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Spine Health: What You Need to Know

Spine Conditions

October 16th is World Spine Day. World Spine Day is part of Bone and Joint Decade Action Week. The day was formally launched by the World Federation of Chiropractic in 2012, with the goal to raise awareness about spinal health and spine disorders.

World Spine Day will be celebrated on every continent, with health professionals, exercise and rehabilitation experts, public health advocates, schoolchildren and patients all taking part.

If you’ve ever experienced back pain before, you know how much it hurts. Often the problem is muscular, but occasionally the problem is directly related to the spine.

On World Spine Day, we're discussing spine health, what types of problems can develop, risk factors for spinal conditions along with their diagnosis and treatment. Spine Health is important to maintaining good mobility throughout old age. Learn what you can do to prevent these common problems.

Common Types of Spinal Conditions

Spinal Conditions

Degenerative spine and disc conditions:

Other spine conditions and disorders can include:

This link to the website Spine Universe gives you a complete list of all the various spinal conditions and information about them.

Causes of Spine Disorders

Spine disorders have a wide variety of causes depending on the particular condition. For some conditions, the causes are unknown. Common causes include:

  • Abnormal Bone Growth
  • Accidents or falls
  • Cancer
  • Congenital disorders (present since birth)
  • Degenerative wear and tear that comes with ageing
  • Inflammation
  • Infection
  • Inherited disorders
  • Injuries ranging from minor to traumatic

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Risk Factors for Spine Disorders

Factors that can increase the risk of developing a spine disorder include:

  • Excess weight or obesity
  • Improper lifting techniques
  • Nutrition and lifestyle habits such as sedentary lifestyle, low calcium intake, or smoking
  • Other conditions such as osteoarthritis, rheumatoid arthritis, or thyroid disease
  • Overuse from exercise or occupational movement
  • Poor posture
  • Repetitive strenuous activities

Symptoms of Spine Disorders

Signs and symptoms depend on the specific spine disorder and often affect other parts of the body, depending on the area of the spine or spinal cord that is affected. Common symptoms include:

  • Abnormally rounded shoulders or back
  • Back or neck pain that can be sharp and stabbing, dull and aching, or burning
  • Bladder or bowel dysfunction
  • Nausea and/or vomiting
  • Pain radiating in the arms or legs
  • Stiffness or tightness
  • Uneven appearance, such as one shoulder or hip being higher than the other
  • Weakness, numbness, or tingling in the arms or legs
back pain and spinal conditions

Diagnosis of Spine Disorders

Spine experts will conduct a thorough evaluation, including:

  • Physical exam
  • Discussion of personal and family medical history
  • Discussion of symptoms and risk factors
  • Neurological exam, if a nerve injury or disorder is suspected

Depending on each patient’s individual case, your doctors might recommend one or more tests, such as:

  • Magnetic resonance imaging (MRI) scan: MRI uses radio waves and a strong magnet to produce detailed images of the spine. MRI is useful in detecting injuries and disorders in soft tissue such as muscles, ligaments, tendons, spinal cord, and nerves.
  • Computed tomography (CT) scan: CT uses specialized X-rays with or without a contrast agent to produce cross-sectional, 3D images of the spine. CT provides images that are more detailed than plain X-rays for evaluating bone injuries or disorders.
  • X-ray: X-rays of the neck or different areas of the back to check for bone problems such as fractures, other injuries, and chronic disorders.
  • Biopsy: If cancer is suspected, neurosurgeons can take a small tissue sample for analysis under a microscope.
  • Electromyography (EMG): Electrodiagnostic examinations measure electrical activity generated by muscles and nerves. They generally involve seeing how different parts of the body react to stimuli.

Treatment for Spine Disorders

Spine specialists often use one or more treatments, depending on the specific condition or injury. Treatments offered include:

  • Back bracing
  • Cancer treatment such as surgery to remove tumors, radiation therapy, radiosurgery, and chemotherapy
  • Chiropractic Care
  • Ice or heat therapy for injuries
  • Injections, such as corticosteroids or nerve blocks, for pain
  • Massage for relief of back pain
  • Medications such as anti-inflammatories, pain relievers, or muscle relaxers
  • Rehabilitation using physical therapy to strengthen and stretch the back and abdominal muscles
  • Surgery to replace discs, fuse (connect) vertebrae, open up the spinal canal, or repair nerves
healthy spine

Lifestyle Is Important

It’s important to pay attention to your lifestyle when it comes to spine problems. If you are overweight, it puts added pressure on your spine and can cause issues like arthritis to become even more painful. Exercise on a regular basis and do spine strengthening moves such as stretches and yoga.

Be aware of your surroundings in order to avoid accidents and falls. Use proper safety equipment at all times, especially if you are working at heights such as roofs or trees.

Lift properly, using your legs and not your back. Even a minor change in your lifting habits will help to protect you. Engage your core muscles and using lifting straps for heavier items.

Quitting smoking is always good as it helps to increase blood circulation which is always good for the body including the spine.

Conclusion

A healthy spine is a happy spine. If you are experiencing problems with your back, see your Family Physician first to rule out any serious problems. Massage or Chiropractic care may be the first step to healing, or you may need to see a specialist. The important thing is to seek treatment early so you have the best chance of gaining full recovery.


Pamela Jessen lives in Langford, BC Canada. She is a blogger who writes about Chronic Pain, Chronic Fatigue and Invisible Illness at pamelajessen.com.  She also writes for The Mighty,  PainResource.com and various independent publications. Pamela is also a Patient Advocate with the Patient Voices Network in BC.  She sits on 4 committees and one Provincial working group and has also been involved in advocacy work at the Canadian National level as well. Pamela is married to her amazing husband Ray and they have one cat named Dorie. 

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Domestic Violence (It Affects Us All)

****Trigger Warning: This post contains depictions of violence against women.

I’m writing about a difficult and personal subject today. Domestic Violence is rampant in North America, and around the world and while I could write a full book on the subject, I want to address it in the context of my own personal story – that of a person who also lived with Chronic Pain.

The Story

I met Dallas on Christmas Day of 1979 when I was 17 and he was 34. I was instantly smitten with him and he was a charmer who got what he wanted when he wanted it. I was delighted his attentions fell on me because I was lonely and on my own – hitchhiking my way around the US and far from any family or friends.

At first, I didn’t realize that Dallas was also a pathological liar. His natural ability to talk to anyone about anything and sound so convincing, plus his good looks had instantly blinded me to anything that could knock him off the pedestal I had placed him on. Oh sure, some things didn’t really “click” with me and he often told the same stories to people that built him up, but I didn’t really think about it.

I learned very quickly that Dallas was also a jealous man and didn’t like other men paying attention to me – especially when they talked to me. We were both traveling the country now, with no set plans in place, and of course he didn’t have a job (a very common scenario as I would soon figure out), but he was good at getting things from people and so we traipsed around, talking about “settling down” and heading to whatever destination would be best for Dallas to come up with a plan. That involved talking to people – or rather, him talking and me trying to make myself invisible.

The first time he hit me was after we had been sitting in a bar on the ground floor of the truck stop we were staying at. He had gone back to our room for something and when he came back, I was chatting to a gentleman next to me, who had literally just asked: “so how are you tonight”? Dallas grabbed me by the arm, dragged me to our room and then started screaming at me about being unfaithful. He backhanded me so hard, I fell across the bed and onto the floor. He yanked me up by my hair and hit me again and I just took it, I was so shocked. It was the first time of many this happened.

But I stayed. I had been living with Chronic Pain for a couple of years at this point in my life and when he wasn’t in a jealous mood, Dallas was so loving and considerate of me. He kept promising to find us a place and get a job and every few months that would happen. We’d settle somewhere, he’d start working and then do something stupid like write some bad checks or shoplift (or outright steal things from people), and we’d have to pack up and leave town, like regular thieves in the night.

Somehow, over time, this pattern became my fault though. If I WASN’T always in pain, we could just travel around the country – that was his theory. He wanted to be a truck driver, but had lost his license so wasn’t able to drive. He resented me for “holding him back from his dreams,” though I’m not sure how he actually reconciled those thoughts. What was apparent was that everything that went wrong was somehow my fault.

One night, while he was in a rage about life not turning out to be fair, he locked me outside of the wee trailer we staying at, in the middle of the night, while I was naked. It was pouring rain, there were no neighbours nearby (we were living out of town) and it was cold. I pounded on the door, but he wouldn’t let me in, and I finally was forced to hide out in the shed on the property, wrapped in a mouldy blanket I found.

The next morning, he acted like nothing had happened. He never apologised, not in words, but sometimes, he would treat me with kid gloves. I never knew from day to day, or even hour to hour, which version of Dallas I was going to get.

I spent 3 years with this man. At one point, he left me for another woman we had met after he completed a 3-month prison stint for a Parole Violation. I returned home to Canada, worked to save up some money and went back to the US to find him. I was that in love and desperate to be with him. So sad when I think about it now. I even ended up pregnant, until a fight with him turned physical and he beat me badly enough that I lost the baby.

We made up, again…I got pregnant for the second time and ended up giving birth to a lovely little boy on Jan. 30th. This time, we were going to do things right! We found a place in Bellingham, Washington to live, and Dallas began working as a house painter. For 6 months, he actually managed to stay at the same job…I truly thought he’d turned a new leaf, with his son being the motivating factor. We still fought viciously, but he only hit me a couple of times, so I thought we could still work things out. Then I became pregnant again when our son was only 6 months old.

This time, it was different. One day, he told me he was going to Seattle for a quote on a huge painting job that could really put us in the money. He left on a Thursday, promising he’d be back on Sunday night.

He never came back.

I sat at the window of the small room we lived in, waiting all Sunday night, not wanting to admit the truth but by end of the day Monday, I had to admit he was really gone. He abandoned his son and child to be, and me, the woman who had stood by him faithfully through all the pain and beatings and lies.

It took a long time for me to recover. I moved back home to Canada, gave birth to my daughter alone and became a single mom to two wonderful kids. I dreamed about Dallas all the time – what could I have done differently to make him happy? How could I have been a better person for him, so he wouldn’t beat me? What did I do that caused him to hate me so much and how could I track him down again?

I didn’t try to find him again. I did see him twice after he left – he contacted me and came to where I was, first when the kids were 1 and 2 and then again when they were 5 and 6. That was the last time I laid eyes on Dallas, and though I grieved for so many things, I had grown some self-esteem by that point and realized how much better I was on my own. I vowed I would never again be abused in any way.

Forms of Abuse

Physical

Physical abuse is probably what we think of first when we hear the word ‘abuse.’ There were always incidents of yelling and screaming at me, hitting me, pulling my hair, punching me in places that the bruises wouldn’t show and little shoves etc, in front of others to keep me under control. I learned quickly not to start conversations with people and to speak only when I was spoken to, so he didn’t get physical with me.

Mental

Mental abuse is almost harder to take than physical abuse. The bruises heal, but the words said cut deeply into the soul and you start to believe the things being said about you. I was repeatedly told I was a burden, stupid and incapable of doing the most basic things. He called me names on a constant basis, told me I was worthless and that I was lucky he let me stay with him.

Financial

Because Dallas often refused to settle down and work a steady job, money was always tight and we often didn’t know where we would eat on any given day. If we were somewhere settled, it was usually better for a bit, but when we were hitchhiking around, we were dependent on Soup Kitchens and Missions and Shelters for a meal. Sometimes I would have to prostitute myself in order for us to have money. I’m not proud of that, but I did what I needed to do in order to survive.

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Security

Security abuse is rarely talked about, but it’s when you don’t have the stability of a secure place to be. We slept under overpasses and in the desert, at shelters and missions, at the homes of people Dallas would befriend in our travels…we just never knew where we would be at any given time.

It was especially difficult when I was pregnant the first two times. In addition to my Chronic Pain, I was dealing with morning sickness and cravings, and my body ached in ways it never had before. When you sleep on concrete under an overpass with just a mover’s blanket for covering, it does a number on your body.

So, what are the lessons I learned here?

The Lessons

First off, I learned that nothing I could have done would have changed Dallas. Change has to come from within and you have to want to change in order to make change happen. He didn’t see anything wrong with the way we were living except I was a constant burden to him with my chronic pain. When he wasn’t treating me with kid gloves, he was screaming and berating me.

Secondly, I learned that sometimes, people don’t show you exactly who they are right from the start. It took me a long time to accept that the real Dallas was the one who stole and lied and hit and screamed – not the one who could charm the pants off of you.

Thirdly, I learned that there are various forms of abuse and being beaten isn’t the only way that someone can hurt you. It’s especially hard to accept abuse in your life when you already live with chronic pain or illness of some type.

Fourthly, I learned that there are ways of getting out, but you have to find your own inner strength to do it. You have to stop believing the lies being told about you and realize you are worthy of better treatment. For a long time, I didn’t believe that, and I put up with the abuse because that was all I knew. When Dallas was actually loving me, he loved me so good that I could forget the nightmarish parts of our life.

It wasn’t until the next incident would happen that would put him over the edge before I’d be right back in the middle of the terror and despair and wonder why I was allowing this to happen. My self-esteem was being beaten out of me at every turn and it came to the point that I accepted I really was as stupid and worthless as he made me out to be.

Words of Advice

Does any of this sound familiar to you? You may be a victim of Domestic Violence without even realizing it, especially if your spouse isn’t physically abusing you. Financial abuse (withholding money from you), emotional abuse (berating you and calling you names) and mental abuse (separating you from family and friends, keeping you from working, etc.) are all ways that you can be abused without recognizing it at first.

If you realize that are in an abusive situation, you need a plan to get out. Don’t believe for an instant when the person says they’re going to change. They’re not and they never will. It took me 3 whole years to realize that, 3 years of being beaten and downtrodden. Even after I was finally on my own, it took time to accept that I was the innocent party in all of this.

I had a lot of guilt. You may be experiencing some guilt, as well. If only…if only I’d been a better partner. If only I’d kept my mouth shut. If only the house was cleaner or the kids were better behaved. If only I hadn’t asked for grocery money or needed tampons. The “if onlys” are so hard to deal with, but you need to accept that you are not the one who is at fault. The abuser chooses to abuse…it’s as simple as that. We all have a choice in how we handle situations and most of us choose not to hurt other people.

There are shelters and organizations that can help you if you are in an abusive situation and need to get out. It’s true that most shelters are overcrowded, but you still owe it to yourself to try them. Talk to people who run them to find out what all your options are. Start building a plan to get out, even if it can’t happen immediately. Start by calling the crisis lines in your area or any mental health organization. Here’s a list to help you get started: List of International Domestic Violence Hotlines and Advocacy Organizations

Document everything that’s going on including injuries and outward marks on your body. If you’re able to take pictures that you can safely keep (or send to someone and then delete), do so. If you can safely keep a journal, do so. If you can safely confide in one person…do so. All of this will become helpful if you decide to prosecute your abuser.

Above all, remember that there is always hope. Do what you can to minimize the violence in your situation while looking for ways to get out safely. It may not seem possible now, but don’t give up hope. Confide in someone, and be prepared to make a clean break, without going back to the abuser. You have a beautiful future ahead of you and you deserve every good thing in your life. Remember that.


Pamela Jessen lives in Langford, BC Canada. She is a blogger who writes about Chronic Pain, Chronic Fatigue and Invisible Illness at pamelajessen.com.  She also writes for The Mighty,  PainResource.com and various independent publications. Pamela is also a Patient Advocate with the Patient Voices Network in BC.  She sits on 4 committees and one Provincial working group and has also been involved in advocacy work at the Canadian National level as well. Pamela is married to her amazing husband Ray and they have one cat named Dorie. 

As a survivor of domestic abuse, telling my stories is essential to healing and supporting other women who are or have dealt with abuse from partners, family members or even friends or roommates. Join the Zebra Pit in raising awareness of these issues this October and every day.
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Dental Care And Chronic Illness

I am terrified of the dentist!!! I have a wonderful care provider who is gentle and kind but having to go see him, even for a cleaning, requires medication for anxiety. I was there recently for a cleaning, the right side one week and the left side the next

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Here I am, high on Ativan, with my warm blankie and a bolster under my knees for comfort. You can see my look of trepidation!

And now to work!

Dental Care and Chronic Pain

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Despite my fear, I do this because it’s good for my health. It can be painful in several ways, though. It reminded me how even “normal” things like the dentist aren’t easy when you live with Chronic Pain.

Here are a few tips to make your next visit easier. 

General Thoughts

Get comfy!

Ask for a blanket and something for under your knees to help you feel more comfortable in the chair. Most dental offices are happy to provide these items. If there are headsets available, use one, or bring your own music to help keep you distracted. 

Use sedation if necessary. 

I use Ativan to help relieve my anxiety and it works wonders. It helps me stay relaxed during the visit and then conveniently helps me forget the visit when it’s over. You do need someone to drive you there and back again, but that’s a small price to pay for not being stressed out!

Keep regular appointments

By going for regular appointments, you lessen the amount of work that needs to be done at each cleaning and you catch any other problems sooner rather than later. Follow the schedule set by your dentist. 

Maintain your oral health at home

Take care of your oral health at home with regular brushing, using a brush designed for your requirements (soft or medium bristles, spinning or regular, etc.). Use mouthwash to help protect your teeth and if you suffer from dry mouth (often a problem for those who live with Sjogren’s Syndrome), use a product designed to keep your mouth moist. 

Floss your teeth with every brushing. It’s important to remove plaque that builds up and flossing is the best way of controlling this. 

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Limit Starchy and Sugary food and drinks

These items can lead to decay so it’s important that you limit them or use them in moderation to preserve your dental health. 

Talk to your dentist about mouth pain

If you are experiencing any type of mouth or jaw pain, talk to your dentist to see if you are developing TMJ (temporomandibular joint). This painful condition can be treated in various ways including medication, a mouth guard or possibly surgery. 

Be Aware Of Periodontal Disease

Periodontal disease can have serious effects on your health. If you notice that you have any of the symptoms of gum disease, call your doctor or dentist.

  • Red, swollen, or tender gums.
  • Bleeding when brushing or flossing.
  • Gums that are pulling away from the teeth.
  • Sores or colored patches in the mouth.
  • Persistent bad breath or a bad taste in your mouth.

Special Health Considerations*

Diabetes

Diabetes is a disease that affects your body’s ability to process sugar. It can be managed with treatment. Left untreated, it can cause many kinds of problems, including some in your mouth. These include:

  • Less saliva. This can make your mouth feel very dry.
  • More cavities. Saliva is needed to protect your teeth from cavities.
  • Gum disease. Your gums can become inflamed and bleed.
  • Slow healing. Cold sores or cuts in your mouth may take longer to heal.
  • Infections. You are more likely to get an infection in your mouth.

If you have poor oral health, you are more likely to get diabetes. Gum disease is an infection. Infections cause blood sugar to rise. If you have gum disease and don’t treat it, your blood sugar could increase. This can raise your risk of developing diabetes.

Cardiovascular problems

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Your mouth contains hundreds of different kinds of bacteria. A healthy mouth has the ability to fight off the bad bacteria that cause disease. But when you have gum disease, an infection, or another problem in your mouth, you lose that ability to fight off those germs.

Many studies show an association between gum disease (also called periodontal disease) and cardiovascular disease. The bacteria in your mouth can cause certain types of infection and inflammation. This research suggests that heart disease, clogged arteries, and even stroke could be related to these types.

Another cardiovascular condition linked to oral health is endocarditis. This is an infection in your heart. It is usually caused by bacteria in the bloodstream that attach to weakened areas of the heart. These bacteria could come from your mouth, if your mouth’s normal defenses are down.

Cancer

More than one-third of cancer patients experience problems with their mouth. Cancer and its treatment methods can weaken the body’s immune system. This makes you more likely to get an infection, especially if you have unhealthy gums. They also can cause side effects that affect your mouth. These include:

  • Mouth sores
  • Dry mouth
  • Sensitive gums
  • Jaw pain

HIV/AIDS

HIV and AIDS also weaken your immune system. That puts you more at risk of infections or other oral problems. It is common for people with HIV/AIDS to develop issues in their mouths, including:

  • Mouth sores
  • Dry mouth
  • Thrush (yeast infection of the mouth)
  • White lesions on the tongue
  • Serious gum disease and infection
  • Mouth ulcers

Osteoporosis

Osteoporosis causes your bones to become weaker and more brittle. This could lead to bone loss in your teeth. You could eventually lose teeth because as they become weak and break. In addition, some medicines that treat osteoporosis can cause problems in the bones of the jaw.

Sexually transmitted infections

A number of different sexually transmitted infections (STIs) can cause symptoms in your mouth. These include:

  • HPV (human papillomavirus) – Some strains can cause warts in the mouth or throat. Other strains can cause head and neck cancers. These can be hard to detect. They usually develop at the base of the tongue, the tonsils, or the back of the throat.
  • Herpes – Herpes simplex virus type 1 causes cold sores and other mouth lesions. Type 2 usually causes blisters in the genitals. But both types can be passed between the genitals and mouth. So type 2 could also cause painful blisters in or around the mouth.
  • Gonorrhea – This bacterial infection can cause soreness and burning in your throat. Sometimes you may see white spots in your mouth, as well.
  • Syphilis – In its primary (first) stage, you may get sores (chancres) on your lips, tongue, or other places inside your mouth. The sores may go away, even if left untreated. But you will still have the infection and can spread it.

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Preterm birth

Severe gum disease has been linked to preterm labor and low birth weight in babies. Research suggests that oral bacteria can affect the placenta and interfere with the growth and development of the baby. It also shows that a severe oral infection could trigger labor too early. This could cause the baby to be born prematurely.

Hip Replacement

It is often advised that anyone who has had a hip replacement undergo a course of antibiotics prior to having dental work done. This is to prevent bacteria from entering the blood stream, which can cause problems such as infection with your hip replacement. Talk to your dentist to see what they advise. 

Conclusion

Oral Health Care is important for everyone, but is especially critical if you live with Chronic Illness. See your dentist as recommended and don’t be afraid to call if you notice problems. If you are someone like myself who has a fear of the dentist, ask about solutions such as Ativan, or IV Sedation to make your appointment easier. Don’t let fear put you off from having the mouth and smile of your dreams! Remember…

There Is Always Hope

Resources and Related:


Pamela Jessen lives in Langford, BC Canada. She is a blogger who writes about Chronic Pain, Chronic Fatigue and Invisible Illness at pamelajessen.com.  She also writes for The Mighty,  PainResource.com and various independent publications. Pamela is also a Patient Advocate with the Patient Voices Network in BC.  She sits on 4 committees and one Provincial working group and has also been involved in advocacy work at the Canadian National level as well. Pamela is married to her amazing husband Ray and they have one cat named Dorie. 


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Need a few tips on how to survive the dentist with chronic pain and anxiety? The Zebra Pit had them! You'll also find condition specific care tips for a wide range of conditions in this post and some great resources where you can find out more.
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Poetry For The Invisibly Ill

All That Matters

It’s the Little Things That Matter
They’re the things that mean a lot
They’re the things that I can count on
When I’m giving things a thought

Oh there’s lots of big grand gestures
That are meant to mean big things
But in the end, they aren’t the ones
That tug at my heartstrings

I prefer the smaller hidden ones
The things that seem quite shy
The little acts that are given out
Not meant to catch your eye

It’s the little things that matter
That make a quiet sound
I love them best from all the rest
They make the world go round

by Pamela Jesssen

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I’m fighting a battle that no one can see
Invisible Illness, it’s all inside me
On the outside, I’m perfect, look healthy and fit
But inside is different, and I’m all over it

Pain is my companion each day and each night
And Chronic Fatigue is something else that I fight
My body is aching, from my head to my toes
How long can I do this, God only knows

There’s a feeling of throbbing in all of my joints
My hands and my feet feel like stabbing pinpoints
I’m shaky and trembling and can’t stand up long
And yet on the outside, I look so damn strong

My heart feels so weary each new day I face
The world ’round me screams I must pick up my pace
But my spoons are all gone and I’ve none left to give
And I’m telling you now, this is no way to live

And yet…

There is still hope inside me, and I must be strong
There are good days ahead and for those days I long
I still have my loved ones who stand at my side
My husband’s amazing, my kids are my pride

My cat loves to cuddle, she seeks out my lap
I love her, she’s purrfect, a warm furry wrap
My garden is growing, there’s roses galore
Hydrangeas, Marigolds, Pansies and more

I’ve good books to read and Netflix to binge
Avengers! The X-Men! Superheros! (don’t cringe!)
A good movie can take my mind off of my pain
And there’s several I don’t mind watching again

What I’m trying to say is there are good things in life
And I have to cling on to them, despite any strife
For these are the things that help me get through the days
We all have our tricks, and we all have our ways

I’m grateful for everything and I often give praise
For the sunrise, the sunset and all the good days
Days when I manage the pain and don’t fade
When I come out on top and know I’ve got it made

There are so many people who are worse off than me
And I try to remember them, for they help me see
that my life may hold pain, but that’s not my whole life
I’m a friend, and a mother, an advocate and wife

I’m able to offer my time and my skills
I volunteer often (despite all my pills)
I help to make healthcare better for all
It’s intensive, rewarding and for certain my call

I blog about Health, and I share what I know
There’s a network of us and we continue to grow
I pray for the cures to the issues we face
and I share education, in my little blog space

So, my life really isn’t all that bad in the end
It’s all about attitude, and sometimes I pretend
That pain doesn’t grip me, fatigue isn’t there
Fake it til you make it, even if it’s not fair

Life is a choice, and I choose to smile
Despite any hardships, it’s just not my style
To wither and whine or to despair with no hope
I refuse to sink down, so throw me that rope

My friend, make the most of all that you’ve got
Life is short and we’re only given one shot
Look to the bright side, and may joy be your friend
From now to forever, beginning to end

There is Always Hope

by Pamela Jessen

All rights reserved. Copyright 2019 by Pamela Jessen. These works may not be reprinted without the permission of the author.

Pamela Jessen lives in Langford, BC Canada. She is a blogger who writes about Chronic Pain, Chronic Fatigue and Invisible Illness at pamelajessen.com.  She also writes for The Mighty,  PainResource.com and various independent publications. Pamela is also a Patient Advocate with the Patient Voices Network in BC.  She sits on 4 committees and one Provincial working group and has also been involved in advocacy work at the Canadian National level as well. Pamela is married to her amazing husband Ray and they have one cat named Dorie. 

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Living With Forestier’s Disease, aka DISH

spine_general_DISH_intro01Forestier’s Disease is a rare form of degenerative arthritis. More commonly known as diffuse idiopathic skeletal hyperostosis (DISH), this disease attacks the ligaments of the body and turns them to bone.

The process is caused by the buildup of calcium salts in the ligaments and tendons, creating abnormal new bone growth (ossification). Doctors are unsure what causes this process to occur, but some suspect there is a genetic component. The hardening of the ligaments leads to joint stiffness and eventual loss of mobility.

DISH can occur in any part of the body, but most commonly affects the spine and lower back. Some people have DISH in their neck ligaments, which can make swallowing difficult. Other areas affected include the shoulders, elbows, ribs, knees, feet and ankles.

When it attacks the ligaments of the feet and ankles, DISH results in heel spurs, small sharp growths of bone that appear along the heel. DISH can be progressive. As it worsens, it can cause serious complications.

Causes of DISH

  • Sex. Men are more likely to develop DISH than women.
  • Age. DISH is most common in older adults, especially in people older than 50.
  • Diabetes and other conditions. People with type 2 diabetes might be more likely to develop DISH than are those who don’t have diabetes. Other conditions that can raise insulin levels in your body may also increase your risk, including hyperinsulinemia, prediabetes and obesity.
  • Certain medications. Long-term use of medications called retinoids, such as isotretinoin (Amnesteem, Claravis, others), which are used to treat skin conditions such as acne, can increase your risk.

Symptoms of DISH

DISH does not initially produce symptoms. As it progresses, you might experience:

  • pain and stiffness in your joints, especially in the morningSymptoms of DISH
  • loss of motion in your feet, lower back and other affected areas
  • inability to stretch fully
  • pain in your back, knee or heel
  • Loss of range of motion
  • Tingling, numbness, and/or weakness in the legs
  • Spinal fractures and increased risk of breaking other affected bones
  • Compressed or pinched nerves (radiculopathy)
  • Compressed spinal cord (myelopathy) which can lead to partial or complete paralysis of the legs and/or arms (paraparesis, tetraparesis)
  • Difficulty swallowing (dysphagia)
  • Hoarse voice or difficulty speaking (dysphonia)
  • Sleep apnea
  • Decreased lung capacity (if DISH affects the ribs)
  • Difficulty breathing possibly due to airway obstruction

You should always consult a doctor if you’re experiencing pain and stiffness or if you have bone spurs.

Complications

In most cases, DISH causes mild discomfort, allowing patients who have it to live with the symptoms through a combination of pain relievers, stretching exercises, other interventions and in rare cases, surgery to remove bone growth.

For others, the disease may continue to progress which can result in a complete loss of mobility in the affected joints. For instance, if you have DISH in your shoulder, it can make it difficult to raise your arm or move it in all its natural positions.

Fractures are a serious complication of DISH because the stiffness of your tendons makes your bones more likely to fracture if you’re injured.

One huge drawback with DISH is that the pain and stiffness can mimic many other conditions, so proper diagnosis and treatment is essential.

Diagnosis and Treatment

DISH Thoracic_spine_AP
An xray shows the skeletal changes of a DISH patient in the Thoracic Spine.

A diagnosis of diffuse idiopathic skeletal hyperostosis (DISH) is often suspected by the signs and symptoms a person has. X-rays can confirm the diagnosis. In some cases, a computed tomography (CT scan) and/or magnetic resonance imaging (MRI) may also be ordered to rule out other diseases that cause the same symptoms.  All three types of imaging studies may be used to see which other areas of the skeleton are affected by DISH.

There is no cure for DISH, but you can

  • Treat underlying conditions. If you have diabetes or another condition associated with insulin resistance, getting that condition under control will help minimize the symptoms of DISH. Maintaining a healthy weight will also help.
  • Get pain relief. Ask a podiatrist for pain relievers that can treat joint stiffness in your legs, feet, and ankles. Your doctor might prescribe corticosteroid injections for more severe pain.
  • Increase mobility. Gentle stretching exercises can keep your ligaments from becoming overly stiff and brittle. Ask your doctor to recommend a regimen for your joints that will keep them moving. Walking, bicycling, and Aqua exercises are all excellent ways to stay mobile.

My Personal Experience

I was diagnosed with DISH in 2014 after going to the Emergency Room for chest pain. After a number of tests were done, including a CT Scan, the doctor informed me that they had discovered I had DISH in my Thoracic Spine (after ruling out heart problems for the chest pain).

I had always had pain and stiffness in my spine but assumed it was “regular” arthritis, as I have Osteoarthritis throughout my body. Finding out it was something different came as a surprise to me. I discovered that because I have Diabetes Type 2, it was likely a contributing factor. In the years since the diagnosis, I have developed bone spurs in my left ankle, and the DISH has spread to include my Lumbar spine as well as the Thoracic spine. The bone spurs on my spine look more like melted candle wax than actual spurs which is typical for this disease.

I find the stiffness is the most difficult part of having DISH. The sensation is like trying to stretch, but never quite getting enough range of motion, so you’re left feeling “incomplete.” It’s almost like one good “pop” would make things better. I do stretching exercises and use a foam roller to help minimize the stiffness, and I’m conscious of my voice as well. I’ve developed some hoarseness over the years which could indicate that the DISH has affected my cervical spine.

I don’t take any additional medication for DISH with the exception of an occasional muscle relaxant if my back is particularly stiff. By relaxing the muscles around the spine, I get some relief from the stiffness that is part of DISH. I find that my stretching exercises are usually effective enough to bring relief. Heat sometimes helps with the stiffness as well, and a good muscle rub or magnesium rub can make a difference in pain levels as well.

activity-fitness-leisure-374589

Conclusion

If you are experiencing pain and stiffness in the spine or noticing that you are developing bone spurs on your feet (or hands), consult with your doctor and ask about whether DISH could be causing your problems. X-rays and/or other imaging tests can help to determine if there are problems with the ligaments or if there is increased bone growth.

Discovering DISH early can help you get a treatment plan in place to provide relief. Although DISH is considered “rare”, it seems like it’s becoming more predominant than in the past so the sooner you get a diagnosis, the better.

Resources and Further Reading

Pamela Jessen lives in Langford, BC Canada. She is a blogger who writes about Chronic Pain, Chronic Fatigue and Invisible Illness at pamelajessen.com.  She also writes for The Mighty,  PainResource.com and various independent publications. Pamela is also a Patient Advocate with the Patient Voices Network in BC.  She sits on 4 committees and one Provincial working group and has also been involved in advocacy work at the Canadian National level as well. Pamela is married to her amazing husband Ray and they have one cat named Dorie. 


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