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Risk of Heart Attack and Stroke in Lupus
Lupus is an autoimmune disease in which the patient’s own immunity attacks the patient’s body. Any organ can be affected and ranges from mild to very severe forms with kidney and brain involvement. Survival in lupus has improved significantly over the past few decades. In 1950s 50% of patients die within 5 years of diagnosis but now a near normal life span is expected. New problems have emerged with longer duration of disease. Now major issues leading to higher risk of death and disability are infections, heart attacks and strokes.
Heart attack occurs when blood supply to a portion of heart muscle gets interrupted. As we grow older, the arteries get stiff and cholesterol gets deposited along the walls. Over time, clots form and bits of cholesterol break off from the arterial wall lining and get in the way of blood flow. The muscle in that area dies, leading to chest pain and loss of function in that part of the heart. Patient will then experience the typical symptoms of chest pain, shortness of breath and increased sweating. Some patients may feel the pain in the upper arm and jaw. Nausea, vomiting or sudden dizziness can also occur. Stroke happens when blood supply to a certain part of the brain is suddenly interrupted. Symptoms are variable, depending on the area and extent of brain that is affected. Most drastic is the inability to move one side of the body but it can range from silent damage to severe disability.
The risk of heart attack and stroke is increased in lupus. All patients, even young women, have 5-10% higher risk than their healthy counterparts. This is due to many reasons including inflammation, sticky blood and more risk factors in patients with Lupus. The general risk factors include high blood pressure, elevated cholesterol levels, diabetes, obesity, smoking, and inactive, sedentary lifestyle. Lupus-specific risk factors include active disease, longer disease duration and long-term corticosteroid use.
The risk can be reduced by controlling the risk factors and Lupus activity. You can help to reduce the risk by having an active life style. Exercise regularly but avoid sudden bouts of heavy exercise. Develop a routine that suits your condition. Watch your diet, maintain your weight, avoid smoking and take your medicines regularly. Good control of blood pressure, cholesterol and diabetes will significantly lower the risk of heart attack and diabetes in all patients, including patients with Lupus.
Disease Control is very important as uncontrolled disease with more inflammation translates into higher risk of heart attack and stroke. You should consult your doctor regularly and take your medicines as prescribed. Corticosteroids and other medicines (such as Imuran, Cellcept, Cyclophosphamide) can sometimes cause side effects but they are necessary to control the disease, which in turn results in lowering the risk of heart attack and stroke. If you encounter problems, discuss with your doctor and explore options. Do remember, close co-operation between patient and doctor is required to achieve a good disease control.
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I have been diagnosed with Lupus. What should I do next?
In life, we have two options: we can be miserable and ask, “Why must it happen to me?” or we can stay positive, and be thankful for the things we still have.
I make an effort to stay optimistic and remain confident in the team of doctors and nurses that tend to me. Let me share my experience in discovering and managing my condition Systemic Lupus Erythematosus (SLE, or Lupus) and Antiphospholipid Syndrome (APS). I can vividly recall the events that occurred 5 years ago, in June 2008. I was told that in order to save my life, my right leg had to be amputated. At that point, things were beyond my control. I did not suffer from hypertension, high cholesterol, diabetes, heart or kidney problems; conditions that would have predisposed blockage of the blood vessels in my legs. However, my legs had become swollen, and over 3 months, my right leg had become cold and numb due to poor blood circulation. I was advised by my doctors to have it amputated.
It was a difficult decision as time was of the essence and I did not have much of a choice as my leg was deteriorating and beginning to darken due to the lack of proper blood circulation. When I was
formally diagnosed with Lupus and APS, I slipped into depression and cried a lot during that trying period. Slowly but surely, I decided to regain control of my life using small positive steps. I made lists of the positive things in my life daily whilst warded in the hospital and steered my mind away from negative thoughts. I visualized the things that I could accomplish and convinced myself that I could achieve them. I imagined walking with the aid of my prosthetic leg and a black walking stick. This empowered me and I managed to walk again 7 months after my operation.
I began writing a book to motivate through my experience. It has taken me 4½ years to complete it and I am now looking for a publisher in hope of providing a source of aid, encouragement and comfort to patients suffering the same fate as myself. I started the Marina Bay walking group on 4 June 2012. This walking group has approximately 1100 active members from all walks of life. We walk every Saturday morning at various parks in Singapore. A month later, I established the Walk for Lupus walking group. This group walks once a month at sunset hours. The walks are great opportunities to stay healthy and to make friends. I am also a volunteer at the Lupus Association Singapore. On World Lupus Day 2013, the Marina Bay walking group walked 3.5 km along Marina Bay Waterfront Promenade. In my opinion, I feel that there is a need to create and increase public awareness about Lupus as few have heard of or have knowledge about it, unlike common diseases such as cancer. It is also important for patients to explore ways to cope with the stress of suffering from Lupus. I believe that frequent exercise and relaxation will make it easier for Lupus patients to battle the disease. Exercise not only reduces stress, lifts the mood, but also improves sleeping.
Stay active and positive always. May you be blessed with good health!
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Skin Problems and Skin Care in Lupus
A patient with Lupus is usually in one of these stages: acute, subacute, chronic, or quiescent stage. The skin signs are different at different stages, and so is the care of the skin.
In acute Lupus, the disease is not yet controlled. It is typified by a ‘butterfly rash’ on the face, but it can also appear as a non-descript rash on the body. Patients often suffer from recurrent mouth ulcers which impair enjoyment and intake of food. One way to manage these ulcers is to numb them by applying salicylate gel (e.g. Bonjela gel), or to simply swish and swallow a mixture of one part (2.5ml) antacid (e.g. Mylanta, an over-the-counter syrup that reduces stomach acidity) with one part (2.5ml) diphenhydramine (e.g. Benadryl, a pharmacist-only medication with anti-histamine effects). Alternatively, one can reduce the inflammation by applying a steroid gel (e.g. Oracort E or Kenalog in Orabase), which can be purchased from a pharmacy. To reduce further aggravation of pain, avoid fried, sour, spicy, crispy, caffeinated and alcoholic food and beverage.
Another common complaint in the acute stage of Lupus is hair-fall. Some people may even recognize this as a symptom of disease relapse. The good news is hair-fall that is associated with acute Lupus is often temporary, and will reverse gradually as the disease gets under control. However, most females are very disturbed by this. To accelerate the regrowth of hair, one can purchase minoxidil 2% solution from a pharmacy, and massage it into the entire scalp twice daily. Upgrade to a 5% solution when the hair-fall fails to improve after 4 months of regular use. Alternatively, one can see a dermatologist to discuss the use of lasers and/or other medications.
A person with chronic Lupus has rashes on the body that are relatively more difficult to eradicate. These recalcitrant rashes are most often found on the ears and face, and are characterized by thick scaly dotty red-to-brownish islands. Such rashes necessitate the use of strong topical steroid creams/ointments. However, indiscriminate use of these topical steroid creams/ ointments can cause side-effects such as skin thinning and the appearance of fine blood vessels and stretch marks. To avoid these problems, apply the creams sparingly without rubbing onto surrounding unaffected skins. Apply no more than twice daily, and reduce to once daily or every other day when the lesions clear. Occasionally stick a plaster onto the affected skin overnight (after applying the topical steroid) to achieve a more powerful effect. A dermatologist can inject steroids directly into very difficult-to-treat lesions. Where side-effects have developed, a dermatologist can discuss with you the use of steroid-sparing ointments.
Skin complications of medication
Many patients with Lupus are on long-term oral steroid therapy. Steroids reduce one’s immunity, so a person can be more prone to developing a fungal infection on the skin. It typically manifests as circular red scaly patches (“ringworm”). One can apply an anti-fungal cream (e.g. miconazole, clotrimazole, terbinafine) twice daily. When the rash clears, it is important to continue using the cream for another 2-3 weeks to ensure that the fungus is thoroughly eradicated. Fungal infections may manifest as whitish patches on the tongue or sides of the mouth (“thrush”), or irritation and redness on the angles of the mouth. One can use miconazole oral gel twice daily to handle these infections.
Another common problem associated with long-term steroid therapy is acne. If there are few whiteheads, blackheads and red bumps, one can apply over-the-counter benzoyl peroxide cream or acne cream (or lotion) twice daily. A salicylic acid-based cleanser can help manage the whiteheads and blackheads. Anti-bacterial cleansers (containing trichlosan, cetrimide or chlorhexidine) cleansers are useful where there are predominantly red bumps. When the skin starts to clear, apply a retinol or retinaldehyde-based cream onto the whole face nightly for maintenance. For those with moderate to severe acne (many more inflamed lesions – red bumps, big bumps, pus-filled bumps), it is advisable to see a dermatologist.
Prevention of Lupus flare-ups
Whatever the stage of Lupus, it is imperative that all patients with Lupus protect themselves from the sun. Ultraviolet radiation is a well-known trigger of Lupus and can cause skin flare-ups, or other Lupus organ flare-ups. Although staying indoors and actively avoiding outdoor movement between the peak periods of 10am to 4pm are helpful, one cannot totally avoid ultraviolet radiation in Singapore. It is strongly advisable to apply a good sunscreen on all sun-exposed areas of the body at least twice daily. Use a sunscreen of SPF 30 and above (ultraviolet B protection), and one with adequate ultraviolet A protection (PPD >15 or PA +++). Choose the appropriate sunscreen for one’s needs and skin type. Consider whether you need a water-resistant sunscreen, whether your skin is acne-prone (select only a ‘non-comedogenic’ product), or whether you have a sensitive skin (select products with purely or mostly physical agents).
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20 Legal Terms You Need To Know
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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Are Electric Bicycles Too Fast For Street Use?
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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The Right Way To Expunge A Criminal Record
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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The Differences Between Compensatory vs. Punitive Damages
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind. This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
This is an example of a WordPress post, you could edit this to put information about yourself so readers know where you are coming from. You can create as many posts as you like in order to share with your readers what is on your mind.
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Everything You Need to Know About Social Security
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Protect Your Intellectual Property with These 5 Trade Secrets
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