When it comes to establishing an exercise program, it is critical to not push too hard or too little. Exercising at the appropriate level of intensity will help you get the most benefits. The goal is to exercise a minimum of 30 minutes five days every week and incorporate moderate-intensity activities during most days of the week. If you have never exercised, it is important to start slowly and discuss this with your healthcare provider. Not all, but some individuals with diabetes or multiple risk factors for heart disease may need to take an exercise test before starting an exercise program. 

To make it easier to keep exercising, pick an exercise regimen that you enjoy and that fits into your daily schedule. 

Understanding aerobic exercise, resistance training, and stretching exercises 

Aerobic exercise increases the blood flow through the heart. It refers to exercising at a level in which the large muscles receive adequate oxygen during sustained activity. 

Resistance training includes lifting weights and is designed to increase muscle strength. 

Stretching exercises improve flexibility and prevent injuries. These movements allow joints to have a wider range of motion. They help maintain musculoskeletal function, agility, and balance. 

Understanding exercise intensities 

The intensity of exercise is a subjective measure and correlates to how hard the activity feels to you while you are doing it. It shows up in your heart rate, breathing, how tired your muscles feel, and whether you’re sweating. 

The activities of daily living, such as casual walking, cooking, cleaning, and shopping, are low-intensity activities 

During moderate-intensity exercise, you should be able to carry on a conversation, but not sing. Even though your breathing quickens, you are not out of breath. Sweating starts after 10 minutes of activity. 

High-intensity exercise is more intense, and you cannot say more than a few words without pausing for breathe. Breathing is rapid and deep. Sweating begins after a few minutes of activity. 

Using maximum heart rate and target heart rate zone to gauge the intensity 

You can also gauge the intensity of activities by looking at your heart rate or how hard your heart is beating during an activity. You should understand your maximum heart rate, which is the upper limit of what your heart and blood vessels can handle during an activity. To find the maximum heart rate you need to subtract your age from 220. For example, if you are 40 years old, subtract 40 from 220 to get a maximum heart rate of 180. This should be your heart rate per minute during an activity. You can calculate your desired target heart rate zone once you know your maximum heart rate. The target heart rate zone is the level at which the heart is not overworked. 

The American Heart Association generally recommends a target heart rate of: 

• Moderate-intensity exercise: 50% to about 70% of your maximum heart rate 
• High–intensity exercise: 70% to about 85% of your maximum heart rate 

Method to calculate target heart rate zone:  

• Know your resting heart rate by counting how many times your heart beats per minute when you are at rest. 
• Know your maximum heart rate by subtracting your age from 220. 
• Subtract your resting heart rate from your maximum heart rate to calculate your Heart Rate Reserve (HRR). 
• Multiply your HRR by 0.7 (70%). Add your resting heart rate to this number. Multiply your HRR by 0.85 (85%). Add your resting heart rate to this number. These two numbers create your average target heart rate zone. Your heart rate during vigorous exercise should generally be between these two numbers. 

Exercise Program

An ideal exercise program includes a warm-up section, a workout section with aerobic exercise, resistance training, and stretching, and a cool-down section. 

Warm-up

Warming up for at least 10 minutes before leaping into your exercise regimen is an essential part of a workout. Warming up gradually increases your heart rate and reduces the risk of injuries. A good warm-up should work for all major muscle groups. Start with low-level aerobic exercises, such as walking, cycling, calisthenics (exercises large muscle groups and includes standing, grasping, and pushing), and then add stretching and flexibility movements. 

Work out

To make your workout enjoyable and interesting, it is important to incorporate aerobics, strength training, and stretching exercises.  

Cycling, rowing, stair climbing machine, swimming, running, and brisk walking are all examples of aerobic activities. Low-impact activities are often better to avoid the risk of injury. Running is a high-impact activity. 

Examples of resistance training include training with weights, machines, or exercise bands. Lifting household objects or doing exercises, such as pushups at home, are also resistance training exercises. Most experts recommend doing at least one set of exercises with 8-12 repetitions for each of the major muscle groups. 

Stretching exercises should include every major joint: hip, shoulder, back, knee, upper trunk, and neck. 

Cool down

Through a sequence of movements, it is best to cool down for at least 10 minutes. Cooling down allows the body to eliminate acid that has built up in the muscles. It prevents muscle cramps and lightheadedness that can be due to sudden drops in blood pressure. A cool-down may include aerobic exercises. 

The takeaway message

Exercise is essential for your health and well-being.  We are meant to sit less and move around more. Listen to your body and take it slow. Set a goal to build up to more vigorous activities as you become more accustomed to exercising. Working with a professional can provide guidance in creating an exercise program to fit your needs and preferences. 

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What causes Prediabetes?

Insulin resistance or resistance of the cells to insulin which affects the movement of glucose into the cells results in high blood glucose levels in people with prediabetes. Insulin resistance can worsen over time as you age or gain weight. The exact cause of why insulin resistance occurs is not known. But family history and genetics play a key role. The factors that can increase the risk include: 

• Being overweight and having a large waist size  

The risk of insulin resistance and Prediabetes/Diabetes goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches. Other conditions that are associated with obesity such as high blood pressure, low good cholesterol, and high triglycerides can cause insulin resistance increasing the risk of Type 2 Diabetes. 

• Diet that contains sugar-sweetened beverages, red and processed meat 
• A parent or a sibling with Type 2 Diabetes 
• Gestational diabetes (Diabetes that occurs during pregnancy) 
• Polycystic ovary syndrome (PCOS), is a syndrome characterized by irregular menstrual cycles, obesity, and excess hair growth 
• Smoking tobacco

What are the signs and symptoms that suggest progression to Type 2 diabetes? 

The signs and symptoms that suggest that you have progressed to Type 2 Diabetes include increased thirst, increased hunger, frequent urination, fatigue, and frequent infections. 

How is Prediabetes Diagnosed? 

The same tests used to diagnose Type 2 diabetes are used to diagnose Prediabetes. These tests include: 

• Hemoglobin A1C (HbA1C) blood test – Prediabetes is diagnosed if the value is between 5.7% and 6.4%. HbA1C test tells you what your average blood sugar level has been over the past 2 to 3 months. 
• Oral Glucose Tolerance Test – In the Oral glucose tolerance test, your blood sugar levels are first measured after an overnight fast and then 2 hours after consumption of a sugary solution. Prediabetes is diagnosed if the blood sugar levels 2 hours after consumption of sugary solution are between 140 mg/dL and 199 mg/dL 
• Fasting Blood Glucose Test – The fasting blood glucose must be between 100 and 125 mg/dL to be diagnosed as Prediabetes. Fasting blood glucose is defined as no intake of any calories for at least 8 hours

How do I prevent Type 2 diabetes and return my blood sugar levels to normal? 

Maintaining an ideal body weight 

You can start by losing weight if you are overweight. You can lower your risk significantly by just losing 5 to 7% percent of your body weight. That is losing 10 to 14 pounds if you weigh 200 pounds. Research has shown that people with Prediabetes can reduce the risk for diabetes during the next 3 years by almost 60% if they lose 5% to 7% of their body weight and exercise about 30 minutes a day. Eventually, aim for a body mass index (BMI) between 18.5 and 25. 

Eat a healthy diet 

You should eat the healthiest foods in moderate amounts. Your overall diet should be low in fat and calories and rich in nutrients. Try to eat a diet with lots of fruit, vegetables, and whole grains. Try to avoid sweet drinks, like soda and juice.  

Age, sex, height, weight, and level of physical activity are determinants of the target calorie number, you need to maintain and lose weight.  

General guidelines for calories needed per day to maintain weight: 

Be active for at least 30 minutes a day 

Physical activity helps the body use insulin more effectively. Whether it is walking, gardening, dancing, or going to the gym, aim for at least 150 minutes (about 2 and a half hours) of moderate physical activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous exercise. 

Quit Smoking

Smoking cessation can improve the blood sugar levels by improving the way Insulin works. 

Is there any medication to treat Prediabetes? 

Medication is not recommended for prediabetes unless lifestyle changes are not improving blood sugar levels. If medication is needed, metformin is usually the recommended drug. 

Takeaway 

Getting a diagnosis of Prediabetes is a “wake-up call” to make the necessary changes to prevent a chronic condition that cannot be cured from happening. Even small changes can have a huge impact on delaying or preventing diabetes all together. 

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The misconception that body weight is easily controlled by changes in diet and physical activity level is the root cause of weight bias. Problematic social media perpetuates this misconception. People suffering from obesity are often misconstrued as lacking willpower or self-discipline. Overcoming obesity is not as simple as eating less and moving more. It is a complex disease with the interplay of many factors – Inherited, physiological, environmental, and lifestyle choices. More than 400 different genes have been implicated in the causes of overweight or obesity. 

There is evidence that stigmatizing situations can cause a release of stress hormone (glucocorticoid) which inhibits inflammation and eventual development of Hypertension, Insulin resistance, Diabetes, High cholesterol, and cardiovascular events. Being made to feel bad does not motivate healthy changes to lifestyle but instead can lead to Depression, Anxiety, and eating disorders that can be real and long-lasting. 

Unfortunately, jokes or disparaging comments based on someone’s weight or age are still acceptable, tolerated even in the closest of circles. Words have power – They can help people build confidence or lose confidence. It is all about using respectful language when talking about weight and equal treatment for people of all body weights and sizes. 

As a society, we all have a responsibility to do better, have a weight-inclusive mindset, and work toward eliminating weight stigma. The utility of social media, a valuable tool in shaping people’s attitudes, should play a prominent role in lessening the weight stigma. Social media should help provide a space to build solidarity and reduce social isolation. People with obesity should be placed at the center of our policies and practices. 

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People with sleep apnea have chronic snoring along with feeling tired even after a full night’s sleep. They stop breathing when they are asleep, which is often noticed by another person. Morning headaches, dry mouth, sore throat, difficulty staying asleep, excessive daytime sleepiness, and trouble thinking clearly are symptoms commonly experienced by people with Sleep apnea. 

What happens in obstructive sleep apnea that causes the throat to narrow or close? 

The muscles in the back of the throat that support the soft palate and other structures relax. The airway narrows or closes as you breathe in. Since you cannot get enough air, the oxygen level in the blood drops. This drop in oxygen level is sensed by the brain which briefly rouses you from sleep so that you can reopen your airway. You may not remember waking up because the awakening period is brief. This pattern may repeat all through the night every 5 to 30 minutes or more each hour reducing the quality of sleep. 

Excess weight with fat deposits around your upper airway, thicker necks, narrowed airways due to inheritance; adenoids; tonsils, having a family history, use of alcohol; sedatives, smoking are all risk factors that can increase the risk. 

What happens if sleep apnea is not addressed?  

Sleep apnea is a serious condition that may increase the risk of car accidents and other accidents due to inadequate quality sleep and daytime sleepiness. Moreover, people who have sleep apnea compared to ones who do not, have a higher prevalence of high blood pressure, heart attacks, and other serious heart problems. This occurs because of sudden drops in blood oxygen levels putting strain on the heart and blood vessels. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.  

Frequent frustrations and sleep-deprived partners who sleep near you because of loud snoring are common. 

How is Sleep apnea diagnosed? 

“Sleep study” may be done if your doctor suspects sleep apnea based on your signs and symptoms. Sleep study may be done at home or in the sleep laboratory where you spend the night. You are hooked up to equipments that measure your heart rate, blood oxygen level, airflow and breathing patterns, and bodily movements. 

What are modifiable things that can help with Sleep apnea? 

• Losing excess weight can help relieve constriction of your throat. Regular exercise can help with losing weight and help ease symptoms of obstructive sleep apnea. 
• Avoid alcohol, sedatives, and tranquilizers which relax the muscles in the back of the throat narrowing the airway.  
• Do not smoke. Smoking causes inflammation and fluid retention in the upper airway. 
• Avoid sleeping on your back. Instead, get into the habit of sleeping on the side or abdomen. Sleeping on the back can cause your tongue and soft palate to rest against the back of your throat blocking the airway.  

What are treatments of sleep apnea?

• Continuous positive airway pressure (CPAP) is the most effective treatment and delivers air pressure through a mask while you sleep. This pressure keeps your airway passages open preventing apnea. 

If you are prescribed a CPAP machine by your doctor, be patient with using it. It may be uncomfortable initially and may take some time to adjust to using CPAP. There are newer versions of CPAP machines that are less noisy, smaller, and more comfortable. Talk to your doctor regarding this. People who use a CPAP machine feel more rested and feel better with an improvement in symptoms 

• An oral appliance or mandibular advancement device is a device that you wear in your mouth to keep your throat open. CPAP is more effective than oral appliance. 
• Surgery may be recommended in rare cases when nothing helps to keep the airways open.  

The takeaway message 

To improve the quality of life and to prevent serious complications, sleep apnea needs to be managed and not ignored. Start your journey to more restful sleep by making lifestyle changes and using CPAP.  

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Obesity increases the risk of diseases and health problems. There is a striking reduction in life expectancy. However, the good news is that even a modest reduction in weight can improve or prevent problems. 

What are the Criteria for Overweight or Obesity? 

Body mass index (BMI) is used to diagnose Overweight and Obesity and is calculated by dividing weight in kilograms by height in meters squared.

What are the health consequences of obesity? 

Obesity is a ticking time bomb waiting to go off. Along with diminishing the overall quality of life Obesity can cause various health problems and some can be serious. These health problems include:

Diabetes mellitus 

More than 80 percent of cases of type 2 diabetes can be attributed to obesity. Insulin resistance has been attributed to overweight and Obesity along with other factors such as overeating, sedentary lifestyle, and genetics.

Changes in lipid metabolism 

Obesity can result in: 

• High blood levels of triglycerides and bad cholesterol – low-density lipoprotein (LDL) cholesterol and very-low-density lipoprotein (VLDL) cholesterol can increase the risk of clogged arteries causing a heart attack, stroke. 
• A reduction in good cholesterol – High-density lipoprotein (HDL) cholesterol. Good cholesterol is needed to remove excess bad cholesterol {Low-density lipoprotein (LDL-C)} by attaching to it and returning it to the liver where bad cholesterol is broken down. This also increases the risk of clogged arteries causing a heart attack, stroke 

High Blood Pressure 

The amount of work your heart and blood vessels must do is increased to meet the energy needs if the body mass is higher. This can make the blood vessels stiffer with an increase in pressure. The risk of hypertension is greatest in people with upper body and abdominal obesity. 

Heart disease

Obesity is associated with an increased risk of: 

• Coronary artery disease – The frequent coexistence of other cardiovascular risk factors with obesity such as diabetes, hypertension, and high cholesterol levels contribute to the clogging of the coronary arteries, the arteries that supply the blood to the heart. When the blood supply to the heart is compromised, it will lead to Angina, and heart attack. 
• Other heart disease includes Heart failure because of the increased workload by the heart to meet the needs; fat accumulation in the heart; Heart rhythm disorder called atrial fibrillation due to an increase in the size of the left atrium, one of the chambers of the heart 

Stroke 

Plaque formation or clogging of arteries supplying the brain is increased with cardiovascular risk factors such as Obesity, Hypertension, and Diabetes. The clogging of these arteries can compromise the blood supply to the brain causing a stroke. 

Deep vein thrombosis 

Deep vein thrombosis is a condition that occurs when the clots form in deep veins of the body, usually in the legs. Several studies have found a significantly increased risk for deep vein thrombosis, and/or pulmonary embolism in obese people, and the risk is reduced in underweight people. 

Cancer 

There is strong evidence supporting the association between obesity and cancers – Uterine cancer, Kidney cancer, Colorectal cancer, Ovarian cancer, Breast cancer, multiple myeloma, Liver cancer, and Stomach cancer. The mechanisms include alterations in sex hormone metabolism; insulin and insulin-like growth factor levels. 

Osteoarthritis 

Osteoarthritis is a condition wherein protective cartilage that cushions the ends of the bones wears down over time. Obesity is a risk factor for the development of osteoarthritis and studies have shown that weight loss is associated with a decreased risk of osteoarthritis. 

Gout 

Increased fat deposition and weight gain are risk factors for incident gout. Weight loss in overweight people is likely beneficial in reducing blood urate levels and gout symptoms in people with established gout. 

Gall bladder disease and Nonalcoholic Fatty liver disease (NAFLD) 

There is an increased risk of gall stones with obesity. Nonalcoholic fatty liver is a condition with no history of alcohol use that resembles alcohol-induced liver injury with fat accumulation in the liver cells. Increased delivery of triglycerides to the liver as seen with obesity; excessive conversion of carbohydrates and proteins to triglycerides secondary to overfeeding leads to NAFLD. 

Reproductive effects 

Irregular and absence of ovulatory menstrual cycles are common in obese women. Pregnancy complications are increased in people with Obesity. 

Kidney disease, Kidney stones and Urinary incontinence 

Obesity along with other commonly associated risk factors such as Hypertension, Diabetes, metabolic syndrome can cause compromised kidney function. There is an increased risk of kidney stones with Obesity. Women who are obese are also at increased risk of Urinary incontinence. 

Sleep apnea 

Sleep apnea is a sleep-breathing disorder. The risk correlates well with the Body mass index. There was a six-fold increase in the risk of sleep apnea with a 10 percent increase in weight, as per one study.  

Psychosocial issues 

• There is an increased risk of depression, especially in younger women.  
• Obese people are also at increased risk of dementia (loss of memory, language, and problem-solving) 

The takeaway message 

Obesity, a chronic disease, should be addressed to prevent complications. It is important to set clear behavioral goals and find people around you who support your weight loss. You can start off with first by trying to avoid gaining more weight. You can create milestones and health-related goals once you know your starting point. Work with your healthcare provider who can assist and guide you to lose weight in safe and effective ways. 

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Insulin Secretagogues are medications that stimulate the release of insulin from the pancreas and thereby lower the blood glucose level. Insulin helps glucose in the blood enter the cells in the liver, muscles, and fat. It is released normally by the pancreas in response to a rise in blood glucose levels. Sulfonylureas and Meglitinides classes of oral diabetic medications are insulin secretagogues that act quickly to lower the blood glucose level.

Sulfonylureas 

The sulfonylureas class of medications were first discovered by chemist, Marcel Janbon, and his coworkers while studying sulfonamide antibiotics. They observed that the compound, sulfonylurea, induced low blood sugar levels in animals.

Sulfonylureas are further classified into the first-generation and second generation. The first-generation sulfonamides include Chlorpropamide and Tolbutamide. The second-generation sulfonylureas include Glyburide (also known as Glibenclamide), Glipizide, Glimepiride, and Gliclazide.

Meglitinides 

The meglitinides class of medications are fast-acting and short duration. They are structurally different from sulfonylureas. Meglitinides are often prescribed with meals to reduce the blood sugar level spike that occurs after meals.

The medications in this class include Repaglinide, Nateglinide, and Mitiglinide.

Adverse effects of insulin secretagogues 

Hypoglycemia

Hypoglycemia occurs when the blood glucose level drops below 70 mg/dL. This may be associated with symptoms such as sweating, shakiness, irritability, confusion, racing heartbeat, and a feeling of hunger. These medications stimulate the secretion of insulin regardless of the blood glucose level. Because of this, hypoglycemia can occur and is the major concern associated with sulfonylureas.

Situations in which hypoglycemia is most likely to occur include missing meals, after exercising, taking a high dose of medication, taking longer-acting medications, and alcohol intoxication.

Glipizide, Glimepiride, and Gliclazide are associated with a lower incidence of hypoglycemia, as compared to Glyburide.

Weight gain

Modest weight gain is a common side effect of insulin secretagogues. Weight gain can be prevented or reduced by adopting healthy lifestyle practices

Keep an open mind and discuss with your doctor how the prescribed medications work for you. Understanding the potential side effects and ways to manage and prevent side effects is important when taking any diabetes medications.

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Learn to respect your body

It is more difficult to take loving care of something that you do not respect. Respecting your body is a way to learn to love yourself. We are all meant to look different, be unique, and personally define what brings our life personal meaning and fulfillment. Taking care of your body so it can carry out its functions for everyday living is what is important.
Learn how to best nurture your body with healthy nutrition and physical activity. For example, choose healthy foods, such as vegetables, fruits, and whole-grain foods. Choose complex carbohydrates, such as whole grains, over simple carbohydrates. Complex carbohydrates and many plant-based foods have been proven to improve insulin resistance, which is commonly experienced with PCOS. Avoid a sedentary lifestyle and give your body the movement it craves. Get adequate sleep. Meditate or relax to reduce stress. Practice self-care and do positive things for your body, both physically and mentally, including watching a favorite movie or TV show, listening to your favorite music, dancing, reading a good book, or chatting with a friend.

Use social media wisely

With the growing influence of social media, self-worth can be defined by appearance for some people. Correlational studies have proven that social media usage is associated with body image issues among young women and men. Studies also show that this association may strengthen over time.
Look to follow body-positive content that can positively impact your self-perception. Delete and unfollow sources that cause you to feel less than good. Find communities or support groups that can help you uplift your mindset and maintain a positive self-image.

Surround yourself with people who lift your spirits

To help you heal, surround yourself with people who appreciate and remind you of your personality, talents, and strengths. Spend time with family members and friends who love, accept, and support you.
Connecting with people on similar journeys can make it easier to stick to your PCOS goals and address your body image.

Takeaway message

You can take care of your body physically and mentally only when you start respecting and nurturing it with a healthy lifestyle and beliefs. Stop negative self-talk and avoid comparisons to others. Focus on yourself with love and compassion. Changing deeply held negative beliefs may be challenging, but change is always possible.

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Every month, a buildup of the uterus lining prepares the body for pregnancy. If there is no fertilization of the released egg by sperm, the buildup is shed, causing blood and tissue to pass out of the body through the vagina. This is called a “period” or “menses”. The duration of a normal menstrual period is equal to or less than 8 days. A girl generally starts her period between 8 and 15 years of age.

The menstrual cycle generally lasts 28-35 days. The first day of the period represents the first day of the menstrual cycle. The menstrual cycle then ends on the first day of the next period. The menstrual cycle’s length may vary month-to-month, but periods are considered regular if they usually come every 24-38 days. There may be significantly more cycle variability during the first 5-7 years after the periods begin, and the last 10 years before the periods cease.

The 3 menstrual cycle phases are the follicular phase, midcycle surge and ovulation, and luteal phase.

Follicular phase  

The follicular phase normally lasts 14-21 days, depending on the duration of the menstrual cycle. The follicular phase is 14 days for a person with a menstrual cycle duration of 28 days and 21 days with a menstrual cycle duration of 35 days. The follicular phase ends with a surge of luteinizing hormone (a high amount of LH hormone).

During this phase, one dominant follicle is destined to ovulate (egg is released) in the ovary due to increases in FSH. The follicle causes the level of estrogen to rise. This increase in estrogen causes the lining of the uterus to become thick and stimulates the pituitary to release a large amount of LH.

Mid-cycle surge and ovulation  

The LH surge during the mid-cycle results in ovulation (release of the oocyte from the follicle).  Ovulation occurs approximately 36 hours after the LH surge.

 A woman is most likely to get pregnant if she has sex without birth control in the three days before and up to the day of ovulation. A woman’s egg lives only 12-24 hours after ovulation. In contrast, sperm can live 3-5 days inside a woman’s reproductive organs.

Luteal phase

The luteal phase normally lasts 14 days for women regardless of the duration of the normal menstrual cycle. The luteal phase remains relatively constant, and changes in the interval between the periods are primarily due to changes in the follicular phase.

After ovulation, the ovary also produces progesterone. During the mid to late luteal phase, progesterone gradually rises and there is a progressive slowing of LH secretion. Progesterone is the hormone that prepares the body for pregnancy.

If the released egg is fertilized by the sperm, it develops into an embryo (unborn offspring in the process of development). The embryo travels through the fallopian tube to the uterus. Progesterone prepares the uterus for the embryo to be implanted. The early embryo begins to secrete the chorionic gonadotrophin hormone, which maintains progesterone production.

If the egg is not fertilized by the sperm, the lining of the uterus is shed, causing a menstrual period, and the progesterone and estrogen gradually fall.

Changing hormone levels throughout the menstrual cycle are responsible for the various symptoms that may occur. These include mood swings, depression, anxiety, and changes in energy level.

Menstrual blood is the only source of blood that is not traumatically induced. Yet in modern society, this is the most hidden blood, the one so rarely spoken of and almost never seen, except privately by women.

– Judy Grahn

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Infertility is defined as the failure to achieve pregnancy after 12 months of regular, unprotected sexual intercourse.

To understand the answer to the question, “Why does it take women with PCOS longer to get pregnant?”, it is important to know first how the normal menstrual cycle occurs.

Normal menstrual cycle  

This sequence of events occurs once every month and involves the ovaries, brain, pituitary gland (located in the brain), and uterus to help prepare the body for pregnancy. The pituitary gland produces two hormones: Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Progesterone and estrogen are two hormones that are developed in the ovaries.

During the first half of the cycle, a follicle containing egg or oocyte occurs in the ovary due to an increase in FSH. The follicle triggers the estrogen level to rise. This increase in estrogen causes the lining of the uterus to thicken, and stimulates the pituitary to release large amount of LH. The LH surge that occurs during the mid-cycle results in ovulation (release of oocyte from the follicle).

If this egg is fertilized by the sperm, it develops into an embryo (unborn offspring in the process of development). The embryo travels through the fallopian tube to the uterus. After ovulation, the ovary also produces progesterone. Progesterone prepares the uterus for implantation of the embryo. If the egg is not fertilized by the sperm, the lining of the uterus sheds causing the menstrual period.

What happens with PCOS? 

In women with PCOS, small cysts approximately 4-9 millimeters in diameter accumulate in the ovaries. Research has shown that women with PCOS have a type of low-grade inflammation that can stimulate cysts in the ovaries. There is an imbalance in the hormones (estrogen, progesterone, LH and FSH) that maintain a normal menstrual cycle and ovulation. Ovulation or release of an egg does not occur because of this hormone imbalance, which results in irregular or absent periods, or loss of an opportunity to get pregnant. High levels of LH cause an increase in androgens. Androgens are male hormones normally produced in both men and women in differing amounts. Androgens include Testosterone, Androstenedione, Dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS). These are produced by the ovaries and adrenal glands.

Treatment of infertility associated with PCOS

Though PCOS is one of the causes of infertility, the good news is that the chance of getting pregnant using fertility treatments is good. Methods and treatments that can help include:

Maintain a healthy weight

PCOS is associated with elevated levels of insulin in the blood and insulin resistance. Excess insulin can increase androgen production, causing difficulty with ovulation. The imbalance of hormones also produces excess androgens, which are male hormones normally produced in both men and women, in differing amounts.

Weight loss can reduce insulin and androgen levels. This may restore ovulation. Work with your doctor and dietitian to design a weight loss program. This will include a well-balanced low-calorie diet combined with moderate-intensity exercise activities.

Clomiphene

Clomiphene is a synthetic estrogen-like hormone that acts on the hypothalamus (part of the brain), pituitary, and ovaries to increase FSH and LH. The increase in the FSH level improves the chance of developing an ovarian follicle that can trigger ovulation.

It is estimated that approximately 80% of women who had problems with ovulation may ovulate, and 30-40% may become pregnant after taking Clomiphene.

Letrozole

Letrozole causes an increase in FSH, which improves the chances of developing a follicle that can trigger ovulation. It can also increase the number of eggs released during the monthly cycle.

Metformin

Metformin, widely used in the treatment of Type 2 Diabetes, can also be recommended for women with PCOS experiencing ovulation problems. Metformin also can help with weight loss and slow the progression to Type 2 diabetes if you have prediabetes.

Gonadotrophins

Gonadotrophins are a second-line of treatment in women who do not ovulate or conceive with Clomiphene. Gonadotropins are hormones (LH and FSH) normally produced by the pituitary gland that stimulates the ovaries to produce a follicle containing an egg or oocyte. Gonadotrophins used for infertility are produced in a laboratory and are injected under the skin to stimulate a woman’s ovaries to produce follicles containing an oocyte (egg).

The Takeaway message:

PCOS is a hormonal imbalance that interferes with the growth and release of eggs. By regulating your menstrual cycles, you can increase your chance of getting pregnant by maintaining a healthy weight and other treatment options. Having PCOS does not mean you can never get pregnant. Work with your healthcare team to understand and explore all the options to achieve pregnancy.

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Cholesterol, a waxy substance, is found in the blood. Your cholesterol level is determined both by what your body makes and by the foods that you eat.

What are good cholesterol, bad cholesterol and triglycerides? 

Low-density lipoprotein cholesterol (LDL-C), also called “bad” cholesterol, can combine with fat and other substances to build up in the inner walls of arteries when in excess. These arteries carry the blood away from the heart to the rest of the body. The hard, thick substance that builds up is called “plaque”. The condition in which plaque builds up in the arteries is called “Atherosclerosis”. Atherosclerosis can cause problems in 2 ways: 

• Plaque can accumulate and reduce blood flow to parts of the body. 
• Plaque can rupture or break open, causing a blood clot at this site or block blood supply to tissues beyond the clot, causing a stroke or heart attack. 

High-density lipoprotein cholesterol (HDL-C), known as “good” cholesterol removes “bad” cholesterol from the arteries and delivers it to the liver for elimination from the body. It is called “good” cholesterol since it lowers the risk of heart attacks, strokes and other health problems.

Triglycerides are a type of fats made by the body and come from food that is eaten. They also build up in the arteries and can cause plaque.

Know your cholesterol numbers

Checking your cholesterol levels and knowing your numbers is important to manage and lower your cholesterol level with lifestyle intervention and/or medication, if needed.

What factors contribute to harmful cholesterol and triglyceride levels? 

How can I reduce my risk of heart attack and stroke if I have high cholesterol? 

A heart-healthy lifestyle is necessary whether you are trying to prevent high cholesterol in the first place, or you have high cholesterol and are trying to reduce the risk of a cardiovascular event.

Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet are proven to reduce the risk of cardiovascular events. A heart-healthy diet consists of eating a larger quantity of vegetables and fruits, controlling your portion size, selecting whole grains, choosing low-fat proteins, and limiting unhealthy fats and salt.

High cholesterol is just one of many factors that can increase the risk of cardiovascular events. Other risk factors are cigarette smoking, high blood pressure, diabetes, older age, and a family history of heart disease.

Quitting smoking, drinking alcohol in moderation, exercising for 30 minutes or more most days of the week, maintaining a healthy weight, and managing stress are all important to mitigate your risk. If you have a family member (parent, sister or brother) who now has or has had a heart disease, talk to your doctor and stay on top of all your medical appointments.

While there are medications to lower cholesterol, not everyone with high cholesterol needs medication. They are generally prescribed for people:

• who had a prior heart attack or stroke 
• with a known heart disease or condition 
• with Diabetes 
• with Peripheral Artery disease (narrowing or blockage of arteries in the leg due to atherosclerosis) 
• who have had an Abdominal Aortic Aneurysm (enlargement of the major blood vessel in the body, called the Aorta) 

Take away message 

High cholesterol is one of the major contributors to cardiovascular events that decrease life expectancy and impact quality of life. In general, people are not aware that they have high cholesterol due to a lack of evident symptoms. A blood test is required to indicate you have high cholesterol. The American Heart Association recommends that all adults aged 20 or older have their cholesterol and other traditional risk factors checked every 4-6 years, even if the risk is low.

Stay on top of your health. Aim to mitigate your risk of heart disease, stroke and other health conditions associated with high cholesterol and atherosclerosis. Prevention makes a world of difference.

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One hormonal disorder infrequently discussed and misunderstood is Polycystic Ovary Syndrome (PCOS). The exact cause of PCOS is unknown and it lacks a test for a definitive diagnosis. PCOS causes irregular menstrual periods due to missed monthly ovulation and occurs in about 5-10% of women. Factors that may play a role in developing PCOS include:

Insulin abnormalities 

Insulin, a hormone produced by the pancreas, helps glucose in the blood enter cells in the muscles, fat and liver. Insulin is released in response to an increase in blood glucose levels. It helps keep blood glucose levels within the normal range. PCOS is associated with elevated levels of insulin in the blood and insulin resistance. Excess insulin can increase androgen production, causing difficulty with ovulation.

Insulin resistance with PCOS increases the risks for Prediabetes and Diabetes. It is estimated that women with PCOS who are obese have a three-fold increase in risk for Prediabetes compared to obese women without PCOS.

Menstrual cycle and ovarian cysts 

In women with PCOS, small cysts approximately 4-9 millimeter in diameter accumulate in the ovaries. Research has shown that women with PCOS have a type of low-grade inflammation that can stimulate cysts in the ovaries. There is an imbalance in the hormones (Estrogen, Progesterone, Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH)) that maintain a normal menstrual cycle and ovulation. High levels of LH cause an increase in androgens. Androgens are male hormones, normally produced in both men and women, in differing amounts.

Androgens include Testosterone, Androstenedione, Dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS). These are produced by the ovaries and adrenal glands.

Other factors 

Metabolic system abnormalities, which control the processing of carbohydrates, fats, proteins, and certain genes, may be linked to PCOS.

Symptoms of PCOS 

Changes in hormone levels, as described above, cause tell-tale symptoms of PCOS: irregular periods, excess face and body hair, occasionally severe acne, and male-pattern baldness.

Menstrual irregularity 

Normally during the first half of the menstrual cycle, the ovary develops a follicle that contains an egg (oocyte). The follicle produces rising levels of estrogen, which causes the lining of the uterus to thicken. A large amount of LH is also produced. This mid-cycle surge of LH causes the egg to be released from the ovary (ovulation) approximately 36-48 hours following the LH surge.

In PCOS, ovulation does not occur. Therefore, the lining of the uterus does not shed and regrow, as in a normal cycle. The lining becomes thicker and may shed irregularly, causing irregular, heavy, and/or prolonged bleeding. The thickening of the uterus lining can increase a woman’s risk for overgrowth and uterine cancer.

Women with PCOS may have fewer than nine periods a year.

Infertility

Women with PCOS can take longer to get pregnant since ovulation does not occur regularly.

Male-pattern hair growth (Hirsutism) and Acne

Excess hair growth may be seen on the upper lip, chin, neck, sideburn areas, chest, upper or lower abdomen, upper arms, and inner thighs due to increased levels of male hormones (androgens).

The oily skin and blockages in hair follicles, from increased androgens, can cause acne.

Weight gain

Approximately 50% of women with PCOS may experience gradual weight gain and obesity.

Other problems can impact quality of life 

• Depression, anxiety and eating disorders 
• Increased risk of cardiovascular illness due to abnormal cholesterol and triglyceride levels 
• Increased risk of high blood sugar 
• Increased risk of high blood pressure 
• Sleep apnea 
• Uterine cancer 

Actions to Take

The key component to managing PCOS is healthy lifestyle modification. Note that fatigue, poor sleep quality, associated eating disorders, and depression can be barriers to adopting and sustaining lifestyle changes.

Put in place a weight control program that includes diet modification and moderate exercise activities. Regarding diet, choose complex carbohydrates over simple carbohydrates, which raise blood sugar levels more slowly. Also, choose regular physical activities that you find enjoyable.  

“Turn your wounds into wisdom.”

– Oprah Winfrey 
 

“Believe you can and you’re halfway there.”

– Theodore Roosevelt

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Chilblains, also known as Pernio or Perniosis, is a condition causing itching, red patches, swelling and blistering mostly on hands and feet in response to cold exposure and most often experienced by people living in cold climates. Other symptoms may include burning, pain, depigmentation, skin thickening, ulceration or secondary infection. Young and middle-aged women are the populations most commonly affected. Being underweight may increase the risk of chilblains.

In most people, a skin manifestation of chilblains occurs 12-24 hours after exposure to cold, and resolves within a few weeks. Symptoms generally begin in winter and resolve by spring. There may be seasonal recurrences.

CLE may develop sporadically, meaning it can occur later in life in adults. It can be inherited due to gene mutation, but generally the reason for arising is unknown.

Raynaud’s Disease and chilblains are different, though both are problems with circulation. A person may experience both. People with Raynaud’s disease are more susceptible to getting chilblains.

Raynaud’s disease (or phenomenon) is an exaggerated body response that causes constriction of the blood vessels. The mechanisms that control the blood vessels constriction are altered or defective. Most commonly occurring in fingers and toes, Raynaud’s disease symptoms are evidenced by a change in skin color from cold weather or emotional stress. When Raynaud’s does occur, there are three phases represented by changes in skin color.

Phase 1: Severe constriction of blood vessels in the affected area makes the skin surface cold to touch and white in color. There is virtually no blood flow to the affected area.

Phase 2: When the reduced flow of blood in the skin slowly returns, the skin typically turns a purple-blue color.

Phase 3: When the affected blood vessels become completely dilated allowing blood flow to resume, the skin turns red.

Chilblains is thought to be caused by inflammation due to poor circulation where blood vessels are constricted due to cold exposure. The inflammation causes the tell-tale signs of chilblains swelling and blisters.

Remedies for Chilblains

• Keep the affected skin dry and warm.
• Apply lotion to alleviate any itching. Do not scratch.
• To prevent infection, keep the affected area clean with antiseptic and a bandage.
• If chilblains does not clear up using the above remedies, your doctor may prescribe corticosteroid cream and/or blood pressure medication, called Nifedipine, which dilates the blood vessels to improve circulation.

How to Prevent Chilblains

• Avoid exposure to cold temperatures.
• Keep warm and dress in layers of loose clothing and water-resistant footwear. Do not wear tight-fitting clothes or shoes.
• Keep your home and workplace comfortably warm.
• Keep your hands, feet and face warm and dry.
• Do not smoke. Smoking has a detrimental effect on blood vessel disease and wound healing.
• Make sure to rewarm skin that is gradually exposed to cold. Rapid rewarming may make chilblains worse.
• Poor circulation puts people at increased risk of chilblains. Take steps to improve circulation by staying active. Studies have shown that lower body stretching exercises release chemicals that expand the arteries, so more blood can enter. Stretching exercise can also help protect against heart disease and stroke.

Lower body Stretching exercises

When do you call the doctor?

• If chilblains does not improve within a few weeks
• When there are signs of infection that may include:
  • swelling and pus in the affected area
  • a high body fever 100.4 Fahrenheit (38 Centigrade) or above
  • swollen glands

Take away message

Having Chilblain Lupus Erythematosus can be challenging and painful. The best approach for this condition is to take all precautions to avoid developing it. Dress warmly in loose-fitting clothes, and cover any exposed skin from cold. One of the best ways to improve the health of blood vessels is to regularly exercise. Most importantly, keep stretching your legs to improve your circulation.

“A champion is defined not by their wins but by how they can recover when they fall.”

– Serena Williams

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A healthy heart diet is critical, especially if you have risk factors or cardiovascular disease. Below are foods with proven benefits for these chronic conditions. 

The benefits of a heart-healthy diet are innumerable. Mediterranean diet and DASH diet are proven diets that keep your heart healthy and prevent cardiovascular disease, as well as, help in managing diabetes and cholesterol. Any diet that is well-balanced and nutritious includes a variety of foods that are beneficial and excludes foods that are harmful. What is most important is the overall pattern of your food choices. Treat your body right by choosing the best foods to set you up for a healthy life! 

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With the adoption of roller mills, we moved from eating whole grains to eating refined and processed grains with the nutritional quality greatly reduced. All the healthy nutrients, such as fiber, vitamins, minerals and phytochemicals are present in the bran and germ parts of the grain. Refined grains are milled with all or part of the germ and bran removed.  

Why do unprocessed whole grains rate higher than processed and refined grains for health? 

Maintain steady blood sugar levels  

Fiber is a complex carbohydrate that slows the breakdown of starch to glucose. This helps maintain a steady blood sugar level in our bodies. It also reduces the risk of developing Type 2 Diabetes. Fiber provides structural support and protection to plants, so it is hard to break them down. 

Lower cholesterol, help maintain a healthy weight, and reduces the risk of cardiovascular diseases 

High fiber helps “bad” fat pass through the intestines. Eating whole grains lowers our total cholesterol (TC), bad cholesterol (LDL) and triglycerides (T). Cardiovascular events are prevented, such as heart attack, stroke associated with high cholesterol, and plaque buildup in the arteries. Fiber is also digested very slowly, like a slow-release capsule, making you feel full and preventing overeating.  

Keep the digestive tract working smoothly 

Since fiber is difficult to digest, it increases the weight and bulk of stools and softens them. This makes them easier to pass, preventing constipation.  

Fiber is also a prebiotic, meaning the friendly bacteria in our gut feed on them, releasing short-chain fatty acids (SCFA). SCFA play a role in muscle function, cancer prevention, bowel disorders and chronic diseases. 

A high fiber diet will reduce your risk of developing hemorrhoids, diverticular disease, and colorectal cancer. 

Prevent the formation of small blood clots 

A high fiber diet appears to help with Fibrinolysis (process of breaking down clots in the blood). It works on clots that can trigger heart attacks or strokes. 

Protect against some cancers 

Bran and germ contain phytochemicals and essential minerals, such as copper, selenium and magnesium, which protect against some cancers. 

What are examples of whole grains? 

Words of caution:

• Be wary of deceptive food marketing and advertising. Read the package labels when choosing foods labeled as “whole grains”. Some manufactures are marketing foods as healthy, while adding synthetic fiber to foods that are otherwise unhealthy, such as ice cream, margarine and breakfast bars. Whether synthetic or purified, the U.S. Food and Drug Administration (FDA) allows almost all fiber to be included in the “Nutrition Facts” on food product labels. Products are also allowed to be marketed as whole grain if they contain at least 51% whole grain. 

• Whole grains do not have sufficient folic acid. Refined grain products are fortified with folic acid, which is Vitamin B9. If all the grains that you eat are whole grains, you may end up being deficient in folic acid. Food sources rich in folic acid include fruits, vegetables, legumes and ready-to-eat fortified cereals. 

• Abdominal bloating and gas can be caused by adding too much fiber too quickly to your diet. For the bacteria to adjust to the change make sure you increase fiber gradually. Drink plenty of water to help with its digestion. 

What is the whole grain stamp? 

The whole grain stamp is a golden-yellow mark used on food products. This mark is eye-catching to stand out on products that contain whole grains. It shows the number of grams of whole grain ingredients in one serving of the product. There are three different levels of whole grain stamps: 100% stamp, 50% or more stamp, and the basic stamp. 

100% Stamp:  This indicates all grain ingredients in this product are whole grain. The product should contain a full serving (16 gm) of whole grains per designated serving. 

50% Stamp: This indicates at least half of the grain ingredients are whole grain. The product should contain a half serving (8 gm) of whole grains per designated serving. 

Basic Stamp:  This food product contains at least half a serving (8gm) of whole grain, but may contain more refined grain than whole grain. 

Tips to add more whole grains to your meal: 

• Use whole wheat bread or rolls to make a sandwich  
• Eat whole wheat cereal 
• Choose whole wheat toast or whole grain bagel for breakfast 
• Choose whole wheat flour to make roti, chapati and paratha (traditional Indian breads) 
• Replace white rice with brown rice, quinoa, wild rice, barley or bulgur 
• Choose whole grain tortillas and pastas 
• Choose whole grain snacks, such as popcorn, and whole-wheat or rye crackers 
• Use barley in vegetable soups 
• Add quinoa to salads 

Takeaway message

Eating grains in their whole form is always a healthier choice. It not only makes your meals and snacks interesting, but it can prevent and help treat various illnesses. Most foods we eat daily are now significantly altered from their original states. If you want to be healthy, eat REAL food, and not food that is processed and refined to the point that fiber and nutrients are destroyed. In today’s world, it is more challenging to cook from scratch and eat the way our grandparents and great-grandparents did. However, incorporating smart lifestyle changes daily can go a long way toward keeping you healthy and strong. 

“Don’t eat anything your great-grandmother wouldn’t recognize as food.”  

– Michael Pollan, Author of The Omnivore’s Dilemma and In Defense of Food.

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They can motivate and encourage – pushing us to feel better and do more, despite lupus. But they can also make us feel dejected and disappointed, especially when we fail to finish what we were just sure was possible.   

I’ve spent many years trying to strike a balance between these two. How do I make plans when I know they’re likely to be derailed? How can I still feel accomplished when my goals might go unattained?   

Having goals and setting expectations amid an unpredictable, debilitating illness can be challenging, but exercise has been a vital part of my journey with lupus. It’s easy (and disheartening) to set yourself up for failure again and again by trying to accomplish too much. But figuring out how to work within the boundaries of your disease while maximizing your potential? That takes some brainpower. And willpower. And lupus warrior power. 

At the end of any day, my goal is to figure out how to hope, plan and strive for a better life, while not jeopardizing my chances for a healthier, happier me. 

Here’s one quick tip I try to remember when managing my expectations. This can also come in handy when dealing with friends and family members. Given the fact that many lupus symptoms are invisible, it’s only natural that those around us might have difficulty figuring out what we can do and when. Sharing this suggestion may help:   

Set Goals, But Be Forgiving

Goal setting is something I do on a daily basis. Some days, the goal is simple: commit to starting my nap on time, or make sure I take my Cellcept on an empty stomach. (Some mornings, that hour can seem like for-ev-er!) 

Other times, I’ve made long-term goals, like phasing out of a stressful job, mustering up the courage to ask for accommodation, or attempting to overhaul my habits to lessen my symptom activity.   

Whatever the complexity or timeline of the goal, I try to remember that a goal is just words on a piece of paper or aspirations in my head. They can be revised or rewritten at any time. While it may feel like capitulation, changing the goal line should actually be viewed as a strategic move – all in an effort to make life more livable, more doable, more manageable. 

EXAMPLE

Years ago, I decided I was going to set a goal of giving up my daily nap, a routine I had started to deal with afternoon lupus fatigue.  I didn’t have a plan as to how to go about it, but I made the proclamation that within one year, I would no longer have to rest every afternoon.   

(Note that I have always suffered from lupus fatigue. Always. No matter what the cocktail of medication I was on. But as my most annoying, lingering symptom, I really wanted to make it subside.) 

So I gave it a go. I ate well, cutting out any and all-natural inflammatory foods. I stayed off alcohol, took my medicines as directed, and tried not to tax myself. I exercised daily, didn’t work too hard or too late, and generally treated myself the best I could in order to get as healthy as possible so that the lupus fatigue would improve. 

When I was ready, I tried cutting down on my regular nap, 15 minutes at a time. The first 15 minutes came off pretty easily. I don’t remember the increments I used exactly, but I imagine I fashioned it like a Prednisone taper – just a few minutes less a day for a week or two, and then another few minutes less the following few weeks. Before I knew it, I was waking up almost 30 minutes less consistently every day. That was a big deal! 

But that’s about where it ended. I tried to continue, cutting off a few more minutes at a time. But the less I napped, the worse I felt. My body needed more sleep, and I… needed to take another look at that goal of mine. 

I realized the goal of “no nap” was an arbitrary one – something that wasn’t based on fact, necessity, or disease activity. It was just a symptom I wanted to will away. 

Sure. I could have pushed it. During the first 3-4 years after my diagnosis, I definitely would have gone overboard. I would have fought my body, ignoring its call for sleep, and risking my health to do it. Some might say, “Oh, but Sara, you could be sitting here today, nap-free.” But I say, “I don’t know that I would be sitting here at all.” 

That’s the thing about lupus. You can push, but your body is going to push back. And there may come a point when the consequences of our actions are going to result in some pretty crummy stuff – permanent damage, irreversible symptom activity, or even organ failure. 

But you’re not going down that road. You’re here, using this app, because you know there’s another way. You know that listening to your body, tracking symptoms, advocating for yourself (sometimes against your alter ego!), and allowing for forgiveness are admirable exercises. You know how to practice restraint, and let yourself off the hook. You are capable of revising your plans. You are in charge of rewriting that goal. 

So that’s what I did. I reminded myself that, years before, I had strategically inserted a nap into my day because it worked. It curbed my symptom activity. It gave me back my evenings and nights. It allowed me to live a pretty normal life, despite lupus. 

So the nap stayed, and I got over it. I set a goal but forgave myself when it didn’t come to pass.  

The definition, by the way, of to forgive: to stop feeling angry or resentful toward someone (in this case, yourself), for an offense, flaw, or mistake. About sums it up, right? 

 And hey – I did manage to cut my nap down from 120 to 90 minutes. So that’s something.  

And me, being healthy and stable – that’s everything!  

Sara Gorman

Sara Gorman is an award-winning health blogger and author of “Despite Lupus: How to Live Well with a Chronic Illness.” Shortly after her diagnosis with Systemic Lupus and Lupus Nephritis, she launched a line of stylish, fabric pill organizers to promote medication adherence that are available on her website, on Amazon, and in retail stores across the U.S. Visit her at www.despitelupus.com, or at www.saragorman.com. Note that the contents of this article are for informational purposes only. They are the opinions of the author, and should not be a substitute for professional advice, diagnosis or treatment.

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I also remember being on as low a dose as 2.5 mg daily, with complete disease management. But then a flare would hit, and my doctor would increase my dosage to 10 mg daily.  That increase often did the trick to manage my flare, but tapering off slowly would take months. My doctor was never in a rush, and we would go 2.5 mg at a time. I might be stuck at 5 mg one day, and 2.5 mg the next for a month. Then we’d attempt a decrease of 2.5 mg. I always tried to find success in the baby steps, even if just for 2.5 mg. Less Prednisone is, well, less Prednisone!  
 
No matter how slowly I taper, or how smoothly it goes, I can’t help but get a little nervous when the day arrives that I have to start a lower dose. I used to get pretty anxious about the whole process, because I so desperately wanted my body to cooperate. I longed to be able to tolerate the lower dose. But today I’ve learned to balance that feeling of desperation with the knowledge that tapering, just like so many things in life, isn’t an all or nothing thing. Here are three thoughts of consolation that give me the courage to try that lower dose, to split those pills, and to bravely withstand steroid withdrawal: 
 
1) If it doesn’t work, I can always go back up.  
 
My doctor has never been unreasonable. If a treatment isn’t working, he tweaks it. If my disease is getting worse, he deals with it. So, while he may direct me to taper off Prednisone, I know he’d never leave me floundering if my body didn’t respond as hoped. If I need to go back up, he makes the call. I’ve learned that while he strives to use the medications as judiciously as possible, he attempts to keep me as comfortable as he can along the way. And through his tutelage, I’ve come to realize that just because I’m not successfully able to taper one week, doesn’t mean my body won’t be game the next. I think “tapering off steroids” should come with a disclaimer: Patience required! 
 
2) My doctor believes in me
 
It may sound silly, but just knowing that the doctor believes that my body may be capable of tapering off a dose helps me make the move. I know it’s not a perfect science, and there’s no guarantee that my body will respond to the medication as he thinks it will. But I still appreciate the vote of confidence. In my opinion, this is where positive thinking comes in… not so much in willing your disease activity to subside, but rather, in finding the courage (from the confident plan put forth by your doctor) to take steps that will allow you to keep moving forward in the management of your disease. Whether it’s reducing a medication to stave off crummy side-effects, starting a heavy hitting drug that could finally get your disease under control, or making monumental changes at home or work that will ideally improve your life with Lupus… every little bit of encouragement helps! 

3) I know what to look for
 
By now, I’m a champ at assessing steroid withdrawal, especially when I utilize a tracking system, like the KnowYourMeds app, to keep tabs on the process. The first day I go down on my dose, I’m going to feel crummy. The second day, still crummy, but no worse or maybe even the slightest bit better. The third day, better still, and so on. Ideally, the increase in symptoms (flu-like symptoms, increased fatigue, joint pain, fever, etc.) should incrementally subside as the days march on from the start of the lower dose. The key here is that they get better, not worse. So, it’s my job to check my tracking app to see how much I’ve been taking and for how long, and to communicate back to my doctor if my body isn’t reacting as planned. As long as I’m honest and open about the severity and frequency of my symptoms, my doctor can successfully determine whether or not the change in medication is working. Knowing what to expect, and then using the tools I’ve been given to determine if those expectations are being met, makes it so much easier to take that first step! 
 
Note: my doctor and I usually allow 2-7 days before making an assessment of the success (or failure) of my Prednisone tapering. Please consult your doctor for your own plan of attack! 

Sara Gorman

Sara Gorman is an award-winning health blogger and author of “Despite Lupus: How to Live Well with a Chronic Illness.” Shortly after her diagnosis with Systemic Lupus and Lupus Nephritis, she launched a line of stylish, fabric pill organizers to promote medication adherence that are available on her website, on Amazon, and in retail stores across the U.S. Visit her at www.despitelupus.com, or at www.saragorman.com. Note that the contents of this article are for informational purposes only. They are the opinions of the author, and should not be a substitute for professional advice, diagnosis or treatment.

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Number One:  What is Methotrexate?

The goal here was to shift my mindset to be opened-minded about starting a new drug. I can’t think of Methotrexate as “a drug I really don’t want to start”, which is the way I felt when my doctor initially brought it up. Instead, I needed to think, “Here’s a drug my doctor’s considering. What are the pros, the cons, and how will it compare to what I’m currently taking regarding side effects, symptom control, etc.?” I know – serious patient maturity required here!  
 
But I’d done my due diligence. I’d researched the drug online. I’d asked my other doctors for input. I’d talked to my friends who were on it. I’d considered the side effects and the limitations, and mentally prepared for them as much as possible.  Most importantly, I’d acknowledged that if my current medication regimen isn’t doing the job, I needed to find something that will. Sure, it was difficult to comprehend why my beloved combination of Plaquenil and Prednisone had suddenly stopped working – after all these years. And I could have continued to search for answers, or even worse, try and force my body to conform. But what would be most productive was to listen to my body and accept what it’s saying. If my disease had changed such that my medication needed to change, then that’s what I needed to do. 

Number Two:  Current symptom activity – is it manageable? 

The only way I know how to determine how good or bad my symptoms really are is to track them. When I’m dealing with varying degrees of joint pain and swelling from morning until evening, and sometimes through the night, there’s no way I can accurately or objectively log that activity in my head. I start getting yesterday’s symptoms confused with the day before, and before you know it, I can’t remember how long it’s been since I haven’t been able to turn over in bed or fasten my clothes first thing in the morning.  

That’s where the KnowYourMeds app comes in handy. I can track joint pain, swelling, fever, fatigue, and anything else that is impacting my quality of life. I can even export a report that will show my flow of symptom activity in the form of a graph. When I was considering Methotrexate, I wasn’t interested in what factors were contributing to my flare. I just wanted to know how well my current medications were managing that flare, and how reasonable (or unreasonable) that level of management was.  
 
The graph function in particular worked really well on the app. The visual picture of what I’d been experiencing was really coming into view. It was becoming clear that it wasn’t just steroid withdrawal I was experiencing. My symptoms were still pretty active, and I still had a few steps to go on my Prednisone taper. Pretty obvious when you see it in black and white.  

Number Three:  Are my lifestyle accommodations sustainable? (Aka, if the pain is tolerable, how long can I keep up the charade?)

As one runs through these kinds of questions, one always has to consider this fact: your doctor gets to weigh in on the situation, too. I could show up to my next appointment, and he may say that my kidney function isn’t good, my lungs aren’t clear, or my blood tests are out of whack. Any of those might necessitate a change in medication or treatment, which would make whatever decision I’ve come to obsolete.   
 
I’ve upended many aspects of my life to accommodate my disease over the years. I’ve inserted naps, rearranged agendas, cancelled plans, and revised goals in order to do what I can to keep disease activity at bay. And I’ve reached a comfortable level of living well, despite those accommodations. While I know my life with lupus isn’t necessarily normal, it’s my normal. There’s a certain level of predictability that I’ve come to expect, and it works. But when I was considering this change to Methotrexate, I’d been forced to create additional workarounds throughout the day in order to stave off severe symptom activity.  And the question was – how long can that go on before I conclude that those new lifestyle accommodations were abnormal? When do I decide that I’m no longer living well, despite lupus?  
 
My dad and I were talking about how difficult it can be to figure this out. If you’re like me, you try to put a pretty positive spin on life as it is. In fact, my dad referenced a book that I’d recommended to him, “Flying Without Wings”, by Dr. Arnold Beisser. Beisser says there’s a certain “degree of denial” that’s necessary for any of us to carry on in this crazy world, given whatever our cross is to bear. And I completely agree with that. But because of that fact, I made a promise to myself years ago, once I’d recognized how permanent this whole lupus thing was going to be. I could think positively, and hope for the best. But when it came to assessing how things were really going, I needed to muster up the courage to distinguish hopes from reality. I needed to be strong enough to take a step back, and objectively evaluate how good (or bad) my disease activity was.  
 
What did that mean? It meant I wouldn’t lie to myself. I wouldn’t pretend to be feeling great, if I really wasn’t. Nor would I lower my standards so that I could say things weren’t that bad. Of course, this promise came after years of doing just that – acting like the disease wasn’t affecting me, even though my body was saying something else. After finally learning how to embrace my disease rather than fight against it, I concluded that being honest with myself is essential for living well. It boils down to this – even if the pain is tolerable, how long can you keep up the charade?  
 
Truth was, I couldn’t pretend that the changes I’d made over the months prior weren’t out of the ordinary. The trips we’d put off, the nights we’d stayed in, or the appointments I’d cancelled in order to try and keep that flare from progressing were not long-term solutions. Those were things I do in crisis-mode, or should I say, flare-mode. When it comes to living well as a permanent state of being – my definition includes a certain degree of painlessness, while maintaining a personally fulfilling lifestyle, whatever that looks like to me. If there’s a way, via Methotrexate, Cellcept or some other big gun medication, to achieve that personal level of comfort and fulfillment, then I say bring it.  
 
I had too much to do and too little time to waste pretending that my joints didn’t hurt. I could plot all day long, but if at the end of that tapering period, my level of pain was unacceptable, or the workarounds were too extraordinary, then I needed to do something about it. And if my doctor had a solution, I needed to take him up on it. Considering a new drug that your doctor has proposed, or have questions about one you’re already on? Don’t forget to chat with KnowYourMeds’ in-app pharmacist. As always, I’m also happy to offer a patient perspective!  

Sara Gorman

Sara Gorman is an award-winning health blogger and author of “Despite Lupus: How to Live Well with a Chronic Illness.” Shortly after her diagnosis with Systemic Lupus and Lupus Nephritis, she launched a line of stylish, fabric pill organizers to promote medication adherence that are available on her website, on Amazon, and in retail stores across the U.S. Visit her at www.despitelupus.com, or at www.saragorman.com. Note that the contents of this article are for informational purposes only. They are the opinions of the author, and should not be a substitute for professional advice, diagnosis or treatment.

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<p>The post Starting a New Lupus Drug: 3 Questions to Ask first appeared on KnowYourMeds.</p>

Lupus and the Lungs  

Lupus may affect the lung tissue, membranes covering the lungs (pleura), and blood vessels inside the lungs. Because of the disease causing an immunocompromised state, medications and related infections may also affect the lungs.  

• Pneumonitis  

Lung tissue inflammation leads to a condition called Pneumonitis. This is generally brought on by infection. Symptoms include fever, shortness of breath, chest pain and cough.   

• Interstitial Lung Disease  

Lupus can also cause scarring of the lung tissue called Interstitial Lung Disease. Interstitial lung disease may occur due to inflammation or as a side effect of certain medications. The onset of symptoms can include dry cough, shortness of breath, and fatigue.   

• Pleuritis  

An inflammation of membranes covering the lungs (pleura) can occur in Lupus, resulting in chest pain when you breath and shortness of breath.  

• Pulmonary Hypertension  

Involvement of blood vessels in the lungs can lead to high pressure within the blood vessels, causing Pulmonary Hypertension. The symptoms include irregular heartbeat, shortness of breath, fatigue, and fainting episodes. Raynaud’s Phenomenon, which is blue and white discoloration of the fingers during exposure to cold and stress, is usually present in 60% of people with pulmonary hypertension.  

• Pulmonary Embolism  

There is an increased risk of blood clot formation in some people with Lupus with a condition called Antiphospholipid Antibody Syndrome. Pulmonary Embolism, a condition in which blood clots cause blockage of the arteries leading to the lung, may be evidenced by sudden shortness of breath or chest pain that worsens with breathing.   

Lupus and the Heart 

• Coronary Artery Disease and Heart Attack  

Atherosclerosis, a condition with plaque formation in the arteries, is common in people with Lupus. Atherosclerosis that affects coronary arteries (arteries supplying the heart), called Coronary Artery Disease, increases the risk of decreased blood flow to the heart. A heart attack occurs when the blood flow to the heart is completely blocked. The symptoms of a heart attack can be typical (chest pain or pressure that spreads to the left arm or jaw), or nonspecific (shortness of breath and excessive sweating), while missing the classic chest pain that is typical of a heart attack.  

The traditional risk factors of atherosclerosis (high lipids, sedentary lifestyle, high blood pressure and obesity) may be caused by Lupus itself or steroid treatment.  

• Endocarditis  

Endocarditis, or inflammation of the heart valves and the lining of the inner chambers, can lead to clumps of material buildup on the valves. These clumps can break loose and travel, affecting other organs.  

• Myocarditis  

Inflammation of the heart muscle can cause myocarditis, which may affect the heart’s ability to pump. Symptoms include chest pain, rapid and irregular heartbeat, shortness of breath, and swelling of legs, ankles, and feet.  

• Pericarditis  

The sac-like tissue surrounding the heart, called the pericardium, can be involved. This causes sharp or stabbing chest pain behind the breastbone or inside the left side, which improves when sitting up and leaning forward. The chest pain worsens with deep breath, coughing, and when lying down. Other symptoms are shortness of breath, low-grade fever, and coughing.  

Lupus and blood vessels 

Lupus may cause inflammation of blood vessels of any size. Skin or small vessel inflammation can lead to symptoms such as ecchymoses, bruises, or pinpoint round spots. Blood vessel involvement of the skin can also cause Raynaud’s Phenomenon, characterized by blue or white discoloration of fingers due to cold temperature or emotional stress.  

Blood vessels supplying the liver, pancreas, and intestines may also be affected with related symptoms.  

Antiphospholipid Antibody Syndrome can increase the risk of blood clots in the blood vessels. This causes serious complications, such as stroke, heart attack, and pulmonary embolism.  

Steps to protect your heart, lungs and blood vessels  

• Eat a healthy, balanced, nutritious diet that is rich in vegetables fruits, and whole grains. Make sure you consume no more than 1,500 mg of salt per day, especially if you have high blood pressure and/or kidney disease.  

Actions to take if you have high cholesterol are:  

• Include legumes, whole grains, fruits, vegetables and plant oil in your diet.  
• Include certain beans (lentils or navy, pinto or black bean) in your diet.  
• Consume nuts that are high in mono- or polyunsaturated fatty acids (particularly walnuts, almonds, pistachios, macadamia nuts, pecans and hazelnuts).  
• Include foods that are rich in Omega-3 FA-fatty fish (especially salmon, herring, mackerel and trout), and fish oil and plant products, such as flaxseed, chia seeds, canola oil, soybean oil and some nuts.  
• Reduce consumption of saturated fat, including butter, ghee, lard, coconut oil, cakes, biscuits, pastries, cheese, cream and ice cream.  
• If you smoke, plan to quit immediately. Smoking is not only one of the risk factors of atherosclerosis, but it is also associated with active Lupus, which may affect various organs. Smoking also reduces the efficacy of Hydroxychloroquine, a widely used medication for treating Lupus.  
• Get regular physical activity to stay fit and reduce fatigue. Physical activity is beneficial in reducing weight, blood pressure and cholesterol, all risk factors for heart disease.  
• Talk to your doctor regarding taking daily low-dose aspirin. Because of its anti-clotting ability, aspirin can help prevent heart attacks. 
• Make sure you keep all appointments with your doctor and healthcare team who regularly will monitor your disease progression.  

The takeaway message  

Lupus can affect people in different ways. Symptoms may arise suddenly or develop slowly. It is important to understand the implications of uncontrolled inflammation, know the side effects of medications and take precautionary measures to control the inflammation.   

The more you know, the more equipped and confident you are in managing Lupus. Since all medications have side effects, actively participate in your treatment plan by having regular discussions with your healthcare team. Be sure to inform them immediately if you experience any side effects or symptoms.  

<p>The post How Lupus Can Affect the Heart, Lung and Blood Vessels first appeared on KnowYourMeds.</p>

Vegetarian diets continue to grow in popularity for a variety of reasons, including animal welfare, religious and cultural considerations, the use of hormones and antibiotics with livestock, and environmental sustainability.  

A typical vegetarian diet avoids consumption of meat, poultry, fish, and seafood. However, a vegetarian diet can have variations depending on which foods that are excluded or included.  For example: 

• Ovo-vegetarian: Excludes meat, poultry, fish, seafood and dairy products, but includes eggs 

• Lacto-vegetarian: Excludes meat, poultry, fish, seafood and eggs, but includes dairy products 

• Lacto-ovo vegetarian: Excludes meat, poultry, fish and seafood, but includes dairy products and eggs 

• Pescatarian: Excludes meat, poultry, dairy and eggs, but includes fish and seafood 

• Vegan: Excludes meat, poultry, fish, seafood, dairy and eggs 

• Semi-vegetarian: Occasionally includes meat, dairy, eggs, poultry and seafood 

What are the benefits of a properly planned vegetarian diet? 

• Lower risk of cardiovascular events, such as heart attack 

Consumption of less saturated fats and more phytonutrients, Vitamin C, fiber, folic acid, magnesium, and potassium relative to meat-eaters, reduces total and bad cholesterol, lowers blood pressure, and prevents weight gain. These influence long-term health and reduce the risk of cardiovascular events such as heart attack and stroke. 

• Lower risk of Type 2 Diabetes 

Research has shown that a plant-based diet can reduce the risk of Type 2 Diabetes. High fiber whole grains and legumes are digested slowly, This helps maintain steady blood sugar levels, preventing a rapid rise in blood sugar level as demonstrated with refined carbohydrates and starches.  

• Reduced risk of certain cancers 

Multiple studies have proven that vegetarians who eat a variety of fruits and vegetables have a lower risk of developing certain cancers compared to non-vegetarians. Avoiding eating red meat, whether you are a vegetarian or not, eliminates the risk factor for colorectal cancer. 

What essential nutrients are challenging to get on a vegetarian diet? 

• Proteins  

If not properly planned, all vegans may fall short on daily protein needs. Proteins are required for healthy skin, muscles, bones, and organs. Lacto-ovo vegetarians get proteins from eggs and dairy products. Non-meaty sources of proteins include soy products, legumes, lentils, nuts, whole grains (wheat, oats, barley, and brown rice), and seeds. 

• Calcium  

Dairy foods have highest amounts of calcium. Vegetarian diets that do not include dairy products may put you at risk of a calcium deficiency if you don’t properly plan. Besides their vital role in building and maintaining strong bones and teeth, calcium is required for proper functioning of the heart, muscles, and nerves. Dark green vegetables such as kale, broccoli, collard greens, turnip, and Chinese cabbage are good sources of calcium. Other options are calcium fortified or enriched products such as cereals and juices. 

• Vitamin D  

Vitamin D, along with calcium, is required to maintain healthy bones. A deficiency happens if not enough Vitamin D fortified foods are consumed or there is limited sun exposure or both. Vitamin D is generally added to cow’s milk and cereals. 

• Vitamin B12  

Vitamin B12, which is almost exclusively found in animal products, is required for our red blood cells to produce hemoglobin and prevent anemia. This deficiency may go unnoticed in vegans for a long time until severe problems occur. Therefore, it is important to get Vitamin B12 from supplements, cereals, and fortified soy products. 

• Vitamin K  

Though some Vitamin K is present in green leafy vegetables, vegetarians should rely on fortified foods to get Vitamin K. Vitamin K is needed for blood clotting and building bones. 

• Omega-3 Fatty Acids  

Omega-3 fatty acids, Eicosapentaenoic Acid (EPA), and Docosahexaenoic Acid (DHA) found in fish or eggs have numerous benefits for the heart and body metabolism. Fortified products and supplements should be considered to consumers of Omega-3 fatty acids. Plant-based sources of Omega-3 fatty acids are canola oil, flax seed, soy oil, soybeans, and walnuts. However, these are not sufficient to meet the body’s daily needs. 

• Iron and Zinc 

Iron and Zinc are not easily absorbed from plant sources.  

Iron is required for hemoglobin synthesis of red blood cells and to prevent anemia. Lentils, whole grain products, dark-leafy vegetables, and dried fruits are good sources of iron. The amount of iron required for vegetarians is almost double the requirement for meat and poultry eaters. To increase absorption of iron, Vitamin C foods should be consumed at the same time. Vitamin C is found in citrus fruits, strawberries, cabbage, broccoli, and tomatoes. 

Zinc is required for many enzymes in the body. It is also essential for protein formation. Good sources of zinc include cheese, whole grains, soy products, nuts, legumes, and wheat germ. 

• Iodine 

Vegans do not get enough iodine in their diet. It is important to use iodized salt to boost your intake. Iodine deficiency can lead to deficiency of thyroid hormones, causing a goiter. 

The take home message 

Giving up meat and adopting a vegetarian diet provide many health benefits for preventing and treating certain diseases. However, it is important to know and focus on consuming nutrients that can be challenging to get when eating a vegetarian diet. An appropriately planned diet has nutritious, well-balanced foods and beverages that emphasize nutrients that are missing if meals are not planned properly. You might consider a pescatarian or Lacto-ovo vegetarian diet which provides more nutrients for a healthy body than a vegan diet, such as calcium, Vitamin D, Omega-3 fatty acids, and protein from dairy products, eggs, fish, and seafood.  

Equip your kitchen, learn about food substitutions, pack in proteins, and plan your well-balanced diet. The key to healthy nutrition is to carefully choose the best foods to include, and cut down on prepared foods that contain high quantities of sugar, salt, and fat. Your body will thank you!  

<p>The post The Health Benefits and Risks of Being a Vegetarian first appeared on KnowYourMeds.</p>

Fast forward a few years, and I am healthy and stable, and stronger than ever. My workouts (about 4-5 days per week) include cardio, leg work, weights and abs – a far cry from what I was limited to when my disease was active. But I recently incorporated a new activity into my present workout routine – stretching – which would have been a perfect solution when my lupus was flaring years ago.  

Stretching for 10 minutes in the morning has been so refreshing. It literally gets my blood flowing, and while I know it sounds cheesy, I feel so alive afterward. I do legs and back, arms and neck, and I am amazed at how much tightness I have as I begin. The first day I stretched, I got up off the floor afterward to walk to the bathroom, and realized how smooth and loose I was. I wasn’t hobbling as I often did, though I never even considered it hobbling. I thought it was just old-lady-early morning-tightness syndrome, certainly not due to lupus or a lack of stretching!  

I find my stretching regimen to be relaxing, invigorating and a wonderful way to check in with my body each morning. So much of disease management is about self and body awareness.  Stretching would have been a wonderful way to take stock of my lupus symptom-ridden body every day. I could have made notes in my KnowYourMeds tracking app, noting how I felt day-to-day. I could have reported back to my doctor with more precision and accuracy on how my body was feeling. Most days, I couldn’t keep straight when my pain came or went, or how bad it was from one day to the next!  

I hope you give stretching a go. If you do, or have your own helpful daily activity routine, be sure to let me know. Happy stretching!  

Sara Gorman

Sara Gorman is an award-winning health blogger and author of “Despite Lupus: How to Live Well with a Chronic Illness.” Shortly after her diagnosis with Systemic Lupus and Lupus Nephritis, she launched a line of stylish, fabric pill organizers to promote medication adherence that are available on her website, on Amazon, and in retail stores across the U.S. Visit her at www.despitelupus.com, or at www.saragorman.com. Note that the contents of this article are for informational purposes only. They are the opinions of the author, and should not be a substitute for professional advice, diagnosis or treatment.

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<p>The post Daily Activity with Lupus: Have You Considered Stretching? first appeared on KnowYourMeds.</p>

Mycophenolate Mofetil is available in capsule, powder (for suspension) and liquid forms. You take it on an empty stomach either 1 hour before or 2 hours after meals, unless your doctor gives you different instructions.

Things to know prior to starting treatment with Mycophenolate Mofetil 

• Pregnancy and Breast feeding

This medication is known to increase the chance of miscarriage or birth defects in babies during the first trimester of pregnancy. Therefore, Mycophenolate Mofetil should be avoided during pregnancy. Your doctor may give you a pregnancy test before you start this medicine. While taking the medicine, it is important to use effective birth control. Begin birth control one month prior to starting the medication and continue taking it for 6 weeks after your last dose of this medicine.

Mycophenolate Mofetil is excreted in breast milk, so it should not be taken by women who are breastfeeding.

• Immunizations

All people who plan to take Mycophenolate Mofetil need appropriate immunizations prior to starting treatment. Make sure you talk to your doctor about this.

• Other tests

Your doctor may do additional tests prior to starting treatment, including a complete blood panel, liver and kidney function assessments, tuberculosis screening, and hepatitis infection test.

Things to know while being treated with Mycophenolate Mofetil

• Effective birth control methods

To prevent pregnancy, talk to your doctor regarding effective birth control methods while using this medication. You may need to use two forms of birth control methods at the same time.

• Regular skin examinations

Taking Mycophenolate Mofetil may increase the risk for skin cancer. Talk to your doctor about getting regular skin examinations. Avoid sunlamps and tanning beds. Wear clothes will protect you from sunlight. When outdoors, use sunscreen or sunblock lotion with a sun protection factor (SPF) of 30 or higher on a regular basis.

• Watch out for symptoms of lymphoma

Lymphoma, a cancer of the cells that fight infection, happens rarely with this medication. Therefore, it is important to test your blood regularly during treatment with Mycophenolate Mofetil. Talk with your doctor if you experience unusual bleeding, bruising, weakness, weight loss, swollen lymph nodes in your neck, underarms or groin, or raised bumps on the skin with pus or red, scaly patches.

• Avoid getting infected

Since you may be more prone to infections while taking this medication, wash your hands often and stay away from people with an infection, cold or the flu. Check with your doctor if you experience fever, chills, flu-like symptoms, bad sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or change in the phlegm’s color, pain when urinating, or a wound that is not healing.

• Keep an eye out for Progressive Multifocal Leukoencephalopathy (PML) and BK Virus-Associated Nephropathy (BKVAN), a brain infection

Talk with your doctor right away if you are having more than one of these symptoms of PML: loss of coordination, change in vision, clumsiness, memory loss, difficulty speaking or understanding what others say, or weakness in the legs.

BKVAN may cause a kidney transplant to fail. Check with your doctor right away if you are having more than one of these symptoms: infrequent urination, decrease in the amount of urine, bloody urine, increased thirst, loss of appetite, lower back or side pain, nausea, swollen face, fingers or lower legs, trouble breathing, unusual tiredness or weakness, vomiting or weight gain.

• Watch out for symptoms of reactivating Hepatitis B or C Infection

Call your doctor right away if you experience dark-colored urine or pale stools, nausea, vomiting, yellow skin or eyes, loss of appetite, or pain in your upper stomach.

• Consult with your doctor before taking any vaccinations or immunizations

Because Mycophenolate will lower your body’s resistance, there is a chance that you could get an infection with the immunization that you take to prevent an illness.

Common side effects

Some of the common side effects of Mycophenolate Mofetil include heartburn, burping, lack or loss of strength, rash, trouble sleeping, weight loss or stomach pain. This is not a complete list. Check with your health care professional if you experience any symptoms that continue or are problematic.

Take away message

Mycophenolate Mofetil, formerly used only for people with an organ transplant, is now recommended to manage many autoimmune diseases. Like all medications, Mycophenolate Mofetil has benefits and risks. It should not be used if you are planning to get pregnant or are already pregnant.

Make sure you discuss the benefits and risks with your doctor if you are planning to take this medication. If you do experience any symptoms that are problematic, notify your healthcare team.

<p>The post What You Need to Know About Taking Mycophenolate Mofetil Medication first appeared on KnowYourMeds.</p>

It is extremely important to work with your doctor to control high blood pressure. If it is uncontrolled, the blood’s high pressure against artery walls can damage the arteries and cause serious health problems, such as a heart attack and stroke.

What are the consequences of uncontrolled high blood pressure?

• Cardiovascular disease

High blood pressure damages the artery, causing Atherosclerosis, or plaque buildup in the arteries. This can lead to a heart attack, stroke and Peripheral Artery Disease.

• Heart failure

Because of the high pressure in the arteries, the heart must pump harder. This causes the heart to enlarge. An enlarged heart does not function properly, eventually resulting in heart failure.

• Kidney disease or failure

High blood pressure can weaken and narrow the arteries in the kidneys, affecting their ability to filter the blood.

• Vision loss

Blood vessels in the eyes can become thick, narrow or torn, causing vision loss.

• Sexual dysfunction

Erectile Dysfunction in men or low libido in women can happen with high blood pressure.

• Vascular dementia (impaired memory and judgement)

Narrowed or blocked arteries limit blood flow to the brain leading to a type of dementia called Vascular Dementia.

What is hypertensive crisis?

Hypertensive crisis is a condition in which blood pressure is equal to or higher than 180/120 mm Hg. It is an emergency condition that requires urgent medical care. The consequences of such high pressure can be severe and lead to a stroke, heart attack, fluid buildup in the lungs, and damage to the eyes and kidneys. If your blood pressure reading is equal to or higher than 180/120 mm Hg, recheck it after 5 minutes. If the blood pressure is still high, call your doctor immediately. Call 911 or your local emergency medical number if along with this high number, you also experience shortness of breath, chest pain, vision problems, numbness or weakness, or any other signs and symptoms of a heart attack or a stroke.

What are ways to lower the high blood pressure? 

• Know your numbers

Monitor your blood pressure regularly and keep a log to track patterns. This can help you modify your lifestyle factors to improve your blood pressure.

• Eat a healthy diet and reduce salt

DASH diet is an evidence-based diet which gets its name from the Dietary Approaches to Stop Hypertension study. It is a beneficial diet plan to follow to lower high blood pressure. Plan to eat a diet that is rich in fruits, vegetables, nuts, legumes and whole grains. Also, eat low-fat dairy products and skinless poultry and fish. Limit your consumption of saturated fat, trans fat, red meat, sugar-sweetened beverages and sweets.

Sodium, the main ingredient in salt, causes high blood pressure. It shows up as salt and in prepared, processed and packages foods as baking soda, a preservative. Be sure to read all food labels and select foods with less or no preservatives. If you have high blood pressure, the American Heart Association (AHA) recommends limiting salt intake to no more than 2,300 milligrams (mgs) a day, with an ideal limit of no more than 1,500 mg per day (about a teaspoon).

Over-the-counter decongestants (Oxymetazoline, Phenylephrine and Pseudoephedrine) also contain sodium.

• Get physically active

Hence to support that dynamic aerobic exercise prevents and controls hypertension. Examples of dynamic aerobic exercises include brisk walking, jogging, dancing, bicycling, swimming and use of certain exercise equipment, such as elliptical machines. For overall health benefits, the American Heart Association (AHA) recommends most healthy adults to get a minimum of 150 minutes (2 hours and 30 minutes) each week of moderate-intensity physical activity.

If you have been inactive, increase physical activity gradually. Consult with your doctor regarding your type of exercise if you have another condition besides high blood pressure. Whether indoors or outdoors, find something that you enjoy and get active!

• Maintain a healthy weight

Losing weight has proven to lower your blood pressure, in addition to many other health benefits. Maintain a healthy weight by eating well and moving your body frequently.

• Avoid alcohol or drink in moderation

If you do drink alcohol, it is recommended you limit consumption to no more than 2 drinks per day for men and no more than 1 drink per day for women. Alcohol in excess of these amounts can raise your blood pressure.

• Quit smoking

There is a temporary increase in blood pressure every time you smoke. Smoking and high blood pressure are contributors to plaque buildup in arteries, increasing your risk for heart attack and stroke.

• Manage stress

While a direct link between high blood pressure and stress is unclear and still being studied, poor diet and alcohol consumption along with stress can indirectly increase blood pressure.

Know your stress triggers and aim to avoid them. Relax, spend time with loved ones, give yourself down time, use positive self-talk, feel gratitude, and focus on living with joy to reduce your stress.

• Take your medications regularly as prescribed by your doctor

Partner with your doctor. Be sure to adhere to all prescriptions and directions from your doctor, and go to all scheduled doctor appointments.

The bottom line

Uncontrolled high blood pressure can cause numerous health problems, some quite severe. Whether you have it or not, commit to making significant changes in your lifestyle to reduce or prevent risks. Because high blood pressure often does not appear with symptoms, it is important to check your blood pressure during every doctor’s visit. If you are diagnosed with high blood pressure, know your numbers by checking them often, adopt a healthy lifestyle, and take medications as prescribed by your doctor.

<p>The post Don’t Ignore “The Silent Killer” first appeared on KnowYourMeds.</p>

The four main components of blood are red blood cells, white blood cells, platelets and plasma. In humans, all red blood cells, platelets and most white blood cells are produced in the bone marrow (the soft fatty substance housed in the cavities of bones).

Red blood cells, which are bright red in color from hemoglobin (protein) and shaped like biconcave discs, make up 40-45% of the total blood volume. Red blood cells carry oxygen from the lungs to parts of the body, and return carbon dioxide from the body back to the lungs for exhalation. Synthesizing hemoglobin requires iron, vitamin B12 and folate (vitamin B9).

White blood cells protect the body against infection and are much fewer in number than red blood cells. The different types of white blood cells are granulocytes (neutrophils, basophils and eosinophils), lymphocytes (T cells and B cells), and monocytes.

Platelets, called thrombocytes, are fragments of cells that help blood clot to prevent blood from leaking at wound sites. They also stick to the linings of injured blood vessels.

Plasma, the liquid component of the blood, consists of water, sugar, fat, proteins and salts. Plasma helps in transporting blood cells throughout the body.

Disorders of blood with Lupus 

• Anemia (reduced red blood cell count)

Anemia is a condition associated with significantly lower red blood cells. If the body does not get enough oxygen, it can cause fatigue, weakness, shortness of breath and an irregular heartbeat. Anemia is a common disorder affecting more than 50% of people with lupus. Inflammation, medication, iron deficiency from blood loss, and kidney involvement may all contribute to the development of anemia with Lupus.

Lupus medications, Cyclophosphamide, Mycophenolate and Hydroxychloroquine, are associated with bone marrow suppression. They can cause a decrease in red blood cells.

Nonsteroidal anti-inflammatory medications (NSAIDs) can cause digestive tract bleeding, resulting in iron deficiency anemia from blood loss.

• Leukopenia (reduced white blood cell count)

A decrease in white blood cells can occur especially when the disease is active. Most of the white blood cells in our body are neutrophils. A decrease in the number of neutrophils, called neutropenia, may be accompanied by infection. Causes include immunosuppressive medications and viral infections. Lymphocytopenia, a decrease in the number of lymphocytes, may also occur.

It is rare for white blood cells to be low enough to cause infection. The immunosuppressive agents – Cyclophosphamide, Azathioprine, 6-Mercaptopurine and Glucocorticoids (Prednisone, Prednisolone, Methylprednisolone), cause bone marrow suppression and an eventual decrease in white blood cells

• Thrombocytopenia (reduced platelet count)

Antibodies against platelets are the major cause of the reduced quantity of platelets with lupus. Other causes are immunosuppressive agents that suppress bone marrow. A low number of platelets can lead to petechiae or bleeding. Although thrombocytopenia is common in lupus, it rarely causes serious bleeding.

• Pancytopenia (reduced number of red blood cells, white blood cells and platelets)

A reduction in all three components of blood is less common in lupus. There are many potential causes of pancytopenia, including bone marrow toxicity caused by medications and infections.

• Leukocytosis (increased number of white blood cells)

An infection or high dose of steroids are the usual causes of increased white blood cells with lupus. A flare or infection increases the number of neutrophils. An increase in the number of lymphocytes can be due to swollen lymph nodes or cancer.

• Thrombocytosis (increased number of platelets)

An increase in the platelet count may occur from blood loss due to gastrointestinal bleeding, iron deficiency, infection or inflammation with Lupus.

Swollen lymph nodes 

The lymphatic system, which plays a key role in the immune system, is a network of organs (tonsils, spleen and thymus glands), lymph nodes and vessels. Lymph nodes, also called lymph glands, are bean-shaped structures throughout the body that contain immune cells (white blood cells). Clusters of lymph nodes are found in the neck, underarm, groin, chest and abdomen.

Swollen lymph nodes occur most commonly as result of infection or cancer. Lymph node enlargement occurs in approximately 50% of people with Lupus.

Disorders that affect blood are periodically checked by your doctor. It is important to keep all your doctor appointments. If you experience a reduction or increase in any blood cell types, your doctor may conduct tests to determine cause and manage the blood disorder.

<p>The post How Lupus Affects Blood and the Lymphatic System first appeared on KnowYourMeds.</p>

Cyclophosphamide comes in various forms including tablet, capsule, powder for solution, and liquid solution. It is an alkylating agent. Alkylating agents target the cells by damaging their DNA. The agents are most active during the cells’ resting phase.

Know these facts before taking Cyclophosphamide

• Make sure you advise your doctor of all medications you are taking or planning to take prior to starting Cyclophosphamide. Include all over the counter medications, aspirin, vitamins and herbal remedies.
• Cyclophosphamide may harm an unborn baby. Your doctor will do a pregnancy test prior to taking these medications.
• Cyclophosphamide may cause bone marrow suppression, leading to low white and red blood cells and platelets. Your doctor may check your blood counts before starting and periodically while taking this medication.
• Your doctor may also do tests to assess your kidney and liver prior to starting this medication and periodically after.
• This medication may affect fertility and the ability for men to father a child. This condition may or may not return to normal after drug is stopped. Talk to your doctor about this before starting treatment.
• Menstrual periods may stop while taking this medication and may not return to normal. Talk to your doctor about this before starting Cyclophosphamide.

Some things to know while taking Cyclophosphamide  

• Always wear gloves while handling Cyclophosphamide. If you touch it or the medication gets in your eyes, immediately wash your hands and/or eyes.
• Upset stomach, nausea and vomiting are common side effects when taking higher doses. Talk to your doctor regarding taking Cyclophosphamide with food in smaller doses throughout the day.
• While being treated with Cyclophosphamide, do not have any immunizations without approval from your doctor. You can easily contract an infection from the vaccine, because Cyclophosphamide lowers the body’s resistance by suppressing immunity.

• Bladder irritation, and less commonly bleeding, can occur with Cyclophosphamide. Take it first thing in the morning and drink extra fluids throughout the day to reduce the risk of bladder problems. It is important to empty your bladder frequently. Check with your doctor immediately if you experience blood in the urine or pain when urinating.
• There may be increased risk of bleeding as this medication may reduce the number of platelets for proper blood clotting. Be careful when using a regular toothbrush, dental floss or toothpick. Check with your doctor before having any dental work. Be careful not to cut yourself when using sharp objects. Avoid contact sports and other situations in which you could get bruised or injured. Check with your doctor immediately if you have unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• Because Cyclophosphamide can cause suppression of your immunity, you are more prone to infections. Wash your hands often and stay away from people who are ill. Check with your doctor if you experience fever, chills, flu-like signs, bad sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or change in the color of phlegm, pain when passing urine, or a wound that will not heal.
• You must use birth control while taking this medication and for a period after the last dose due to its harmful effects on an unborn baby.
• Do not breastfeed while taking this medication.
• Cyclophosphamide may affect the lungs and sometimes can be deadly. Call your doctor immediately if you experience a new or worsening cough, fever or shortness of breath.
• Cyclophosphamide may lower your sodium level, causing changes in balance, weakness, headache, trouble focusing, memory problems, feeling confused and seizures. If you experience any of these symptoms, call your doctor immediately.
• Avoid drinking alcohol or keep it to minimum. Though rare, Cyclophosphamide can affect the liver and cause serious problems. Check with your doctor immediately if you experience weakness, loss of appetite, dark urine, yellow eyes and skin, upset stomach, stomach pain or light-colored stools.

Cyclophosphamide is an immune suppressing medication which can affect even normal cells. Many people do not have side effects or minimal side effects with Cyclophosphamide. It is important to talk to your healthcare team regarding its benefits, side effects and ways to prevent or manage the side effects. Make sure you keep all appointments with your doctor. They will check periodically to see if this medication is working for you.

<p>The post Using Cyclophosphamide to Treat Lupus first appeared on KnowYourMeds.</p>

Medications, such as steroids and immunosuppressive agents, can reduce the body’s resistance to infection. With active lupus or a flare, fever is often accompanied by other symptoms of lupus. It responds to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or Acetaminophen (Tylenol).  

Lupus increases the risk of infection, which can be another cause of fever. Two main causes of infections are lupus’ effect on the immune system, and the use of immunosuppressive agents like steroids (in moderate to high doses), biologics, and certain medications. Mycophenolate and Methotrexate medications can leave you prone to infectious agents by causing low white blood cell counts and infection fighting cells.  

Infections involving the respiratory system, urinary system and skin are more common in people with lupus. It is important to wash your hands often and stay away from people with infection, cold or the flu. Check with your doctor if you have symptoms, such as fever, chills, flu-like signs, painful sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or a change in phlegm color, pain when urinating, or a wound that does not heal. Before having any dental work or surgery, talk to your dentist and surgeon about preventive antibiotics.

There is an increased risk for cancers that affect blood, bone marrow, and lymph nodes, particularly lymphoma. Along with fever, lymphoma can present itself with unusual bleeding, bruising, weakness, weight loss, swollen lymph nodes in the neck, underarms or groin, raised bumps on the skin with pus, or red, scaly patches. Lupus is also a risk factor for cervical cancer, which could be yet another cause of fever.

The Bottom Line 

Immediately contact your doctor anytime you have a fever of 100 degrees Fahrenheit (F) or higher. The doctor will need to address your fever and rule out infectious causes.

<p>The post The Red Flag of Experiencing Fever with Lupus first appeared on KnowYourMeds.</p>

• Mouth

Ulcers (open sores) in the mouth and inflammation of the gums can occur in lupus. Make Peptic Ulcer Disease-causing ulcers (open sores) in the stomach may occur as a side effect of non-steroidal anti-inflammatory medications (NSAIDs). Pain in the abdomen or food-provoked abdominal discomfort, fullness, or nausea are symptoms experienced with peptic ulcer disease. Make sure you visit your dentist regularly.

• Esophagus

The esophagus is a tube that connects the mouth and stomach. Symptoms such as chest pain, heartburn, regurgitation (backward flow of food), difficulty swallowing and painful swallowing are common symptoms among people who have lupus and esophagus disorders. The disorders include: 

• Medication-Induced Esophagitis 

Aspirin and other anti-inflammatory medications can cause inflammation of the esophagus. The size of the pill, quantity of fluids taken with the medication, and patient’s position when taking the medication can affect the risk of irritation. 

• Infectious Esophagitis 

Due to immunosuppression, people with lupus may have an increased risk of esophageal infection. 

• Stomach 

Ulcers (open sores) in the mouth and inflammation of the gums can occur in lupus. Make Peptic Ulcer Disease causing ulcers (open sores) in the stomach may occur as a side effect of non-steroidal anti-inflammatory medications (NSAIDs). Pain in the abdomen or food-provoked abdominal discomfort, fullness or nausea are symptoms experienced with peptic ulcer disease. 

Intestines 

Intestinal Pseudo-Obstruction 

Intestinal-pseudo-obstruction is an obstruction of the small or large intestines, in the absence of any growth or tumor that is causing it.

Lupus may cause inflammation of the blood vessels or smooth muscles in the intestines, which may end up causing intestinal pseudo-obstruction. Common symptoms are abdominal pain, bloating and distension.

Protein Losing Enteropathy

This is a rare occurrence in people with lupus, and typically affects young women. There is an excess loss of protein through the gastrointestinal tract. Swelling and severe diarrhea can occur.

• Liver

Inflammation of the liver from lupus or medications used to treat lupus may occur. Initial symptoms are usually nonspecific and may include loss of appetite and fatigue. People with severe cases may experience jaundice, nausea and vomiting.

• Pancreas

2-8% of people with lupus may experience inflammation of the pancreas. Abdominal pain that spreads to the back, nausea, vomiting and fever are symptoms associated with inflammation of the pancreas.

• Abdomen

It is rare, but involvement of the abdominal lining and subsequent buildup of fluids in the abdomen may occur during a lupus flare. People can experience swelling, pain, nausea, vomiting and fever.

Lifestyle changes that may prevent or ease symptoms 

• Healthy eating – Eat a nutritious, well-balanced diet containing plenty of vegetables, fruits and whole grains.  

• Be physically active. 

• Quit smoking – If you drink alcohol, drink in moderation. Alcohol can worsen medication side effects and inflammation of the liver or pancreas. 

• Medications – To prevent pill esophagitis side effects, take aspirin and other anti-inflammatory medications with lots of fluids while sitting upright. Avoid taking them at bedtime.  

• Take medications with food or milk – Gastrointestinal side effects of NSAIDs can be reduced if medication is taken with food or milk. 

Manage stress – Use relaxation techniques and get support from family and friends.

It is important to stay on top of your health and treat symptoms early. Know your medication benefits and risks. Discuss with your doctor ways to manage and prevent side effects. Take preventive lifestyle measures to avoid a flare and the involvement of other organ systems.  

<p>The post How Lupus Affects the Digestive System first appeared on KnowYourMeds.</p>

Methotrexate is one medication that is commonly used in the treatment of several forms of inflammatory joint diseases and autoimmune conditions, including lupus. Methotrexate is very effective in reducing symptoms of the disease when active, and in preventing joint damage.

Methotrexate is an immune suppressant, which suppresses or weakens the immune system when it is necessary. Methotrexate causes the release of a molecule, called adenosine, which blocks other chemicals that cause inflammation. It is used in inflammatory conditions, including Lupus, Rheumatoid Arthritis, Crohn’s Disease and Psoriasis.

Methotrexate also blocks folate, a form of vitamin B, used by cancer cells to multiply and grow. Because of this, it is used in treating certain cancers. The dosage used to treat cancer is extremely high compared to the dosage for autoimmune conditions. The side effects of Methotrexate at doses generally used in treating autoimmune diseases are rarely life-threatening.

Methotrexate, a slow-acting medication, may take 2-3 months before your symptoms show improvement. You can take it in tablet form or as a liquid by injection.

Some common side effects of Methotrexate

• Nausea, vomiting and upset stomach
• Sore mouth
• Headache
• Fatigue or malaise
• Impaired ability to concentrate
• Skin rashes often on the elbows and knees
• Fever
• Hair Loss

Folic acid is a vitamin that is generally prescribed to help reduce the possible side effects of Methotrexate, such as nausea, vomiting, fatigue and sore mouth.

Tests or check-ups done before starting Methotrexate

• Before starting treatment, tests are done on the liver, kidney and lung functions. A complete blood count is also checked. Methotrexate can affect blood count and cause liver and lung problems. Methotrexate may not be prescribed if your bone marrow, liver or kidneys are not functioning properly.
• If you haven’t had chicken pox or shingles, your doctor may check to see if you are immune to them. You may be given a vaccine to protect yourself from these conditions prior to taking Methotrexate. 
• Methotrexate can be harmful to an unborn baby. If you are female, a pregnancy test is completed before starting treatment. Methotrexate blocks folate, which is needed for the development of an unborn baby. Its deficiency may cause serious birth defects, called neural tube defects. Neural tube defects can affect the spine, spinal cord or brain of a fetus.

What you need to know or do when taking Methotrexate

• Tell all your healthcare providers you are taking this drug, including your dentist and pharmacist.
• Talk to your doctor regarding folic acid supplements to counteract common side effects.
• Because Methotrexate suppresses immunity, you may be more prone to infections. Wash your hands often. Stay away from people with infections, colds or flu. Check with your doctor if you have symptoms, such as fever, chills, flu-like signs, painful sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or a change in phlegm color, pain when urinating, or a wound that does not heal.
• Methotrexate can lower the number of blood platelets, which are necessary for proper blood clotting. Be careful when using a regular toothbrush, dental floss or toothpicks. Check with your medical doctor before having any dental work done.
• Be careful not to cut yourself when you are using sharp objects. Avoid contact sports or other activities where bruising or injury could occur. Check with your doctor right away if you have unusual bleeding or bruising, black, tarry stools, blood in your urine or stools, or pinpoint-sized red spots on your skin. 
• Talk with your doctor before getting any vaccines. 
• You may sunburn more easily while on Methotrexate. Avoid sun, sunlamps and tanning beds. Use sunscreen, and wear clothing and eyewear that protects you from the sun. 
• Methotrexate may affect fertility by causing low sperm count. This may lead to the inability to father a child. Check with your doctor on this. 
• Because of the harmful effects of Methotrexate on an unborn baby, call your doctor right away if you miss a menstruation period, have unprotected sex, or think that your birth control has not worked. Women are advised to avoid getting pregnant for at least 6 months after stopping this medication. It is also important that men who are taking Methotrexate and have female partners use an effective form of birth control during treatment for at least 3 months after the last dose of Methotrexate. 
• Avoid drinking alcohol while taking this medication. Alcohol and Methotrexate can interact and affect your liver. 
• There is evidence that immunosuppressants, such as Methotrexate, may also slightly increase the risk of Lymphoma (cancer of lymphocytes, infection-fighting cells). Because of this, it is important to have regular blood tests throughout the time you are taking Methotrexate. Talk with your doctor if you experience unusual bleeding, bruising, weakness, swollen lymph nodes in your neck, underarms, or groin, raised bumps with pus on your skin, red, scaly patches or weight loss. 
• Methotrexate may cause Fibrosis and inflammation of the lungs. Check with your doctor if you experience shortness of breath, cough or other respiratory symptoms. 
• Methotrexate may cause liver problems. Check with your doctor right away if you are experiencing nausea, vomiting, yellow eyes or skin, pain or tenderness in the upper stomach, pale stools, dark urine or loss of appetite. 
• It is important to avoid a class of medications, called Sulfonamides (Sulfasalazine, Sulfamethoxazole or Sulfonylurea class of Diabetic medications). Interactions with Methotrexate could cause unexpected side effects. 
• It is advisable to talk to your doctor if you are planning to take non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen. These can interact with Methotrexate. 

When deciding to take this medication, assess the benefits and risks with your doctor. Be sure to follow all instructions. Your doctor will monitor your progress during office visits to ensure Methotrexate is working properly and check for unwanted side effects. It is critical to keep all appointments with your doctor. Do not take other medications while taking Methotrexate unless they have been discussed with your doctor.

<p>The post Using Methotrexate to Treat Lupus first appeared on KnowYourMeds.</p>

Most commonly occurring in fingers and toes, Raynaud’s disease symptoms is evidenced by a change in skin color in response to cold weather or emotional stress. This disease is more common in women than men.

In an occurrence of Raynaud’s, there are three phases represented by changes in skin color.

Phase 1

Severe constriction of the blood vessels in the affected area makes the skin surface cold to touch and white in color. There is virtually no blood flow to the affected area.

Phase 2

When the reduced flow of blood to the skin slowly returns, the skin typically turns a purple-blue color.

Phase 3

When the affected blood vessels become completely dilated allowing blood flow to resume, the skin turns red.

Besides color changes, symptoms that can be experienced during an attack include a feeling of “pins and needles”, aching, numbness, or clumsiness in the affected hand(s).

Raynaud’s disease can occur alone without a related disease. Also, it may be a family trait or occur as a secondary condition to an underlying condition such as Autoimmune Rheumatic Disease (a group of conditions that affect the joints, bones, muscle, and connective tissues).

What are the triggers and ways to prevent or avoid triggers?

• Stay warm and bundle up. Since cold exposure can trigger an attack, find ways to keep the entire body warm, such as dressing in layers and wearing mittens, socks, tights and a hat. Avoid rapidly shifting temperatures and cold breezes.
• Avoid smoking. The nicotine in cigarettes causes constriction of the blood vessels. Smoking can cause and aggravate Raynaud’s disease.
• Consult with your doctor to avoid medications that cause blood vessels to constrict. These medications include decongestants, such as Phenylephrine, Ephedrine and Pseudo Ephedrine. They also include migraine medications, such as Ergotamine, and medications used to treat ADD, such as Amphetamine.
• At the first sign of an attack, immerse your hands and/or feet in warm water. If warm water is not easily accessible, cross your arms and place your hands in your armpits.
• Stress can also trigger Raynaud’s disease. Actively manage your stress and consider using relaxation techniques that can quickly ease stress.
• Vibrations from hand mixers and power tools can trigger a flare-up. Avoid using these tools.
• Protect your hands to avoid a trigger when removing items from the freezer.

What medications are used to treat existing Raynaud’s disease?

Medications are generally recommended if the prevention measures mentioned above do not reduce the frequency and severity of attacks. The medications used include Calcium Channel Blockers, Nitrates, and Sildenafil (Viagra).

<p>The post Avoid Symptoms that Cause and Trigger Raynaud’s Disease first appeared on KnowYourMeds.</p>

Not all medications are used in everyone with lupus. The treatment plan varies by individual and depends on age, lifestyle and other health conditions.

Lupus Medications that are used are:

Work with your doctors to identify the right treatment plan for you. The right treatment plan should include medications to control your symptoms, prevent damage to your organs, and prevent your immune system from attacking your body.

<p>The post Medications Used to Treat Lupus first appeared on KnowYourMeds.</p>

Diabetes is a chronic illness causing persistent high blood sugar levels. These high levels can affect virtually all parts of the body causing nerve damage, kidney disease, heart disease, and more. On the other side, extreme blood sugar control can cause low blood sugar level, called hypoglycemia. It is important to balance food intake, physical activity, and medications to ensure that blood sugar level stays in the recommended range, and to avoid hypoglycemic episodes.

Managing diabetes is possible with education, practice, and support from your Dietitian. Some controllable factors are foods and the quantities you eat, level of physical activity, and adherence in taking medications.

The importance of diet in managing diabetes

What you eat and how much impacts the blood sugar level significantly. Making healthy food choices and tracking eating habits are important with your own diabetic diet plan. These keep your blood glucose in check and control heart disease risk factors, such as high cholesterol and high blood pressure. If you don’t watch what you eat, extra calories and fat can cause unwanted increases in your blood glucose.

What should I eat?

There is no diet known as a “diabetic diet”. You should eat the healthiest foods in moderate amounts. Your overall diet should be low in fat and calories and rich in nutrients.

Recommended calorie intake

Age, sex, height, weight, and level of physical activity are determinants of the target calorie number you need to maintain your weight.

General guidelines for calories needed per day to maintain weight:

A safe rate of weight loss is about 1-2 pounds per week. If you are planning to lose weight at the rate of 1-2 pounds per week, you need to subtract 500-1000 calories from your total calories needed per day to maintain your weight.

Carbohydrates

The target amount of carbohydrates consumed daily for people with diabetes is uncertain. Carbohydrates should come from fruits, vegetables, whole grains, legumes, low-fat milk, and much less from added sugars. A diet that is high in fiber (25-30 grams per day) may help in controlling blood sugar levels.

Fat

People with diabetes are at increased risk of high cholesterol levels, heart disease, and stroke. Quality of fat intake is more important than quantity. Choose monounsaturated and polyunsaturated fats found in fish, olive oil, and nuts over saturated fats and trans-fats.

Proteins

The average daily intake of protein is typically 15-20% of total calorie intake. People with Diabetic Kidney Disease should aim to maintain the recommended daily allowance (RDA) of 0.8g/kg of body weight per day.

Sodium

The recommended sodium intake is usually less than 2300 mg per day (approximately 1 tsp.). A sodium level of 2000mg per day may be better if you have high blood pressure, heart failure, or diabetic kidney disease.

What is carbohydrate counting and why is that important?

Carbohydrates can have a direct impact on blood sugar level. The amount of carbohydrate intake varies person-to-person, and there is no one-size-fits-all amount. Monitoring carbohydrate intake, or “carbohydrate counting”, is an important factor, especially when you are taking insulin.

There should be consistency in the amount of carbohydrates at each meal if you take the same amount of insulin at the same time every day. Eliminating carbohydrates completely is also not healthy because the body requires some carbohydrates each day for proper functioning.

Your dietitian will help you determine the number of carbohydrates needed at each meal and snack time based upon your insulin regimen, typical eating habits, physical activity level, body weight, and nutritional goals. Keep daily records of your food consumption and blood glucose levels. These will help you understand what affects your own blood glucose levels.

One way of counting carbohydrates is to look for the total carbohydrate grams on the packaging labels. To figure out the carbohydrate content of a food’s serving size, simply subtract the number of grams of dietary fiber from the number of grams of total carbohydrates.

You can use this number when counting carbohydrates for your insulin dose.

What kind of exercise is recommended for people with diabetes?

Regular physical activity plays an important role in regulating your blood glucose level. It makes your cells more sensitive to insulin. Regular exercise can help you lose weight and keep it off. Research has shown that the chances of heart disease and premature death are reduced in people who do moderate-intensity exercise for 150 minutes per week, as opposed to people who are sedentary.

Exercise is important even if you are experiencing complications to keep your blood sugar in check and prevent further progression. Talk to your doctor before trying any new kind of physical activity. If you have never exercised before, start off with light activity. Any physical activity is much better than nothing at all.

Exercising with complications and comorbidities

What else is important to know before I exercise?

It is important for people taking insulin or Insulin Secretagogues (medications that increase insulin secretion from the pancreas, such as Sulfonylureas and Glinides) to check their blood sugar level before exercising. These medications can lower your blood sugar level, causing hypoglycemia. You may not always exhibit symptoms of low blood sugar levels. Therefore, it is important to ensure your blood sugar level is not below 100mg/dL (5.6 mmol/L) before and after you exercise.

If your blood sugar is below 100mg/dL, you will need to eat a small snack containing 15-30 grams of carbohydrates before you begin exercising, such as fruit juice, fruit, crackers, or even glucose tablets. If your glucose level is low before exercising, check your blood glucose every 15 minutes while exercising.

If your blood sugar is more than 240 mg/dL, you should not exercise. Call your doctor immediately if your blood glucose stays above 240mg/dL.

Discuss with your doctor ways to exercise safely and manage low blood sugar level while exercising.

The take away

Whether you are managing Type 1 diabetes, Type 2 diabetes, or prediabetes, healthy eating and regular physical activity are crucial for preventing diabetes disease progression. If you have prediabetes, you can prevent or delay Type 2 diabetes by adopting the healthy lifestyle changes mentioned.

For recommended diet and physical activities, eat a consistent number of calories. Consume carbohydrates from healthy food sources, such as fruits, vegetables, and whole grains. Count your carbohydrates if you are taking insulin. Replace all saturated fats and trans-fats with monounsaturated and polyunsaturated fats. Eat less salt and engage in 150 minutes or more of moderate-intensity activities every week.

“There are many ways to love your body, but fueling your body with nutritious food is the highest form of self-respect.”

– Ania Drosnes

“I have high blood sugars, and Type 2 diabetes is not going to kill me. But I just have to eat right, and exercise, and lose weight, and watch what I eat, and I will be fine for the rest of my life.”

– Tom Hanks

<p>The post The Importance of Diet and Physical Activity in Managing Diabetes first appeared on KnowYourMeds.</p>

Diabetic foot care

Do’s

• Keep your blood sugar levels as close to your target as possible: by taking your medications as directed, seeing your doctor regularly, making a healthy diet, and lifestyle changes.
• Examine all parts of your feet daily for broken skin, sores, blisters, areas of increased warmth or redness. Inform your health care provider if there are any changes.
• Wash your feet daily with lukewarm water and mild soap. Dry your feet by gently patting them with a clean, absorbent towel, paying special attention to spaces between toes.
• Wear cotton socks that fit loosely. Make sure to change your socks every day.
• Wear shoes with a wide-toe box. Your shoe shape should match your foot shape. Select shoes that are snug but not tight.
• Get regular foot exams. Ask your doctor for a foot check at least once a year and more frequently.
• Do use care while trimming the nails. Trim the toe nails straight across.

Dont’s

• Don’t smoke
• Don’t walk barefoot
• Don’t use a heating pad, hot water bottle on your feet. Don’t step into a hot bath before testing the temperature first.
• Don’t break the skin on your own and do not pop blisters.
• Don’t cut your cuticles or allow anyone else (eg, a manicurist) to do so.

<p>The post What You Need to Know About Diabetic Foot Care first appeared on KnowYourMeds.</p>

Understanding how the disease occurs will empower you to better manage your condition. Also, knowing the pathology of the condition will help you understand the ways medications and healthy lifestyle habits work to lower the blood glucose level and reduce eventual complications.

Blood glucose regulation and synthesis in the body

Glucose is sugar and the main source of energy found in the blood. It is the most simple form of carbohydrate.

Glucose in the blood is derived from three sources:

• Intestinal absorption of ingested food is converted to glucose in the stomach. Absorption usually occurs 2-4 hours after a meal.
• Liver cells produce glucose by converting non-carbohydrate sources, such as proteins and fats. The liver also breaks down glycogen (a stored form of glucose), resulting in production of glucose. Glycogen is made up of many connected glucose molecules.
• When necessary, kidney cells can (though not always) synthesize glucose

The blood glucose level is controlled by many hormones, in particular, insulin and glucagon. These hormones are synthesized in the pancreas. Both help regulate the levels of blood glucose in the body.

Insulin helps the glucose in the blood enter cells in the muscle, fat, and liver. Insulin is released in response to the rise in blood glucose levels. It helps keep the blood glucose level within the normal range.

Glucagon, a hormone that is also produced by the pancreas, is synthesized when the glucose level is low. Glucagon stimulates the liver cells to synthesize more glucose, in order to bring the low sugar level back to normal.

Rise of blood glucose in type 1 diabetes

Type 1 Diabetes Mellitus is an autoimmune condition. This means the body’s immune system is triggered by environmental factors that cause the destruction of beta cells in the pancreas that produce insulin. Type 1 diabetes is most commonly present during childhood in genetically susceptible individuals.

Because of the destruction of insulin-producing cells and a lack of insulin, the mechanisms required to control blood sugar levels are affected. Glucose does not enter the cells in the muscle, fat, and liver, causing a rise in blood sugar levels.

This is why insulin becomes the main mode of therapy for people with type 1 diabetes.

Rise of blood glucose in type 2 diabetes

The development of type 2 diabetes is quite different from type 1 diabetes. There is no autoimmunity, however, there is a combination of defective secretion of insulin plus insulin resistance. Insulin resistance occurs when cells in the muscle, fat, and liver do not take up the glucose because they are resistant to insulin’s effect. Contributing causes of insulin resistance are obesity, sedentary lifestyle, and overeating. Also, genetics and aging are less prominent contributions to insulin resistance. Defective insulin secretion is largely due to genetic influences.

Certain medications can also contribute to insulin resistance, and put you at higher risk of developing type 2 diabetes. These are some first- and second-generation antipsychotics, fluoroquinolone class of antibiotics, HIV medications, beta-blockers, statins, and thiazide diuretics. If you are taking any of the medications associated with insulin resistance as a side effect, do not stop without first consulting with your doctor. Medications are generally prescribed after assessing benefits and risk factors. Work with your doctor who may be monitoring you regularly.

In a nutshell

Type 1 diabetes is an autoimmune condition which occurs due to the destruction of insulin-producing cells in the pancreas. Type 2 diabetes occurs due to the combination of insulin resistance and defective insulin secretion.

Despite the causes of diabetes, maintaining a healthy lifestyle and keeping your blood sugar level within the normal range is possible, even if challenging. Making healthy food choices, maintaining a healthy weight, adhering to medications, and keeping all your doctor appointments can help you ensure the best quality of life and prevent complications.

<p>The post How do Type 1 and Type 2 diabetes occur? first appeared on KnowYourMeds.</p>

The answer is simple. Different colored vegetables and fruits – from red strawberries to green broccoli and yellow butternut squash – do more than paint a colorful picture on your plate and in the produce section at the grocery store. They also contain chemicals, called phytonutrients, which add to the range of colors and contribute to various aspects of our health.

One important type of phytonutrients where colors come from is flavonoids. Flavonoids are antioxidants that offer multiple beneficial effects, such as lowering blood pressure, reducing the risk of cardiovascular disease, and improving cognition.

The different classes of flavonoids are:

• Flavonols – such as Quercetin
• Flavones – such as Luteolin
• Flavan-3-ol Monomers – such as Catechin
• Anthocyanins – such as Cyanidin
• Polymers – such as Theaflavin

How do flavonoids work?

Oxidants and free radicals are produced from cell metabolism or external sources, such as cigarette smoking, pollution, or radiation. They have a dual role. They can be harmful or helpful to the body. An overload of free radicals accumulated in the body leads to oxidative stress. Oxidative stress leads to cell damage and plays a role in developing illnesses, including cancer, autoimmune disorders, rheumatoid arthritis, neurodegenerative diseases, cardiovascular diseases, cataracts, and aging.

To counteract oxidative stress, some antioxidants are produced by the body and others in foods we eat. The antioxidants from food sources include Vitamin E, Vitamin C, Carotenoids, and Flavonoids.

Each vegetable and fruit have a unique combination of flavonoids that have different effects on the body. Their potent antioxidant activity helps prevent or delay chronic and degenerative ailments.

Cardiovascular benefits of flavonoids

Drinking green or black tea in moderation appears to be safe and may have beneficial effects. Drinking tea has been linked to lower levels of cholesterol. Green and black tea are rich in flavonoids, and people who drink them seem less likely to develop cardiovascular disease.

Studies have shown that tea and flavanol-rich cocoa products significantly reduced blood pressure, compared with low-flavanol-containing cocoa powder or flavanol-free interventions.

Flavonoids, being antioxidants, keep blood vessels healthy and blood flowing throughout the body.

Quercetin, Resveratrol, and Catechins – flavonoids found in high concentrations in red wine, have proven to reduce the risk of atherosclerosis, which is plaque buildup in arteries that can lead to heart attack or stroke.

Fending of forgetfulness

Scientists comparing people with the lowest daily flavonoid intake to people with the highest daily flavonoid intake found that those with the highest intake were less likely to report trouble with memory and thinking. The flavonoids that appeared to be protective are flavones, flavanones, and anthocyanidins. Some beneficial fruits and vegetables that help with cognition are brussels sprouts, strawberries, cauliflower, raw spinach, blueberries, sweet potatoes, and orange winter squash.

It is believed that flavonoids fight brain inflammation, as well as reduce the accumulation of substances called “amyloid,” as seen in Alzheimer’s disease.

Setting flavonoid goals

Tracking flavonoids in foods is not easy, and the amount varies from food to food. Aim to consume a wide variety of fruits and vegetables, which contain several types of flavonoids, along with many other phytonutrients. Balancing all the colors is important. No one color is superior to another.

Recent studies have shown that having 2 servings of fruits and 3 servings of vegetables each day is most effective. A total of 5 servings a day of vegetables and fruit offers the greatest benefits.

The bottom line

Eating more plants and less animal products is healthier. This provides necessary micronutrients, like flavonoids, which are proven to reduce heart disease, improve memory and prevent cancer. Vegetables and fruits are also good sources of fiber. Fiber keeps your appetite in check, promotes weight loss, improves blood glucose levels, and benefits digestion.

The western-style diet, which is high in calories, processed foods, and animal products has a detrimental effect on human health and the environment. The greenhouse gas emissions from producing animal-based foods are higher than for plant-based foods, making this type of diet unsustainable in the long term.

Eating only a plant-based diet can carry risks of not getting enough iron, other minerals, vitamins, and protein. Know that this can be overcome by choosing the right vegetarian foods if you eat only a plant-based diet. Beans, lentils, edamame, quinoa, and nuts are all good sources of protein. Lentils and spinach are rich in iron. Vitamin B12, primarily sourced from animal products, can also be found in fortified cereals.

Aim at consuming 5 servings every day, and pack your plate full of colorful vegetables and fruits. Keep fruits where you can see them for snacks and desserts. Try new recipes that include more vegetables. It is always better to eat fresh produce, as they contain higher levels of nutrients. Frozen varieties are better if they are consumed within a few weeks. If you do choose frozen or canned produce, read the labels to make sure they do not contain extra sugar, sodium, or additives.

A nutritious diet and other healthy lifestyle habits can go a long way to better health. These include quitting smoking, maintaining a healthy weight, being active, and managing stress.

“Every time you eat or drink, you are either feeding disease or fighting it.”

– Heather Morgan

“The food you eat can be either the safest and most powerful form of medicine, or the slowest form of poison.”

– Ann Wigmore

<p>The post Know Your Flavonoids and How They Contribute to Your Health first appeared on KnowYourMeds.</p>

Dietary choices contribute to both the risk of developing high blood pressure and complications from uncontrolled high blood pressure. Complications include heart disease, stroke and kidney disease. Understanding the roles that foods and essential nutrients play in health and disease is continually growing. Evidence-based diets, such as the Mediterranean Diet and DASH Diet have proven effective in reducing disease risk.

DASH Diet derives its name from the Dietary Approaches to Stop Hypertension study. This study evaluated the influence of dietary patterns on blood pressure. There were significantly greater reductions in blood pressure in the patients on DASH Diet versus the patients who consumed a control diet that was similar in composition to a typical American diet. In addition, DASH Diet can lower bad cholesterol, known as low density lipoprotein cholesterol. Elevated bad cholesterol level and high blood pressure are both risk factors for heart disease and stroke.

DASH Diet plan is rich in fruits, vegetables and low-fat dairy. It also includes a reduced amount of saturated and total fat.

The number of servings is based on your daily calorie needs.

Below are the recommended servings from each food group for a 2,000-calories-a-day DASH Diet.

DASH Diet Plan: Dietary component and recommended servings

Recommended daily salt intake – 2,300 mg or 1 tsp

DASH Diet is easy to follow, and is a balanced eating plan that helps create a heart-healthy eating style for life.

Work on your diet in collaboration with your doctor. Your doctor might modify your diet depending on any complications, comorbidities (multiple conditions) or medications you are taking.

<p>The post What does the DASH Diet Have to Do with High Blood Pressure? first appeared on KnowYourMeds.</p>

The American College of Rheumatology recommends the COVID-19 vaccination for people with lupus, except those with a known allergy to a vaccine component or a life-threatening illness. This recommendation is based on the first-ever large-scale study conducted, known as the International Vaccination Against COVID in Systemic Lupus (VACOLUP) study. Researchers found that the COVID-19 vaccine is largely well-tolerated by people with lupus.

The study included 696 participants with lupus across 30 different countries. Researchers assessed the occurrence of flares and side effects. 50% of people reported some side effects. Of these, the majority (83%) reported minor or moderate symptoms that did not interfere with daily tasks. 21 people of the 693 participants reported a medically confirmed lupus flare about three days after vaccination.

Generally, lupus medications will not affect how the COVID-19 vaccine works. In some cases, your doctor may have special instructions so you can get the greatest possible benefit from the vaccine, particularly if you are taking a powerful immunosuppressant drug.

Consult with your doctor if you have questions or concerns about the vaccine, and how the vaccine fits into your treatment plan. You and your doctor should decide together if the vaccine is right for you and, if so, which version is most beneficial.

<p>The post How is COVID-19 Vaccine Tolerated in People with Lupus? first appeared on KnowYourMeds.</p>

Lupus cause and risk factors

The prevalence of Lupus in the United States is 20 to 150 cases per 100,000 people. The exact cause is unknown but is believed to occur when a person inherits a genetic predisposition to lupus and is exposed to an environmental trigger.

There are more than 50 identified genes associated with lupus. The estrogen hormone is also believed to be involved in causing lupus. This explains why it is prevalent in women.

Factors that contribute to an increased risk for lupus are:

• Common in women.
• Most often diagnosed between 15-45 years old.
• More common among African Americans, Hispanic and Asian Americans.

<p>The post What are the Cause and Risk Factors of Lupus? first appeared on KnowYourMeds.</p>

A flare is a reappearance or worsening of disease symptoms. A new occurrence or worsening of existing symptoms, such as diarrhea, abdominal pain, bloody stools, frequent or urgent bowel movements, fatigue, weight loss, and lack of appetite, may indicate a flare-up.  

Some of the possible factors that can result in a flare-up are:

• Non-adherence to medication directions, including skipping, missing or taking the wrong dose
• Taking medications, such as nonsteroidal anti-inflammatory drugs or antibiotics, can worsen returning symptoms 
• Stress
• Smoking

<p>The post Crohn’s Disease Flare-ups and Tips to Manage Them first appeared on KnowYourMeds.</p>

Having a chronic illness, such as IBD, brings a significant amount of stress. Managing and juggling domestic duties, work, relationships, and disease can be overwhelming at best. Your quality of life can be greatly affected by these simultaneous challenges.

So, exactly what is stress?

Stress is an adaptive response to stressors or adverse threats. Stressors can be psychological, physical, real, or perceived. Anxiety, sadness, depression, overwhelm, excitement, fear and anger are all common stressors that can affect the gastrointestinal tract. Lifestyle stressors can also impact your health. These include time management, inadequate sleep, changes in the environment, work or relationship issues, watching the news, and much more.

Stress is the body’s natural hormonal response to dealing with a situation. It can be harmful to your physical and mental health when there is prolonged exposure to stressors, such as experiencing a traumatic event. The physical reactions to stress include increased heart rate and perspiration.

What is the connection between stress and inflammatory bowel disease?

There is a two-way influence between stress and IBD. Inflammation leading to symptoms, such as pain, can lead to stress. And whenever stress occurs, the development of IBD symptoms can be affected to some extent. Stress associated with adverse life events or chronic psychological stress has been shown to be associated with subclinical (unrecognizable) increases in inflammation.

Multiple pathways, including the autonomic nervous system and hypothalamic-pituitary-adrenal axis (HPA axis), are activated when the brain receives stress input. Because there is a two-way connection between the brain and nerves in the lining of the gut (brain-gut axis), stress will eventually affect the contractions and movements of the gastrointestinal tract. This increases gut sensitivity and causes bacteria to cross the gut lining and activate the immune system, increase inflammation in the gut, and change the gut microbiota.

Gut microbiota, or microbiome, is a micro-system of organisms in the gut. This microbiome consists of bacteria, viruses, fungi, and parasites. There are two kinds of microbes: beneficial and pathogenic organisms. Beneficial organisms have a mutually beneficial relationship with our bodies. They help prevent bowel disorders, cancer, and chronic diseases. Pathogenic organisms have the propensity to cause diseases if left unchecked. In a healthy person, these two kinds of organisms live peacefully. Disruption of this peaceful existence and increase in the pathogenic organisms can occur with illnesses, medications, and certain diets.

There is strong evidence that gut microbiota (microbes that reside in the gut) has an important role in the interactions between gut and brain. The trillions of microorganisms that live in the human gut may also affect behavior and emotions. In inflammatory bowel disease, alteration of the gut microbiota causes a reduction in beneficial organisms.

Common emotional disorders among people with inflammatory bowel disease include depression, anxiety, and perceived stress.

How do I deal with stress with inflammatory bowel disease?

Life is a balance, and so is IBD. Getting this balance right takes time and effort. Listen to your body and adapt to activities that you enjoy doing.

Ways to manage stress effectively include:

• Strike a better balance between your work and lifestyle. You can organize your work schedule to be similar every day and schedule breaks between activities.
• Identify your key stressors. Identify situations that exceed your ability to cope. Of course, some problems can’t be avoided. Planning ahead, rearranging your environment, and managing things that you can control can help you cope better during stressful situations. If coping with symptoms is the primary cause of your stress or if you feel depressed or anxious, talk to your healthcare team. They may recommend and help you connect with a psychiatrist or prescribe appropriate treatment.
• Use constructive self-talk. Address the ongoing commentary in your mind. If there are persisting negative thoughts, replace them with constructive self-talk, letting go of the past and moving forward focusing with new possibilities.
• Socialize or spend time with family and friends. People with IBD tend to isolate and become lonely due to a fear of experiencing symptoms in social situations or public places. For social situations, plan ahead for managing episodes of diarrhea or abdominal pain. Identify bathroom locations where you will be and carry extra supplies you may need. Mobile apps can assist you in locating nearby restrooms within the U.S. and around the world.

Sharing your concerns with your family and friends can provide much-needed support. In addition, you can connect with Crohn’s and Colitis communities and their members who have similar experiences.

Focus on self-care as a lifestyle requirement

There are many aspects of self-care that can help you cope in the short- and long term. These include:

• Exercising and sports
• Deep breathing
• Mediation and yoga
• Listening to relaxing music

Activities, such as creative projects, gardening, or spending time in nature, can similarly add to feelings of enjoyment and inner peace. Overall, add daily activities to your schedule that you enjoy and that lift your spirit. As important, take time to rest and get the right amount of quality sleep your body needs.

Feed your body with healthy nutrition

Adapt to a diet that builds a healthy gut microbiome. Aim to balance your intake of foods and beverages that are good for you with those that may worsen your symptoms. Work with a dietician to evaluate foods and beverages, keep a diary of your foods and symptoms on your KnowYourMeds app, and find the balance that works for you. You might discover that a plant-based, minimally processed and high-fiber diet is beneficial to your gut microbiome and symptoms.

Maintain a positive and optimistic mindset

There are many things beyond our control. Keeping a positive attitude can help offset difficult situations and your reactions to them. Stress comes from how you respond to a stressor. Refocus your mind on doing things that make you happy and more relaxed. Even changing your focus from negative to positive thoughts or feelings can provide immediate relief from stress.

<p>The post Managing Your Stress Level and Daily Stressors When Living with Crohn’s and Colitis first appeared on KnowYourMeds.</p>

Body image dissatisfaction is commonly associated due to the impact of IBD. There are several factors that can lead to greater body image dissatisfaction, including disease activity, long-term use of steroids, skin involvement, joint and muscle involvement, surgery and living with an ostomy. The constant fluctuation between weight gain and loss can be another cause of body image dissatisfaction for people. Most people experience some weight loss during a flare (when the disease is active).

Ostomy, or stoma, is a surgically created opening for bowel movements to exit the body other than through the anus. After a stoma surgery, it often takes time to adjust and accept your changed body.

Of the major medications used in the treatment of IBD, steroids are most associated with body image dissatisfaction. Weight gain is a common side effect of long-term use of steroids.

Because of the nature of the disease and treatments, you may notice a constantly changing body. You may have also felt a loss of control and experienced lower self-esteem. It may feel like your body is rebelling against you, especially during active disease activity. During this time, it is important to keep a positive mindset and accept the changes that you cannot control, while taking control of what you can.

Keeping a positive body image can be a battle, and here are some ways to help you stay in control:

Be nice to yourself

Do not let the disease take over your life. Focus on building your self-esteem. Positive self-talk and reframing how you view things will help boost your self-confidence. Leaving little notes for yourself around the house with positive expressions or aspects of yourself that you love will make a huge difference to your mindset.

“Positive self-talk is to emotional pain as a pain pill is to physical pain.” – Edmond Mbiaka

If your body image dissatisfaction is due to stoma, nurture the positive feeling that stoma contributes to your well-being and being rid of your symptoms.

Also, remind yourself that you have IBD, and IBD does not have you. Start doing activities that you enjoy. Even simple things, like laughing, taking a long bath, reading, and listening to music, can help move you in a positive direction.

Incorporate physical activity of any form

Exercise may be the last thing you may do if you are experiencing a flare-up and fatigue. When you are in remission or your symptoms are mild, you can be active but do not push beyond your limits. Learn what you are capable of and scale your activities accordingly. Physical activity will relieve stress, improve immune function, and strengthen your body. Before making any significant changes to your level of activity, talk to your healthcare team.

Create a support system

Surround yourself with people who love you, and plan activities or spend time with them to fend off feelings of isolation. Avoiding social situations or meeting people will add to a feeling of isolation. Consider joining one or more support groups, as the members may have experienced what you are going through and can help you better deal with your issues

Work with your doctor and communicate honestly about how you feel

Many people do not seek help or discuss their mental and emotional health with others. They fear that others might see it as weakness. Do not be afraid to talk to your doctor regarding body image dissatisfaction. Your doctor can support you in many ways, including connecting you with a therapist or counselor knowledgeable about the effects of Crohn’s and colitis. Do not go on a restrictive diet if weight gain is an issue. Work with your doctor or dietitian to come up with an enjoyable and healthy eating plan.

Pursue relationships and stay in ongoing communication with your partner regarding how IBD is affecting you

For many people, IBD has prevented them from pursuing an intimate relationship. Body image can also play a role, in addition to fear of symptoms. Avoid wasting time on people who will not accept you due to your condition. If you are worried about how stoma might affect your partner’s relationship, it is not likely your stomach influenced the initial attraction. The key point is to maintain constant communication with your partner about these issues. If your partner does not know how you are feeling, it may lead to misunderstanding on both sides.

Though your body can be frustrating at times, focus on what your body can do. Reflect on the benefits of having a healing treatment plan, your support community, and having a healthy diet and lifestyle plan. Living with IBD should not limit you from having or doing what you want in life. Be patient, positive, and ask for support when you need it.

“Feeling beautiful has nothing to do with what you look like.”

– Emma Watson

“Speak to your body in a loving way, it’s the only one you’ve got, it’s your home, and it deserves your respect.”

– Iskra Lawrence

“Your body hears everything your mind says.”

– Naomi Judd

<p>The post Does Inflammatory Bowel Disease Affect Your Body Image? first appeared on KnowYourMeds.</p>

Crohn’s disease may involve any part of the digestive tract. In contrast to ulcerative colitis, Crohn’s inflammation involves the colon.

Symptoms vary with the involvement of different parts of the digestive tract. If you have Crohn’s disease, it is important to know which part of your digestive tract is involved, so that you can manage the condition properly. The more you know, the more you can control the symptoms. More than one type of Crohn’s disease can be seen in some people. It may skip areas, meaning there could be involvement and inflammation in the mouth and small bowel and nothing in between.

Knowing body anatomy and understanding what happens to digested food in the digestive tract will help you understand the different types of Crohn’s disease.

Human digestive system

The human body with various systems, including the digestive system, is intricate and complex. All the systems work synchronously to sustain the body functions. The gut-brain connection is one such example demonstrating the link between the brain and digestive system. The thought of eating or watching a cooking show showing a fresh-baked apple pie can release stomach juices. The connection goes both ways. A troubled gut can send signals to the brain. Similarly, the endocrine system (network of glands in your body) works in coordination with the digestive tract to digest and absorb food. The respiratory system, heart and circulatory system work together to purify the blood, supply oxygen to various organs, and remove carbon dioxide.

The human digestive system, which is 30 feet in length in adults, is a series of connected organs leading from the mouth to the anus. It is divided into 8 parts:

• Mouth
• Esophagus
• Stomach
• Small intestine (small bowel). The small intestine parts are Duodenum, Jejunum and Ileum. Duodenum connects the stomach to jejunum, and ileum is the lower end of the small intestine that connects to the large intestine.
• Large intestine (large bowel)
• Liver, pancreas and gallbladder add secretions to support digestion
• Rectum
• Anus

The food we eat passes from the mouth into the esophagus after the process of mechanically breaking down the food is completed. The process, called peristalsis (movement of organ walls), moves and pushes the food through the gastrointestinal tract. The esophagus connects the mouth to the stomach. A ring-like muscle at the end of the esophagus controls the passage of food into the stomach and controls the food from backing up into the esophagus. The stomach further breaks down the food, liquefies it, and adds digestive juices. Then the contents from the stomach are slowly released into the small intestine, where most of the digestion and absorption of nutrients takes place. The liver, pancreas, and gallbladder also aid in the digestive process by adding secretions into the small intestine. Unabsorbed materials go into the large bowel after passing through nearly 20 feet of the small bowel. The remaining liquids and electrolytes are absorbed in the large intestine before the solid material passes through the rectum and anus as feces during a bowel movement.

Involvement of the digestive tract

Crohn’s disease often causes inflammation involving the deeper layers of the digestive tract. This affects the absorption of nutrients and causes diarrhea and other symptoms.

The most common type of Crohn’s disease involves the small intestine.

5 Types of Crohn’s disease

• Ileitis
• Ileocolitis
• Crohn’s Colitis
• Perianal Disease
• Mouth or Gastroduodenal Disease

Ileocolitis

Involvement of the ileum (lower end of the small intestine) and large bowel, occurs in approximately 50% of people with Crohn’s disease. People with this type of involvement may present with abdominal pain in the middle or right lower part of the abdomen

Crohn’s colitis

This disease is limited to the colon in approximately 20% of people. In 50% of people, the rectum is spared. Because of the involvement of the colon, there may be an increased risk of colon cancer. Screening for colorectal cancer with a colonoscopy is generally done every 1-2 years with people who have had symptoms of IBD for 8 years or longer. The frequency of testing may be less than every 1-2 years, depending on the results of the previous colonoscopy.

Perianal disease

Anal involvement and/or the area around the anus is seen in a third of people.

Mouth or gastroduodenal disease

Involvement of the mouth or stomach and duodenum (an uppermost portion of the small intestine) is seen in approximately 5-15% of people. Gastroduodenal involvement may present with upper abdominal pain, nausea, and vomiting after meals.

Types of Crohn’s disease and symptoms

The starting point to better manage your condition is learning more about the disease affecting you. With Crohn’s disease, knowing the area of the digestive tract involved, the symptoms of the parts involved, and the different treatment approaches for your type of involvement, will all help prepare you for your future and enable you to be your own health advocate.

Your healthcare team is the best source of information for questions or concerns related to your disease involvement. Communicate openly and share all that is happening with you with your healthcare team.

<p>The post Understanding the Types of Crohn’s Disease first appeared on KnowYourMeds.</p>

Probiotics

These are examples of fermented foods containing live bacteria, which support your digestive health.

• Plain Yogurt.
• Raw Honey.
• Fermented vegetables.
• Kefir.
• Miso.
• Kimchi.
• Pickles.
• Tempeh (Grain-Free).

<p>The post Probiotic Foods for Balancing the Gut Microbiome first appeared on KnowYourMeds.</p>

Ulcerative Colitis Disease Activity

• Remission
• Periods when inflammation is controlled
• No symptoms
• Occurs spontaneously or after medical and/or surgical intervention

Mild Ulcerative Colitis

• Less than 4 stools per day with or without small amounts of blood
• Mild, crampy abdominal pain
• Sense of incomplete emptying after a bowel movement
• Periods of constipation

Moderate Ulcerative Colitis

• Frequent (4 to 6 per day) loose, bloody stools
• Moderate abdominal pain
• None or minimal symptoms, such as fever or weight loss

Severe Ulcerative Colitis

• Frequents, loose bloody stools (more than or equal to 6)
• Severe cramps, high fever, weight loss

Fulminant Ulcerative Colitis

• Bloody stool frequency more than or equal to 10 per day with urgency
• High fever, severe cramps, abdominal distention

<p>The post Ulcerative Colitis Disease Activity first appeared on KnowYourMeds.</p>

Janus kinase inhibitors work by blocking the enzyme Janus kinase, which is involved in inflammation. Tofacitinib is used in other conditions associated with inflammation, such as Rheumatoid Arthritis and Psoriatic Arthritis.

Tofacitinib is taken by mouth with or without food. The time for Tofacitinib to take effect varies person-to-person. While some people have a relatively rapid response within one week, for others it may take up to 8 weeks.

Common side effects are:

• Diarrhea
• Upset stomach
• Vomiting
• Headache
• Nose or throat irritation
• Signs of common cold

Tofacitinib and vaccines

Talk with your doctor before getting any vaccines. Tofacitinib may lower the body’s resistance to infection, so you may end up getting an infection with the vaccine.

Avoid being near anyone who has received a live virus vaccine, as there is a possibility that they could pass the virus on to you. Examples of live vaccines include influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, measles, mumps, and rubella.

Tofacitinib and pregnancy

Currently, there is no sufficient data using pregnant women to determine the effects of tofacitinib on a fetus. Discuss the risk and benefits of the medication with your doctor if you are planning for pregnancy.

Tofacitinib may cause fertility problems in females, which may affect the ability to have children. Talk to your doctor if this is important for you.

Tofacitinib and breastfeeding

Breast-feeding is not recommended while taking this drug. Also, avoid breastfeeding after you stop this drug until there are no traces of this drug left in your body. Talk with your doctor regarding breastfeeding while on this medication.

Interactions with other medications and food

Tofacitinib is known to interact with Adalimumab, Azathioprine, Atezolizumab, Bleomycin, Corticotropin, Clarithromycin, Certolizumab, Golimumab, Hydrocortisone, Infliximab, Interferons, Methotrexate, Mercaptopurine, Rifampin, and Tacrolimus. This is not a complete list of drug interactions. Check with your doctor if you are planning to take any medications while taking Tofacitinib.

Be sure to talk with your doctor if you drink grapefruit juice or eat grapefruit often.

Tests or check-ups done before starting Tofacitinib

• Skin test to check for tuberculosis
• Hepatitis test
• Immunity to chicken pox or shingles if you haven’t had them. You may be given a vaccine to protect from catching them.

Tests or check-ups done while taking Tofacitinib

Blood Counts

Tofacitinib may cause bone marrow suppression, leading to low white and red blood cells and platelets. Blood counts may be checked periodically by your doctor while on this medication.

Lipid Profile

High cholesterol levels can occur with this medication. Your doctor may periodically check your cholesterol levels. Be sure to eat a heart-healthy diet while on this medication.

Liver Function Test

Even though it is rare, Tofacitinib may cause liver problems. Your doctor may periodically assess your liver function.

Check with your doctor if you experience dark urine, tiredness, lack of hunger, upset stomach or stomach pain, light-colored stools, vomiting, or yellow skin or eyes.

Skin Examination

Tofacitinib is associated with an increased risk of skin cancer. Your doctor may conduct regular skin exams.

Avoid sun, sunlamps, and tanning beds. Always wear sunscreen, clothing, and eyewear that provides sun protection.

Things to know or do while taking Tofacitinib

• Inform all your health care providers that you take this drug, including your dentist and pharmacist.
• Since you may be more prone to infections while on this medication, wash your hands often and stay away from people with infections, colds or the flu. Check with your doctor if you experience fever, chills, flu-like signs, bad sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or change in the color of phlegm, pain when passing urine, or a wound that will not heal.
• Lymphoma, cancer of infection-fighting cells, happens rarely with this medication. Because of this, it is important to regularly test your blood during the time you are taking Tofacitinib. Talk with your doctor if you experience unusual bleeding, bruising, weakness, swollen lymph nodes in the neck, underarms, or groin, raised bumps with pus on the skin, weight loss, or red, scaly patches.
• Tofacitinib can lower the number of platelets that are necessary for proper blood clotting. Be careful when using a regular toothbrush, dental floss or toothpick. Check with your medical doctor before having any dental work done.
• Be careful not to cut yourself when using sharp objects. Avoid contact sports or other situations where bruising or injury might occur.
• Check with your doctor right away if you have unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• The liquid form of the medication may contain sugar, aspartame and/or alcohol. Talk to your doctor if you have (birth defect that causes an amino acid called phenylalanine to build up in the body)
• Blood clots, though rare, have occurred with this medication, especially in people 50 years of age or older. Check with your doctor immediately if you have sudden shortness of breath, chest pain, or else pain, redness, swelling, or tenderness in your arms or legs.
• This drug may affect certain lab tests. Again, tell all your lab workers and health care providers when you are taking this drug.

No medication comes without any side effects. If your doctor has prescribed this medication, they will have weighed your benefits and risks, and chosen this medication when the benefits outweigh the risks. Keep all appointments with your doctor, so your doctor can closely monitor you and check for side effects.

<p>The post Taking Tofacitinib to Treat Ulcerative Colitis first appeared on KnowYourMeds.</p>

Parenteral and enteral nutrition

Parenteral nutrition

Feeding intravenously, bypassing the usual process of eating and digestion.

Enteral nutrition

Liquid supplemental nutrition is either taken by mouth or is given via a feeding tube.

Nasal or oral feeding tube a- terminates at, either

• Stomach (Nasogastric)
• Duodenum (Nasoduodenal)
• lenunum (Nasojejunal)

Gastrostomy Tube

A feeding tube that leads through an artificial external opening into the stomach.

Jejunostomy Tube

A feeding tube that leads through an artificial external opening into the small intestine.

<p>The post What is Parenteral and Enteral Nutrition? first appeared on KnowYourMeds.</p>

Methotrexate is an immune suppressant, which suppresses or weakens the immune system when necessary. Methotrexate causes the release of a molecule, called adenosine, which blocks other chemicals that promote inflammation. Because of this, it is used in inflammatory conditions, such as rheumatoid arthritis, Crohn’s disease, and Psoriasis.

Methotrexate also blocks folate, a form of vitamin B, that is used by cancer cells to multiply and grow. Because of this ability, it is used in certain cancers. The dosage used to treat cancer is extremely high compared to the dosage for autoimmune conditions. The side effects of Methotrexate at doses typically used for the treatment of autoimmune disease are rarely life-threatening.

Methotrexate, a slow-acting medication, may take 2-3 months before your symptoms improve. You can take it in tablet form or by injection.

Some of the most common side effects of methotrexate are:

• Nausea, vomiting and upset stomach
• Mouth soreness
• Headache
• Fatigue or malaise
• Impaired ability to concentrate
• Skin rashes often on the elbows and knees
• Fever
• Hair loss

Folic acid is a vitamin that is generally prescribed to help reduce the possible side effects of Methotrexate, such as nausea, vomiting, fatigue, and soreness of the mouth.

Tests or check-ups done before starting methotrexate

• Before starting treatment, tests are done on liver, kidney and lung functions. Complete blood count is also checked. Methotrexate can affect blood count and cause liver and lung problems. Methotrexate may not be prescribed if your bone marrow, liver or kidneys are not functioning properly.
• If you haven’t had chicken pox or shingles, your doctor may check if you are immune to them. You may be given a vaccine to protect from these before taking Methotrexate. 
• Methotrexate can be harmful to an unborn baby. If you are a female, a pregnancy test is completed before starting the treatment. Methotrexate blocks folate, which is needed for the development of the unborn baby. Its deficiency may cause serious birth defects, called neural tube defects. Neural tube defects can affect the spine, spinal cord or brain.

Some things to know or do while taking Methotrexate

• Tell all your healthcare providers you are taking this drug, including your dentist and pharmacist.
• Talk to your doctor regarding folic acid supplements to counteract common side effects.
• Because Methotrexate suppresses immunity, you may be more prone to infections. Wash your hands often. Stay away from people with infections, colds or flu. Check with your doctor if you have symptoms, such as fever, chills, flu-like signs, painful sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or a change in phlegm color, pain when urinating, or a wound that does not heal.
• Methotrexate can lower the number of blood platelets, which are necessary for proper blood clotting. Be careful when using a regular toothbrush, dental floss or toothpicks. Check with your medical doctor before having any dental work done.
• Be careful not to cut yourself when you are using sharp objects. Avoid contact sports or other activities where bruising or injury could occur. Check with your doctor right away if you have unusual bleeding or bruising, black, tarry stools, blood in your urine or stools, or pinpoint red spots on your skin.
• Talk with your doctor before getting any vaccines.
• You may sunburn more easily while on Methotrexate. Avoid sun, sunlamps and tanning beds. Use sunscreen, and wear clothing and eyewear that protects you from the sun.
• Methotrexate may affect fertility by causing low sperm count. This may lead to the inability to father a child. Check with your doctor on this.
• Call your doctor right away if you miss a menstruation period, have unprotected sex, or think that your birth control has not worked, because of the harmful effects of Methotrexate on an unborn baby. Women are advised to avoid getting pregnant for at least 6 months after stopping this medication. It is also important that men who are taking Methotrexate and have female partners use an effective form of birth control during treatment and for at least 3 months after the last dose.
• Avoid drinking alcohol while taking this medication. Alcohol and Methotrexate can interact and affect your liver.
• There is evidence that immunosuppressants, such as Methotrexate, may also slightly increase the risk of Lymphoma (cancer of lymphocytes, infection-fighting cells). Because of this, it is important to have regular blood tests throughout the time you are taking Methotrexate. Talk with your doctor if you experience unusual bleeding, bruising, weakness, swollen lymph nodes in the neck, underarms, or groin, raised bumps with pus on the skin, weight loss, or red, scaly patches.
• Methotrexate may cause Fibrosis and inflammation of the lungs. Check with your doctor if you experience shortness of breath, cough or other respiratory symptoms.
• Methotrexate may cause liver problems. Check with your doctor right away if you are experiencing nausea, vomiting, yellow eyes or skin, pain or tenderness in the upper stomach, pale stools, dark urine or loss of appetite.
• It is important to avoid a class of medications, called Sulfonamides (Sulfasalazine, Sulfamethoxazole or Sulfonylurea class of Diabetic medications). Interactions with Methotrexate could cause unexpected side effects.
• It is advisable to talk to your doctor if you are planning to take non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen. These can interact with Methotrexate.

When deciding to take this medication, assess the benefits and risks with your doctor. Please follow all the instructions. Your doctor will check your progress during regular office visits to make sure Methotrexate is working properly and check for unwanted side effects. It is particularly important to keep all the appointments with your doctor. Do not take other medications while taking Methotrexate unless they have been discussed with your doctor.

<p>The post Methotrexate for Treating Inflammatory Bowel Disease first appeared on KnowYourMeds.</p>

This unrelenting exhaustion is far more than ordinary or usual tiredness. With ordinary tiredness, you are able to get out of bed. Your day-to-day activities are not impaired much. Doing things that you love doing or taking a nap may perk you up.

Illness-related fatigue is the most common symptom of depression and underlying conditions requiring treatment. Over 3/4 of people with Crohn’s Disease and Ulcerative Colitis, both forms of Inflammatory Bowel Disease (IBD), experience fatigue. Fatigue is a common and under-recognized symptom with IBD. Because there is unpredictability in the occurrence of fatigue in people with IBD, it can affect socializing, planning, travel, or participating in other activities you enjoy doing.

Although fatigue can occur in people of all ages and both sexes, some studies suggest a greater effect on women who have IBD.

What are contributing factors for causing fatigue in IBD?

The combinations of factors causing fatigue in people with inflammatory bowel disease include:

Pain

Abdominal pain caused by inflammation, blockages, and bloating can be draining. Other extraintestinal symptoms, such as joint pain and back pain, can contribute to fatigue. Pain also may contribute to fatigue through emotional and psychological distress or poor quality of sleep.

Inflammation and flare-ups

Inflammation and flare-ups release chemical signals that act on the brain, causing tiredness and lack of motivation. Multiple studies have shown that fatigue is associated with the severity of the disease.

Fatigue may continue in some people while in remission (their symptoms are under control). It is thought that inflammation remaining in the gut may be the cause.

Nutritional deficiencies

Various nutritional deficiencies may occur due to decreased food intake, disrupted food absorption, increased energy expenditure, and/or increased loss of muscle or bone.

Anemia is a common complication seen in inflammatory bowel disease. Lack of healthy red blood cells affects the body’s ability to transport oxygen throughout the body, causing exhaustion. Potential contributors of anemia in people with IBD are iron deficiency, vitamin B12 or folate deficiency, chronic inflammation, and side effects of medications, such as Sulfasalazine, Methotrexate, Azathioprine, and 6-Mercaptopurine.

Iron deficiency is the most common cause of anemia in IBD. It can be the result of lower nutritional intake, chronic gastrointestinal bleeding due to ongoing inflammation, or mucosal ulcers.

Other than contributing to bone loss and immune system dysregulation, vitamin D deficiency may also contribute to fatigue. Vitamin D deficiency can be due to several factors. These include improper absorption and anorexia with IBD, steroid medications (Prednisone, Prednisolone, Budesonide) used to treat IBD, diet, and sun exposure.

Micronutrient deficiencies, such as zinc, calcium, vitamin A due to malabsorption, and self-imposed dietary restriction, can also contribute to fatigue.

Emotional stress

Anxiety and depression are common comorbidities with any chronic condition due to negative emotions and reduced quality of life. Along with the lack of motivation often experienced with psychological disorders, stress can trigger inflammation and pain in people with Crohn’s disease and colitis, contributing to fatigue.

Medications

Azathioprine, 6-Mercaptopurine, and steroids used to treat inflammatory bowel disease have been linked with fatigue.

Poor sleep quality

Poor sleep has been linked to worsening symptoms, especially fatigue in people with IBD. Factors that cause poor sleep include pain, ongoing active disease, nocturnal symptoms, and depression.

Additional factors that might contribute to the cause of fatigue are feeling lack of support, body image issues, alcohol and diet, and weather extremes.

Why is it important to talk about fatigue?

Most of the time, people are hesitant to discuss feeling fatigue with healthcare providers or loved ones for fear of being seen as lazy or experiencing it as a personal failing. However, science can explain why fatigue occurs with chronic conditions.

It is important for you to talk openly about your fatigue, especially with your doctor and/or your care team, so that they can provide you with support and proper care. This may include:

• Doing blood tests to check for nutrient deficiencies or how active the disease is. Collaborating with an experienced dietician to correct any nutrient deficiencies and ensure a nutritionally replete diet, can improve fatigue and other symptoms.
• Reviewing your medications and adjusting dosage or type of medication can help. Doctors may consider removing medications that are associated with fatigue.
• Receiving support from a specialist who can address psychological issues or disorders. Anxiety and/or depression can be addressed through counseling, talking therapy and/or cognitive behavioral therapy.
• Obtaining proper treatment for pain, if pain is contributing to your fatigue. Pain management can include medication, exercise or physical therapy, and counseling.
• Getting educated on sleep hygiene, identifying risk factors for sleep impairment, and receiving appropriate treatment.

What other things can I do to reduce my fatigue?

Actions to reduce fatigue may vary from person to person. What works for others may not work for you. You know your body better than anyone else. Learn what triggers cause you fatigue and work towards reducing those. Areas to consider to reduce fatigue include:

• Stress reduction
• Meditation and yoga
• Some forms of exercise and physiotherapy
• Frequent breaks from work, or flexible working hours
• Quality sleep
• Stop smoking
• Eating smaller meals with frequent healthy snacks, rather than larger meals

Illness-related fatigue can have a major impact on daily life, work, and quality of life. Overcoming fatigue can be challenging. Surround yourself with people you can talk with. Also, communicate regularly with your doctor regarding all the symptoms you are experiencing and how they affect your daily life.

<p>The post Fighting Fatigue with Inflammatory Bowel Disease first appeared on KnowYourMeds.</p>

The two main types of inflammatory bowel disease are Ulcerative Colitis and Crohn’s Disease. The exact causes of Crohn’s and colitis are not known but both are believed to be caused by immune dysfunction in genetically susceptible people.

A disease flare is a period of symptom activity and can include abdominal pain, stool changes, urgency, and loss of appetite, among other symptoms that are attributable to Inflammatory bowel disease (IBD)

Because of the nature of the disease, inflammatory bowel disease can have a profound effect on the lives of people affected and their families. Much of the day and night may be spent making trips to the restroom during a flare-up. The symptoms may cause pain, exhaustion, fatigue, and disturbed sleep.

There are several factors that can trigger a flare-up: medications [nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics], infections, travel, emotional stress, tobacco use, and poor adherence to prescribed medications.

Poor adherence with prescribed medications

The best way to control IBD is by taking medications as recommended by your doctor. Missing doses or taking the medication incorrectly can worsen the inflammation. It is important to take prescribed medications, even when you are on remission, to keep your inflammation under control and prevent future flare-ups.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory medications such as aspirin, naproxen, and Ibuprofen are not recommended if you have inflammatory bowel disease (IBD). These medications can worsen your symptoms. NSAIDs can cause erosion, ulcer, and perforation of the gastrointestinal tract as side effects. NSAIDs can also cause colitis similar to IBD. If you need to take a pain reliever, acetaminophen (brand name, “Tylenol”) should not affect inflammatory bowel symptoms. Talk to your doctor about this.

Antibiotics

In some circumstances, antibiotics can trigger a flare. Antibiotics influence the risk of disease development due to their effect on the microbiome. Please notify all your healthcare providers that you have inflammatory bowel disease before being prescribed any medications.

Stress

Anxiety and depression can worsen symptoms, such as abdominal pain and diarrhea, through activation of the gut-brain axis. When the brain receives stress input, multiple pathways are activated. This causes alterations in gut microbiota, the release of inflammatory mediators, and disruption of the intestinal barrier.

Infections of the gastrointestinal tract

C. Difficile Infection and Cytomegalovirus Infection can cause symptom flares due to inflammation and immunosuppression. Your doctor may check for these in your stool if you experience symptom flares. 

Foods

For some people with IBD, certain foods can make symptoms worse.  If this happens to you, your doctor might suggest avoiding those foods for a while to see if you improve. If you do avoid certain foods, your doctor may suggest taking supplements.

Cigarette smoking

It is particularly important to avoid (or quit) smoking if you have IBD, especially Crohn’s disease. Smoking can lead to more severe symptoms, more frequent flares, and an increase in the risk of needing surgery. More recent studies suggest flare due to smoking is mediated through oxidative stress. Oxidative stress is a disturbance in the balance between free radicals causing damage to cells and antioxidant defenses. There may also be lower amounts of interleukin-8 (IL-8), IL-10, and IL-23. Interleukins are proteins that play an important role in inflammation.

Reasons why flare-up occurs due to various factors

Most of these risk factors are modifiable. You can address them to reduce the occurrence of future flare-ups.

Some of the ways to modify the risk factors include:

• Adherence to all your medications. Even if you feel better, do not stop taking your prescribed medications. If the medications are not working for you, talk to your healthcare provider as they may change the medication or adjust the dose.
• Do not smoke. If you do smoke, stop smoking. Ask your doctor for assistance in stopping this habit.
• Reduce stress. Take frequent breaks from work or adopt flexible working hours. Surround yourself with people and belongings that make you feel better. You can also join support groups. Additional ways of combating stress are deep breathing, yoga, meditation, talk therapy and cognitive-behavioral therapy.
• Before being prescribed any medications, make sure you notify all healthcare providers, including your dentist, about your condition. Check with your doctor before taking any counter medications.
• To identify foods that may be causing symptoms, keep a log or diary of all food and beverages you consume. Over several weeks, record exactly what you eat, including ingredients and quantities. During this same time period and for a time after, record the occurrence and duration of any health symptoms. Look for information and patterns.

The first thing you must do when you experience a flare is contacting your doctor. Your doctor will assess you, and look for a cause and way to treat the flare. His goal is to help you alleviate your symptoms and improve your health.

<p>The post Factors that Trigger the Inflammatory Bowel Disease Flare-up first appeared on KnowYourMeds.</p>

Cyclosporine is an immunosuppressant that is normally reserved for use with Ulcerative Colitis patients who have not responded well to other medications.

Cyclosporine belongs to a class, called Calcineurin Inhibitors. This class of medications binds to and inhibits calcineurin. Calcineurin is a cellular enzyme that is responsible for the proliferation of a type of white blood cells, called T-lymphocyte, which plays a critical role in immunity.

Besides ulcerative colitis, Cyclosporine is used to prevent the body from rejecting the transplanted organ, and treat severe rheumatoid arthritis, severe plaque psoriasis, and certain eye conditions.

Cyclosporine can be taken in the form of:

• Orally as capsules or solution
• Intravenously with Injections given (an infusion into a vein over a period of time)
• Eye drops

In the oral form, is important to take the products, in the same manner, each time – always with food or always on an empty stomach. Also, take Cyclosporine at the same time of day. Speak with your doctor about this and follow all instructions.

Drug and food interactions of Cyclosporine

Some of the medications that have major interactions and should not be taken with Cyclosporine are:

• Simvastatin
• Pitavastatin
• Cochicine
• Bosentan
• Lercanidipine
• Dronedarone

This is not the complete list. Talk to your doctor before taking any other medications with Cyclosporine.

Additional warnings include:

• Do not start, stop or change the dose of any drug without checking with your doctor. This includes over the counter medications, and herbal or vitamin supplements.
• Do not use supplements or salt substitutes containing potassium without first checking with your doctor.
• Avoid grapefruit or grapefruit juice with Cyclosporine as these will increase the amount of medicine in the body.

Adverse effects of Cyclosporine

Kidneys

Cyclosporine can cause serious kidney problems, including infection with a virus, called the BK virus. BK virus infection may cause kidney loss in kidney transplant patients.

Check with your doctor immediately if you experience any of the following symptoms:

• Change in the amount of urine passed
• Difficulty or pain when passing urine
• Blood in the urine
• Nausea or vomiting
• Swelling of the feet or lower legs
• Weakness

High blood pressure

High blood pressure can occur with this medication, generally within the first few weeks of therapy. Talk to your doctor about checking your blood pressure regularly.

Brain and nerves

Cyclosporine and other calcineurin inhibitors can cause pain syndrome. There can be symmetrical pain in the lower limbs, usually involving the bones of the feet, ankles, and knees.

A brain condition, called Posterior Reversible Encephalopathy Syndrome (PRES), which may be very serious and sometimes deadly, has occurred with this drug. Check with your doctor immediately if you develop symptoms, such as seizures, confusion, reduced alertness, change or loss of eyesight, or intense headache. A mild tremor is also common with Cyclosporine.

Liver

Even though it is rare, Cyclosporine may cause serious liver problems. Check with your doctor immediately if you experience:

• Nausea
• Vomiting
• Loss of appetite
• Pain or tenderness in the upper stomach
• Pale stools
• Dark urine
• Yellow eyes or skin

Predisposition to cancer

There may be an increased risk of skin cancer with Cyclosporine. Talk to your doctor about scheduling regular skin examinations. Avoid sun, sunlamps and tanning beds. Always use sunscreen and wear clothing and eyewear to protect you from the sun.

Lymphoma, cancer of infection-fighting cells, may occur with this medication. Talk to your doctor if you have concerns about this risk.

Increased risk of infections

Because Cyclosporine is an immunosuppressant, there is an increased risk for infection. Check with your doctor immediately if you experience:

• Any signs of infection, such as sore throat, fever, chills, flu-like symptoms. cough, more phlegm or change in color of phlegm
• Ear or sinus pain
• Painful urination
• Mouth sores
• A wound that will not heal

Avoid being near people who are sick, and wash your hands often.

Metabolic abnormalities

A high potassium level and low magnesium level may occur with Cyclosporine. Check with your doctor if you experience mood changes, seizures, confusion, muscle pain or weakness, a heartbeat that does not feel normal, not hungry, or very bad upset stomach or throwing up as these may be signs of electrolyte problems.

Cyclosporine may cause high blood sugar levels. If you have diabetes, you will need to watch your blood sugar closely.

Cyclosporine may increase total cholesterol and low-density lipoprotein (LDL) cholesterol (the bad cholesterol). Talk to your doctor regarding this.

Cyclosporine can cause high uric acid levels in the blood. Watch out for attacks of gout.

Things to know or do while taking Cyclosporine

Do not have any immunizations or vaccines without your doctor’s approval while being treated with Cyclosporine or after you stop treatment with Cyclosporine. Because Cyclosporine lowers the body’s resistance to infections, you might get an infection using the vaccine that is meant to prevent it.

You should not be around people who have received live virus vaccines, as it is possible they could pass the virus on to you. Examples of live vaccines include influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, measles, mumps, and rubella.

Some people may experience tenderness, swelling, or bleeding of the gums. Massaging your gums, brushing and flossing your teeth regularly may help prevent this. Check with your doctor or dentist if you experience swelling, tenderness, or bleeding of the gums.

Other side effects associated with the use of Cyclosporine are loss of appetite, abdominal discomfort, nausea, vomiting, and diarrhea.

Cyclosporine is very strong medicine and may cause serious side effects, including kidney problems. This medicine is occasionally used in the treatment of various immune-mediated diseases. Your doctor will weigh the benefits against the risks when taking this medication.

Learn about the various medications used in the treatment of inflammatory bowel disease. You’ll want to understand the risks and benefits and decide with your doctor if the medication your doctor recommends is right for you.

<p>The post Cyclosporine Medication for Treating IBD first appeared on KnowYourMeds.</p>

Azathioprine and 6-Mercaptopurine are both members of the thiopurine class of drugs. Both medications are slow acting with typical responses observed after 3-6 months of therapy. Because of this, they are often started simultaneously with faster acting medications, such as steroids.

These can be taken by injection or as a pill.

The most common side effects of Azathioprine and 6-Mercaptopurine are loss of appetite, nausea, and vomiting, especially if the dose is increased too rapidly. These symptoms can be minimized by taking the drug with meals.

Testing for tuberculosis and/or hepatitis may take place before starting treatment using these medications. If these diseases are present, the doctor may treat them prior to starting one of the thiopurines. Your doctor may monitor your blood count and liver enzymes while taking these medications, because of possible bone marrow suppression and liver complications. Make sure to keep all your doctor appointments, and discuss this with your doctor.

The use of Azathioprine is associated with increased risk of non-melanoma skin cancer and cervical abnormalities or cancer. Please talk to your doctor about getting regular skin examinations and cervical smears. Always use sunscreen and wear clothing for protection from the sun.

If you are taking Azathioprine or Mercaptopurine, you should not receive live vaccines, such as MMR (measles, mumps and rubella), yellow fever, nasal flu or polio vaccines. You should also avoid coming into contact with anyone who has recently received a live vaccine, as there is a chance the infection could be passed to you.

Even though very rare, Lymphoma (cancer of infection-fighting cells, called lymphocytes) has occurred in people who have taken these medications. Discuss this with your doctor. Also, talk with your doctor immediately if you experience a swollen gland, night sweats, shortness of breath, or weight loss without trying.

AZA and 6-MP can lower the number of platelets, which are necessary for proper blood clotting. Be careful when using a regular toothbrush, dental floss or toothpick. Check with your medical doctor before having any dental work done. In addition, be careful not to cut yourself when you are using sharp objects. Avoid contact sports or other situations where bruising or injury could occur. Check with your doctor immediately if you have unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin

Although rare, liver problems have also occurred with these medications. Talk with your doctor if you experience dark urine, tiredness, lack of hunger, upset stomach or stomach pain, light-colored stools, vomiting, or yellow skin or eyes.

AZA and 6-MP are not given to people who are pregnant or likely to become pregnant in the near future. These drugs may cause harm to an unborn baby.

Suppressed immunity can be problematic and make you more prone to infections. Contact your doctor if you begin to feel unwell, or think you may have caught an infection. Wash your hands regularly, and avoid being around people who are sick.

Almost all medications come with benefits and risks. You and your doctor are partners in your healthcare and many decide to take these medications after weighing the benefits and risks. AZA and 6-MP are helpful in reducing or eliminating the need for steroids and maintaining remission when other medications have failed to do so.

<p>The post Understanding the immunosuppressants – Azathioprine and Mercaptopurine first appeared on KnowYourMeds.</p>

Inflammatory bowel disease is an umbrella term used for chronic inflammatory conditions affecting the gastrointestinal tract. The two main conditions are ulcerative colitis and Crohn’s disease. Ulcerative colitis, which involves the innermost lining affects the colon, while Crohn’s disease can involve any part of the digestive system.

With the scientific advances in IBD treatments, the good news is that it is a manageable disease. There are four main types of medications used to treat inflammation in IBD. These are Aminosalicylates, Steroids, Immunomodulators and Biologics. In this article, we will discuss 5-Aminosalicylates, one of the treatment options for IBD. 5-Aminosalicylates have long been a staple in managing IBD.

If left untreated, the symptoms and long-term damage of IBD can be debilitating. It can dramatically inhibit your daily life, especially with symptoms, such as fatigue, diarrhea, abdominal pain, and urgency to use the bathroom.

The goals of treatment for people with inflammatory bowel disease are symptom resolution, remission or maintenance.

5-Aminosalicylate (5-ASA) drugs are one class of medications used in treating mild to moderate inflammatory bowel diseases. They are believed to inhibit the formation of a chemical known as prostaglandins, which is responsible for controlling pain and inflammation. 5-ASA medicines are chemically related to aspirin and contain 5-Aminosalicylic acid.

5-Aminosalicylates act as anti-inflammatories and are used primarily in achieving and maintaining remission for ulcerative colitis. It is also used to control mild inflammation and other symptoms of Crohn’s disease.

This class of medications can be taken in pills, suppositories or enema form. The form prescribed will depend on several factors, including the location of the inflammation in the gastrointestinal tract.

Suppositories deliver the medications directly to the rectum. An enema or procedure to introduce medication into the rectum and colon by way of the anus, can reach higher than a suppository.

List of 5-Aminosalicylates

1. Sulfasalazine
2. Balsalazide
3. Olsalazine
4. Mesalamine

Side effects are much more common with Sulfasalazine. The other 5-Aminosalicylates are generally very well tolerated.

Sulfasalazine

Sulfasalazine was originally proposed for the treatment of Rheumatoid Arthritis because of its anti-inflammatory and anti-microbial properties. It is now used for inflammatory bowel disease and other inflammatory joint diseases.

What you need to know when taking Sulfasalazine:

• It is important to stay hydrated by drinking plenty of fluids, especially water.
• Avoid taking the medication on an empty stomach or with antacids.
• People on Sulfasalazine may notice that their urine, tears and sweat develop an orange tinge, which can stain clothing and contact lenses. Sulfasalazine is yellow-orange color.
• Sulfasalazine may affect the absorption of folic acid. Talk to your doctor about taking a folic acid supplement. You may need a higher dose of folic acid while taking the medication, and if you are pregnant. Speak to your doctor if you are hoping to become pregnant.
• The most common side effects of Sulfasalazine are headaches, nausea, fever, rash, sensitivity to sunlight, and reversible infertility in men. Headaches are more likely with higher doses of the drug and are less likely to occur if the dose is gradually increased.
• People who are allergic to sulfa drugs may have a cross reaction to Sulfasalazine.
  Examples of sulfa medications include Sulfamethoxazole, Glyburide, Sumatriptan, Celecoxib, Hydrochlorothiazide and Furosemide. Talk to your doctor if you have a sulfa allergy.
• You may get sunburned more easily while taking Sulfasalazine. Avoid sun, sunlamps and tanning beds. Use sunscreen, clothing and eyewear that protects you from the sun.
• Sulfasalazine may cause a decrease in fertility in males with low sperm count. The effects are reversible and related to dosing.

Balsalazide, Olsalazine and Mesalamine

Balsalazide, Olsalazine and Mesalamine are 5-Aminosalicylates medications that are similar to Sulfasalazine with a 5 amino salicylate(5-ASA) component but lacks a sulfapyridine component that is present in Sulfasalazine. The sulfapyridine component has disease modifying effects in people with rheumatoid arthritis, hence Sulfasalazine is the only 5-aminosalicylate used for treatment in arthritis. The 5-ASA component is responsible for many of the beneficial effects in people with inflammatory bowel disease.

What you need to know when taking Balsalazide, Olsalazine and Mesalamine

• It is important to drink lots of non-caffeinated liquids while taking these medications. That is unless your doctor advises you to drink less liquids. Do not take antacids while taking this medication orally.
• You may sunburn more easily while taking these medications. Avoid sun, sunlamps and tanning beds. Use sunscreen, clothing and eyewear that will protect you from the sun.
• The most common side effects are headaches, malaise (a vague feeling of illness), cramps and gas.
• Though rare, these medications may cause kidney problems, including kidney stones. Check with your doctor immediately if you have lower back or side pain, increased thirst, decreased frequency or amount of urine, bloody urine, loss of appetite, nausea, vomiting, unusual tiredness or weakness, swelling of the face, fingers or lower legs, weight gain, or trouble breathing.
• Though rare, these medications may also cause liver problems. Check with your doctor immediately if you experience pain or tenderness in the upper stomach, loss of appetite, nausea, vomiting, yellow eyes or skin, pale stools or dark urine.
• Additional rare side effects with these medications include a reaction that looks like symptoms of ulcerative colitis. Check with your doctor immediately if you have stomach pain, bloody diarrhea, cramps, fever, headache, or a rash while you are using this medicine.

5-ASA medicines limit digestive tract inflammation. The optimal way to allow your intestines to heal is by adhering to medication as prescribed by your doctor. It is important to take your medications, even during periods of remission, to prevent asymptomatic inflammation and future flare-ups. It may take a few weeks for 5-Aminoslicylates to work. Keep taking your prescribed dose, even if you feel better.

There are certain tests that your doctor may do before and while taking 5-ASA. These tests include a complete blood count, checking the functions of the kidneys and the liver.

Overall, 5-ASA medications are very well tolerated. Serious side effects are uncommon or rare, and usually resolve when the medication is stopped. If you experience unpleasant side effects, do not stop taking your medications before you speak with your doctor.

<p>The post Using 5-Aminosalicylates to Treat Mild to Moderate Crohn’s and Colitis first appeared on KnowYourMeds.</p>

The benefits of probiotics for various diseases are still in the explorative stage. There is not enough data to say definitively that probiotics help. Researchers are still trying to fully understand the health benefits.

In simple terms, probiotics are “friendly bacteria” that help restore or enhance the gut microbiome. The microbiome is the micro-ecosystem of trillions of organisms (microbiota) in your gut and every surface of your body. This includes bacteria, viruses, fungi, and parasites. Each person has a unique network of microbiota.

The organisms that exist in the microbiome are in two classes – helpful and potentially harmful. Most are helpful and symbiotic, meaning there is a beneficial relationship for both the human body and organisms. A small number promote disease. In a healthy body, both types of organisms (symbiotics and those causing disease) coexist peacefully without problems. Illnesses, medications such as antibiotics, and certain diets can disrupt this peaceful existence. The key to being healthier is to nourish the balance among both classes of bacteria in the gut. The gut mostly consists of bacteria.

Probiotics help to:

• Replenish normal bacteria in the gut
• Suppress the growth of bugs that are potentially harmful
• Improve the gut-barrier function
• Modulate the immune system by suppressing proinflammatory substances
• Modulate pain perception

Pills containing probiotics are taken by some people believing that these will help keep them healthy. While a few studies have shown that probiotic pills might improve health, other studies demonstrate no benefit. Though more research is needed, the evidence does show that probiotics may: 

• Improve Irritable Bowel Syndrome (IBS) symptoms 
• Help reduce allergies 
• Help reduce inflammation 
• Help fight or prevent infections in the stomach and intestines caused by antibiotics

Should I take probiotic pills?

You should not take probiotic pills without first talking to your doctor. You could get sick from using probiotics if you have a condition or medication that suppresses your immunity.  

Probiotics are dietary supplements. The US (United States) Food and Drug Administration (FDA) does not monitor manufactured supplements as they do with standard medications.

Foods that contain probiotics

Good sources of probiotics are fermented foods and beverages containing live bacteria. The list includes yogurt, kefir, kombucha, sauerkraut, kimchi (Korean fermented cabbage dish), miso, pickles, traditional buttermilk, and certain types of cheese, such as gouda, mozzarella, and cheddar.

Things to consider before taking probiotic pills

• Talk to your doctor to find the right strain(s) for your individual needs. Probiotic’s potential benefits are broad, and there is no one-size-fits-all product. 
• Choose the product that explicitly shows the ”sell-by” date. 
• Some probiotics need to be refrigerated. Be sure to follow the storage instructions to maintain the effectiveness of the probiotic over time. 
• In the first few days after taking probiotics, you may experience loose stools which will go away. Taking probiotics at the end of the meal may help reduce symptoms. 

Below is a list of gastrointestinal disorders and various probiotic supplements that may be helpful. Your doctor knows your condition best and must give you final approval prior to taking probiotics for any condition.

Though probiotics have shown promise for some conditions, much remains to be learned. Always consult with your healthcare provider first if you are considering taking a probiotic dietary supplement.

<p>The post Are Probiotics Good for You? first appeared on KnowYourMeds.</p>

Oral Aminosalicylates and Corticosteroids have long been a staple in the management of IBD, and can be effective in inducing symptomatic remission. This approach, however, has not proven to reduce long-term complications or improve patient outcomes. Clinicians and researchers have been seeking therapeutic approaches that address mucosal healing and generate improved long-term outcomes.

Scientific advances in understanding IBD have resulted in the development of multiple new therapies as alternatives to current treatments.

New medications that are currently approved for the treatment of IBD are:

• Infliximab
• Adalimumab
• Certolizumab pegol
• Golimumab
• Vedolizumab
• Ustekinumab
• Tofacitinib

Infliximab, Adalimumab, Golimumab, and Certolizumab Pegol belong to a class of medications, called anti-tumor necrosis factor (TNF) agents. The basis for using these agents is TNF-alpha has several biologic activities that may directly relate to immune system dysregulation and IBD development.

Infliximab was initially approved by the FDA for use in the treatment of Crohn’s Disease. In 2005, the FDA also approved the use of Infliximab in the treatment of Ulcerative Colitis.

Subsequently, Adalimumab was approved by the FDA to treat Crohn’s disease in 2007, and in 2012 to treat ulcerative colitis.

In 2013 Golimumab was approved by FDA for the treatment of moderately to severely active ulcerative colitis (UC) in adults

Certolizumab pegol was approved in 2008 for treatment of moderate to severe Crohn’s disease.

Vedolizumab became an anti-integrin agent approved in the treatment of ulcerative colitis and Crohn’s disease in 2014. This medication blocks the migration of leukocytes (white blood cells) to the gut, thus reducing inflammation.

Ustekinumab was approved in 2016 for the treatment of Crohn’s disease and blocks inflammation brought on by interleukins.

Tofacitinib is the first oral medication approved for the treatment of moderate to severe ulcerative colitis. Approved in 2018, this medication is a selective Janus Kinase Inhibitor, which works by modifying the immune system.

Multiple other potential drugs are now in the development pipeline. Medications that have been studied in clinical trials include Upadacitinib, Filgotinib, Etrolizumab, Brazikumab, Risankizumab, Mirikizumab, and Ozanimod.

<p>The post New Medications Are Approved for Treating Crohn’s and Colitis first appeared on KnowYourMeds.</p>

The NSAIDs sold over the counter (without a prescription) include Aspirin, Ibuprofen and Naproxen.

NSAIDs are available in multiple formats, such as pills and topical creams or gels that are applied directly to the skin.

Mechanism of action and difference between COX -1 inhibitors and COX-2 inhibitors

NSAIDs work by inhibiting a certain specific group of enzymes called cyclo-oxygenase (COX) enzymes. These enzymes are necessary to produce prostaglandins. Prostaglandins, which are active lipid compounds, control many different processes, such as inflammation and pain.

There are 2 types of COX enzymes, COX 1, and COX 2. Most NSAIDs inhibit both enzymes to a certain extent. NSAIDs that do have a higher propensity in inhibiting one enzyme compared to the other are called COX-1 or COX-2 inhibitors, respectively. This is the basis behind why there are different side effects between these two types of NSAIDs. COX-1 enzyme is required to protect the lining of the gastrointestinal tract. Inhibition of COX-1 enzyme is a major mechanism contributing to gastrointestinal side effects. COX -2 inhibitors have less gastrointestinal adverse effects. In contrast, COX-2 inhibitors have more side effects related to the heart and blood vessels (cardiovascular).

List of NSAIDs:

Adverse effects of NSAIDs:

Gastrointestinal side effects

Common NSAIDs’ gastrointestinal side effects include heartburn, nausea, vomiting, bloating, diarrhea, and constipation. They are usually related to the NSAID (Non-Steroidal Anti-Inflammatory Drug) duration, dosage, and concurrent use with other medications, such as steroids, bisphosphonates, and anticoagulants (blood thinners).

Long-term use of NSAIDs, especially at high doses, can cause gastrointestinal bleeding and peptic ulcer disease. Peptic ulcers are ulcers in the stomach and first part of the intestine, causing abdominal pain.

Cardiovascular side effects

NSAIDs may cause an increase in blood pressure.

Some NSAIDs, especially COX-2 inhibitors, have an elevated risk of blood clots. These increase the risks of experiencing a heart attack or stroke.

Heart failure and palpitations have also been reported with use of NSAIDs.

Tinnitus – Ringing in the ear

Ringing in the ear is commonly experienced by people who take high doses of Aspirin. It is an uncommon side effect with other NSAIDs.

Liver toxicity

Though rare, long-term use of NSAIDs at high doses can cause harm to the liver.

Kidney toxicity

NSAIDs may harm the kidneys. It affects the blood flow to the kidneys causing sodium and water retention, which can lead to swelling and an elevated potassium level. High sodium level also causes an increase in blood pressure. While on NSAIDs, your doctor may periodically monitor your blood pressure and kidney function.

Pregnancy – Complications for the unborn baby

NSAIDs are not recommended during the last 3 months of pregnancy because of an increased risk of complications in the baby. However, these are safe to use during breastfeeding as directed by your doctor.

Reye’s syndrome

Aspirin use with young children, though rare, may cause a life-threatening condition that causes swelling in the liver and brain.

Worsening of Asthma

In some people with Asthma, aspirin and other NSAIDs may cause a worsening of asthma and related symptoms.

Ways to manage the side effects of NSAIDs

• Gastrointestinal side effects of NSAIDs can be lessened if the medication is taken with food or milk. If symptoms persist, talk with your doctor. They may recommend you take antacids or drugs that block acid production in the stomach.
• Avoid consuming alcohol when taking NSAIDs. Alcohol can increase the risk of gastrointestinal bleeding.
• Call your doctor immediately if you experience severe abdominal pain, a black, tarry stool (bowel movement), or blood in your stool.
• Seek immediate medical attention if you experience yellowing of the eyes, as this may indicate liver toxicity.
• Seek immediate medical attention if you experience cloudy or bloody urine, decrease in amount of urine, or ankle swelling. These symptoms may indicate problems with the kidneys.
• Do not take more than one NSAID at once (for example, aspirin with other NSAID), unless directed by your doctor. This may increase the likelihood of gastrointestinal bleeding.
• If you have high blood pressure and are taking NSAIDs as directed by your doctor, make sure you and your doctor check your blood pressure regularly. NSAIDs are known to cause an increase in blood pressure level.
• If you are deciding to take an over-the-counter pain killer or fever reducing medication, Acetaminophen is a better choice than NSAIDs, as it is less likely to irritate the stomach.

The takeaway

NSAIDs are widely used medications, especially because of their pain-relieving and anti-inflammatory properties. But like any medication, benefits come with some risks. Taking a low dose for a brief period poses minimal risk to most people. Mild side effects can be managed with lifestyle changes and other medications.

If these medications are not working for you, talk to your doctor. There are other treatment options. Genes matter, and how people react to NSAIDs may vary from person to person. It may take some trial and error to discover the one that works best for you.

<p>The post Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) first appeared on KnowYourMeds.</p>