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What can we do to prevent or care for flares?

Sometimes we can’t do anything to prevent flares, but when we can, doesn’t doing something to prevent flares make sense?  Here is a list of things that we can and should do to prevent or care for ourselves during flares. My commentary is in red letters after each bulleted point which discusses well-recognized and common-sensical approaches to things that we can do to manage flares:

  • Learn to recognize the warning signals of YOUR flares and tell your doctor about them.‘Knowledge is power’ and the lupus patient who is more-informed about his illness and is a partner with his physician tends to have a better outcome.
  • Be sure to check with the doctor who manages your lupus, (often a rheumatologist) before receiving any immunization. There can be ‘ingredients’ in immunization solutions which cause the immune system to over-react or to which an individual might be allergic. It is our responsibility to know what OUR particular triggers are and to what WE react. This gives patients power.
  • Maintain your physical health. Be sure to visit your doctor regularly, even if you are feeling well. Schedule regular dental, eye, and gynecological exams. This  is one way in which your doctor know that you’re serious about managing your illness, and being a partner with your doctor. 
  • Get enough sleep and rest. Be flexible with your schedule. Pacing your activities allows for more rest. Rest recharges the immune system and allows for more normal functioning and fewer flares.
  • Eat a healthy diet. Only your doctor can make suggestions regarding changes or additions to your diet, but it is generally accepted that all Americans need supplementation at times: Vitamin D3 for bone health and immune system health is just one example, and a good multivitamin is another example.
  • Try to limit your stress. Because this may be hard to do at times, consider developing a plan for dealing with potentially stressful situations. Develop a support system that includes family, friends, medical or nursing professionals, community organizations, and support groups. Remember, it helps to talk to someone when you’re feeling stressed. There are unexpected stressors in our lives that we can’t control. We CAN’T control the boss who has a bad day and ‘takes it out on us.’) What we CAN control is our reaction to our boss-if we allow him to ‘GET TO US!’
  • Participate in a well-planned exercise program to help maintain physical fitness and reduce stress. Exercise has been shown to decrease our stress level and feeling of well-being as well as WELL-BEINGBe careful when trying any over-the-counter preparations used on your skin or scalp. First, determine whether you have a sensitivity or an allergy to it. Put a small amount of the preparation on the inside of your forearm or on the back of your ear. If any redness, rash, raised areas, itching, or pain develops, do not use the preparation. These are new medications and new medications have the potential to trigger a flare.
  • Talk with your doctor before you stop taking any prescribed medications. Starting or stopping medications can be another trigger for a flare. 
  • Limit your exposure to the sun and other sources of ultraviolet light, such as fluorescent or halogen lights. We spoke in the last 2 posts on triggers how exposure to ultraviolet light can trigger a flare.
  • Tell your doctor right away about any injury, illness, or infection or if you do not feel well in any way. Your rheumatologist can’t help you if you aren’t completely honest with him. Doctors can’t be certain what you have tried and succeeded in managing symptoms.
  • Delay elective surgery (including dental surgery and teeth pulling) until your lupus is under control or in remission. Any surgery is a stress on your system and a system that is under stress is more likely to flare.
  • Lupus may cause problems for a pregnant woman and her baby. As a result, women with lupus should carefully plan any pregnancy. Do not stop using your method of birth control until you have discussed the possibility of pregnancy with your doctor and he or she has determined that you are healthy enough to become pregnant. Pregnancy places a stress on your system and pregnancy can have vascular complications.
  • Check with your doctor or nurse before taking any over-the-counter medications. As discussed before, there are over the counter preparations which can make lupus symptoms worse, like Echinacea.
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Flares and their Triggers

First, this is a recap of previously agreed upon flare triggers:

Do you notice a trend; I do! I see that anything that places a stress on your system and requires that your body physically or emotionally adjust to a new set of circumstances has the potential to cause a flare of your symptoms.

So, how can each of the above triggers, throw you into a flare of your symptoms?  All of them put a physical or emotional stress on your system, but there are additional ways worth mentioning

  • not enough rest: Sleep deprivation is harmful to the immune system HOW? T cells are decreased when we get too little rest and when T cells are decreased or are decreasing, the body has a harder time fighting infection.
  • pregnancy places a stress on the body and if women become pregnant 6-8 months after symptoms become quiescent, they’re are less likely to develop a lupus flare during pregnancy. This means they need to plan pregnancies
  • when lupus patients have infections, they are likely to be started on medications. If you remember, STARTING a medication is an adjustment the body needs to make and rapidly starting a medication can trigger a flare
  • when people are overworked, they get too little sleep which can worsen their symptoms
  • emotional stress often causes us not to be able to sleep, to lie awake thrashing. When we don’t get enough sleep, T cells of the immune system have a harder time fighting infection.
  • ultraviolet light can trigger a flare Normally, an intact immune system rids us of aging or dying skin cells. Because sunburn can cause cell death and enough sunburn can cause enough inflammation so that more than ‘a simple’ sunburn results. UV rays can cause enough inflammation so that not just the skin, but the joints, muscles and internal organs are affected. FLARE
  • surgery: is a physical stress on the system and an emotional stress on the body, both of which trigger flares. Also, surgery can introduce medications (like antibiotics or anesthetics) not taken before, which can trigger a lupus flare. A cortisone injection (intravenous or intramuscular) is sometimes given.
  • viruses cause trigger lupus flares because they are a kind of infection and exposure to any infection causes the immune system to work ‘overtime.’

Wouldn’t it be great to be able to prevent flares, but knowing what can cause flares and how flares are triggered, gives some ideas as to how they can be managed. We’ll address that in another post.

 

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Triggers and how they cause flares

First, this is a recap of previously agreed upon flare triggers:

Do you notice a trend; I do! I see that anything that places a stress on your system and requires that your body physically or emotionally adjust to a new set of circumstances has the potential to cause a flare of your symptoms.

So, how can each of the above triggers, throw you into a flare of your symptoms?  All of them put a physical or emotional stress on your system, but there are additional ways worth mentioning

  • not enough rest: Sleep deprivation is harmful to the immune system HOW? T cells are decreased when we get too little rest and when T cells are decreased or are decreasing, the body has a harder time fighting infection.
  • pregnancy places a stress on the body and if women become pregnant 6-8 months after symptoms become quiescent, they’re are less likely to develop a lupus flare during pregnancy. This means they need to plan pregnancies
  • when lupus patients have infections, they are likely to be started on medications. If you remember, STARTING a medication is an adjustment the body needs to make and rapidly starting a medication can trigger a flare
  • when people are overworked, they get too little sleep which can worsen their symptoms
  • emotional stress often causes us not to be able to sleep, to lie awake thrashing. When we don’t get enough sleep, T cells of the immune system have a harder time fighting infection.
  • ultraviolet light can trigger a flare Normally, an intact immune system rids us of aging or dying skin cells. Because sunburn can cause cell death and enough sunburn can cause enough inflammation so that more than ‘a simple’ sunburn results. UV rays can cause enough inflammation so that not just the skin, but the joints, muscles and internal organs are affected. FLARE
  • surgery: is a physical stress on the system and an emotional stress on the body, both of which trigger flares. Also, surgery can introduce medications (like antibiotics or anesthetics) not taken before, which can trigger a lupus flare. A cortisone injection (intravenous or intramuscular) is sometimes given.
  • viruses cause trigger lupus flares because they are a kind of infection and exposure to any infection causes the immune system to work ‘overtime.’

Wouldn’t it be great to be able to prevent flares, but knowing what can cause flares and how flares are triggered, gives some ideas as to how they can be managed. We’ll address that in another post.

 

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Those evil flares

The title is a pretty short question which begs a pretty short answer. But, that begs the question, WHAT IS A FLARE? A flare is an exacerbation of the lupus symptoms that are normally experienced. But it is important to remember that what causes a flare of my symptoms may be completely different than what causes your flares.

Lupus symptoms can wax and wane, come and go: or be quiescent. Physicians are hesitant to use the term, “in remission,” because the term can connote that lupus is a CURABLE disease which it is not.

Flares might be triggered by one or MORE of the situations that we encounter in everyday life. Some common ones, in no particular order, are:

Researchers and practioners tend to agree that these are bonafide triggers of a flare. But again, it needs to be remembered that what triggers my flares may be, and likely is, different than the cause of yours. In another post we’ll talk about how each of these can cause a flare.

 

 

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Some symptoms of lupus and their causes

Lupus causes many symptoms, but here are a few. Again, this list isn’t all-inclusive. How can you figure out what causes a symptom? Often all you need to do is consider the powerful inflammatory action that lupus causes, or the ending ‘itis:’ inflammation

  • The malar rash (butterfly rash) is often the first thing that comes to mind when talking of the symptoms of lupus; but not everyone with lupus gets it. When the immune system mounts it attack on the skin (cutaneous lupus), the attack is either acute or chronic. If the attack is acute, (acute meaning it comes rapidly and ‘goes’ rapidly), you might see the classic “butterfly” rash. It is often referred to by doctors as ‘malar’ because of the location on the face where it occupies. Many also refer to it as the “butterfly rash” because it’s redness involves the bridge of the nose and the cheekbones, looking like the the body and wings of a butterfly.
  • fatigue: The precise cause of lupus-related fatigue isn’t known, but disease activity, pain, age, and medicines can contribute to fatigue caused by lupus. Lupus compromises your sleep and too little sleep or poor-quality sleep can result in flares of your symptoms. During these flares, you’re likely to be depressed that there is more pain and other symptoms seem worse. 
  • chest pain. The lung is lined by a membrane, the pleura. Inflammation of the pleura results in the pleura rubbing rubbing up against the lung causing pain. This pain is usually a pain on inspiration (when you breathe in), a pain which may mimic the chest pain of a heart attack. This pain should never be taken lightly and should be reported to your doctor immediately. Most people who have/or had lupus, have had an instance of this inflammation.
  • If the membrane surrounding and protecting the heart (pericardium) becomes inflamed, pericarditis can result. Symptoms of pericarditis often resemble those of a heart attack because there may be sharp, stabbing pain as the heart rubs agains the pericardium. There can also be a fast heart rate or a dry cough or shortness of breath. This should not be ignored.
  • chest pain: Another source of chest pain is called costochondritis. I was privileged (?) to have costochondritis once and it felt like I’d been kicked in the chest: by a horse! Costochondritis is an inflammation of the cartilage that connects a rib to the sternum. Recurring episodes of costochondritis often lead doctors to make a more thorough exam and a diagnosis of lupus follows.
  • shortness of breath in lupus can be caused by several things, too. If there is pleuritis (inflammation of the pleura, or pleuritis) pain of lupus is caused by pleuritic chest pain, the person might guard against the pain, by not taking deep breaths. Taking shallow breaths results in not getting enough air in the lungs; therefore shortness of breath.
  • headache. The most common type of headache in lupus is the tension or muscle tension headache which will usually ‘go away on its own’ or with over-the-counter analgesics. Lupus also causes migraine headaches which are much more prevalent in lupus sufferers than non-lupus sufferers. However, another kind of headache is more rare, but much more serious and indicative of a life-threatening complication., meningitis. It is due to inflammation of the meninges (membranes which encase the brain). Your physician should be aware of a headache that you have.

These are just a few symptoms of lupus, but for brevity’s sake, I didn’t discuss them all. I’ll discuss others in another post.

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But it hurts just to get out of bed-now exercise?

We all know that exercise has benefits. But when it comes to lupus and other autoimmune diseases, exercise that is non-weight bearing can be much more beneficial. In many cases that exercise is swimming, because there are very few risks involved.

Swimming decreases arthritis pain; but wait, it hurts to get up, get going and get into the pool. In a short few weeks, once you commit to making swimming part of your day, not just ‘squeezing it in when you have  nothing better to do,’ you’ll begin to notice the flexibility, anti-arthritic benefits of swimming. Eventually, as you stick with it and work up to it, swimming just a half hour a day will burn 476 .calories.

Why did I mention 476 calories? Well, every 3500 calories burned subtracts a pound from your weight. It only takes @7 x 30 minute swim sessions to lose that pound. So, swimming 30 minutes is too much? Start at 10 or 15 minutes and before you know it, you’ve worked your way up to 30 minutes or an hour. If you can swim one hour for 3 1/2 times, you’d lose that same pound. And we all know that weight increases the load on our joints. Even the loss of 5# can make a different to those with arthritic problems of the knees and hips.

The most important thing; SET A GOAL FOR YOURSELF THAT IS REALISTIC. If you know you can knock off 30 minutes easily, set a goal of 45 minutes or 1 hour. But if you’re relatively new to swimming, think small. Take a water aerobics class to get used to the water and get your heart and lungs used to the work; then try a 15 minute swim. Do 15 minutes for a while and then try 25 or 30 minutes.

Inquire and see if your health insurance company offers Silver Sneakers benefits, a program for those who are 65, have Medicare Advantage Plans or Medicare Supplement plans. You can check your eligibility here Most benefits are free and at many ‘Y’s and health clubs, such as ‘Curves™’ ‘Bally’s.™’ Many swim to decrease joint pain, one of the major benefits of swimming.

 

exercise pools

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Pain Management tips for chronic pain

Tips to Finding a Pain Management Solution When You Struggle With Chronic Pain

For individuals who suffer from a chronic condition such as fibromyalgia, neuropathy, or multiple sclerosis, finding effective pain management can be harder than it sounds. When you live with one of these conditions or one that is similar, receiving a diagnosis is rarely the only obstacle that you will face. However, with a few tips, you may be more successful at getting the help that you need to address your painful symptoms.

One of the first steps to getting a solution is to find a doctor that is ready to help you down a long road. Different doctors may be more experienced in treating numbness, tingling, or shooting pains while others may have success with aching. Often, finding the most effective pain management is a process that can take months and even years of trial and error before reliable relief can be found.

Start with recommended physicians or specialists and see which have the qualities that you need in your care team. Look for patience, understanding, and avoid those medical professionals that seem to be more interested in getting you out the door with a prescription rather than improving your overall health.

Especially with MS and fibromyalgia, it can be difficult to pinpoint the most likely causes of a flare up. Keeping track of daily symptoms can make adjusting your treatment more effective. Making honest entries each day may help you identify patterns or triggers overtime. Although it still may take several months in order to find the solution that is right for you, having a record of how your body reacts to different types of treatment can reduce confusion.

Finally, do not give up. Few people find the right doctor or the right treatment on their first, second, or third try. Joining a support group may be an effective way to stay motivated when your symptoms worsen or effective management of your pain seems impossible to achieve.

Finding pain management when you live with chronic pain can be difficult, but it is not impossible. By applying these tips, you may be more successful in your efforts to improve your quality of living from one day to the next.

 

About the author – Dr. James Lin specializes in chronic pain management.  He studied at UCLA and currently publishes several blogs and articles with pain management tips. Follow him on Twitter @DrJamesTLin

 

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