Living With Ankylosing Spondylitis: 8 Ways to Boost Self-Esteem

As a chronic progressive condition, ankylosing spondylitis can erode your self-confidence. Find out how to live well, emotionally and physically.

Living with a chronic condition like ankylosing spondylitis, an inflammatory form of arthritis that can cause pain, limit mobility, and lead to changes in appearance, can take a toll on your self-esteem and lower your quality of life. In fact, about two in three people with ankylosing spondylitis have low self-esteem, according to data published in 2013 in the Annals of Rheumatic Diseases. What’s more, when you have low self-esteem, you’re also more likely to have more active symptoms of ankylosing spondylitis and depression or anxiety, the study found.

For Crystal Balentine, 43, of Horn Lake, Mississippi, the erosion of her self-esteem began in her teens, when she started experiencing pain in her back and legs. At the time, her symptoms were chalked up to growing pains. Despite worsening pain and the onset of digestive symptoms in her twenties, she didn’t get a formal diagnosis until she was close to 40 years old. Until then, she was told repeatedly that her symptoms were due to anxiety. She had to stop working, and soon, she and her husband were facing a tight budget — a problem that was compounded by the fact that Balentine was unable to participate in certain activities with her family. In 2012, she finally learned that she had ankylosing spondylitis. Yet those years of not knowing why she was in pain had taken a mental and physical toll on her.

“[I felt ashamed] because I had gained weight, couldn’t do the normal things I used to do, and had to rely on someone else to take me to appointments,” she says.

Now that she has her diagnosis, she’s working on rebuilding her sense of self, in part by telling her story to build awareness about ankylosing spondylitis.

How to Shore Up Your Self-Esteem

If you have ankylosing spondylitis, take these steps to protect your inner self:

Learn more about ankylosing spondylitis. “You need to learn what ankylosing spondylitis is, what it can do, and what you’re battling,” Balentine says. Educating yourself so you better understand ankylosing spondylitis can help you better manage the condition and continue to lead a healthy and active lifestyle.

Take a leading role in your care. “Having an active role in a treatment plan that suits you and being supported by medical staff and family can help boost your self-esteem,” says Steffi Brown, 26, of Roscommon, Ireland. Brown’s pain symptoms began when she was 20, but she wasn’t diagnosed with ankylosing spondylitis for another three years. Even then, Brown says that no one told her what ankylosing spondylitis was or talked to her about the full range of treatment options. “That feeling of being out of control hugely knocks a person’s confidence and self-esteem,” she says. Do your own research on ankylosing spondylitis treatments and how they work so you feel comfortable talking about your options with your care team and discussing any issues or concerns you may have.

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Three New Therapies Approved for Multiple Myeloma

The FDA recently approved three new drugs to treat multiple myeloma. One of the drugs is the first approved cancer therapy to target the CD38 protein (pictured).Credit: Wikimedia Commons / Emw, CC-BY-SA-3.0

The Food and Drug Administration (FDA) has approved three new drugs for the treatment of multiple myeloma that has returned after prior therapy.

On November 16, the FDA approved daratumumab(Darzalex®) for patients who have previously received at least three prior treatments. On November 20, the agency approved ixazomib(Ninlaro®) to treat patients with relapsed multiple myeloma who have received at least one prior treatment, and on November 30 it approved elotuzumab (Empliciti®) for patients who have received one to three prior therapies.

“Relapse is almost universal with myeloma,” explained Mark Roschewski, M.D., of the Lymphoid Malignancies Branch in NCI’s Center for Cancer Research. “Some patients enjoy long durations of remission after their first treatment, but very few patients can be cured today.”

The approval of ixazomib, a proteasome inhibitor, was based on the resultsExit Disclaimer of a large randomized clinical trial of 722 patients in which patients treated with ixazomib in combination with lenalidomide and dexamethasone had longer median progression-free survival than those who received lenalidomide and dexamethasone alone: 20.6 months versus 14.7 months.

“There are already two proteasome inhibitors [bortezomib and carfilzomib] that have been approved for the treatment of multiple myeloma,” said Dr. Roschewski. “But this is the first one that is available orally. So that’s a very important improvement.”

Daratumumab’s approval was based on two single-arm trials. In the first trial, 29 percent of patients experienced a complete or partial reduction in their tumor burden that lasted for a median of 7.4 months. In the second trial, 36 percent of patients had a complete or partial reduction in tumor burden.

The approval of elotuzumab was based on the results of a randomized clinical trial of 646 participants whose myeloma did not respond to or had relapsed after previous treatment. Patients treated with elotuzumab in combination with lenalidomide and dexamethasone had longer median progression-free survival than patients who received only lenalidomide and dexamethasone: 19.4 months versus 14.9 months.

“Elotuzumab by itself doesn’t have single-agent activity,” noted Dr. Roschewski. “But if you add it to other agents, elotuzumab extends progression-free survival.”

The side effects that occurred most often in patients taking the drugs included fatigue, diarrhea, peripheral neuropathy, and fever. Daratumumab may also cause a decrease in white blood cells.

Elotuzumab and daratumumab, both monoclonal antibodies, target proteins on myeloma cells that have yet to be part of other FDA-approved therapies for this cancer type, explained Dr. Roschewski.

“The most exciting of the three drugs is daratumumab, because it showed single-agent activity,” Dr. Roschewski said. “It is not, by itself, going to cure multiple myeloma, and the duration of remission is relatively short, but it certainly provides some meaningful benefit, particularly if a patient doesn’t have any other treatment options.

“Any time you can get three new medicines in your armamentarium, that opens up many new research opportunities that now need to be explored,” Dr. Roschewski said.

4 Surprising Facts About Celiac Disease

Celiac disease is a tricky condition. It can take many years to get a diagnosis because it is often missed or mistaken for other conditions. The symptoms are quite vague and some people have no symptoms at all! The Celiac Disease Foundation estimates that 2.5 million Americans are undiagnosed and therefore at-risk for long-term health complications.

When someone with celiac disease eats gluten, it causes damage to the small intestine and nutrients aren’t absorbed properly. About 1 in 133 Americans have this genetic, autoimmune disorder. Symptoms can range widely. The most common in kids are: stomachaches, bloating, constipation or diarrhea, weight loss or poor growth, irritability and fatigue.

There is no cure for the disease and the treatment is to remove all gluten from the diet, including cross-contamination. In an effort to spread awareness about the condition, I’d like to share some potentially surprising facts about celiac disease:



Many diseases have a typical series of events that lead to a diagnosis. This isn’t the case with celiac disease. It can happen at any age and the symptoms vary widely. It is often a rule-out disease. If your child has been small all along and then drops off the growth curve, this might be a warning sign. The most common route for testing is via gastrointestinal symptoms. However, a large portion of patients are tested when other symptoms don’t have a good explanation. Or when a sibling is diagnosed with it. Many patients have associated conditions, like type 1 diabetes. A blood diagnostic test called tTG-IgA is often the first way we test for celiac disease.


Even if your child has had a negative tTG-IgA test in the past, it doesn’t mean that he can’t develop the disease later in life. It is possible for the disease to be dormant, but triggered after life events such as viral infection, stress, pregnancy, or surgery. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) suggests that all first-degree relatives get tested for tTG-IgA. Also, genetic testing can be done at any time, even if your child is already eating a gluten-free diet.


Your child is at a higher risk of developing celiac disease if she has Turner syndrome, or another autoimmune disorder like type 1 diabetes, thyroid disease or juvenile idiopathic arthritis. We don’t know exactly why the disease is more common in children with these conditions, but it seems linked to genetic differences in our immune systems. And perhaps differences in our gut bacteria at key times in life, including infancy.


Celiac disease is not a one size fits all condition. Each child will have different symptoms and will react differently to various amounts of gluten. Just because your child has a higher tTG-IgA level doesn’t mean that her disease is more severe. We’ve seen kids with high tTG-IgA with no symptoms at all. It is important to note that even if your child isn’t having symptoms, to stick to the gluten free diet. Long-term complications from eating gluten can lead to poor growth, nutrient deficiencies, bone issues, fertility problems, and potentially bowel cancer.

There’s a lot we don’t know about celiac disease and we hope to learn more as we continue to study it. What we do know, however, is how much better patients do and feel on a completely gluten free diet. This can feel like an overwhelming task, so I do recommend you work with a dietitian to help eliminate it from your child’s diet. He or she can help you find factual materials and weed through the overload of information out there.

16 Early Symptoms and Signs of Rheumatoid Arthritis (RA)

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is a type of inflammatory arthritis. RA disease is characterized by chronic joint inflammation (in the fingers, hands, knees, feet, for example). RA may also be called rheumatoid disease because at times rheumatoid arthritis causes systemic illness that impacts many organs of the body.

What are early signs and symptoms of rheumatoid arthritis, and what areas of the body are affected?

While early symptoms of RA can be mimicked by other diseases, the symptoms and signs are very characteristic of rheumatoid disease. The 16 early RA symptoms and signs discussed in this article include the following:

  • Fatigue
  • Joint pain
  • Joint tenderness
  • Joint swelling
  • Joint redness
  • Joint warmth
  • Joint stiffness
  • Loss of joint range of motion
  • Many joints affected (polyarthritis)
  • Limping
  • Joint deformity
  • Both sides of the body affected (symmetric)
  • Loss of joint function
  • Anemia
  • Fever
  • Depression


Fatigue is a very common symptom in all stages of rheumatoid arthritis, particularly when the joint inflammation is active. Fatiguein rheumatoid arthritis can be caused by the body’s reaction to inflammation, poor sleep, anemia, and medications.

The fatigue of rheumatoid arthritis that results in lack of energy can adversely affect emotions and mood, occupation, relationships with people, sex drive, productivity, attentiveness, creativity, and happiness. Fatigue from rheumatoid arthritis can also be associated with poor appetite and weight loss.

Joint pain

Joint pain from rheumatoid arthritis is caused by the inflammation present in a joint when the disease is active. Joint pain can also occur when the disease is inactive or controlled if the joint has been damaged by rheumatoid arthritis in the past.

Active rheumatoid arthritis causes the joint to swell because of both thickening of the joint lining tissue (synovium) and because of excess joint fluid. The swollen, inflamed joint stretches and irritates the capsule that surrounds the joint. The joint capsule has nerves endings within it that immediately send pain signals to the brain.

Past rheumatoid arthritis can lead to permanent joint destruction with damaged cartilage, bone, and ligaments. When the damaged joint is used, it can cause intense pain.

Joint tenderness

Rheumatoid arthritis characteristically leads to tenderness of involved joints. This is because the inflamed joint lining tissue has irritated the nerves in the joint capsule. When the irritated joint capsule is compressed by external pressure, such as from touching the joint, it is frequently tender. The pain elicited from compression is immediate. This is one of the reasons that rheumatoid arthritis can lead to difficulty sleeping and insomnia.

Joint swelling

Swollen joints are very common in rheumatoid arthritis. Sometimes the joint swelling is minimal and can be difficult to appreciate. Other times the joint swelling is very apparent. Generally, people who are affected by rheumatoid arthritis can easily tell when their joints are swollen. The joint swelling can lead to loss of range of motion of the joint. Joint swelling in the fingers can make it hard to get rings off and on easily.

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Tinnitus is Latin for “to tinkle or to ring like a bell.” It can come as a ringing, a hiss, a crackle, a buzz or even a whistle… but in whatever form you hear it, it’s actually a sign of hearing loss. Tinnitus can be a temporary or permanent condition, depending upon the cause.

Whether you’ve been diagnosed with tinnitus or you’ve been struggling to manage symptoms on your own, here are the top 5 things to know.

1. There is no actual noise present with tinnitus.

It sounds like you hear something, but you really aren’t. It’s what doctors call an acoustic hallucination – the perception of a sound, not an actual sound. It’s usually “heard” in the ears but it can also occur in your head. The sounds happen when cells in your inner ear are damaged, causing them to send faulty signals to your brain.

2. Tinnitus is most commonly caused by loud noise.

So, how do those cells get injured? The most common cause is noise. Even a single incident of exposure to an extremely loud noise, such as fireworks or other explosions or a gun shot fired close to the ear can trigger hearing loss or tinnitus. If you work in noisy surroundings it’s important to protect yourself from tinnitus.

3. Tinnitus is one of the most common health conditions in the country.

According to the American Tinnitus Association and the CDC, nearly 15% of the general public – over 50 million Americans – experience some form of tinnitus, and an estimated 2 million have extreme and debilitating cases. In addition to loud noises and simply growing older, tinnitus can also be caused by head trauma, stress, ear infections and even compacted ear wax.

4. Many tinnitus patients also experience hyperacusis.

Hyperacusis can cause tinnitus patients to find loud noises extremely uncomfortable, even leading some to experience pain when hearing sounds that would not bother someone else – such as dogs barking down the block or even the refrigerator running in the kitchen. People with this condition might say they hear sounds “too much,” and it can lead to stress, irritability and isolation.

5. There is no cure, but there are treatments that can help.

Unfortunately, there is as yet no scientifically proven cure or treatment against tinnitus. But you can ask your doctor or audiologist about other treatment options, including hearing aids, prescriptions and sound masking devices.


Some medications can worsen movement symptoms of PD, including slowness, stiffness, tremor and dyskinesia. These drugs, listed below, are used to treat psychiatric problems such as hallucinations, confusion or gastrointestinal problems, such as nausea. The stress of your illness, hospital stay or new medicines can increase your risk of hallucinations while hospitalized. Common anti-hallucination medicines to be avoided are listed by generic or chemical name followed by the trade name.


Note: the anti-hallucination medicines Quetiapine (Seroquel) or Clozapine (Clozaril) can be used. The following should be avoided:

aripiprazole (Abilify), chlorpromazine (Thorazine), flufenazine (Prolixin), haloperidol (Haldol), molindone (Moban), perphenazine (Trilafon), perphenazine and amitriptyline (Triavil), risperidone (Risperdol), thioridazine (Mellaril), thiothixene (Navane)


metoclopramide (Reglan), phenothiazine (Compazine), promethazine (Phenergan)


Pain medicines – Meperidine (Demerol), Tramadol (Ultram),Antispasmodic medicine Flexeril , Dextromthorphan and St Johns Wort.

This is not a complete list of medicines to avoid. If you have questions about other medications, ask your pharmacist or doctor.

Any medication that blocks dopamine in the body can cause Parkinson’s symptoms.

By Louis Neipris, M.D., Staff Writer, myOptumHealth

You may have heard of Parkinson’s disease (PD), a movement disorder. Someone with it may have characteristic signs, such as a pill-rolling tremor in the fingers or a hunched forward posture. You may recognize someone with this disease from the faltering, tiny steps they take when they walk or by their rigidly emotionless face.

The cause of Parkinson’s disease is mostly unknown. Some people develop Parkinson’s-like symptoms after treatment with certain medications. This is called drug-induced parkinsonism (DIP) or secondary parkinsonism. Certain medications can also worsen symptoms in someone who already has Parkinson’s disease.

Any medication that blocks dopamine in the body can cause Parkinson’s symptoms. Dopamine is a brain chemical that helps control movement. Common dopamine-blocking drugs are antipsychotics. They are used to treat certain mental illnesses or severe nausea. Less commonly, certain types of calcium channel blockers cause drug-induced parkinsonism. These drugs may be used to treat chest pain and high blood pressure, or irregular heart rate.

Other types of medications that may cause drug-induced parkinsonism are:

* Some antidepressants
* Certain anti-nausea drugs
* Some drugs used to treat vertigo
* Certain drugs used to treat epilepsy
* Some anti-arrhythmics (used to treat irregular heart rhythm)

Not all drugs in these classes will cause symptoms of parkinsonism.

What’s the difference?

Drug-induced parkinsonism usually develops on both sides of the body, while typical Parkinson’s disease does not. Also, drug-induced parkinsonism usually does not progress like typical Parkinson’s.

Unlike Parkinson’s, drug-induced symptoms usually go away after the drug is stopped. It may take several months, though, for the symptoms to completely stop. If the symptoms remain, then it is possible that the drug may have “unmasked” underlying Parkinson’s disease.

Who is at risk?

  • Female: Women are twice as much at risk as men.
  • Elderly: Older people are more likely to be on multiple medications or to have underlying Parkinson’s disease.
  • Those with a family history of Parkinson’s disease.
  • People with AIDS.

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15 Best Home Remedies for Heartburn (Acidity) during Pregnancy

Pregnancy may be a beautiful experience, but that does not mean it is not accompanied by a few inconveniences. Prime among them? Acidity. First things first, here is the why of it all. Your bloated uterus pushes up against your digestive system causing the acid in your stomach to push up to your throat. Every meal becomes a bit of a rollercoaster ride with the taste staying with you and annoying you for hours after every meal. You probably wonder what helps acid reflux when pregnant. Well, there are plenty of natural ways to get rid of heartburn while pregnantAs is the case with any condition there are plenty of home remedies for acid reflux during pregnancy to help alleviate your discomfort.

1. Say No To Fatty, Spicy, and Deep-Fried Food

Unfortunately, everything with fat, spice and deep-fried preparations are a big no-no. Your cravings may be demanding you grab a handful, but you will pay for it later. This cure for heartburn while pregnant is more of a piece of advice – abstain from these sinfully delicious foods as they trigger a reaction in your belly that increases acid production. Some even erode your sphincter allowing for easy backflow of acid to your throat and create a double whammy with easy reflux. Maybe a few morsels here and there just to stem the cravings, so you are not killing the father of your baby but remember not to overdo things!


2. Caffeinated, Carbonated Drinks and Chocolate

The same as the previous point, these elements encourage the production of acid in your belly and cause heartburn. While giving up chocolate may seem like blasphemy and upset your baby and you, you will both be a lot happier once you do. Either way, caffeine and carbonated drinks have been proven to be bad for pregnant women.

3. Gravity is Your Friend

Your body is built to keep things flowing downwards, and you can use gravity to your advantage. Prop yourself up on pillows when sleeping so your head is raised above your stomach and feet. This will force it downwards away from your throat and into your intestines. This is one of many timeless home remedies for acid reflux during pregnancy.

4. Eat Less

Another cure for heartburn while pregnant that may seem too horrible to hear is eating less. All you need to do is eat often with plenty of small meals composed of easy to digest ingredients. This has the added advantage of preventing morning sickness as well. Your stomach has less of an opportunity to generate an acid that climbs to your throat if it is busy digesting food.

5. Early Meals

A key element you should keep in mind involves eating early, so your stomach is not too full when you lie down. This will not push the acid back up and cause heartburn or acid reflux that will drive you insane all night. Make a note of the fact that you should eat no later than 3 hours before bed.

6. No lying On The Job

Once you have eaten, you must not lie down within 60 minutes of a meal. Give your food a chance to digest, or it will get even with you through painful heartburn and the oh-so-fun acid reflux. Once you do sleep, lie on your left. As mentioned earlier, your body is built for this, and the acid goes into the intestines better while more nutrients go to the baby and placenta.


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8 Things Rheumatologists Want You to Know About Ankylosing Spondylitis

9 Early Signs and Symptoms of Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation of joints.

RA tends to begin slowly with minor symptoms that come and go, usually on both sides of the body, which progresses over a period of weeks or months.

Symptoms of this chronic condition vary from person to person and can change from day to day. Bouts of RA symptoms are called flare-ups, and inactive periods, when symptoms are less noticeable, are called remission.


You may feel unusually tired well before any other symptoms become obvious. Fatigue can come before the onset of other symptoms by weeks or months.

It may come and go from week to week or day to day. Fatigue is sometimes accompanied by a general feeling of ill health or even depression.

Morning stiffness

Morning stiffness is often an early sign of arthritis. Stiffness that lasts for a few minutes is usually a symptom of a form of arthritis that can worsen over time without proper treatment.

Stiffness that lasts for several hours is generally a symptom of inflammatory arthritis and is typical of RA. You may also feel stiffness after any period of prolonged inactivity like napping or sitting.

Joint stiffness

Stiffness in one or more of the smaller joints is a common early sign of RA. This can occur at any time of day, whether you’re active or not.

Typically, stiffness begins in the joints of the hands. It usually comes on slowly, although it can come on suddenly and affect multiple joints over the course of one or two days.

Joint pain

Joint stiffness is often followed by joint tenderness or pain during movement or while at rest. This also affects both sides of the body equally.

In early RA, the most common sites for pain are the fingers and wrists. You may also experience pain in your knees, feet, ankles, or shoulders.

Minor joint swelling

Mild inflammation of the joints is typical early on, causing your joints to appear bigger than normal. This swelling is usually associated with warmth of the joints.

Flare-ups can last anywhere from a few days to a few weeks, and this pattern can be expected to increase with time. Subsequent flare-ups may be felt in the same joints or in other joints.

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Multiple myeloma – Diagnosis and treatment


In some cases, your doctor may detect multiple myeloma accidentally when you undergo a blood test for some other condition. In other cases, your doctor may suspect multiple myeloma based on your signs and symptoms.

Tests and procedures used to diagnose multiple myeloma include:

  • Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.

    Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.

  • Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they’re detected in urine.
  • Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).

    In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.

  • Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).

Assigning a stage and a risk category

If tests indicate you have multiple myeloma, your doctor will use the information gathered from the diagnostic tests to classify your disease as stage I, stage II or stage III. Stage I indicates a less aggressive disease, and stage III indicates an aggressive disease that may affect bone, kidneys and other organs.

Your multiple myeloma may also be assigned a risk category, which indicates the aggressiveness of your disease.

Your multiple myeloma stage and risk category help your doctor understand your prognosis and your treatment options.


If you’re experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of multiple myeloma.

Immediate treatment may not be necessary

If you have multiple myeloma but aren’t experiencing any symptoms (also known as smoldering multiple myeloma), you may not need treatment. However, your doctor will regularly monitor your condition for signs that the disease is progressing. This may involve periodic blood and urine tests.

If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.

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