Exercise and Lupus

The latest Lupus Foundation Newsletter from www.lupus.org has a Q&A with Dr. Hazel Breland regarding exercise and Lupus.

What is Lupus?

Lupus is an autoimmune disease characterized by, among other things, fatigue and joint pain.  It is a disease that alters a person's lifestyle.  Lupus patients are very aware of the limitations the disease creates and therefore are doubly motivated to do things even when they don't feel well.  There are good days and bad, and some patients don't know how they will feel on any given day until they wake up in the morning.  They also don't want to do anything that may cause the disease to "flare."

The consensus regarding exercise is that, with the approval of the patient's physician, a program that involves low impact motions, such as yoga, Tai Chi, water aerobics, a stationary bike, or walking, are best.  Staying hydrated during exercise is also important.  Exercises that promote staying limber and maintaining range of motion are recommended.

Patients are encouraged to stay active and at the same time pay attention to their tolerance levels to get the most benefit without overdoing it.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Women With Lupus: Osteoporosis

Osteoporosis affects 44 million Americans.  For those with lupus, some treatments increase the risk of the disease, resulting in weaker bones and a greater chance of fracture.  In fact, women with lupus experience osteoporosis-related fractures almost five times more often than other women.  Therefore, bone health is important.

Bone Loss

How can you keep your bone strong?  Get moving!  Activities, even walking, that strain bone, both stimulate bone growth and reduce bone loss.  In addition, your lupus physician will perform bone density testing, determine nutrient values in your blood, and prescribe medications and supplements to prevent osteoporosis.

Source:  Lupus Foundation of America

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Understanding Lupus

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood and kidneys.  It is of special interest to me because my wife has the disease, and so do many of my patients.  Here are some facts to help understand the disease:

• it is an autoimmune disease that causes inflammation and tissue damage
• it is chronic and last a lifetime
• it is not contagious--it can't be caught or given away
• it is not like or related to cancer
• it is not like or related to HIV or AIDS
• it can cause a mild skin rash or achy joints, or can effect internal organs
• it is unpredictable, as symptoms can appear, disappear or change
• it can be mild or life-threatening and requires treatment by a physician
• with appropriate medical care, most people with non-organ threatening lupus lead a full life

Source: Lupus Foundation of America

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus and Vitamin D

Vitamin D is a Marker for Disease

Vitamin D deficiency is a marker for disease activity and damage in systemic lupus erythematosus.  Low levels of vitamin D are associated with autoimmune diseases, especially lupus.  It is activated by a chemical reaction made possible by exposure to the sun's ultraviolet B rays.  Since people with lupus may need to avoid sun exposure because of the photosensitivity side effects of medications, this can increase the risk for vitamin D insufficiency, as can kidney failure and treatment with steroids.  209 people were studied at the Ohio State University Medical Center in 2008.  The patients were mostly women, with an average age of 40, having had lupus for an average of eight years and having a variety of clinical features, most prevalent being kidney and skin involvement.  Results in these patients indicated that the more vitamin D in the blood, the lower the lupus disease activity, and vice versa.  The authors recommended that all people with lupus continue to use sunscreen and consult with their physicians about adequate intake of vitamin D. 

Source:  LFA  Research Report  

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Men Can Have Lupus

Even though 90% of cases of lupus are diagnosed in women of child bearing age, the other 10% of cases are in men, with much the same symptoms and treatment.  The Lupus Foundation of America has a Patient Education Series, with information on understanding the disease, living with the disease, coping with the disease, how it affects the body and managing lupus in relation to family life and the workplace.  It also has information on the emotional impact of chronic disease.

Source: www.lupus.org

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Ready To Start Exercising?

Exercise Program

Spring is here and summer is coming soon.  More of us will be outdoors and we will want to take advantage of it by starting to exercise or to exercise more.  We're all different, and the typical caution when beginning any exercise program is to discuss the program with your physician first.

Low impact activities, such as walking, swimming, bicycling, yoga, and pilates, are excellent for toning muscles, aerobic stimulation, and developing stamina.  Most experts recommend 3 to 3 1/2 hours of this kind of activity per week.  One special benefit is increasing bone density, without joint aggravation.

Sometimes the above benefits can be gained by increasing daily activities--walking up stairs instead of taking the elevator, moving around each half hour instead of sitting all the time, or working your arms while you walk.  Try walking around the block a few times per day.

As always, if you have a chronic disease such as lupus, or are a senior, be mindful of your body.  Pain is a warning sign that your routine may have to change.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus and Risk of Heart Disease and Stroke

A systematic review of 28 different studies by researchers from Harvard Medical School assessed two things:  the risk of heart disease and stroke among patients with lupus compared to those without the disease, and which factors can increase the risk of heart disease and stroke for those with lupus.

The findings:

• those with lupus had at lease a two to threefold increased risk of heart disease and stroke compared to those without lupus
• if those with lupus had added risk factors (smoking, increased age, high blood pressure and high cholesterol) there was even a higher risk

For those with lupus, the above facts underscore the importance of prevention:  regular exercise, not smoking, eating a healthy dies to control cholesterol, and controlling blood pressure.  Those with lupus must work with their physicians to monitor their health status and potential risk factors.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Understanding Lupus

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood and kidneys.  It is of special interest to me because my wife has the disease, and so do many of my patients.  Here are some facts to help understand the disease:

• it is an autoimmune disease that causes inflammation and tissue damage
• it is chronic and last a lifetime
• it is not contagious--it can't be caught or given away
• it is not like or related to cancer
• it is not like or related to HIV or AIDS
• it can cause a mild skin rash or achy joints, or can effect internal organs
• it is unpredictable, as symptoms can appear, disappear or change
• it can be mild or life-threatening and requires treatment by a physician
• with appropriate medical care, most people with non-organ threatening lupus lead a full life

Source: Lupus Foundation of America

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus Treatment: Oral and Dental Complications

Syndrome of Lupus

All Lupus patients suffer from some sort of oral involvement, and these complications often come about as a side effect of medical treatment. Certain forms of organ involvement carry dental warnings: with kidney involvement, certain antibiotics (tetracycline) or analgesics (aspirin, NSAIDS) adversely affect kidney function. Antibiotics need to be given prior to treatment for those with Liebman-Sacks Endocarditis (a form of heart involvement) or mitral valve prolapse. Nitrous Oxide (laughing gas) is contraindicated for those with lung problems. Caution should be taken with patients with abnormal bleeding. Those with Sjogren's Syndrome usually have severe dry mouth that may result in massive decay, dental infections, yeast infections and gum disease.

Oral Health 

Medications: Anti-convulsants can cause gum atrophy and bleeding. Anti-malarials (plaquenil) can cause intraoral rashes. Immunosuppressive agents (methotrexate) suppress the immune system and may result in bacterial or fungal infections. NSAIDS (advil, motrin, feldene, daypro) can cause oral ulcers. Steroids--prednisone and other corticosteroids increase the likelihood of bacterial and oral fungal infections. Any medications which cause dry mouth put the patient at risk for tooth decay and gum disease.

Lupus patients require frequent dental checkups and periodontal maintenance to optimize their oral health.

Source:  Lupus Guide to Dental Care, HeatherGalusha-Phillips

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus and Lung Complications Is Common

According to the Johns Hopkins Lupus Center, about 50% of people with Lupus will experience lung issues during the course of their disease.  Lupus Now explains the connection between Lupus and lungs.  Although the underlying connective tissue disease is the root cause of lupus-related lung problems, the exact mechanism can be different for each of the most common conditions.  The most common is pleurisy (inflammation of a membrane on the outside of the lungs and inside of the chest cavity), which causes a fluid buildup and pain. Sometimes the lung tissue itself is involved.  Blood clots in the lungs present another possible complication.  High blood pressure in the lungs' blood vessels can be present.  The good news is that diagnosing these potentially life-threatening conditions is usually straightforward, and treatment is successful in most conditions, especially if caught early.  The two common symptoms are shortness of breath and pain with breathing.  Each lung condition has its own symptoms and diagnostic methods.  Treatment focuses on both the underlying lupus and the specific lung problem.  Your lupus doctor and your pulmonologist are equipped to manage these issues to keep you healthy! 

Source:  Lupus Now

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus and Joint Pain

More that 90% of people with lupus experience joint and/or muscle pain at some time during the course of their illness.  More than half of the people who develop lupus mention pain in their joints as their first symptom.

Symptoms of Lupus 

Inflammation  is the most common reason for muscle pain and aches.  When major inflammation exists (i.e. lupus is a chronic inflammatory disease), the aches, pains and weakness are signs of your body's inability to cope with whatever process has overwhelmed it, especially during periods of increased disease activity (flare).  Lupus arthritis causes pain, stiffness, tenderness and warmth in your joints.  The joints most often affected are the ones farthest from the middle of the body, such as fingers, wrists, elbows, knees, ankles and toes.  General stiffness upon waking in the morning, which gradually improves as the day goes on, is a key feature.  Sometimes joint pain may develop later in the day, and involve several joints, with similar joints on both sides of the body.  Compared to rheumatoid arthritis, lupus arthritis is less disabling and less likely to cause destruction of the joints.  Fewer than 10% of people with lupus arthritis will develop deformities of their hands and feet associated with weakening of cartilage and bone.  


Source:  Lupus Foundation of America    


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Ways To Be Protected from UV Rays

Summer sun safety is all about ultraviolet (UV) radiation.  UVA rays interfere with the skin's immunity, allowing damage to cells and promoting the development of autoimmune antibodies, such as ANAs.  The ANA test is used to confirm a lupus diagnosis.  UVA exposure can trigger symptoms and lead to a lupus diagnosis or trigger cutaneous (skin) lupus or cause flares of existing systemic lupus.  UV photosensitivity can take many forms--feeling sick, having chills, fever, joint pain, in addition to sunburning easily.  There is no such thing as a "safe" tan from UV light.  A "base tan" is only protective melanin produced by the skin to indicate damage has already been done.  Tanning beds, which use UVA rays, are particularly dangerous.  UVB is required for the body to make vitamin D, so sunscreen and clothing decreases UVB exposure and vitamin D.  For a person with lupus, vitamin D supplements or foods with vitamin D are better than increased time in the sun.  The sun is the primary source of UV light and even on cloudy days you can be exposed to 80% of the UV of a sunny day.  UV rays coming through windows can be blocked with coatings.  Rays from halogen and fluorescent bulbs can be blocked with plastic covers, or stay more than four feet away.  Given all of the above, summer is all about skin protection for lupus patients.  Fabrics can be treated to increase SPF levels of protection by adding products to your laundry.  Hats, long sleeves and long pants are recommended.  Sunscreens have an interaction with your skin and need to be added 30 minutes prior to sun exposure.  Sunblocks reflect radiation immediately.  The Academy of Dermatololgy recommends sunscreens containing Mexoryl which blocks UVA-1 and -2 and UVB.  Sunglasses with at least 99% blockage are best and should cover the sides of your face.  

Source:  Lupus Now, Spring 2012

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Adapting to Changes in Cognitive Function

Many diseases, such as lupus, affect cognitive function.  Anything that limits your ability to think clearly, reason, or remember something is a cognitive symptom.  This can involve--trouble concentrating, inability to multitask, poor memory, difficulty finding the right word, slower processing or problem solving.  Those faced with these changes can cope.

Develop A Plan 

A neuropsychological evaluation assesses every part of brain function and identifies strengths and weaknesses.  That's way, each individual can develop a mechanism for adapting.  Here are some ways, recommended by both experts and patients:

• assume you will succeed in your plans
• write down everything you have to do
• take whatever time is necessary to accomplish things and schedule yourself accordingly
• create a way to signal yourself (something you can see) for things to be done, for things finished
• do one thing at a time

Developing skills to work around cognitive difficulties can be both work and fun, and contribute to self acceptance and self esteem.

Source:  www.lupus.org

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Staying Comfortable On Your Feet

It's often said that you can't appreciate or understand how incapacitating an ailment can be, like a severe back problem, until you experience it yourself.  This is also true of foot problems.  Since we use our feet all the time, we can't put them in a sling to isolate them and allow them to heal undisturbed.

Lupus symptoms often include swelling and pain from arthritis in the foot and ankle.  The ache may be constant.  In addition, sometimes feet turn blue from sensitivity to cold.  If you have these symptoms and don't know why, ask your doctor about a potential lupus diagnosis.

More info available at www.lupus.org

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

What Is "Lupus Fog?"

As many as half of all people with lupus describe feelings of confusion, fatigue, memory loss, and difficulty expressing their thoughts.  This collection of symptoms is termed cognitive dysfunction, although many people call it "lupus fog."  It is associated with problems with memory, concentration, speech and logical reasoning.  Currently, it is not understood whether these problems are medication related or a reaction to a chronic illness.

Research is being done to determine the causes of cognitive impairment with lupus.  Staying physically fit and keeping a healthy diet are critically important to good cognitive health.  This means avoidance of nicotine, excessive caffeine, and alcohol, and, equally importantly, it means regular exercise.  Improved organization can also help overcome the difficulties and frustrations associated with worsening memory and concentration.  In addition, separate from lupus fog, people with lupus may be twice as likely to experience migraine-like lupus headaches.  This problem is usually treated by a neurologist, because different types of headaches respond to different types of treatment.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

The Lupus Implications of Staph Infections

Chronic exposure to even small amounts of staph bacteria could be a risk factor for the chronic inflammatory disease lupus, Mayo Clinic research shows.  Staph, short for Staphyloccus aureus, is a germ commonly found on the skin or in the nose, sometimes causing infections.  In the Mayo study, mice were exposed to low doses of a protein found in staph and developed a lupus-like disease, with kidney disease and autoantibodies like those found in the blood of lupus patients.  The findings are published online this month in the Journal of Immunology.

Research on Lupus  

The next step is to study lupus patients to see if the staph protein in question plays a similar role in humans. "We think this protein could be an important clue to what may cause or exacerbate lupus in certain genetically predisposed patients," Dr. Vaidehi Chowdhary, co-author, says.  "Our hope is to confirm these findings in lupus patients and hopefully prevent flares."  In the mice studied, a staph protein activated white blood cells, leading to an inflammatory illness mirroring lupus.

Research on people has shown that carrying staph bacteria is linked to autoimmune diseases such as psoriasis, Kawasaki disease and granulomatosis with polyangilitis.  Since the cause of lupus is still unknown, the discovery of the staph protein's role is exciting, Dr. Chowdhary says.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Managing Lupus When Energy Is Limited

When your energy level is limited, it's hard to balance work, home, and social life in the face of all that life demands.  Learning how to manage time effectively, how to say "no," is a difficult but necessary part of managing lupus.  Overexertion or excess stress can increase fatigue and the fog of lupus, making it difficult to do anything well.  While it is tempting to tackle every opportunity or request that comes your way, doing so is often counterproductive.  In fact, being smarter about your schedule can give you more energy and makes everything better.  Ultimately, managing lupus requires setting boundaries, making lists, prioritizing, and rethinking your schedule according to your energy level.  Let your body be your guide.  Take advantage of your support system, honestly communicate how you are feeling and take it easy if you're not feeling great, and reward yourself with little incentives to take care of yourself. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Learning To Live With A Chronic Condition

The Kubler-Ross model, commonly referred to as the "five stages of grief", is a hypothesis introduced by Elisabeth Kubler-Ross, that says that when a person is faced with the reality of an awful fate, he or she will experience a series of emotional stages of grief.  It was introduced in her 1969 book On Death and Dying. 
Kubler-Ross originally applied these stages to people suffering from terminal illness, but later expanded it to apply to any form of catastrophic personal loss, including the onset of a disease or chronic illness.  Thus, it is applicable to conditions such as multiple sclerosis, lupus, and fibromyalgia, and many others.

• Denial: "I feel fine.  This isn't happening."  Denial is a defense mechanism--to dispute the diagnosis, to try to maintain your lifestyle, to pretend the condition will not affect you.
• Anger: "Why me?  This isn't fair."  You can be angry at your doctor, yourself, your body or your surroundings.
• Bargaining: "I'll do anything for... What if I become a better person?"  This is an attempt to cure yourself, or negotiate away the situation for more freedom from the condition and avoiding treatment by doing good things.
• Depression: "I'm sad, so why bother with anything?  I don't care anymore."  When the illness or condition is a certainty, you may withdraw or lose interest in outside activities.
• Acceptance: "I will move forward."  The goal is to come to terms with the reality of the condition and learn to live with it.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Men Can Have Lupus

Even though 90% of cases of lupus are diagnosed in women of child bearing age, the other 10% of cases are in men, with much the same symptoms and treatment.  The Lupus Foundation of America has a Patient Education Series, with information on understanding the disease, living with the disease, coping with the disease, how it affects the body and managing lupus in relation to family life and the workplace.  It also has information on the emotional impact of chronic disease.

Source: www.lupus.org


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Understanding Lupus

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood and kidneys.  It is of special interest to me because my wife has the disease, and so do many of my patients.  Here are some facts to help understand the disease:

• it is an autoimmune disease that causes inflammation and tissue damage
• it is chronic and last a lifetime
• it is not contagious--it can't be caught or given away
• it is not like or related to cancer
• it is not like or related to HIV or AIDS
• it can cause a mild skin rash or achy joints, or can effect internal organs
• it is unpredictable, as symptoms can appear, disappear or change
• it can be mild or life-threatening and requires treatment by a physician
• with appropriate medical care, most people with non-organ threatening lupus lead a full life

Source: Lupus Foundation of America

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309