Can you use a lip biopsy to diagnose Sjogren’s Disease? Should you?

In this “Diagnosing Sjogren’s Disease” blog post series, I’ve discussed several methods used to form a diagnosis for Sjogren’s Disease. None of them, alone, can be used for diagnosis, but several of them together are how we do form a diagnosis. Getting an inner lip biopsy to evaluate your salivary glands is one of the best tests (most specific) to aid in a diagnosis of Sjogren’s Syndrome.

Getting an inner lip biopsy to evaluate your salivary glands is one of the best tests (most specific) to aid in a diagnosis of Sjogren's Syndrome.

Getting an inner lip biopsy to evaluate your salivary glands is one of the best tests (most specific) to aid in a diagnosis of Sjogren’s Syndrome.

Approximately one thousand minor salivary glands line the inside of your mouth and swallowing passages. A minor salivary gland biopsy removes a very small portion (less than 10) of your minor salivary glands from the inside of your lower lip. In Sjogren’s Disease, these glands typically have chronic inflammation and are infiltrated with white blood cells (WBCs) called lymphocytes. This is what you would expect to see on the biopsy if Sjogren’s disease is present.

A minor salivary gland biopsy for Sjögren's Disease typically shows specific clusters of inflammatory cells.

A minor salivary gland biopsy for Sjögren’s Disease typically shows specific clusters of inflammatory cells.

Alternatively, other findings from the lip biopsy or lack thereof can help diagnose and rule out conditions such as sarcoidosis, amyloidosis, and lymphoma. People with Sjogren’s disease are at an increased risk for lymphoma so this is a great screening measure for them.

People with Sjögren's Disease have an increased risk of developing Lymphoma, which can be identified through lip biopsy.

People with Sjögren’s Disease have an increased risk of developing Lymphoma, which can be identified through lip biopsy.

To sum things up Sjogren’s Disease can not be diagnosed with just one simple test. It’s a combination of eye tests/symptoms, oral symptoms/tests, blood work and/or lip biopsy results that are used to formulate a diagnosis. If you suspect you have Sjogren’s Disease then talk to your medical providers about it. You can also find more information on the Sjogren’s Syndrome Foundation website.

Sjögrens Disease can not be diagnosed with just one test.

Sjögrens Disease can not be diagnosed with just one test.

Share your experience with Sjogren’s Disease on my Facebook Like Page and be sure to join my private online Facebook support group.

Barbara Grubbs, Nurse Practitioner

Click here for lab tests used to help diagnosis Sjogren’s Disease.

To see how my journey to diagnosis Sjogren’s began click here.

Click here to find out how to diagnosis the dry mouth symptoms of Sjogren’s Disease.

Click here to find out how to diagnosis the dry eye symptoms of Sjogren’s Disease.

 

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What labwork is associated with a Sjögren’s Disease diagnosis? Do I need to get bloodwork drawn for Sjögren’s syndrome?

Labwork (blood testing) is a key component in diagnosing Sjögren’s Disease. When it comes to bloodwork, the antinuclear antibody (ANA) test is used as a primary test to help evaluate a person for autoimmune diseases. It’s a good place to start if Sjögren’s Disease is suspected. Most people think of Lupus (SLE) when they hear “ANA” but ANA is a group of autoantibodies produced by a person’s immune system when it fails to adequately distinguish between “self” and “nonself.” It can signify several different autoimmune disorders.

ANA are a group of autoantibodies produced and identified in the bloodworm that can indicate a rheumatic autoimmune condition is present.

ANA are a group of autoantibodies produced and identified in your blood that can indicate a rheumatic autoimmune condition is present.

To distinguish further what an elevated ANA may mean for a person, further antibody testing can be completed.  Two subsets of ANA: Anti-SS-A (Ro) and Anti-SS-B (La) are useful for identifying Sjogren’s. About 90% or more of people with Sjögren Disease have autoantibodies to SSA.The thing about these blood antibody tests, however, is that they can be positive in people with no known autoimmune disease or symptoms and they can also be positive in other autoimmune conditions besides Sjögren’s. On the other end of the spectrum, all of these lab tests can be negative in someone that does have Sjogren’s. So having them doesn’t necessarily mean you have (or don’t have) Sjögren’s Disease. While the lab work is highly suggestive of Sjögren’s, it is therefore not alone diagnostic.

Other non-specific bloodwork tests such as an ESR (Erythrocyte Sedimentation Rate) or CRP (C-Reactive Protein) are useful to identify inflammation that occurs with autoimmune disorders but they don’t distinguish where the inflammation is coming from or the cause of the inflammation.

ESR & CRP indicate inflammation is present in the body but they don't signfiy the cause of the inflammation.

ESR & CRP indicate inflammation is present in the body but they don’t signify the cause of the inflammation.

RF (Rheumatoid Factor) is a lab test usually used to identify Rheumatoid arthritis but it can also be positive with Sjögren’s Disease. Rheumatic conditions share a lot of overlap symptoms and lab work. This makes it very hard to pinpoint exactly what is going on sometimes. However, all of this lab work is used to help form a bigger picture that hopefully can lead to a diagnosis.

RF (Rheumatoid Factor) is a lab test usually used to identify Rheumatoid arthritis but it can also be positive with Sjögren's Disease.

RF (Rheumatoid Factor) is a lab test usually used to identify Rheumatoid arthritis but it can also be positive with Sjögren’s Disease.

If you have been following this blog post series on Diagnosing Sjögren’s Disease you may remember that my journey to diagnosis started with a finding of Leukopenia (low white blood cell count) on my lab work. Leukopenia can, of course, signify a barrage of different things but an autoimmune disease like Sjögren’s is one possible cause.

The bloodwork most suggestive for a diagnosis of Sjögren's Disease include a positive ANA with subtypes anti-SSA (Ro) and anti-SSB (La) antibodies.

The bloodwork most suggestive for a diagnosis of Sjögren’s Disease include a positive ANA with subtypes anti-SSA (Ro) and anti-SSB (La) antibodies.

So in summary, the bloodwork most suggestive for a diagnosis of Sjögren’s Disease include a positive ANA with subtypes anti-SSA (Ro) and anti-SSB (La) antibodies. Additionally, RF may be positive. Alternatively, a biopsy of salivary glands from the lip showing a characteristic pattern of inflammation can be used for diagnosis. I will discuss this in my next blog post as I wrap up this series!

How were you diagnosed? Let us know on my FaceBook Like Page or in our private FB support group.

Barbara Grubbs, Nurse Practitioner

But wait. How do you diagnose dry mouth in Sjogren’s Disease?

How do you diagnose dry eye in Sjogren’s Disease?

When should you suspect Sjogren’s Disease?

Click here to see how my journey to diagnosis Sjogren’s began.

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How do you diagnose dry mouth in Sjögren’s disease?

How do you know if you have dry mouth disease? How do you test for it? What's normal?

How do you know if you have dry mouth disease? How do you test for it? What’s normal?

Let’s talk about diagnosing dry mouth. Symptoms can actually go a long way in aiding in the diagnosis of this one. Symptoms of severe dry mouth may include:

  • Needing water to chew and swallow food
  • Choking or coughing on food
  • Not being able to speak for long periods of time without constantly sipping water
  • A dry mouth, frequent dental caries or dental complications
  • A dry, red, raw tongue. Altered taste or a burning and tingling sensation on the tongue
  • Sores and cracks in and around the mouth
  • A dry throat with a dry cough
Do you need water to eat dry foods? Do you need water to speak for long periods of time?

Do you need water to eat dry foods? Do you need water to speak for long periods of time?

Diagnostic testing is aimed at the salivary glands since they are the cause of the dry mouth symptoms in Sjögren’s. Sialometry, or Salivary flow rate, is a simple 15-minute test that can be completed in your doctor’s office. Some clinics administer this as an “unstimulated” test and others prefer a “stimulated” version. Stimulated involves chewing a piece of paraffin to stimulate saliva flow while unstimulated testing does not involve chewing anything. Either way, the test involves spitting in a measured cup or test tube to see how much can be collected in the 15-minute time frame. That amount is then compared to established norms.

Sailometry is a test that measures how much salvia you produce over a 15 minute time frame.

Sailometry is a test that measures how much saliva you produce over a 15-minute time frame.

More advanced testing is available but not as widely used in general practice. A Parotid sialography, for example, involves injecting x-ray dye into the salivary glands to follow salivary flow using X-rays. Salivary scintigraphy is a nuclear medicine test that can also evaluate salivary flow. For this test, a radioactive substance in injected into your vein and imaging traces the substance to your salivary glands. In Sjögren’s disease, this test would likely indicate decreased uptake and secretion of the radioactive isotope.

Dry mouth symptoms can include a dry throat and an annoying dry cough.

Dry mouth symptoms can include a dry throat and an annoying dry cough.

Other emerging tests may use ultrasound or MRI. Testing for dry mouth is an area that is experiencing rapid growth as we try to identify and manage debilitating dry mouth symptoms. I have personally only done the stimulated salivary flow rate test once. I find that most practitioners are satisfied to meet dry mouth criteria based on my subjective complaints (symptoms).

Testing for dry mouth is an area that is experiencing rapid growth as we try to identify and manage debilitating dry mouth symptoms & complications.

Testing for dry mouth is an area that is experiencing rapid growth as we try to identify and manage debilitating dry mouth symptoms & complications.

Once again we are unable to diagnose Sjögren’s with any of these tests alone. Dry mouth evaluation coupled with dry eye symptoms and other diagnostics are collected to add to the overall picture that eventually gets put together to form a diagnosis. In my next blog post, we’ll get into the lab work associated with Sjögren’s Disease.

I wish you all a 5 spoon day!

Barbara Grubbs, Nurse Practitioner

How do you diagnose dry eyes?

When should I suspect Sjögren’s Disease?

How my journey to a diagnosis of Sjögren’s started. 

 

 

 

 

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How do you diagnose dry eye in Sjögren’s Disease? SICCA Syndrome.

If you have symptoms of dry eye, then how do you confirm that you are suffering from dry eye related to Sjögren’s Disease?

Dry eye symptoms can be caused by many things. How do you know if it's caused by Sjögren's Disease?

Dry eye symptoms can be caused by many things. How do you know if it’s caused by Sjögren’s Disease?

The most basic diagnostic evaluation of dry eye is by direct observation and examination by an ophthalmologist (eye doctor).  More advanced testing can look at not only your amount of tear production but also the components of the tears themselves. Normal tears are made up of water, oil, mucous, and many other beneficial proteins. All of these components are crucial for eye health.

Normal tears are made up of water, oil, mucous, and many other beneficial proteins that are crucial for eye health.

Normal tears are made up of water, oil, mucous, and many other beneficial proteins that are crucial for eye health.

The Schirmer test is a simple 5 minute test done to see how much tear production you have based on an established norm. One tiny strip of filter paper is placed in the pocket underneath each eye (the lower conjunctival sac) to measure the amount of tears they can soak up in that time frame. You just keep your eyes closed to let the test do its job. The thin strips of filter paper have measurements marked in mm. If 15mm or more become moist with tears then the test is considered normal. If less than 5mm of moisture is on the strip after 5 minutes then the test is considered abnormal and indicative of severe dry eye.

The schirmer's test uses thin strips of filter paper to measure your tears based on an established norm.

The schirmer’s test uses thin strips of filter paper to measure your tears based on an established norm.

Corneal staining (also called a fluorescein eye stain test) is a method of evaluating the outer surface of the eye (the cornea). Dry eye can cause trauma to the cornea due to the lack of a nourishing and protective tear film layer. Fluorescein just means “dye”. Other stains that may be used are “rose bengal” or, more commonly, “lissamine green.” Dye is placed in your eye and then you blink to spread it around. The dyes are effective because they stain damaged cells on the eye. Damaged areas may be related to severe dry eye but other causes are possible too. Fluorescein is good for identifying corneal damage that may occur from dry eye if it is severe.

Dry eye can cause trauma to the cornea due to the lack of a nourishing and protective tear film layer.

Dry eye can cause trauma to the cornea due to the lack of a nourishing and protective tear film layer.

Fluorescein can also be used to evaluate the integrity of the tear film over your eye. Ideally your tears would evenly spread the dye over your eye surface area and this would be visible to your doctor under a high powered eye examination microscope. This fancy microscope is called a biomicroscope and it has a light source called a slit lamp. Despite the fancy name this is the equipment you have likely seen every time you go to the eye doctor and get a dilated eye exam. If you have an inadequate tear film layer over your eyes then that would result in the fluorescein dye not evenly coating the eye surface well and/or the dye would quickly “break up.” This happens when the tear film is not adequate to provide and maintain a smooth even protective layer over the eye.

Special dyes or stains can be placed in your eye to help your eye doctor identify areas of dryness or damage.

Special dyes or stains can be placed in your eye to help your eye doctor identify areas of dryness or damage.

Rose bengal or lissamine green (which is favored because it doesn’t burn and sting as much) stains are more useful for identifying mild or moderate dry eye by showing dry spots on not just the cornea but on the conjunctiva as well. The conjunctiva is the mucous membrane that covers the front of the eye and lines the inside of the eyelids.

Other testing measures and options for testing are becoming more available. Alone, none of this testing can directly say that you have Sjogren’s Disease. That is because Sjogren’s is not the only cause of dry or damaged eyes. However, these tests in conjunction with symptoms and other testing start to paint a picture. When enough things align and add up together then a diagnosis starts to form. That’s how you correlate your dry eye symptoms to sjögren’s. This multifactorial method is what contributes to the complexity of getting a diagnosis.

Alone no one eye test can directly diagnose Sjögren's Disease.

Alone no one eye test can directly diagnose Sjögren’s Disease.

I will continue this blog series next week with a discussion on testing for dry mouth. Please visit my Facebook like page and comment on a post related to Sjögren’s Disease. What is your experience with dry eye?

Have a 5 spoon day!

Barbara Grubbs, Nurse Practitioner

To figure out when you should start to suspect Sjögren’s Disease click here.

To see how my journey to diagnosis started click here. 

 

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How to lose weight for health when you are an emotional eater. How do you stop mindless eating?

People tell me they want to lose weight “all of the time.” Most people have in their head what they should be doing and many feel they are already doing a good job with food and possibly exercise as well. They just can’t understand why they aren’t dropping weight. I’m going to share with you the biggest roadblocks I commonly see that stop people from gaining results.

Mindset matters. When you decide to change then excuses disappear and you FIND a way!

Mindset matters. When you decide to change then excuses disappear and you FIND a way!

You must first understand that you need calories to burn calories.  In addition, you need them at a constant and steady rate. You must eat small, eat healthy, and eat often. Write that down! When you build a fire you know that you need to keep putting wood in the fireplace to keep the fire going all day. That’s what provides the energy and resources to keep it burning! Without the wood the fire burns out. Similarly food stimulates your metabolism. Metabolism is how efficiently your body burns and breaks down the food you eat. When you only eat a couple times a day you are dumping food into an empty fireplace that has no means to start the fire. This kills metabolism and so you instead store fat.

You need calories to burn calories. Eat small healthy meals every 2-3 hours.

You need calories to burn calories. Eat small healthy meals every 2-3 hours.

Check out these all too common excuses I hear in response to my optimal health advice:

  • “I can’t eat every 2-3 hours.”
  • “I can’t eat breakfast. I’ve never been able to. It’s makes me sick or even more hungry all day.”
  • “I can’t do a food diary. I don’t have time to weigh food and figure out portion sizes.”
  • “I can’t afford healthy foods. I don’t have time to grocery shop.”
  • “I can’t give up  ______.”
  • “I can’t eat something different than what I’m feeding my family.”
  • “I can’t plan or prepare meals in advance. I don’t have time.”
  • “I can’t eat that often. I can’t eat while I’m working. I’m too busy and my boss won’t let me.”
  • “I can’t eat that often. I already don’t eat much right now.”
  • “I can’t eat on a set plan. I’m an emotional eater.”
  • “I JUST need to exercise.” -So much science refutes this excuse…

Do any of those phrases sound familiar to you? It’s okay. You’re not alone. But you need to recognize these barriers and address them now! All of those phrases tell me you aren’t REALLY ready for the change required to get healthier and lose weight that you can keep off. Right now it’s just a wish. You “wish” you could lose weight, but not enough to make the changes necessary to actually lose that weight. It’s much easier to just keep doing what you’ve always done. Change takes work and compromise.

You can't do what you've always done and expect things to turn out differently. To GET change you must MAKE change.

You can’t do what you’ve always done and expect things to turn out differently. To GET change you must MAKE change.

You CAN’T do what you have always done and expect change. You also can’t “run away” (exercise) from nutrition. I encourage you to stay active but exercise alone is not enough. The bulk of your results will come from eating the right foods, the right way, and at the right times.

I know what works and I can tell you until I’m blue in the face but you aren’t going to do a darn thing about it until your mind is right and you’ve decided that the pain of staying the same is worse than the pain of change.

So get your head right and then come join me with Medifast and Optavia so I can be your health coach and hold you accountable. When you are ready, I’m ready. Now you just have to decide to start.

Barbara Grubbs, Nurse Practitioner

I am a health coach with Optavia/Medifast. You don’t have to use this program for me to help you. I just truly believe in it and know it works. At a minimum one month on this program may jump start you amazing results. If you’d like more information click here. You can shop meals and get your starter kit here.

You can contact me at Barbara@BarbaraGrubbs.com

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When should I suspect Sjögrens? What symptoms are used to diagnose Sjögren’s? What should I expect?

Diagnosing any condition can be hard. This is especially true with autoimmune connective tissue diseases such as Sjögren’s Disease. This is because so many body systems are involved that a large array of symptoms can be present and those symptoms can be related to any number of other diseases. You have to consider how Sjögren’s Disease is uniquely different.

Sjögren's Disease Signs & Symptoms. Possible complications.

Sjögren’s Disease Signs & Symptoms. Possible complications.

Sjögren’s Disease is notably different from other very similar autoimmune conditions such as Lupus and Rheumatoid Arthritis in that moisture producing glands (exocrine glands) throughout the body are attacked specifically. This results in those “hallmark symptoms” that you always hear about. “Dry eyes and dry mouth.” The problem with this is that many other conditions and medications can cause those symptoms as well. If you can prove that a systemic (affects the whole body)  autoimmune condition is present that includes attack of the exocrine glands then that is how you reach diagnosis.

Specifically, for diagnosis, symptoms of dry eye need to be present for at least 3 months with no other identifiable cause (such as medications). You may feel like you have grit in your eye or a foreign body sensation and usually sufferers use artificial tears three or more times per day.For me, my dry eye symptoms also prevent me from being able to read for any length of time or stare at computer screens. They also get so dry that my vision becomes affected and blurred. It really disrupts life!

Sjögren's Disease is one of many that can cause a severely dry mouth.

Sjögren’s Disease can cause a severely dry mouth.

It’s the same thing with dry mouth. You want to make sure medications are not contributing to this condition. If you have dry mouth symptoms for at least 3 months you would want to investigate this further. Symptoms of extremely dry mouth include needing liquids to swallow dry foods and a chronic dry cough. You may have recurrent or persistently swollen salivary glands. These glands are found under your chin and along your jawline. When mine swell I feel like I have chipmunk face… Outstanding! Right?

Sjögren's Disease can cause swollen salivary glands.

Sjögren’s Disease can cause swollen salivary glands.

Sjögren’s attacks all of your moisture producing glands so expect a dry vagina, dry skin, dry gastrointestinal tract (this may contribute to constipation) and dry respiratory tract (which could lead to more sinus and lung infections). The list of systemic (full body) symptoms associated with Sjögren’s is extensive and usually includes debilitating fatigue, muscle and/or joint pain, mental fog / difficulty concentrating, peripheral neuropathies and, as with me, Raynaud’s phenomenon.

Sjögren's involves so many body systems that it often may seem and feel like it "causes everything"!

Sjögren’s involves so many body systems that it often may seem and feel like it “causes everything!”

This is where diagnosis starts. When you have symptoms that start painting a picture then that’s when you usually move on to other diagnostic measures such as lab work, eye exams, salivary evaluation, and biopsies. I’ll get to those in upcoming blog posts. Do you have symptoms of Sjögren’s disease? Leave your comments under a Sjögrens post on my FaceBook Like page. It’s the best way to share and spread awareness!

Have a 5 spoon day!
Barbara Grubbs, Nurse Practitioner

To see how my journey to diagnosis started click here.

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How do you diagnose Sjögren’s Disease? How my journey to diagnosis started.

I literally got the call on my 30th birthday.

Doctor: “Do you have dry eyes and dry mouth?”

Me: “Huh? Whhha Whhhat? Um, no… I don’t think so…”

Doctor: “Well, have you heard of Sjogren’s Syndrome before”?

Me: “No. Why? What is that?”

Sjögren's Disease. Getting "the call"

Sjögren’s Disease. Getting “the call.” Living with symptoms you didn’t know were abnormal.

Sjögren’s Disease is hard to diagnose. Heck, we are JUST NOW starting to see it called “Sjögren’s Disease” instead of “Sjögren’s Syndrome“. Finally! It’s very much a full body autoimmune connective tissue disease, but how do you get diagnosed?

My journey to diagnosis started 8 years ago. I was going through a very stressful period in my life. I was 29 years old, getting out of a long-term relationship, re-establishing my life, trying to buy a home during the real estate crash of 2008, and trying to put myself through college. Actually at this time I was finishing my Nurse Practitioner training. I was in the overwhelmingly stressful position of taking my boards and finding a new job in the midst of everything else.

Diagnosing Sjögren's. Dragging through life. One step at a time. Just trying to survive.

Diagnosing Sjögren’s. Dragging through life. One step at a time. Just trying to survive.

I felt like I was just “existing,” not living! I became fatigued and underweight. I remember my family urging me to see my medical doctor, but I didn’t have time for that! I could not even think straight or focus. It’s so hard for me to remember the details of this time in my life because I was so truly just trying to survive. I had muscle aches & pains, bone pain, overwhelming death fatigue (well, that’s how it feels…), neuropathies, anxiety, you name it! I attributed it to stress but did eventually get some lab work done.

The most notable thing on my lab results was a low white blood cell count. My doctor was astute enough to then run an ANA panel. This was positive and further antibody testing was indicative of Sjögren’s.

And so it started… I was already overwhelmed. I didn’t have time for a new mystery diagnosis or being sick. I “decided” to live in denial for a while. For years actually… Denial is a coping mechanism and its what I needed to do to push through. I only realize this in hindsight. I didn’t understand this disease and I didn’t want it! Diagnosis wasn’t “definite” anyway. After all, criteria for diagnosis were vague so…. I could just decide this wasn’t happening. Right?

Diagnosing Sjögren's. When you are in the "prime" of your life the last thing you want is a comprehensive mystery diagnosis!

Diagnosing Sjögren’s. When you are in the “prime” of your life the last thing you want is a comprehensive mystery diagnosis!

My next series of blogs is going to address what we know today about trying to diagnose Sjögren’s Disease. I am going to demystify this for you. I will cover criteria used to date including:

  • Symptoms associated with Sjögren’s Disease
  • Lab work associated with Sjögren’s Disease
  • Dry mouth evaluation
  • Dry eyes evaluation
  • Biopsy

I’m going to break everything down for you. Be sure to join my VIP email list so that you get notified when I release valuable information and specials.

To figure out when you should start to suspect Sjögren’s Disease click here.

Please leave a comment on my FB page to let me know you like this topic. Like, Share, and Comment to help my post rank higher so more people can see it and benefit from this information!

Have a 5 spoon day!

Barbara Grubbs, Nurse Practitioner

Below are my videos on Sjogren’s Disease and Autoimmune Disease.

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How do you treat hemorrhoids and what causes them?

Today I saw a patient with painful external hemorrhoids. It was the first time he ever got them and he was extremely anxious and embarrassed. I felt so badly for him. I decided I had to write a blog to help others with this “embarrassing” but COMMON condition.

What causes painful hemorrhoids and how do you treat them?

What causes painful hemorrhoids and how do you treat them?

Internal hemorrhoids are within the body but they can protrude out of the anus and cause pain, itching, bleeding, pressure, mucous discharge and a feeling of having to have a bowel movement. External hemorrhoids are outside or around the anus and can cause many of the same symptoms. They can be especially painful due to the abundance of nerve endings around the anus. If an external hemorrhoid becomes a swollen lump that looks like a grape it may have a clot inside.

You may find this hard to believe but just about everyone has hemorrhoids. They just don’t protrude and become problematic in everyone. Hemorrhoids can become disturbed by constipation, diarrhea, straining, and time. By time I mean age. The older you get the more likely hemorrhoids will sag and cause symptoms. Any straining or pressure in that area can cause the veins to bulge and swell.

Don't strain in the bathroom. Extra pressure causes veins to bulge and swell. Worsening hemorrhoids and hemorrhoid pain.

Don’t strain in the bathroom. Extra pressure causes veins to bulge and swell. Worsening hemorrhoids and hemorrhoid pain.

The good news is that they will usually calm down within 1-4 weeks with conservative treatment. Conservative treatment relies heavily on proper diet. Drink plenty of water and eat fiber to prevent constipation. This will make stools softer and easier to pass without having to bear down or strain.  Aim for 35 grams of fiber per day. You may want to try a product that contains psyllium fiber to meet this goal. Stool softeners such as colace (available over the counter) can be helpful as well. Remember to drink plenty of plain water with fiber containing products. Fiber without water will just turn into a hard lump and cause constipation to get worse. That is the opposite of what we want.

Sitz bath over toilet for hemorrhoid pain.

Sitz bath over toilet for hemorrhoid pain.

Warm baths or “sitz baths” can help relax the anal muscles and provide temporary relief. You can buy one to put on your toilet or just use your own bath tub and sit in warm water. For extremely painful hemorrhoids you may want to try the sitz tub over your toilet and even sit in it to have a bowel movement. Hemorrhoids can be really painful and this can help by keeping those muscles relaxed while you do your business.

Another product to try is witch hazel. It may help numb the pain of hemorrhoids temporarily. Ice packs can help in much the same way. You may also try an oral medication to reduce inflammation such as Ibuprofen. However, check with your medical provider about this first as it may interfere with some of your other medications or medical conditions.

Preparation-H is a topical product that may sooth the outside of the anus. It has an anti-itch ingredient in it called Pramoxine and also contains phenylephrine, which might help temporarily shrink the hemorrhoids. Topical steroids or suppositories with hydrocortisone are known to decrease inflammation. Steroid creams are available in up to 1% strength OTC and can be prescribed at higher dosages if needed. They are especially helpful if you have an external hemorrhoid with a clot in it. Usually these measures will help everything resolve without surgery.

It’s important to call your medical provider to get an accurate diagnosis if you think you have hemorrhoids. I hope this article helps reduce your anxiety until you can there. It’s a very common problem that usually takes care of itself.

Barbara Grubbs, Nurse Practitioner.

 

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The fungus among us. Athlete’s Foot, Tinea pedis, and jock itch.

I see a ton of factory workers as patients. Many have to wear hot, heavy, steel toe boots that have no ventilation and make the feet sweat. In addition to that they work in sweltering hot environments and the hot summer months compound these problems even more. But it’s not just occurring in feet…

Athlete's Foot. It's not just for athletes and doesn't only occur in the feet.

Athlete’s Foot. It’s not just for athletes and doesn’t only occur in the feet.

A very common condition I’ve been seeing in the health clinic is Athlete’s foot. You don’t have to be an athlete to get this skin fungus. In fact, most of us have had the pleasure of this nuisance condition at one time or another. That’s because it’s easy to get and highly contagious. Medical professionals may call this same condition “tinea pedis”. We just love to give things complicated sounding names.

Athlete’s foot usually affects the areas between your toes. It’s a skin condition caused by fungus that develops and grows in a moist, wet, and hot environment. The fungus is everywhere in our environment so most people are exposed to it. Even people with really good hygiene can get this. Symptoms include itching, cracked and peeling skin, soreness if the skin breaks, and scaly skin. Sometimes redness and blisters can occur. It’s often worse between the toes. The feet and toes are not the only area this can occur however. This makes the name “Athlete’s foot” misleading. I have seen some women that get this fungus underneath the breasts. Again, it’s more common in a hot environment and that fold of skin under the breasts can be particularly prone to getting hot, sweaty, and moist. This same fungus can cause jock itch and fingernail or toenail fungal infections. If you have ever heard of ringworm, that is a fungal infection as well.

How do i treat it? Fungal Infections!

So here is how you treat and prevent Athlete’s foot. Go to the store and get an anti fungal powder to apply to the infected areas. It can take 4-6 weeks of treatment. Possibly longer. You can try a cream if you want but i think powders are better because they help wick away moisture. Wear cotton or wool socks and change them out often if they become damp. Bring a couple pairs of socks to work with you. It’s important to keep your feet clean and dry. When possible, wear sandals or shoes with ventilation. Natural materials are better than man-made products. Air out your shoes when you aren’t wearing them. Discard and replace your shoes if they are old and smelly. Be careful in areas that other people may have athlete’s foot that make you more prone to picking it up. Inspect bowling shoes and skate rentals before wearing them and wear something on your feet in public locker rooms, showers, and around the pool. You can also put athletes foot powder in your shoes. When you wash your feet and toes use an exfoliating cloth. Try soaking your feet in a dilute white vinger solution. Mix one part vinegar to 4 parts water. You can also try a foot soak in Burow’s solution. This is an astringent solution that you can find over the counter.These measures should help your feet. Let me know if you want solutions for other areas or have questions about this topic.

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Barbara Grubbs, Nurse Practitioner

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