What causes vasculitis?

What causes vasculitis?

The causes of most forms of vasculitis remain unknown. Infections are strongly suspected of playing a role in in forms such as the association of hepatitis B (a virus) and polyarteritis nodosa, and hepatitis C (another virus) and cryoglobulinemic vasculitis. Bacterial infections have been suspected of playing a possible role in granulomatosis with polyangiitis (GPA, formerly known as Wegener’s) which is the reason that some patients with GPA that is limited to the upper respiratory tract are treated only with an antibiotic, Bactrim (trimethoprim/sulfamethoxazole). A general theory that applies to many types of vasculitis is that the disease results from the occurrence of a particular infection in a person whose genes (and other factors) make him/her susceptible to developing vasculitis.

What is going to happen to me?

The course of vasculitis is often difficult to predict. Some types of vasculitis may occur only once and do not return. Other types are prone to recurrences. For all patients with vasculitis, it is essential to be evaluated by physicians who are experienced in the treatment of these diseases. Vasculitis is treatable, and many patients achieve remissions through treatment. It is important to balance the types of medications necessary to control the disease and the risk of side effects that those medicines often bring. A primary aim of several ongoing new studies in vasculitis is to find drugs that help maintain remission.

Is vasculitis curable?

Most forms of vasculitis are treatable if detected early enough, before substantial organ damage has occurred. While often effective, however, the treatments remain imperfect and require improvement. Further research is needed in all forms of vasculitis. Greater knowledge of these diseases will lead to better treatments and, some day, to cures.

Will my children or other family members get it?

Vasculitis is not contagious. One cannot acquire vasculitis from contact with a vasculitis patient. In addition, despite the fact that genes probably play a role in susceptibility to some forms of vasculitis, it is unusual for vasculitis to occur in more than one member of the same family. Thus, vasculitis is not a heritable disorder. All of these points illustrate the fact that the causes of vasculitis are complex. In all likelihood, patients develop vasculitis because of the simultaneous occurrence of multiple risk factors, most of which remain poorly understood.

Does diet affect vasculitis?

This is one of the most commonly-asked questions by patients with vasculitis. All patients want to do whatever is within their power to help treat their disease. Unfortunately, there is presently no evidence that a person’s diet affects susceptibility to vasculitis, or that consuming or avoiding certain foods or beverages affects the course of the disease. In general, we advocate eating a balanced healthy diet rich in protein and vegetables. Avoidance of excessive empty calories, processed foods, and sugars may be very important, particularly in patients on steroids who are at risk for weight gain.

Will my vasculitis return?

After patients achieve remission from their vasculitis, it is logical for them to wonder if their disease will ever return. The answer, which is often difficult to give with certainty, depends in large part on the patient’s specific type of vasculitis. For example, some types of vasculitis, such as Henoch-Schönlein purpura (HSP) or vasculitis caused by a medication, are often self-limited and resolve on their own. Other forms of vasculitis (e.g., Buerger’s disease, a disease strongly associated with cigarette smoking) resolve with institution of the definitive treatment: smoking cessation.

However,  other forms of vasculitis behave less predictably and never come back in some patients but recur frequently in others. Granulomatosis with polyangiitis (Wegener’s), giant cell arteritis, Takayasu arteritis, microscopic polyangiitis, and many other types of vasculitis fall into the category of diseases that have periods of quiescence and periods of flare. Disease flares in vasculitis can be mild (rash, minor joint pains) or severe (renal failure, skin ulcers). Flares may occur if medications are discontinued or dosage is lower. Flare may occur in the context of infection. Often the reason for disease flare is unknown.

At the present time, the ability of doctors to predict who will suffer disease flares and who will maintain in long-term remissions (or be cured) needs refinement. Progress in this area will come through research.

How should I guard against the occurrence of a disease flare?

We believe that several points are worth keeping in mind:

First, the symptoms of flares are usually very similar those experienced at the onset of disease. If headaches signaled the beginning of giant cell arteritis, then the recurrence of headaches may indicate a disease flare. If leg ulcers began as painful red lumps on the leg the first time, then the return of painful red lumps may mean that vasculitis is back. Patients must become experts about their own manifestations of vasculitis so that they can recognize them immediately, consult their doctors, and begin appropriate treatment before serious damage occurs.

Second, we believe that patients truly know and understand their own bodies. It is important to discuss new or changing symptoms with your physicians. Together, patients and physicians can determine if new symptoms truly represent a vasculitis flare or if the cause is something equally as likely (medication side effect, infection, or other common medical issues).

Finally, because vasculitis treatments require careful monitoring by doctors, patients should discuss any changes in treatment with their physicians. Increasing or decreasing medications without consulting a physician may lead to trouble.

Why do I have to have bloodwork checked frequently?

Blood tests are helpful to monitor for the return of vasculitis by keeping a watchful eye on important parameters such as kidney function, liver tests, and markers of inflammation (ESR and CRP). Blood tests are also very important to ensure that medications are not causing any side effects such as liver irritation or low blood counts.

How often should my blood be checked?

This depends on the specific medicine or medicines that you take. Patients on cyclophosphamide (Cytoxan) should have their counts checked every 2 weeks. Patients on most other kinds of medications used to treat vasculitis (Methotrexate, Azathioprine) usually only need to have their blood work checked monthly. If some laboratory tests are abnormal or nearly so, then more frequent monitoring may be required.

What type of tests do we check?

Regardless of the type of vasculitis and the exact type of medication that a patient takes, similar types of tests are monitored. These tests are:

1) a complete blood count;
2) tests of kidney function including a urinalysis; and
3) liver function tests.

The table below outlines the importance behind checking each of these tests.

Type of Test What should be checked Why?
Complete Blood Count (“CBC”)
  • White blood cells (WBC)
  • Platelets
  • Hematocrit
  • Low WBC count may lead to infections.
  • Low platelets may cause bleeding.
  • Low hematocrit means insufficient oxygen-carrying capacity of the blood.
Kidney Function
  • Creatinine
  • Blood Urea Nitrogen (BUN)
  • High creatinine and BUN indicate that the kidneys are not performing their blood-cleansing function properly.
  • Protein Level
  • Red Blood Cells
  • Normal urinalyses have no protein and no blood.
  • The presence of protein and/or blood in the urine may indicate active vasculitis in the kidneys (or damage to the bladder from cyclophosphamide).
Liver Function
  • Albumin
  • Aspartate aminotransferase(AST)
  • Alanine aminotransferase (ALT)
  • Often a good indication of overall health.
  • Elevated AST/ALT levels indicate inflammation in the liver (usually
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Pulsatile Tinnitus.

What Is Pulsatile Tinnitus?

To understand Pulsatile Tinnitus, one must first understand what exactly tinnitus means. Tinnitus is the name given to a condition in which an individual hears a sound in the ear, usually ringing or whistling sound, without any source for the sound. Sometimes, the sound could resemble that of twittering of birds or that of your heart beating. This sound may come and go but when it is present it tends to be pretty annoying and distracting. Now coming to Pulsatile Tinnitus, it is a form of tinnitus in which the affected individual hears a rhythmical sound resembling that of a heartbeat. This form of tinnitus can be identified easily than the other forms of tinnitus and the same is true for the cause of it. Affected individual may experience pulsatile tinnitus or beating sound of the heart in both ears or in some cases only one ear. They may experience beating sound of the heart in the ear this while lying down or sleeping on one side.



What Can Cause Pulsatile Tinnitus Or Heartbeat Sound In Ears?

Pulsatile Tinnitus or heartbeat sound in ears is usually caused due to an apparent change in blood flow to the vessels which are present near the ears. Some of the vessels which may cause a Pulsatile Tinnitus are the large arteries and veins in the neck and base of skull and the smaller vessels in the ear itself. This alteration in blood flow can be due to the following factors:

Generalized Increased Blood Flow: It is observed that blood that flows faster tends to make more noise than blood that tends to flow a bit slowly. The rate of the flow of blood can increase due to many causes like heavy strenuous activities or during pregnancy. Blood flow can also increase in individuals who have medical conditions like anemia or an overactive thyroid.

Localized Increased Blood Flow: At times, the blood flow is faster only in a single vessel instead of in a generalized fashion. This can be explained by citing an example in which during development of a fetus there is an artery in the middle ear called the stapedial artery which closes as the pregnancy progresses but in some cases this does not happen and in such cases flow of blood adjacent to the ear structures can result in Pulsatile Tinnitus. Another cause of Pulsatile Tinnitus can be benign tumors of the head and neck.

Turbulent Blood Flow Causing Pulsatile Tinnitus: This happens when the inner part of the blood vessels become irregular thus causing turbulence during blood flow which results in production of a sound causing Pulsatile Tinnitus. The vessels usually become irregular because of a condition called atherosclerosis in which the arteries become hard.

Altered Awareness: In case if an individual has conditions like a perforated eardrum, then that individual will tend to hear more sounds from inside of the body since the external hearing becomes impaired. Also increased sensitivity in the auditory pathway tends to alert the brain to the sounds of the blood vessels.

Other Causes of Pulsatile Tinnitus: There are some other causes of Pulsatile Tinnitus or heartbeat sound in ears as well like there is a medical condition called idiopathic intracranial hypertension in which there are frequent headaches and visual impairment along with Pulsatile Tinnitus. This condition is found usually in overweight individuals. The root cause of this condition still remains unknown.

How Is Pulsatile Tinnitus Diagnosed?

In order to diagnose Pulsatile Tinnitus, the treating physician will begin by taking a history of the individual as to the duration of these sensations. The physician will also inquire about any other medical conditions that the individual may have. The next thing will be to conduct a detailed physical examination examining particularly the ears and the neck. The physician may use a stethoscope to listen to any sounds emanating from the ear or the neck. Post this, a hearing test will be performed to look for any abnormalities in the individual’s hearing capability. The physician may also order some imaging studies in the form of ultrasound to look at the blood flow within the vessels of the neck. An MRI of the head and neck may also be performed to better look at the internal structures of the neck and also the ears to look for any sort of abnormalities. Apart from this, an MRA may also be performed to look at the veins and arteries to look for any sort of irregularities or hardening of the arteries causing Pulsatile Tinnitus. A CT Angiogram may also be done for this purpose. Some of the other studies that may be done to investigate the cause of Pulsatile Tinnitus are Blood tests to rule out conditions like anemia or hyperthyroidism, which are quite common causes of Pulsatile Tinnitus. In case if an idiopathic intracranial hypertension is suspected by the physician, then the individual may need referral to other specialists such as ophthalmologists or neurologists who may then investigate this further with their own set of investigative studies.

What Are Treatments For Pulsatile Tinnitus?

The treatment for Pulsatile Tinnitus or heartbeat sound in ears is based on the underlying cause for the condition. In case if Pulsatile Tinnitus is caused due to anemia then regular blood transfusions and medications directed towards treatment of anemia is good enough to treat the Pulsatile Tinnitus. In case of overactive thyroid causing this condition then treatment for that can treat the Pulsatile Tinnitus. If the tinnitus is caused due to a perforated eardrum then these perforations need to be closed by utilizing grafts. If turbulent blood flow due to hardening of the arteries is suspected for causing Pulsatile Tinnitus then repair of these narrowed and hardened arteries is required so that blood flow becomes smooth again and the Pulsatile Tinnitus is cured. In some instances, despite knowing the cause, treatment may not cure the tinnitus like in the case of a specific blood vessel causing Pulsatile Tinnitus which cannot be repaired just because of the location of the vessel. In some instances where there is no identifiable cause for the Pulsatile Tinnitus then the following therapies might be useful in controlling the tinnitus: Sound Therapy, relaxation techniques, cognitive behavioral therapy, psychological counseling, meditation, yoga and in some cases Tinnitus Retraining Therapy which has been found to be helpful for controlling symptoms caused by Pulsatile Tinnitus.

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Maya Angelou’s 3 best lessons about coping.

The 3 Lessons Maya Angelou Taught Us About Coping

Posted: Updated:

By Jan Bruce

When poet, memoirist, screenwriter, film director, jazz singer, dancer, professor, and civil rights activist Maya Angelou died in May at the age of 86, I reflected on two thoughts. The first was, Is there anything this woman couldn’t do?

And the second thing I realized, as social and traditional media overflowed with tributes and expressions of gratitude for her life and work, was this: Maya Angelou helped people feel like they were possible of living great, meaningful lives.

She became, for so many, a symbol of resilience — the capacity to persist in the face of hardship and adversity — and beyond that a symbol of boundless creativity. She didn’t just survive the significant trauma of her early life; she made something magnificent of that life. (Read more about the power of resilience.)

Her many works of art and scholarship are part of her widely recognized greatness, but I think the “magnificent” part is related to my second thought: creating meaningful lives. Her creativity wasn’t about how much better she was than everyone else; it was inclusive. It was grounded in a belief that we ought to help each other sing if we have a song — and that everyone has a song.

In my work helping people develop the skills they need to become more resilient to the stressors and pressures of their lives, be they large or small, I have come to know, beyond a doubt, that resilience, creativity, and generosity are key qualities in coping with stress and crafting a meaningful life. These three quotes speak to Dr. Angelou’s deep understanding of these qualities.

“You may not control all the events that happen to you, but you can decide not to be reduced by them.” — Maya Angelou

Dr. Angelou’s childhood was unpredictable — many moves and many homes — and included a period of devastating violence that left her mute for almost five years. Even after she recovered, her life remained tumultuous, both in her personal choices (working as the first black streetcar conductor at age 16) and the the world around her, as when the assassinations of her friends and colleagues Malcolm X and Martin Luther King, Jr., devastated her. And yet, Angelou persisted; as she wrote in what is perhaps her most famous poem, “Still I Rise.” These events shaped her but they didn’t define or stop her. Read more on the essence of resilience.

“My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style.” — Maya Angelou

Resilience doesn’t have to stop at making it through the day-to-day grind with a little less trouble. Once you free up mental and physical energy, the question is this: What wonderful thing are you going to do with it?

Angelou was drawn to the arts in almost any form — classical music, fine art, drama, dance, poetry. That was her wonderful thing. But thriving isn’t exclusive to painting or poetry, of course. It’s whatever you are driven to be and do. What Angelou modeled was a complete commitment to the expression of her wonderfulness. She showed what it looked like to thrive on a grand scale.

“You can see in others what they don’t see in themselves and what the world doesn’t see in them. We all have that possibility, that potential and that promise of seeing beyond the seeming.” — Maya Angelou

Angelou wrote for her own creative satisfaction, but she was driven by the desire to encourage and inspire people beyond their limitations, whether they were self-imposed, determined by society, or handed down through history. The point of endeavor was, as she wrote, “to be a rainbow in someone else’s cloud.” She sought to be that rainbow for anyone who could read or hear her work.

As Andrew Shatte, Ph.D., one of meQuilibrium‘s co-founders, has discovered in his research, those who feel connected to something larger than themselves, their family, or immediate community are operating at the highest level of achievement. And that higher, generous purpose gives you the power both to withstand anything and to do the hard, worthy work of living a meaningful life.

One last quote from Maya Angelou captures these three qualities of resilience, creativity and generosity, and a zest for life that kept her young, and will keep you young, too:

“The most important thing I can tell you about aging is this: If you really feel that you want to have an off-the-shoulder blouse and some big beads and thong sandals and a dirndl skirt and a magnolia in your hair, do it. Even if you’re wrinkled.”

Jan Bruce is CEO and co-founder of meQuilibrium, the new digital coaching

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Supporting people with invisible illnesses