challenges. This disease can make it difficult to perform many routine tasks. It can also have an effect on other medical procedures that may be necessary, such as surgery.

Although surgery is relatively common and typically very safe, people who have been diagnosed with lupus may have to make some extra preparations before an operation. It’s important to communicate with a doctor about all issues related to lupus and surgery but the following tips can help people start a conversation with their healthcare provider.

How to Prepare

People who have been diagnosed with lupus may have some special considerations prior to surgery. Lupus is generally treated with a variety of powerful medications. These medications can have an adverse effect when combined with local or general anesthesia. In some cases, these adverse reactions could be very harmful or even fatal. Before surgery, lupus sufferers should inform their doctors of:

  • All medications they are currently taking
  • Any recent changes in medications or dosages
  • Dosages of current and recent medications

Before surgery of any kind, communication is key. Making sure that all doctors and healthcare providers are fully informed about a patient’s medications is a critical part of surgery preparation. Leaving anyone out of the loop could have drastic consequences.

It’s also important to get thoroughly checked out before surgery. Scheduling appointments with a primary care physician and specialists, like a rheumatologist, can help patients get a better understanding of their health before surgery. Some people with lupus may develop organ damage over time. Spotting this kind of damage before surgery is important for the health of the patient. Surgery is a major ordeal and it’s important to be healthy before any operations.

It may be necessary to alter or adjust some medications before surgery. Some people with lupus who have been taking steroids may need to increase their dosages prior to surgery to prevent adrenal problems. Consulting with a physician who prescribes steroids is a great way to find out specific information.

Some people with lupus may have additional health conditions, like Sjogren’s syndrome or Raynaud’s syndrome. Letting surgical doctors and nurses know about these conditions and their treatments beforehand can help them avoid any unsafe situations.

What to Expect

Before surgery, patients will be asked to provide specific information about their health, their illnesses and their medications. This will help the anesthesiologist use the correct medications.

Many major surgeries will require general anesthesia. The anesthetic may be administered intravenously or through a respiration mask. Patients will feel drowsy and eventually become unconscious. After surgery, patients can expect to spend some time recovering. Lupus patients may experience additional recovery time and may develop some symptoms, including:

  • Pain near the surgery site
  • Bruising
  • Nausea and vomiting
  • Insomnia
  • Dry mouth

In most cases, these symptoms are normal and will pass with time. However, any symptoms that persist or become worse may be signs of a serious problem and a physician should be consulted.

Risks of Surgery with Lupus

All surgery includes some risk but lupus sufferers may be especially prone to these risks. The medications that lupus sufferers may take can increase their risks of adverse effects during surgery. Additionally, other health conditions such as high blood pressure, diabetes or allergies to certain drugs can further increase the chances of a bad reaction.

Although surgery for lupus sufferers can carry some risk, the benefits almost always outweigh the negative outcomes. The best way to prepare for surgery is to have thorough consultations and checkups with all doctors and specialists that are involved in a patient’s care.

With thorough preparation and a doctor’s supervision, patients with lupus can greatly increase their chances for a safe and effective surgery.


The team at Anesthesiology Consultants takes pride in providing the very best in anesthesiology board preparation. By concentrating on 4 key attributes – knowledge, judgment, adaptability, and communication – candidates don’t just learn how to pass an exam; they learn to become perioperative consultants.

Lupus and Asbestos

Landon Biehl

Have you been exposed to asbestos? Complications that result from exposure to hazardous materials in the environment are often times hard to identify and track down. We come into contact with a large number of potential health threats everyday, making our ability to identify exactly what causes our complications or health issues not easily identifiable.

Lupus has quite an effect on the lungs and can mimic other lung diseases, such as mesothelioma, making the differences in the health threat closely related in nature. A large percentage of lupus patients develop pulmonary issues, and different lung complications and diaphragm issues. Similarly, asbestos exposed victims can develop some of the same complications.

A very common trigger for lung complications is asbestos. Since the risk of exposure to asbestos is common, and tracking down its initial place of contact is nearly impossible, many times individuals believe they have been exposed when they really have not come into contact with asbestos.  However, if there has been exposure, medical treatment should be sought out immediately.

Often times, when experiencing lung complications, many people seek treatment for asbestos. However, after no positive recovery from the symptoms, an alternative diagnosis should be considered.  In many cases, the patient suffers from pulmonary complications of lupus and there was never a problem with asbestos in the first place. Identifying and letting your doctor know of some of the symptoms you are experiencing is critical for correctly diagnosing your complications. In addition, its a good idea to do some background research on any health complications you might be experiencing, anytime an issue arises. Educating yourself on the differences between asbestos exposure and lupus will only increase your chances for a correct diagnosis.

In addition, educating yourself on some of the hazardous threats and materials that we come into contact with on a daily basis can help to ensure our safety and will ensure we are alert at all times. Identifying areas of potential asbestos exposure in your city would be a great start. In addition, educating yourself on the differences between asbestos exposure and lupus will help you to obtain a speedier recovery.

Landon Biehl is a advocate for healthy living and fitness tips. Residing in North Carolina, he enjoys spending time writing and helping to inform others with wellness information that can benefit families. In his spare time, Landon enjoys spending time at the beach, and being outdoors- running, swimming and kayaking among his favorite activities.