IC Disease

Ethex Corporation notified healthcare professionals of a voluntary recall of a single lot of morphine sulfate 60 mg extended release tablets (Lot No. 91762) due to a report of a tablet with twice the appropriate thickness. Oversized tablets may contain as much as two times the labeled level of active morphine sulfate. The lot was distributed by Ethex Corporation under an ‘Ethex” label between April 16th and April 27th of 2008.

An over dosage or over strength of opioids such as morphine have life-threatening consequences, including respiratory depression (difficulty or lack of breathing) and low blood pressure. Due to their illness, many patients for whom this product is prescribed are more likely to be highly debilitated with reduced strength or energy. Their impairment may make it more difficult to determine that a tablet is oversized than an unimpaired individual. For questions about the recall, consumers are encouraged to call their physician, pharmacist or other healthcare provider.

For any questions related to this action, please contact Ethex Customer Service (representatives are available Monday through Friday, 8 am to 5 pm CST):

Telephone 1-800-321-1705
Fax 1- 314-646-3751

Email customer-service@ethex.com

For more information see http://www.fda.gov/oc/po/firmrecalls/ethex06_08.html.

IC Disease patients may find that certain foods and drinks cause their symptoms to flare. This is especially true at the beginning or at the worst part of the illness. When I was at my worst with IC, just drinking water caused excruciating pain and caused my urine to burn terribly.  Until an IC patient has their symptoms and illness under control, an elimination diet may be necessary.  For some patients this may be a life long change they have to make.  For others it can be temporary. 

What can be difficult and confusing for IC patients is that the foods that need to be eliminated are not an across the board, general to everyone with IC type of diet. In order for IC Disease patients to find what foods they can and cannot tolerate, they need to journal their daily food intake and to record what symptoms they experience, if any, after eating each food or drink.

Tomorrow I will cover what foods to avoid for IC patients.

I can’t honestly remember a time in my life when I didn’t have to go to the bathroom much more than everyone else I knew. As a teenager, it was actually a running joke with a close friend of mine that I owed her family cases of toilet paper. I lived about five minutes away (walking distance) from a girl I became good friends with in high school. I would always go to the bathroom before I left my house but by the time I got to her house, would knock on the door, and someone would let me in, I would make a mad dash for their restroom.

My way of dealing with things has always been (and still is) to make jokes and make light of situations when something was wrong. I knew something was wrong with me, I had repeated doctor’s visits for urinary tract infections and bladder infections, but no one ever diagnosed IC Disease. The doctor repeatedly blamed the infections on me saying that I wasn’t wiping properly. I knew how to wipe properly but after a while I just gave up arguing with him about it.

I know now that regardless of what any doctor says, and regardless of what they find in their “tests”, if my instinct tells me something is wrong I am right. For many years I knew my insides weren’t working normally but no one would believe me. I trust ME from now on and you should too.

The European Society for the Study of Interstitial Cystitis Annual Meeting was recently held in Rome from June 5 - 7, 2008.  This year’s meeting consisted of 100 urologists and other healthcare professionals to discuss different presentations that focused on Interstitial Cystitis.  

One goal from this year’s meeting  of the ESSIC was to increase cooperation around the world to learn more about IC Disease and how treatment methods can be improved.  The meeting also included presentations on pain center organization, central nervous system pain processing, evaluation of the pelvic floor in Interstitial Cystitis, irritable bowel syndrome, and vulvar pain syndrome.

Some other topics discussed at the meeting are included below. You can read in detail about each one here.

• Antecedent Non-Bladder Syndromes in a Case Control Study of Interstitial Cystitis/Painful Bladder Syndrome
• Significance of Multidisciplinary Approach to Diagnostics of Causes Of Chronic Pelvic Pain in Women
• Preliminary Data Concerning Pain and Quality of Life in Patients with BPS/IC YKL-40 in Bladder Biopsies from Patients with BPS/IC
• Surgical Treatment of Intractable Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC)
• CISTIC Study Report. Prospective Double-Blind Randomized Controlled Multi- Center Study Investigating the Efficacy of Hyaluronan in BPS/IC
• Bladder Pain Syndrome/Interstitial Cystitis and Vulvodynia: Two Aspects of One Syndrome
• Statistical Analysis of Symptoms, Endoscopy and Urothelial Morphology in Fifty-Eight Bladder Pain Syndrome/Interstitial Cystitis Female Patients
• Urodynamics and Interstitial Cystitis/Painful Bladder Syndrome
• Evaluation of the Efficacy of Intravesical Chondroitin Sulphate in BPS/IC
• Potassium Channel Kv1.3 and Kv1.6 Expression in the Bladder of Patients with Bladder Pain Syndrome/Interstitial Cystitis: A Controlled Study
• GRC 6211, the New TRPV1 Oral Antagonist Diminishes Pain in the Rat Model of BPS/IC

According to the IC Network, approximately 10% of Interstitial Cystitis patients are men but that figure has been disputed.  While the illness is mainly regarded as a “women’s disease”, men are afflicted and suffer as well.  It is thought that there have been several men diagnosed with chronic prostatitis who in fact have Interstitial Cystitis.

At an IC National Meeting, Dr. Robert Evans, a urologist, shared with other physicians the results of a small study that focused on IC Disease in men. Here is some of what he discovered:

Men have as much trouble obtaining a proper diagnosis as women, waiting an average of 4.3 years before diagnosis.

Men have symptoms on average of 3.6 years before diagnosis.

The average age of onset with men is 48 years old.

76% percent of patients were diagnosed with prostatitis, 2% with urethral strictures, 12% with non-specific urethritis, 60% with an enlarged prostate.

44% had a transurethreal prostatectomy with no improvement of symptoms.

100% were told, at some point in time, that they had a prostate or bladder infection.

Men have symptoms that include urinary frequency, frequency at night, pressure and pain in the bladder, scrotum, perineum and penis. Men can also have reduced urine stream and retain urine.

Diagnosing IC Disease in men is similar to women except with men, the doctor must rule out all diseases/conditions related to the prostate. Men typically have a prostate exam.

While it is obvious that Interstitial Cystitis patients use many medical resources, there hasn’t been enough research done on what the economic burden of the illness has caused.

Researchers from Chicago and Portland attempted to determine the direct medical costs to the healthcare system associated with a diagnosis of IC Disease. Their goal was also to determine specific medication and procedure patterns in IC patients. The study partipants included members of Kaiser Permanente Northwest.  Here were the study results:

They found that mean yearly costs were 2.4 times greater for patients than for controls ($7100 versus $2994) and the median yearly costs were 3.8-fold greater ($5000 verses $1304). The costs differences were mainly a result of outpatient and pharmacy expenses. An analysis of medical comorbidities suggested that the excess costs for the patients were more likely attributable to BPS/IC than to accompanying comorbidities incorporated into the treatment-risk model. The relative cost difference was most pronounced for the youngest individuals (25-50 years).

The study authors wanted to note, however, that the costs they report in their analysis may have underestimated the true cost of the disease for different reasons.

They did not reflect IC-related costs accrued before diagnosis and did not included services not covered by Kaiser. They did not incorporate indirect costs, which are much harder to measure, such as work loss due to symptoms. Without a reliably effective treatment, this cost structure could persist for extended periods.

source

As I had previously discussed in this Lupus series, there currently is not a cure for Lupus but the illness can be managed for most patients.  An early diagnosis and appropriate medical care can help control the disease and keep it from progressing.  Treating Lupus is different for each patient, as it needs to be tailored to the specific problems and symptoms that occur in each patient.  Before prescribing a treatment the physician will need to take into consideration:

• the severity of symptoms
• if there is organ involvement
• the patient’s age
• patient’s overall health
• patient’s lifestyle
• the risk of side effects

Here is what the Lupus Foundation of America says about treating Lupus:

For mild cases of lupus, when there is little disease activity and no major organ involved, treatment may be managed by a primary care doctor, such as a pediatrician, for children and teens, a family practitioner, or an internal medicine physician, for adults. However, when lupus is active and the person needs to be watched for complications, he or she should be under the care of a specialist, usually a rheumatologist (a physician specially trained to treat musculoskeletal and joint disease).

If lupus has caused damage to a particular organ, other specialists will be consulted as well: a dermatologist for cutaneous lupus (skin disease), a cardiologist for heart disease, a nephrologist for kidney disease, a neurologist for nervous system involvement, and others as the clinical findings require. An obstetrician or perinatologist who specializes in high risk pregnancies will also be needed when a woman with lupus is considering a pregnancy.

Physicians will use a variety of medications to treat Lupus. These medications are used to treat pain, inflammation, swelling, fever, and they help to suppress overactive immune systems. Dosages prescribed depend on the individual and combination of medications are typically used to help ease treatments.

There are four different types of Lupus.  These include:

• Discoid (cutaneous)
• Systemic
• Drug-induced
• Neonatal

Discoid Lupus
Discoid Lupus affects the skin.  People with this form of Lupus will have a rash that appears on the face, neck and/or scalp.  Discoid Lupus is diagnosed by biopsying the rash.  There is typically no organ involvement in Discoid Lupus and a few people with this form of illness can have a negative ANA blood test.   The majority will have a positive ANA but at a low level, however.

According to the LFA:

In approximately 10 percent of patients, discoid lupus can evolve into the systemic form of the disease, which can affect almost any organ or system of the body. This cannot be predicted or prevented. Treatment of discoid lupus will not prevent its progression to the systemic form. Individuals who progress to the systemic form probably had systemic lupus at the outset, with the discoid rash as their main symptom.

Systemic Lupus
This is a more severe form of Lupus and it can affect not only the skin and joints but also any organ system in the body. Some people may have a less severe case of Systemic Lupus where only the skin and joints are involved. For others with this form of the disease, there may be involvement in the skin, joints, lungs, kidneys, other organs, tissues and even blood. The LFA says:

Systemic lupus may include periods in which few, if any, symptoms are evident (”remission”) and other times when the disease becomes more active (”flare”). Most often when people mention “lupus,” they are referring to the systemic form of the disease.

Drug-induced Lupus
People can end up with drug-induced lupus after taking certain prescription medications. The symptoms of drug-induced lupus and systemic lupus are similar. The prescription medications most commonly linked with drug-induced lupus include:

• hydralazine - used to treat high blood pressure/hypertension
• procainamide - used to treat irregular heart rhythms

It is estimated that only about 4% of people who take these medications will develop the antibodies that suggest drug-induced lupus.  Out of those 4%, a very small percentage will develop full blown drug-induced lupus.  Symptoms will disappear once medication use is stopped.  This form of Lupus is more common in men.

Neonatal Lupus
This is a rare form of Lupus that is acquired through the passage of maternal autoantibodies and can affect the skin, heart and blood of the fetus and newborn. The LFA states:

It is associated with a rash that appears within the first several weeks of life and may persist for about six months before disappearing. Congenital heart block is much less common than the skin rash. Neonatal lupus is not systemic lupus.

Thanks so much to everyone who participated in my first blog carnival here on the IC Disease Blog!  I am excited that I received so many entries.  This month I didn’t have a theme set up for the carnival.  The only thing I requested was that the posts be health-related. 

Next month’s blog carnival will be on chronic pain.  So please choose your favorite post and submit it here for the next carnival on July 23, 2008.  The deadline for submissions is July 18th. 

Tina Samuels presents IC Signs and Symptoms posted at Chronic Pain Today.

Jacki Donaldson presents Lucky posted at my Breast Cancer blog.

Jen Miller presents Fibromyalgia & Hormonal Flares posted at happyfibrofamily.

Romy presents Changing Your Lifestyle: Does Your Diet Affect Your Anxiety? posted at Cool as a Cucumber, Calm as the Sea. Romy says, “I hope this post can help some of you, even those of you who don’t have an anxiety disorder. Even if you’ve just been a bit tense and snappy at work; following these tips should help.”

Andrea presents » The Tooth Fairy and Sensory Integration My Autism Insights posted at My Autism Insights.

Marijke presents Emergency! What to do if a pregnant woman chokes posted at Womb Within. Marijke says, “Emergencies can happen to pregnant women too. Would you know what to do if a pregnant woman was choking?”

Axel Gjertsen presents Suicidal Depression posted at axel g.

Kristy presents » What does the future hold? MOSAIC MOMENTS posted at MOSAIC MOMENTS. Kristy says, “This particular posting shows that nothing is impossible for people with disabilities. There are so many misconceptions out there for mosaic Down syndrome and Down syndrome, that Down syndrome is now closing in to the “Endangered Species” list. I chose this posting, to show others that people with mosaic Down syndrome and Down syndrome CAN do remarkable things. It is just a matter of perspective and how the child is raised.”

Joe Lastier presents Relieving Neuropathy Pain Naturally With Vitamins C and E posted at Natural Pain Relief.

James Chambers presents Hyperhidrosis Causes posted at Hyperhidrosis.

Sara presents Finding comfort with fibromyalgia posted at The Fibromyalgia Experiment.

Bob Morgan presents Knowing More About Acupuncture Depression Treatment | Acupuncture For Pain, Weight Loss, Depression, Cancer, Allergy and Infertility posted at Acupuncture For Pain, Weight Loss, Depression, Cancer, Allergy and Infertility.

Sophia - Healthy Perspectives presents Healthy Perspectives: Take My Breath Away…Literally! posted at Healthy Perspectives.

Marijke presents Bone marrow transplants - would you be a donor? posted at Marijke: nurse turned writer. Marijke says, “Many people don’t realize how bone marrow donations can save a life. Read about what is involved in being on the bone marrow registry and how you can help save a life.”

Kathleen Roberts presents The Clothespin Challenge posted at Easing Chronic Pain. “Here is a great way to show people what your chronic pain is really like.”

Diana Bertoldo presents Stress And Illness: Do Your Beliefs Impede Your Path Towards Health And Healing? posted at Live Beyond Stress and Illness.

Sandi Valentine presents Staying Active During Pregnancy posted at The Pregnant Pause.

Abigail Steidley presents More About the Mind Body Connection posted at The Vagina Dialogues.

Marijke presents Painful dry mouth from medications posted at Help My Hurt. Marijke says, “This is a guest post by a friend of mine who gives a very good explanation on the damage dry mouth can do, as well as some hints to help minimize the damage.”

Sandy Robinson presents Resources: Pain Books & DVDs posted at Fighting Fatigue.

Aparna presents Kapalabhati Pranayam posted at Beauty & Personal Grooming.

Heather Johnson presents The Truth behind SBS Symptoms – Is it Out There? posted at Shaken Baby Syndrome.

Shaheen Lakhan presents Self-Medicating with Over-The-Counter Medicines for Mental Illness posted at Brain Blogger. Shaheen says, “Self-diagnosis, -treatment, and -monitoring is widespread due to the expansion of healthcare and the surplus of medical information available via television, radio, magazines, and the internet. But relying on yourself for medication can lead to dangerous consequences.”

Cancerkitty presents Vaccinations: Good or Bad? posted at DelSquacho. Cancerkitty says, “Are vaccinations dangerous?”

Angie Hurst presents A Link Between Blood Sugar And Alzheimer’s? posted at Vibrant Healthy U.

Robin Cagle presents Fibromyalgia and Depression posted at Ponderings and Pawprints.

Lupus is another chronic disease that there currently is not a cure for. While the illness will never go away (unless a cure is found), symptoms can go into remission and doctors can control the illness with medication. That doesn’t mean that the patient still doesn’t suffer, however.  If a patient is diagnosed early in the disease process this too can help physicians to keep the illness under control. 

If diagnosed early, treatments and medications can help reduce symptoms, reduce inflammation, control pain, and keep serious complications from occurring. According to the Lupus Foundation of America:

For mild cases of lupus, when there is little disease activity and no major organ involved, treatment may be managed by a primary care doctor, such as a pediatrician, for children and teens, a family practitioner, or an internal medicine physician, for adults. However, when lupus is active and the person needs to be watched for complications, he or she should be under the care of a specialist, usually a rheumatologist (a physician specially trained to treat musculoskeletal and joint disease).

If the disease has progressed to where other organs are involved, other specialists will need to be consulted such as a dermatologist for cutaneous lupus (skin disease), a cardiologist for heart disease, a nephrologist for kidney disease, a neurologist for nervous system involvement, and others if necessary.

Tests to Diagnose Lupus
When a doctor suspects a patient has Lupus, certain blood tests are done to see how the patient’s immune system is functioning. Physicians look for evidence of autoantibodies. It takes more than one blood test to diagnose Lupus. There is currently not just one test for Lupus. The tests usually run when Lupus is suspected include:

• Sedimentation rate (ESR) , also reffered to as the “SED” rate, and C-reactive protein (CRP) binding.
• Routine blood tests that can reveal if the patient has anemia, low platelet and low white blood cell counts.
• Serum protein electrophoresis which may reveal increased gammaglobulin and decreased albumin.
• Chemistry panels that can tell if there is kidney involvement, liver function abnormalities, and increased muscle enzymes.

According to the LFA, if Lupus is suspected these tests are also run:

Anti-nuclear antibody test (ANA) to determine if autoantibodies to cell nuclei are present in the blood.
Anti-DNA antibody test to determine if there are antibodies to the genetic material in the cell.
Anti-Sm antibody test to determine if there are antibodies to Sm, which is a ribonucleoprotein found in the cell nucleus.
Serum (blood) complement test to examine the total level of a group of proteins which can be consumed in immune reactions.
Complement proteins C3 and C4 test to examine specific levels.