Depression and Anxiety in RA Patients

Results from a 2012 study support growing evidence of high rates of symptoms of anxiety amongst people diagnosed with RA.  However, risk factors for anxiety, unlike for depression, have not been systematically examined in relation to RA.  Authors caution that lack of consistent cut-off points in different measurement scales of anxiety and depression make prevalence estimates and meta-analytic studies challenging (Covic, 2012).

Anxiety is also common in MS and I have experienced more anxious feelings as my disease has changed and progressed.  It manifests primarily as irritability and impatience with others.  My neurologist prescribed a medication to use as needed when generalized anxiety arises which has been a blessing.

What is interesting is that my rheumatologist has not asked me about anxiety or depression.  I recently received a copy of my medical records and notice that my rheumy has made note of my mood and demeanor.  For one visit she listed “cheerful” and another “mood appropriate.”  We have never discussed my depression or anxiety. 

Read this post in its entirety:
Depression and Anxiety More Common When Living with RA

Be Straight With Your Doctor

An excerpt from a recent post at HealthCentral:

Earlier this month, I wrote about the stress and anxiety I have been experiencing lately.  It's hard to believe that it was almost three weeks ago I wrote that post.  I blinked and here we are at the end of April.

Before my appointment with the nurse practitioner at the neurology clinic, I filled out the symptom checklist (found on page 3 of the returning MS patient forms).  The checklist is very helpful.  Along the left side of the page are symptoms such as loss of vision, vertigo, weakness (arms/hands - left/right), trouble walking/falling, memory loss/cognitive problems, bowel problems, etc.  For each symptom, you are asked to indicate on a scale of 0 to 5 the severity of each symptom (0=absent, 1=mild, 3=moderate, 5=severe).

For the symptom “depression/anxiety,” I went for the maximum and indicated a “5.”  When my nurse came into the room and quickly glanced at the checklist, she was able to zero in on my current, most disabling symptom.  No beating around the bush.  We got down to business and talked about the state of my mental health.

Read this post in its entirety:

Anxiety and Multiple Sclerosis: Seek Help!

Anxiety vs. Depression as Experienced by Arthritis Patients

A new study published in Arthritis Care & Research suggests that one third of US adults living with doctor-diagnosed arthritis (including rheumatoid arthritis, gout, lupus, fibromyalgia, or some other form of arthritis) aged 45 or older report having anxiety, depression, or both.  The study comprised a phone survey of 1,793 individuals living with arthritis from the Arthritis Condition and Health Effects Survey (ACHES) which is the most comprehensive population-based national survey of US adults with arthritis to date.

Eighteen percent of respondents reported having depression, a common comorbidity in patients living with chronic illnesses including rheumatoid arthritis (Murphy, 2012). In previous studies involving RA patients, nearly 20% of patients experienced depression (Söderlin, 2000).  Whether we’re talking about arthritis, rheumatoid arthritis or rheumatic diseases, it seems that rates of depression have remained similar over time.

In the current study, almost twice as many people living with arthritis experienced anxiety (30.5%) as compared to depression (17.5%).  Eighty-four percent of respondents with depression also reported anxiety.  Thus a significant portion of patients (14.7%) living with arthritis experience both depression and anxiety.

Have you ever experienced depression or anxiety, or both, and do you live with a rheumatic disease?

Read this post in its entirety:

Anxiety is More Common in Arthritis Patients Than Depression

Carnival of MS Bloggers #113

Welcome to the Carnival of MS Bloggers, a bi-weekly compendium of thoughts and experiences shared by those living with multiple sclerosis.

The Diagnosis Game, Power of "Om," and Coping with Challenges

Note: My apologies for delayed publishing of the Carnival. Life has been crazy with plumbing issues, solo festivals, and a personal battle with depression and anxiety.

Limbolanders: Deal or No Deal?

by Laura of Inside MyStory

Howie Mandel has invited you to a special edition of “Deal or No Deal,” where the lovely but scantily clad physicians assistants and nurses present you with the opportunity to walk away the big winner. But first you have to pick the right briefcase containing your prize. Slowly you will pick off the cases one-by-one….

Beginning with the first pick, the crowd applauds when the case is opened to reveal Lyme disease. It’s off the board now – the blood tests confirm you’ve not been bitten by a tick. Whew, that was easy.

The next case you pick wipes a big disease off the board – SLE , no, not the latest Cadillac model, but Systemic Lupus Erythematosus. The audience moans a bit but you tell them that’s ok because there is still lots of big stuff left on the board.

Next pick and the crowd goes wild when you knock STROKE off the board. Such a simple common medical problem, anyone can settle for stroke, and you are sure you are destined for something more.

You press on with the game, being tempted with offers to settle from The Doctor, who is substituting for The Banker, in this special Deal or No Deal episode. Your support team urges you to say no deal and keep pressing on.

The stakes are growing because you are down to just a few cases left … which one holds the ultimate prize? Which one sends you home with the most to show for your efforts?

Oh no! The next case you picked contains Central nervous system (CNS) Angitis, and your neurological deficits can no longer be blamed on CNS Angitis.

To sweeten the deal, The Doctor offers you the opportunity to walk away in exchange for Psychological Counseling for life, and not just group therapy- this is individual one-on-one time with the shrink. You think long and hard, because it is tempting. You know you have depression and you know Howie has also done extensive psychotherapy for his OCD and look at what a success he is…. But you are no Howie Mandel and decide that this really isn’t in your head. After a lengthy commercial break while you ponder the choice, in the end you turn down the offer and keep playing.

The moment of truth has come – two cases left. You know you still have Multiple Sclerosis on the board. The second case contains the most dreaded prize of all – come back in six months. Which one does your case hold? The crowd is hushed and you are so excited with anticipation you can barely keep your legs under you.

Background music begins to play while Howie faces the camera and announces the time is up and you’ll have to return for the next episode to find out how you finish Deal or No Deal.

The Diagnosis Slow Lane 

by Olivia of Chronic

I am in the slow lane of the diagnosis process...
In some ways that seems good, surely that means things aren't too bad right?
I am thankful my cervical MRI showed no lesions!
I had a mental party after this news!
Next, my new neurologist has me set up for another
nerve conduction study and a lumbar puncture. (YIKES)
I am also seeing a urologist because I have had back to
back Urinary Tract Infections and a bladder that seriously has a mind of its own.
Next week the urologist will do some type of catheter test to show more of what is going on with my bladder. He seems to think it is a mis firing of my brain telling the bladder to empty and then it will not empty completely.
We will see.
I am sharing these details because when my symptoms first started I cruised the internet trying to find anyone who had a diagnosis story, I know we are all different but maybe my story will make this road a little easier for someone else.
In the meantime I just have to keep on keepin on.
That means, kids school drop off and pick up, laundry, cleaning house, dishes, dinner, and most importantly loving on my loved ones.
I am still dealing with overwhelming waves of fatigue, spasticity, mental delay, bladder frequency/urgency, numbness, tingling, burning nerve pain etc.
However, the show must go on...at a much slower pace mind you.
My house is not perfectly clean but it is decent and my family and friends are loved.
I continue to do yoga twice a day and meditate at least twice a day.
My whole family loves the meditation music....so there are some good things from all of this.

My prayer for today:
Focus on sending out loving energy,
even when my body is screaming it is too tired or it hurts too much.
Continue to learn how to love my new body.

Hugs and blessings to all!
xo
Olivia

Please Don’t Make Me Om

by msguidedjourney

The Yoga Paintings of Jan Hyde

I had always disliked yoga. I actually really loathed yoga. I just didn’t have the yoga personality. I had things to do, people to see, places to go and you mean to tell me I need to cover myself in a blanket and do Shavasana?  If you have never practiced yoga, Google it. It’s the corpse pose. I guess I didn’t have an appreciation for lying still in a corpse-like posture while listening to meditation music and seagulls.  And the mere thought of oming in a room full of people made me want to snicker because it just seemed so silly.

I first tried yoga in a class that was held above the garage of a woman my sister knew. It was a nice studio and Mary seemed like a nice person, but each week when my mom, sister and I went, I felt more and more stressed. I found that I just couldn’t stand the slow pace; the quieting of the mind. I did the 6 week session and declared that yoga just wasn’t my sport. I tried it one more time at the local Y and the instructor showed up wearing jeans to teach the class and she would actually fall asleep, complete with loud snoring, during Shavasana. The only time she seemed like a yoga “teacher” was the time that I sat silently while everyone else omed their three oms; one to the room, one to the earth and one to the universe. She would look at me and sternly say, “let’s try that one more time.”  Please don’t make me om!

That was about 8 years ago and I had the idea in my head that yoga actually made me angry.  When my MS specialist told me that yoga was a very good exercise for people with MS, I still avoided it for several months. On one of my last rides home from Pilates, I happened to drive by a studio that just caught my eye.  It was an old mill building with a brook running beneath it.  I went online, found the website and saw that the schedule was very flexible. There was no commitment to take a set amount of classes. My friend S had been trying to get me to revisit yoga and when I told her about this studio she tried a free class. She loved the place and assured me that there was no oming involved.  I decided to give it a go.  It was a large, but not too large, stylishly Zen studio, comfortably warm and dimly lit.  I immediately felt comfortable there.  The first class I tried was a Vinyasa Sundown Flow and it was very physical.  I felt challenged in that it required a lot of upper body strength and the instructor moved rather quickly from one pose to the next, thus the flow aspect.   It was nothing like any yoga class I had ever done and while maybe that class was too physical for a beginner, I bought a five class pass and started trying different classes twice a week.

One of my favorite classes is the beginner class on Monday mornings and I find it to be a fantastic way to begin the week.  On sunny days, the large windows that wrap around three sides of the studio, provide yoga mat sized sunny patches that make me feel like a cat in the sunshine.  The instructor is so warm and engaging, I would probably om while standing on my head if that is what she asked of me.  While that was probably an exaggeration,  I have been known to now om on occasion and it no longer feels wrong to me.  Shavasana has become my favorite part of class.  Last night I went to a gentle yoga with mediation class and the instructor went around the class during this quiet time, massaging each students head and using aromatherapy oil to give a blessing on our foreheads.  It felt amazing to have my MS rattled head pampered in such a way.  I have also participated in a work shop that was 3 hours of restorative poses, which essentially was an afternoon of creative Shavasana and was simply amazing.

I have caught yoga fever and I’m not looking for a cure.  Whether or not you have a specific health issue, yoga seems to be an all around whole body fitness routine that not only engages your physicality, but also your mind.  As anyone with MS has experienced, closing your eyes while standing straight with arms at your side results in an automatic swaying of the body, but yoga has improved this for me personally as it is excellent for challenging your balance.  I highly recommend it and suggest that you don’t give up before trying it at several studios to find your comfort zone. May the pure light of your spirit shine and guide you through each day… Namaste.

To spend three coins 

by Dan Digman

All I remember is standing on the basketball court one evening at the elementary school I attended across the street from my home. I was taking a break from shooting baskets, and I caught myself staring at our family’s one-story light green house.

It was the last place I wanted to go.

I don’t recall exactly how old I was, but I was old enough to know the realities of a life lost after earlier in the day I had seen my dad cry for the first time. My mom wept with him and, seeing them both so sad, my brother, sister and I cried too.

Dad had received the call that his brother Jerry – my Uncle Doc – passed away at his home in Dyersville, the town where my dad and his 13 siblings had grown up.

It was going to be a sad night, a sad day tomorrow, and another sad day at the funeral when I knew I was going to see all of my beloved aunts and uncles cry as well. I had never see any of them cry before either.

All I wanted was a free pass.

I just wanted to make this all go away and get our lives back to the place where everything was familiar, comfortable and manageable again. I longed for something to fast-forward me past the sadness of my Uncle Doc’s death to the time where all this dust was settled and life was back to normal.

I realized one day it would be better – time heals all wounds – but I was afraid, and I just didn’t know how I was going to be strong enough to get through this.

And so, in my creative elementary school-aged mind, I developed a revolutionary thought:

What if when we were born, God gave us three coins – free passes, if you will – that we could use at any time in our lives. Three opportunities to fast-forward through a difficult time and pick life back up once everything returned to “normal.” We’d have the memories of the experiences we skipped over, but we’d be able to bypass and avoid the pain, fear, sadness and anxiousness that accompanies such overwhelming situations.

Three coins. But when they’re gone, they’re gone. This meant that you really would have to think long and hard, using them only when you were facing what you felt were truly going to be the most overwhelming circumstances you’d ever face.

With this revolutionary thought, I picked up my basketball and went home to face the realities I was avoiding. I realized that even if I did have three coins, I wouldn’t need to use one at this time in my life. I would be strong. This too would pass.

Through a series of sad days, seeing my uncle laid to rest and seeing my dad and his siblings cry together, each new day thereafter was less painful than its yesterday. Soon the dust settled and life was back to normal. I made it through, even without one of my three coins.

I realize such an outlook was developed by my elementary school self, but I’ve carried the three coins thought with me every day since.

I look back on all the times in my life where I wished these three coins were real. Times when I was afraid, and I just didn’t know how I was going to be strong enough to get through them, such as coping with the deaths of my grandmothers, getting diagnosed with Multiple Sclerosis and living through a previously failed marriage.

Through each of these moments, I had convinced myself that if I had a free pass I would have cashed it in and fast-forwarded through the difficult time. If this indeed were the case, I would have found myself today at 39 years old and without any of my three coins.

The reality is, it would have been wasteful to have cashed in my coins on any of these moments. I stand here today living a life where everything is familiar, comfortable and manageable, even after living through the pain, fear, sadness and anxiousness of events like the death of loved ones, an MS diagnosis and a divorce. And I didn’t need any coins to do it.

At the end of each day, I find comfort in knowing that with or without the three coins, I will receive the strength through my God, family and friends to make it through the challenges and difficulties in life.

Perhaps these are the three coins I was given when I was born – God, family and friends – and these collectively will be available to me in unlimited supplies to help me move forward through the most overwhelming circumstances I’ll ever face.

I often find ways here to incorporate a Springsteen lyric that inspires me in times of need, but here with my three coins, I turn to a scripture reading – Matthew 7:7 – that my Grandma Otten had hanging on a plaque in her kitchen that showed a picture of Jesus knocking on a door:

“Ask, and it shall be given you; seek, and ye shall find; knock, and it shall be opened unto you.”

Whatever your faith or beliefs, I wish you the best in discovering the three coins that will help you along your journeys through life.


This concludes the 113th edition of the Carnival.  The next Carnival of MS Bloggers will be hosted here on May 10, 2012. Please remember to submit a post (via email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, May 8, 2012.

Thank you.

Comments for this post.

Taking Time For Yourself to Counter Stress and Anxiety

After writing about anxiety and life events of the past week (post excerpted below), I took a few days away from blogging to get some rest.  For the next few weeks, I really need to focus on events in my physical life.  Please excuse me if it gets a little quiet around here.  Thanks. 

*****
Life has been crazy lately.  I seem to be two steps behind, no matter which direction I reach.  As I result, I feel the stress and anxiety beginning to mount.  In fact, it is already mounted and is at a full gallop.  I’m being dragged behind the tallest imaginary Clydesdale horse I’ve ever seen.  I’m trying to find my feet.

Since the beginning of this year, life has been moving at lightning speed.  Some of it has been exhilarating, some of it has been duty-bound.  All of it has zapped my energy reserve and I’d like for it to slow down just a bit.  So many tasks accomplished, but still too many left undone with ends dangling loose. 

Take writing a post, for example.  I have started many started.  I’ve begun research on great topics.  I’ve read hours of material and saved countless pdf files on my computer for future reference.  Yet, I’ve not been able to complete them to be shared here on HealthCentral. 

Can I be straight with you?  I am underwhelmed with my ability to keep things under control lately.  I am seeing the monster called depression (usually stuck in the corner pouting because he can’t be set free) grow braver and venture out of its cage to cause mischief and mayhem.  (Side note: the word mayhem makes me smile a bit.  Reminds me of the car insurance commercials with the “mayhem” character.  Love those.)

Read this post in its entirety:

Stress, Anxiety, Multiple Sclerosis, and Mayhem

I cried today.

In the past few days, I've accomplished much less than I desired.  Not that I haven't been busy, because I have, but that there is so much more to be done.

Just as I mentioned in the recent "superpowers" post, I wish that I could simply conceptualize something and it would be accomplished, completed, created, finished, etc. 

That's not the way things work.  So today, when Rob and I were talking about what needed to happened (or that we wished would happen) before joining our households, I began crying. 

Just a frown at first, then halted breathing, and finally full-blown tears.  It was uncontrollable (kinda like my life feels right now).

I can't do everything by myself.  I can't do it all alone. 

At least I exploded in tears rather than in some other way.

So today, it was good, I cried.

Anxiety Disorders and Multiple Sclerosis

Much has been written about MS and depression, but very little about MS and anxiety disorders, specifically panic disorder, obsessive compulsive disorder, and generalized anxiety disorder.

I found a fascinating article in the journal Multiple Sclerosis, Anxiety disorders and their clinical correlates in multiple sclerosis patients by M Korostil and A Feinstein (Multiple Sclerosis 2007; 13: 67-72), which sought to determine how common anxiety disorders are in patients with multiple sclerosis. The study was completed by collecting neurological and demographic data, as well as interviewing subjects and completing a battery of assessments, of 140 MS patients who attend a neurological outpatient clinic in Toronto, Canada.

The authors conclude...

Anxiety disorders are common in patients with MS, but are frequently overlooked and under-treated. Risk factors include being female, a co-morbid diagnosis of depression, and limited social support. Clinicians should evaluate all MS subjects for anxiety disorders, as they represent a treatable cause of disability in multiple sclerosis.

Read this post in its entirety:

Mental Health and MS: Anxiety Disorders

Annoying mysteries of life from a frustrated blogger

Why is it when you want to be alone that your phone won't stop ringing?

Or when you just want to go online that your computer connection goes kaput?

These are the questions which have plagued me the past few days. I've had such great ideas for blogging, but couldn't get online. Which also means that I've been disconnected from 'the world' where email and other bloggers live. It's hard to imagine how torturous this has been (and is probably will continue to be as I've finally resorted to establishing a dial-up connection for now.)

Then last night, all I wanted to do was to be quiet and calm after the first day back to teaching since Joshua passed. But guess what I got.....the endless phone calls. Aarghh. It's really hard to sound sweet and polite when what you want to do is throw the phone at the wall.

I guess some of my sadness is moving into veiled anger and irritability. Such is the nature of grief I suppose.

And finally today (or rather yesterday) absolutely NO ONLINE computer activity. Double aarghh!! So here I am though using a dial-up, needing to call the appropriate tech service people AGAIN to try to figure out what has gone wrong.

But anyway, I wanted to let folks know....I'm still here....sorta.

And to do it justice the Carnival of MS Bloggers may be late in coming, but it will be coming!!!!

Finally, Rob and I are going on a road trip this weekend. So I'll be absent again for a few days. But I shall return...I promise.

Fear and Anxiety - What are your dreams?

When I was little, music was always part of my life. My parents were young and started college part-time when I was around 4-5 years old. They both pursued undergraduate degrees in music education and I was present for many rehearsals and concerts during those years.

My mother graduated at the very top of her class in 1979 from Central State University (now University of Central Oklahoma), the very same summer I entered puberty. I remember being so upset that my secret had been told when my grandmother and aunt came over to our house to congratulate me on entering womanhood. This all happened when my mother was only 29 years old...10 years younger than I am now.

Don't go telling my secrets.

For as long as I can remember, I always played the piano. Obviously there was a time that I didn't, but I don't recall that time. My mother says that I often tinkered on the upright Baldwin piano they purchased after starting college. The academic advice at the time was not to have a child learn to read music at the same time he/she was learning to read words. So I did not begin taking piano lessons until I was 7 years old and reading quite well. But once I did, I would practice for 2 hours every day while my parents had to pull me from the piano in order to complete their homework. In 6 months, I was playing the familiar "Minuet in G" by J.S.Bach. Alas, my students take much longer to proceed to that point.

So would you imagine that someone with such love and dedication in playing piano might ever experience anxiety before performing? Well, I did although I didn't understand it at the time.

I used to have this dream where first I would have a broken toe, but it was okay because it was my left foot and I didn't need it to perform. Then the dream expanded and I had a broken leg, but it still was okay because I could still play. Then it was a broken arm, but okay because I could still move my fingers over the keys. Then a body cast, but still okay. But then it was my hands, and finally I conceded that maybe...just maybe...I couldn't play that day and I would finally wake up in a sweat. But when I performed there was no clue that I was nervous...ever; and my mom admired my 'cool as a cucumber' demeanor.

The anxiety inside - nobody knew.

During my first experience with optic neuritis in 2000, I was performing backstage for the opera "Tannhauser" with the Baltimore Opera. With my vision completely gone in my right eye and suffering from the prednisone prescribed, I was unable to drive so I carpooled with a violist, husband of a horn player in the National Symphony Orchestra. In "Tannhauser," the backstage horns only play in the first Act and then over 2 hours later near the final scenes. I had lots of time to rest and talk with other backstage folks, one of which was another hornplayer whose mother has MS. So we talked alot. I was not afraid of MS at the time because my MRIs had come back clear for any 'evidence of demyelinating disease.'

I was safe.

But 5 years later when my left hand was behaving irradically, was numb, felt like pins and needles, and fatigued quickly, I was concerned for my music. I had just performed Debussy's "Arabesque No.1" at the end of my students' annual recital and was mortified because I felt my performance was terribly off, although I still received many compliments. I have since listened to the recording and I was correct - it was pretty bad.

Two months later, I was visiting with a neurologist after MRIs and a radiologist's report listed MS as a differential diagnosis for the lesions and inflammation in my cervical spine. There were bloodtests, a spinal tap positive for o-bands, and a round of IV steriods. I remember crying to my dad that, "my hands aren't mine!!"

One of my greatest fears - not having my hands any longer.

When my left hand lost it's grip strength and my fourth finger went limp as a noodle, I was.....upset. I had to convince my new neurologist that this was not acceptable and that I had to do something about it. So I found an occupational therapist who specializes in hands and together we worked hard to build new neuro-pathways to my hand and fingers. After 2 months of very hard work, I began to have my hands back and feeling hope for living a life with MS.

Only a year later, I again lost my hands but this time they were on fire and crippled into stiff fists. I thought MS? but my neurologist said Carpal Tunnel Syndrome. After EMG (electromyelography) and 3 months of failed conservative treatments, I was sent to the hand surgeon for evaluation. He injected both wrists with steriods and thankfully I began to have my hands again. The surgeon is the one who recommended getting the opinion of a rheumatologist who at our first visit said I definitely have rheumatoid arthritis. She conducted an in-office ultrasound of several joints which showed great inflammation and the beginnings of joint erosion on my left hand.

Once again - I just wanted my hands back!!

When you have multiple sclerosis, sometimes you just want back what you used to have - what you once took for granted. Maybe it's your balance, your eyesight, or the absence of shooting pain. Perhaps the fear of permanently losing what you love and treasure causes much fear and anxiety. Maybe it's your career, your independence, or your financial security.

With such variety of unpredictable symptoms, who wouldn't be fearful?

Bladder Dysfunction
Bowel Dysfunction
Changes in Cognitive Function
Dizziness and Vertigo
Depression and other Emotional Changes
MS Fatigue
Difficulty in Walking and/or Balance or Coordination Problems
Abnormal sensations such as Numbness or “pins and needles”
Pain
Sexual Dysfunction
Spasticity
Vision Problems
Headache
Hearing Loss
Itching
Seizures
Speech and Swallowing Disorders
Tremor
and on...and on...

Each growing fear and each moment of anxiety related to losing my hands and my music has led me to contemplate what exactly I would do if I could no longer play or teach. Although it would be devastating to permanently lose use of my hands to MS or RA, I hope that I have become much more than my music over the years.

I dream of always being able to find ways to adapt to my current abilities and to cultivate those abilities unknown as of yet. This blog has provided me with an opportunity to contemplate the possibilities which may come my way in the future.

I dream of being the same me in years to come - no matter if I couldn't walk, or see clearly, or think straight, or play piano, or control my bodily function.

I dream of - ME.