About Systemic Lupus Erythematosus (SLE)

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bhmkclteeodsgq5wrqwaSystemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage to the heart, lungs, kidneys, joints, skin, brain, and blood vessels.   It is characterized by flare-ups, and symptoms, ranging from mild to severe, including extreme fatigue, chest pain, anemia, swelling in legs and near the eyes, painful joints, fever, skin rashes, hair loss, and kidney problems.

At least 1.5 million Americans suffer from lupus.  The ratio of female to male is 9:1 according to the Lupus Foundation of America.   African-American women are far more likely to be affected than are Caucasian women.   Recent research points to a strong genetic role, but environmental and hormonal factors seem to be involved in lupus as well.

Diagnosis can be difficult and may be delayed because the onset of symptoms is hard for patients to pinpoint and because the wide variety of symptoms overlap with many other conditions.  To diagnose lupus, the clinician takes a careful history, performs a physical exam, and orders anti-nuclear antibodies and other laboratory tests.

Although lupus can be life-threatening, some 80 to 90 percent of sufferers can expect to live a normal lifespan if they are carefully monitored and treated.

Management of lupus is directed at preventing flare-ups, treating symptoms, and preventing or slowing damage to organs.  According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the principal medications include:

  • NSAIDs to reduce inflammation.
  • Anti-malarials such as hydroxychloroquine (Plaquenil®) to prevent flare-ups.
  • Corticosteroids such as prednisone (Deltasone®), hydrocortisone, methylprednisolone (Medrol®), and dexamethasone (Decadron®, Hexadrol®) to reduce inflammation.
  • Immunosuppressive agents such as cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) to inhibit an overactive immune system.  Belimumab (Benlysta®) is a B-lymphocyte stimulator protein inhibitor that was approved by FDA 2011 for patients with lupus who are receiving other standard therapies.  It may reduce the number of abnormal B cells thought to be a problem in lupus.
  • Methotrexate (Folex®, Mexate®, Rheumatrex®), a disease-modifying antirheumatic drug, may be used to help control the disease in some patients.

Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin, which may be useful for controlling lupus when other treatments haven’t worked.

A variety of self-care and complementary approaches can be useful, including exercise, diet, the avoidance of sun exposure, and skin protection.  Patients are advised to recognize early signs of a flare-up and get immediate medical attention.

Findings from prospective human studies have strengthened the evidence of a connection between lupus and vitamin D status.  There is evidence that increased vitamin D levels (via supplementation) may help reduce inflammation.  A reasonable dose would be 2000 IU of vitamin D3 on a daily basis.  Vitamin D levels are easily checked.

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Avoiding Holiday Weight Gain

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars

pumpkin-pie-520655_640Turkey, stuffing, mashed potatoes, gravy, sweet potato casserole, cranberry sauce, more mashed potatoes, pumpkin pie, pecan pie, cherry pie, triple chocolate cheesecake, cookies, fudge, fruitcake. Okay, pass on the fruitcake. Is it any wonder why the vast majority of exercise equipment is sold in the month of January? This year, with a little foresight and planning, things could be different.

Prevention has always been preferable to cure. A few weeks of “preventive dieting” is not a bad way to avoid the shock and horror of stepping on the scale in January. It need not be as stringent as clear liquids and lettuce from Thanksgiving to New Year’s. That would be cruel and unusual punishment. However, a few, simple, common sense measures really can make a significant difference:

  • Have a healthy breakfast with some protein and whole grains. People who routinely eat breakfast (not a crème-filled doughnut) consume an average of two hundred calories less per day than people who skip breakfast.
  • Try not to drink calories. Avoid sugary beverages such as sodas, sweetened tea, lemonade, juice drinks. Diet sodas may be tempting, but they can actually cause an increase in appetite.
  • Cut back on alcohol for several weeks. Save the wine or cocktails for the really special meals. Alcohol consumption generally increases significantly from Thanksgiving through New Year’s. Unfortunately, alcohol is loaded with empty calories and can slow metabolic rate. It also disrupts normal sleep architecture.
  • Preserve and protect sleep. Multiple studies now confirm that sleep deprivation in both children and adults is associated with weight gain. There is no mystery. Even one night of inadequate sleep can adversely affect numerous hormones, including cortisol, thyroid, growth hormone, leptin, and ghrelin. Metabolic rate can drop and appetite increases. The result is weight gain. Ease up on the late nights and parties.
  • Aim for 30 minutes of exercise every day. There’s no need to wait for January 2. The benefits of exercise are legion. Apart from the improvement in conditioning, strength, and flexibility, exercise is a terrific way to cope with holiday stress, improve sleep quality, and possibly escape annoying relatives for a while.
  • Have a light, high-protein snack before heading off to a party. Working all day, skipping dinner, and arriving at a party in a state of semi-starvation is a recipe for overindulgence. Some yogurt, a little cottage cheese, or a small bowl of cereal before leaving the house can boost self-control in the face of tempting treats.
  • Downsize plates, bowls, glasses, and mugs. Most people will eat whatever food is presented on a plate, whether it’s 10 inches or 6 inches. Use small luncheon plates or salad plates at home for every meal. This is a great strategy for year-round weight control.
  • Split dessert with a friend even at the “big event” meals. TUMS will not be required as the after-dinner mint.

Avoiding holiday weight gain is not the impossible dream. It’s entirely possible with a little planning and discipline. Besides, no one will really miss all that fruitcake.

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Cold Symptoms and Complications

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

Couple suffering from cold in bed

By Ben Hayes, MD, PhD, FAAD

Cold symptoms generally emerge between one and three days after a cold virus enters the body and resolve in a week, with or without medication.  One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health.  Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than five percent of colds lead to such complications as bronchitis, middle ear infection, or sinusitis accompanied by a prolonged cough.  But between five and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum.  A cold can produce wheezing, even in children who do not have asthma. Symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks.  Symptoms that persist for more than two weeks or that recur might be more allergy than infection-related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician.  Medical attention is indicated if symptoms progress to:

  • sinusitis
  • ear pain
  • high fever
  • a cough that worsens as other symptoms abate
  • a flare-up of asthma or of another chronic lung problem
  • significantly swollen glands
  • strep throat
  • bronchiolitis
  • pneumonia
  • croup

Babies can have between five to seven colds during their first two years of life. This enhanced susceptibility results both from immature immune systems and from exposure to older children who are often careless abut washing their hands or covering coughs and sneezes.  Nasal congestion and runny nose are the most common symptoms of colds in babies.  Treatment consists of breathing moist air and drinking plenty of fluids.  Medical attention is recommended at the first sign of a cold in infants less than three months of age because of a heightened risk for pneumonia, coup, and other complications.

Physician evaluation is also necessary if a baby of any age:

  • has an uncomplicated cold, the symptoms of which last for more than seven days.
  • does not wet a diaper properly.
  • refuses to nurse or accept fluids.
  • coughs up blood-tinged sputum or coughs hard enough to cause vomiting or changes in skin color.
  • has trouble breathing.
  • has bluish-tinted lips or mouth.
  • has a temperature higher than 102°F for one day
  • has a temperature higher than 101°F for more than three days.
  • shows signs of having ear pain.
  • has reddened eyes or yellow-eye discharge.
  • has a cough or thick green nasal discharge for more than a week.
  • has any other symptoms that concern parents and/or caregivers.

PREVENTION

Common sense plays an important part in preventing the common cold.  Absolute avoidance of cold viruses is virtually impossible to achieve, but experts advise keeping a healthy distance from anyone who is ill.  The actions the human body takes to clear infection are the same actions that spread the infection to others.  Sneezing, for example, is a response to irritation of the nose and mouth.  Sneezing as well as a runny nose is the body’s attempt to expel cold viruses before they can invade the nasal passages more deeply. Unfortunately, a sneeze sends infectious particles hurtling through the air at a speed of more than 100 miles an hour.

Simply being in the company of someone who has a cold can contaminate the hands of another person.  Touching one’s eyes, nose, or mouth can transfer the infection.  It is imperative to wash hands thoroughly after touching someone who has a cold or something that has been touched by someone who has a cold.  Playthings touched by a child who has a cold should be washed before being put away. Cleaning surfaces with antiviral disinfectant may help prevent the spread of infection, and increasing interior humidity can reduce susceptibility.

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Managing Holiday Stress

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology

They’re coming: Thanksgiving; Hanukkah; Christmas; and New Year. Weeks of potential, nonstop stress are right around the corner. And, all of that is followed by seemingly endless bills, three or four months of miserable weather, and tax season. What could be better? Medically speaking, all of this can lead to a perfect storm of illness. Too much stress and too little sleep can set the stage for everything from colds, flu, and pneumonia, to hypertension, heart disease, and diabetes out of control. The discussion about holiday stress aggravating anxiety and depression could fill a book.

The reality is difficult to deny. During this wonderful but weird time, millions of people will go places they really don’t want to go. They will do things they really don’t want to do. And, in many cases, they will visit people they don’t even like. This is not necessary. Too many activities, too much chaos, noise, and stress, not to mention too many calories and too little sleep, combine to create a physiologic disaster. Before the madness begins, a few principles of prevention may help:

  • Minimize caffeine and alcohol. Alcohol is loaded with empty calories and will disrupt normal sleep architecture.
  • Avoid holiday exhaustion. It’s okay to decline invitations. Try not to go out two nights in a row and schedule some quiet time instead.
  • Make time for exercise. It will help dissipate stress, boost energy, and facilitate better sleep.
  • Avoid unrealistic expectations. Don’t try to recreate a Norman Rockwell scene. It puts too much pressure on everyone.
  •  Aim for a few lovely memories—not a credit card extravaganza. Overspending is a major contributor to holiday stress.
  • Be prepared to overlook a lot. Everyone has annoying relatives. We can’t control what they say or do, but we can control our response to it. Don’t let a thoughtless remark ruin the day for everyone.

In short, managing holiday stress involves a healthy dose of common sense. Don’t overeat, overindulge, overreact, or overspend. Do try to have a healthy routine with a little less food, a lot less chaos, and for more rest. That’s a good plan for any time of the year.webinarsSeminars-CTA