What You Need to Know About the Flu

Deaths from the flu are a lot more common than people think. In the 2009 H1N1 Flu Pandemic, over 12,000 people died in the United States from the 2009 flu strain, this according to the Centers for Disease Control.  Worldwide, the number of deaths is estimated to be at least half a million people.

Even in a non-pandemic year, people are still dying from the flu, usually from complications of pneumonia and chronic medical conditions. Experts cite that at least 36,000 people a year die from the flu or flu complications every year.

In the 2014-15 U.S. flu season, there were 141 pediatric deaths from the flu. And these numbers aren’t all kids with risk factors, such as asthma or a chronic illness.  Reports have shown that at least half of the children who have died from the flu have no risk factors for flu complications.

Risk Factors for Certain People  

You need to take special care to avoid the flu if you have a chronic long term condition, such as an autoimmune disease, diabetes, cancer, heart disease or HIV/AIDS.  The same is true for if you are pregnant or over age 65. Children are also at a higher risk. Having any of these risk factors makes you more likely than other people to have complications, such as pneumonia from the flu. Without medical care, these problems can become life threatening.

Preventing Flu Deaths

The best way to prevent flu deaths is to avoid getting sick with the flu in the first place.  You can try to avoid the flu by staying away from people who are sick and by washing your hands frequently.  However, the best and easiest way is to get a yearly flu vaccine.

Misinformation about the Flu

Misinformation is often a reason people are at a higher risks for illnesses, including the flu. The Bankers Healthcare Group, a company dedicated to providing physician loans, has partnered up with doctors around the country and bloggers to help pass along the right information about the flu and debunk the myths.

The graphic below discredits the myths about the flu and provides information about how you can protect yourself from the flu and its complications.

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Anemia of Chronic Disease

Photo Credit: http://anemiaofchronicdisease.com/
Photo Credit: http://anemiaofchronicdisease.com/


Certain disease diseases, such as autoimmune forms of arthritis, chronic infections, or fibromyalgia, can interfere with the production of red blood cells.  The result is a condition called Anemia of Chronic Disease or ACD.

What is Anemia?

Anemia is a disorder where the blood has a lower than normal range of red blood cells. Anemia can also happen when the red blood cells do not have enough hemoglobin in them.  Hemoglobin is an iron rich protein that makes blood red. This protein also helps our red blood cells to carry oxygen from the lungs to the rest of the body.

In people with anemia, their bodies are not getting enough oxygen-rich blood. Symptoms of anemia include fatigue, shortness of breath, dizziness or headaches. Further, severe or chronic anemia can damage body organs including the heart and brain and even result in death.

The good news is that you can even prevent anemia with a healthy diet and treatment can be as simple as a dietary supplement.  Conversely, some forms of anemia, such as ACD, can be severe, chronic and even life threatening if not diagnosed early enough and treated.

Anemia of Chronic Disease  

People who develop Anemia of Chronic Disease do not develop a severe form of anemia.  Further, ACD is second most common form of anemia, after iron deficiency anemia.   While it most often found in patients with chronic diseases, with the elderly being at the greatest risk, it can also be found in young children suffering from a simple ear infection.  Most often, this type of anemia goes undetected and untreated because attention is focused on treating the chronic condition or infection.

According to the National Institutes of Health, ACD occurs when a chronic illness affects the body’s ability to make healthy red blood cells.[1]  In most cases, this happens because the chronic condition prevents the body from using iron efficiently to produce new red blood cells regardless of whether the body has normal or high levels of iron.

Anemia of Chronic Disease is slow progressing so symptoms are generally mild and may be similar to symptoms of the underlying chronic condition.  Symptoms will include paleness, weakness, dizziness and a fast heartbeat.

What Conditions Cause ACD?

It is believed that up to 60% of patients with rheumatoid arthritis (RA) are anemic, this according to a research study reported by the National Journal of Medicine.[2]  RA is not the only inflammatory disease that can cause ACD. Other conditions include lupus, ulcerative colitis, Crohn’s’ disease, degenerative joint disease and diabetes.   Inflammatory diseases provide a response in the body that can produce cytokines, proteins that protect the body against infection and interfere with iron processing and the manufacture of red blood cells.

While fibromyalgia is not considered an inflammatory condition, it is still a rheumatic condition that impairs the joints and/or soft tissues causing chronic pain. Further many fibromyalgia patients have anemia and many often go undiagnosed because of the similarity of symptoms between both conditions.  Without proper treatment, anemia will worsen fibromyalgia symptoms and make life for patients even more difficult.

People with chronic infections or infectious diseases can also develop ACD.  This is because their immune systems will respond to the infection resulting in an impediment of red blood cell production.

Treating ACD is Fairly Easy

Anemia of Chronic Disease is fairly easy to treat.  Treatment may depend on the reason for the anemia and how severe it has gotten.  ACD can generally be managed through medication or dietary supplements, including folic acid.  Most anemic patients take vitamin injections or iron supplements to correct iron levels. Further, most treatment can be administered at home with little monitoring. In rare cases, a blood transfusion may be necessary.

Successful treatment of ACD also involves treating the underlying disease.  As the symptoms of the chronic condition diminish, so will the anemia. If you think you have anemia of any form, talk to your doctor. A simple blood test is all it takes for an accurate diagnosis.

[1]               “Anemia of Inflammation and Chronic Disease.” (2012, April 6.) National Hematologic Diseases

Information Service. Retrieved from http://hematologic.niddk.nih.gov/anemiachronic.aspx.

[2] Wilson, et al. (2004, April 5). “Prevalence and outcomes of anemia in rheumatoid arthritis.” US National Library of Medicine National Institutes of Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15050886.

Did you know that RA patients are at a greater risk for gastrointestinal problems?

Rheumatoid arthritis patients have a higher risk of developing lower gastrointestinal (GI) problems such as ulcers and bleeding, this according to a recent study published in the Journal of Rheumatology. The research looked at the incidence of upper GI tract problems vs. those of the lower GI tract.  Upper GI issues declined over a 28 year study for people with RA while lower GI tract problems held steady over the same time period.  

[Upper GI issues occur between the mouth and end of stomach while lower GI tract issues affect the large and small intestines.] 

Upper GI issues in RA patients are partially attributed to the use of NSAIDs. In the lower GI, there is not enough to find the link between RA and the lower GI problems.  However, smoking, use of corticosteroids (i.e., prednisone, cortisone), prior upper-GI disease and abdominal surgery were all identified in this study as increasing the risk in RA patients. 

“We are still seeing about a 50 percent increase in lower-GI problems in people with RA compared with those without it. More attention is needed to address lower-GI problems,” says study co-author Eric Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, Minn.  “Doctors and patients should be aware of the increased risk of lower-GI problems that can be related to RA and/or its treatments, and of the risk factors that can lead to lower-GI problems. Stopping smoking and avoiding corticosteroids can reduce the risk.”  

The study confirms that people with RA have more upper and lower GI problems and are more likely to die of GI problems than people without the disease.  Experts believe that this is primarily due to the weakened immunity presented by RA. That higher risk is at least 70 percent higher for those with RA than those without the disease.  

Specific GI conditions researched to RA include infectious colitis, lower GI bleeding, and perforation and diverticulitis.  When GI events occur in RA patients, they are more likely to be serious in RA patients and even require hospitalization.

Do you know about the possible complications of Rheumatoid Arthritis?

As you may already know, rheumatoid arthritis (RA) is both a disfiguring and debilitating disease.  Joint pain, stiffness, inflammation and damage can make it difficult to perform daily tasks.  Most RA patients find themselves worn out by daily activity and eventually some are unable to continue doing them.  We have been fortunate, however, that new therapies are available and more effective in slowing down or stopping joint damage. 


The hardest part for most patients, including myself, is the unpredictable nature of RA.  In other words, we never know when the next flare up will be.  We cannot plan for them and we cannot always stop them from happening.  It is possible to control to severity and we can find that some days are better than others.  With flare-ups being so unpredictable, it is not usual to become depressed as a result of associated anxiety and stress.

Joint pain, added stress and anxiety and depression make RA patients more vulnerable to developing disease complications.  This is because the autoimmune process that causes joint inflammation can also affect the eyes, lungs, skin, heart, blood vessels and other organs of the body.  Medications also cause unwanted side effects.

Recognizing early symptoms of potential complications

To manage complications of RA, it is important to recognize symptoms early and get appropriate treatment.  Here are some potential issues you should look out for.

  • ·         Skin problems: About 20% of RA patients will develop rheumatoid nodules.  These are lumps of tissues that generally appear under the skin on elbows, forearm, heels or fingers.  They are an indication of severe disease activity.  It is also possible for them to appear on the lungs or heart.  Inflammation of blood vessels called vasculitis causes skin changes and appear as ulcers on the skin. Other types of rashes/skin changes are possible with RA as a result of disease activity or medication so it is important to alert your doctor of any skin changes you develop.
  • ·         Eye problems: RA can affect the eyes in several ways.  These include inflammation on thin membrane and covering the white of the eye, called the sclera, or inflammation of the sclera. I have gone into detail about the eye conditions associated with RA in this post
    • o   Sjogren’s syndrome: With RA, you are at a higher risk of Sjogren’s.  This is a condition in which the immune system attacks the lacrimal glands, the glands which help us to produce tears.  Eyes can feel gritty and dry and if not treated can lead to infection and scaring of the membrane that covers the eye. RA patients should have regular eye exams but if you are already showing symptoms, let your doctor now about them.
  • ·         Heart and blood vessels:  Many RA patients have a collection of fluid between the pericardium and heart itself called pericardial effusion.   However, not all RA patients have symptoms.  Episodes of pericarditis or inflation of the heart membrane usually develop during flare periods. Persistent pericarditis can interfere with the heart’s ability to work property.  For more information on heart complications with RA, please review this article.
  • ·         Disease of the blood and blood forming cells: Many RA patients experience anemia which causes symptoms such as fatigue, rapid heartbeat, shortness of breath, leg cramps, insomnia and dizziness.  Sometimes, treatment to suppress the immune system can lead to thrombocytopenia, a condition where low levels of blood platelets are present. Felty’s syndrome is also a complication of RA, but fairly uncommon.   This is a condition where the spleen is enlarged and the white blood cell is low.  Felty’s syndrome increases the risk of lymphoma cancer (cancer of the lymph nodes).
  • ·         Lung problems: The same inflammatory process affecting the lining of the heart can also affect the lining of the lungs.  For more information on the various lung complications, please refer to this article.  RA treatment can also affect the lungs.  Methotrexate, for example, can affect the lungs and cause shortness of breath, cough and fever.  Symptoms, in this case, improve after the medication is stopped.
  • ·         Infection susceptibility:  People with RA are prone to infection which is both associated with the disease and medications to treat it.  If you think you have an infection, contact your treating physician for monitoring and treatment.
  • ·         Depression:  As mentioned, living with RA pain and limitations can take a toll on your emotional health.  For more information on RA and depression, please check out this article.

How you protect yourself from RA complications? 

Most patients do not think to mention things like moods, chest pain or dry eyes to their doctor, but it is very important to let your doctor know that you are experiencing these kinds of symptoms.  Your doctor can work with you to either treat your symptoms or act more aggressively in treating rheumatoid arthritis.  Whatever the route taken, your speaking up is the first and most important step in managing and resolving problems that have the potential to turn into serious complications.