If you're living with a chronic illness, you're in the right place.

Friday, February 28, 2014

In the Spotlight: Fibromyalgia

9:09 AM Posted by Stephanie Horgan , ,
Today's entry is the 2nd of 2014, where we have started a "Rare Disease of the Month" series. Last month was achalasia. My apologies on the delayed entry of this post- technically it is still February!  As Tiffany said in her previous post, our goal of this initiative is to bring awareness to 12 chronic illnesses that don't get much press but still can deeply affect those who live with them each day.
Fibromyalgia is a complex chronic pain disorder that affects people physically, mentally and socially. Fibromyalgia is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause. (National Fibromyalgia Association)

What is it? 
Fibromyalgia is characterized by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress. For those with severe symptoms, fibromyalgia can be extremely debilitating and interfere with basic daily activities. Symptoms include: moderate to severe fatigue, sleep disorders, problems with cognitive functioning, IBS, headaches and migraines, anxiety and depression, and environmental sensitivities. Research has documented neuroendocrine physiological abnormalities that may contribute to the symptoms. (National Fibromyalgia Association) 

How common is it? 
The exact prevalence of fibromyalgia in the U.S. population has not been thoroughly studied, but conservative estimates place the total between 3 to 5 percent of the general population . It is found more often in women than men. (Fibromyalgia Network) Roughly one-quarter of people with fibromyalgia are work-disabled. For more information on work-accomodations, check out the Job Accommodation Network website to for ideas. 

What about diagnosis and treatment?
Recent research has suggested a genetic component. The disorder is often seen in families, among siblings or mothers and their children. Fibromyalgia often occurs following a physical trauma, such as an acute illness or injury, which may act as a “trigger” in the development of the disorder. Increasing attention is being devoted to the central nervous system as the underlying mechanism of FM. Recent studies have suggested that FM patients have generalized disturbance in pain processing and an amplified response to stimuli that would not ordinarily be painful in healthy individuals. 

Since there is no known cure for FM, treatment focuses on relieving symptoms and improving function. A variety of prescription medications are often used to reduce pain levels and improve sleep. On June 21, 2007, the U.S. Food and Drug Administration approved Lyrica (pregabalin) as the first drug to treat fibromyalgia. Cymbalta (duloxetine HCl) was approved in June 2008; and Savella (milnacipran HCl) was approved in January 2009. Alternative therapies, such as massage, myofasical release, acupuncture, chiropractic, herbal supplements and yoga, can be effective tools in managing FM symptoms. Increasing rest, pacing activities, reducing stress, practicing relaxation and improving nutrition can help minimize symptoms and improve quality of life.(National Fibromyalgia Association) 
What is the social and emotional impact?
Many people with this illness may feel that others do not believe their illness is real, as there is not a lot of research in this area. Recently there was a study showing moderate evidence for specific changes in the brains of those with fibromyalgia. As more and more research as is done, it will help bring awareness and validation to those who suffer with this day after day. If you are interested in learning about more clinical trials in research that are geared toward fibromyalgia, check out this page, as it lists any open studies that are recruiting patients.

Having a chronic illness that includes fatigue and pain can severely affect the mental and emotional health of a person. According to the National Fibromyalgia and Chronic Pain Association, it is vital to implement a healthy sleep regimen, as well as develop an emotional support network. Many communities throughout the United States and abroad have organized fibromyalgia support groups. These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family. 

If you want to check out the best Fibromyalgia blogs, click for this list here

Hope this was informative!  Stay tuned for a new rare disease post each month.


Sunday, February 23, 2014

Shameless Self-Promotion

5:06 AM Posted by Tiffany Taft ,

First, thanks so much to everyone who reads our blog.  We try our best to keep things fresh and interesting across our social media corners of the world.  Did you know we're on the Facebook and Twitter?

If you didn't know, our Facebook page is https://www.facebook.com/opbmed. Head on over and check it out, give us a "Like."

Or, if you prefer Twitter we're under @OPBMed

One of our new things for 2014 is the "Tidbit of the Day" post where we put up an interesting blurb from the world of psychological research.  Here are some highlights...

Post by Oak Park Behavioral Medicine, LLC.

See you on the Tubes.

Wednesday, February 19, 2014

Who's my Partner?

10:19 AM Posted by Stephanie Horgan , , , ,
With Valentines day just passed, those with chronic illness can be in a variety of different emotional states. Some may feel blessed to have such a great life partner, some blessed to have a variety of friends that lend support, and some may feel the loneliness and longing of having more support. Regardless of where you fall, as a community we can offer hope and encouragement to each other, as patients and providers.

I wanted to pass along a resource for those suffering with Inflammatory Bowel Diseases like Crohn's Disease and Ulcertaive Colitis. Its called CCFA Partners and it is a database of patients in the United States. Currently there are almost 13,000 patients registered, and almost 600 kids and teens registered as well. According to the CCFA, the goal of this initiative is to create an online registry to "help us obtain a better understanding of issues facing IBD patients, how patients are functioning, what they eat, and how they receive treatment in different areas of the country. We will use the CCFA Partners network to provide topics for patients to discuss with their physicians to improve their quality of life."

So far researchers have found some interesting results when studying these 13,000 patients. They have studied everything from risk factors for depression, sleep disturbances, female hormone fluctation, dietary factors, and much more! You can see the abstracts and manuscripts here. I really enjoyed reading about the dietary studies they did, as this is a hot topic that doctors tend to avoid speaking about. They surveyed 6,768 adults and found that foods that were listed by patients to improve symptoms were yogurt, rice and bananas. (Not a huge surprise for most of us IBDers out there). Foods found to worsen symptoms were non-leafy vegetabels, spicy foods, fruit, nuts, leafy vegetables, fried foods, milk, red meat, soda, popcorn, dairy, alcohol, high fiber foods, corn, fatty foods, seeds, coffee, and beans. You can look on their chart of UC vs. CD or disesase locations to see what various sub-groups reported as well. No firm conclusions were made for dietary recommendations, but it is helpful for new patients to have an idea of what kind of foods may end up causing issues at some point.

So who wants to be partners? Let's work together and promote research so we can all improve our quality of life together.

Wednesday, February 5, 2014

Inflammation and Your Mood: A 2-Way Street

Because I'm a nerd, I receive automated updates from Pubmed, a major database of medical and psychological research, to let me know when a study has been published that contains certain keywords.  This past week I received a message about a new study published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry (there's one for your coffee table) titled Inflamed Moods:  A Review of the Interactions Between Inflammation and Mood Disorders.

As the title of the journal might suggest, the content of the article was a bit....thick; but nevertheless reports on some really interesting findings for those who live with chronic inflammatory conditions, such as IBD, RA, or lupus.

Highlights:  The relationship between mood and inflammation in the body is a 2-way street, and was first recognized in 1887 by Julius Wagner-Jauregg of the University of Vienna, Austria who won the Nobel Prize for his work in 1927. Since then, several research studies have confirmed this relationship between our moods and the levels of inflammation in our bodies, including the parts of the immune system that might be playing a role.  Not everyone is susceptible to the inflammation-mood cycle, and there are some things you can do to help lessen the effects.

We know that inflammation is a natural response in the body, and its presence can be appropriate - like when we stub our toe or have strep throat, or inappropriate - like when our body overreacts or reacts to the wrong stimuli, like in the case of autoimmune diseases.  Regardless of if inflammation is appropriate or inappropriate, it can have negative effects on our bodies.  Anyone living with a chronic inflammatory disease can list the negative effects they experience because of the chronic "inappropriate" inflammation party going on in their body.

Inflammation is directly tied to our immune system and the various chemicals it uses to ward off threats to our well-being.  One example of these chemicals is histamine, which is released when we have an allergic reaction to something, like being stung by a bee or, in my case, having a cat lay on my face.  Common over-the-counter medications like Benadryl are anti-histamines, and do what they sound like they should:  reduce histamine in the body, thus reducing allergy symptoms.  There are several other inflammation markers in our bodies, things like IL-6 and TNF-alpha, and when these chemicals are elevated people not only report inflammation symptoms, but changes in their mood, concentration, sleep, and motivation as well.

One way we know about this relationship between mood and inflammation is from people with Hepatitis C, a chronic disease of the liver that's treated with several medications including one called Interferon.  Patients taking interferon, which boosts various parts of the immune system to fight off the Hepatitis C virus, report depression symptoms and 25% to 80% (depending on the dose of interferon) will develop major depressive disorder during their Hepatitis C treatment.  I can attest to the effects of interferon from the clients I've seen with Hep C, all of whom went on an antidepressant as part of their standard care to offset the mood side effects.

I mentioned mood and inflammation run on a 2-way street - what the authors of this study call a positive feedback loop between stress/mood and inflammation.  Researchers have also found that increased psychological, emotional, or physical stress leads to increases in these inflammation markers in the body.  Like I tell all my clients, stress isn't good for any chronic condition and for those with inflammatory conditions, it may lead to a flare-up, or worsening, of symptoms.

So how do these inflammatory substances affect mood?  You may have heard that certain chemicals in the brain, like serotonin (the second S in SSRI medications) affect our moods.  Serotonin production is reduced when certain inflammatory markers are present, and decreased serotonin leads to feelings of sadness, irritability, trouble sleeping, and other symptoms commonly seen with depression.  In addition to reducing levels of serotonin, chronically present inflammatory chemicals in the body can cause damage to healthy pathways in the brain and nervous system, or even destroy them.  Of course, those structures in the brain implicated in mood are often affected (such as the ventricles, mesolimbic pathways, and subgenual cingluate).

Why on Earth would our bodies be wired this way?  It kind of goes against the theory of "survival of the fittest," right?  One researcher, Dr. Hart, posits that this reaction is, in fact, adaptive if we were living in our "wild state" rather in our current modern society. The mood changes that occur, and other symptoms like fatigue, loss of appetite, lethargy, increased sleep, decreased interest in activities and exploration, and decreased sexual activity allow us to devote our time and energy to healing and protection from future attacks. We also are less likely to go out into the herd and share the communicable disease that's bringing us down.  Makes sense, right?  For an acute illness like the flu, we want people to stay home and if feeling down will help with that, great!  But when a chronic illness is present, the effects on mood create entirely different issues, including making the disease's symptoms worse.

Does this mean that everyone with a chronic inflammatory disease, like RA, IBD, or Lupus, also has major depressive disorder (or any other mood disorder)?  Not at all.  There are definitely variations in how a person's mood is affected by inflammation.  The authors of the paper use the term "resilience" to explain this.  Unfortunately, we don't really understand why one person may be more resilient to the effects of inflammation on mood than another.  But we do know of a few things you can do to up your resilience:
  • Aerobic exercise has been consistently shown to improve mood, and part of this may be its anti-inflammatory effects on several substances known to wreck your mood.
  • Certain foods can also help buffer the inflammation-mood cycle.  Omega-3 fatty acids have the most evidence to support their effectiveness.  Other evidence, albeit small, suggests that a "healthy" diet low in calories, fat, and carbohydrates can be protective as well (more research is needed here).
  • Being overweight can decrease your resilience to the inflammation-mood cycle, so maintain a healthy weight.
So, if you're living with a chronic inflammatory condition and you've noticed that you're mood isn't quite right, the inflammation-mood cycle may shed some light on this.  Obviously this is a complex subject, and many things play a role in our daily mood.  But do know that the underlying inflammation in your body may make you more susceptible to feeling down, irritable, or having trouble sleeping at night.  It can even lead to full-on depression.  If you're concerned about how your disease is affecting your mood, talk to your doctor about options, including if therapy might be helpful.

Dr. T.