THE GOLDEN TREE OF ME
THE GOLDEN TREE OF ME STARTS WITH SARA F TWIGG MOWERY WHO DIED WHEN SHE WAS 96 YEARS OLD.
I WAS SIX MONTHS PREGNANT WITH MY FIRST CHILD WHO I ALWAYS KNEW WOULD BE NAMED SARA.
SHE DIED OF A BROKEN HIP AND THE COMPLICATIONS THEREOF. SHE WAS AN AMAZING WOMAN THAT
STILL DID HER OWN DISHES, HER OWN GARDENING, HER OWN COOKING, SHE STILL DID SEWING AND SOME WATCHING
OF THE TELEVISION HER FAVORITE WAS BOB ROSS PAINTING WHICH SHE WAS HAPPILY ENGROSSED IN .
HE AMAZED HER AND SHE AMAZED ME.
SHE HAD MANY CHILDREN DOLORES, MY MOMS MOM. JESS MY AUNT WHOM I LOVED DEARLY, SHE ALWAYS WRAPPED CHRISTMAS
GIFTS IN COMIC PAPER ..INGENIOUS! WANDA WHO LOVED PEOPLE AND I LOVED HER SHE WAS ALWAYS HAPPY EXCITED AND LOVING
I NEVER MET ANYONE LIKE HER AND PROBABLY NEVER WILL THIS IS ERINS GRANDMA AND JERIS MOM.
AUNT NU NU WHOM WAS A VERY COLORFUL CHARACTER WHO LIVED IN THE HEART OF THE BRONX AND SHE CALLED HOME
SHE LIVED THERE ALONE AS AN ELDERLY TENNANT IN AN APARTMENT BUILDING. SHE LOVED IT THERE AND RARELY CAME HOME
HER FAMILY WAS THERE AND THAT WAS HOME TO HER I LOVED THAT WOMAN. AUNT MAX WHOM IS LISAS GRANDMA AND
NANCYS MOMMA MUST HAVE BEEN A MOTHER FROM BIRTH THIS WOMAN IS CARING AND THOUGHTFUL AND OPEN
MINDED AND FAITHFUL AS A FRIEND AS WELL AS TO THE LORD WITH OUT EACH AND EVERY ONE OF THESE PEOPLE I WOULD
NOT BE WHO I AM TODAY
THERE WERE BOYS THAT I DID NOT KNOW WELL UNCLE CHARLES UNCLE NEWT UNCLE
THEN THERES MY MOMMA BARBARA JEAN DAWSON RAYMOND AND DADDY GERALD W RAYMOND
WHO TAUGHT ME THE MOST VALUABLE LESSONS IN LIFE MORALS VALUES AND LIFE LESSONS THEY KEPT IT REAL
ALWAYS AND NEVER SAID WE COULDNT ACCOMPLISH OUR DREAMS THEY WOULD SAY YOU CAN DO ANYTHING YOU
PUT YOUR MIND TO. AND THEY STILL TELL ME THAT TODAY . SINCE THE NINTH GRADE I HAVE ALWAYS
WANTED TO BE A WRITER SO THAT IS WHAT I AM TRYING TO DO WE ALL CAN WRITE I WANT TO GET PAID TO WRITE.
I CAN DRAW SOMEWHAT I AM A ARTSY CREATIVE TYPE PERSON. AND I LIKE THAT ABOUT ME I AM CONFIDENT, NOT COCKY
I AM THANKFUL AND FORTUNATE , NOT BRATY AND UNTHANKFUL JESUS FIRST ALL ELSE FOLLOWS
Saturday, December 31, 2011
Friday, December 30, 2011
review
Reviews for movies
SUPER 8
THIS IS A VERY CREATIVE IMAGINATIVE FILM THAT IS FOR THE WHOLE FAMILY. IT HAS A MAGICAL FEEL TO IT
BUT THERE IS SO MUCH ACTION IN IT. IF YOU HAVE A.D.D YOU MAY NOT HAVE A PROBLEM PAYING ATTENTION TO
THIS FILM.
THIS FILM IS VERY INVENTIVE AS WELL.
MR POPPERS PENGUINS
THIS IS A GREAT FILM. IT FEATURES JIM CAREY. WHICH LETS BE HONEST HE IS AWESOME
IN EVERY FILM.
BUT IT HAS A MAGICAL MOMENTS IN IT AND LESSONS AND ENCOURAGMENT AND LOTS MORE!
IT SHOWS THAT EVERY BEING IS IMPORTANT AND FAMILY IS WHAT YOU MAKE IT. WHEATHER HUMAN
OR ANIMAL FAMILY IS FAMILY IT IS A TOUCHING FILM FOR THE WHOLE FAMILY.
AND I THINK IT ENCOURAGES ADOPTION TO ME...THERE ARE SO MANY KIDS THAT NEED HOMES (ANIMALS TOO)
DUMMY
THIS IS A GREAT FILM ABOUT FOLLOWING YOUR DREAMS. GROWING UP IS NEVER EASY. IT IS ENTERTAINING AND
FUNNY AS WELL AS TEACHING VALUES AND MORALS. I WOULD RECOMMEND THIS MOVIE TO THE WHOLE FAMILY
SLAMMIN SALMON
THIS IS A MOVIE ABOUT
SUPER 8
THIS IS A VERY CREATIVE IMAGINATIVE FILM THAT IS FOR THE WHOLE FAMILY. IT HAS A MAGICAL FEEL TO IT
BUT THERE IS SO MUCH ACTION IN IT. IF YOU HAVE A.D.D YOU MAY NOT HAVE A PROBLEM PAYING ATTENTION TO
THIS FILM.
THIS FILM IS VERY INVENTIVE AS WELL.
MR POPPERS PENGUINS
THIS IS A GREAT FILM. IT FEATURES JIM CAREY. WHICH LETS BE HONEST HE IS AWESOME
IN EVERY FILM.
BUT IT HAS A MAGICAL MOMENTS IN IT AND LESSONS AND ENCOURAGMENT AND LOTS MORE!
IT SHOWS THAT EVERY BEING IS IMPORTANT AND FAMILY IS WHAT YOU MAKE IT. WHEATHER HUMAN
OR ANIMAL FAMILY IS FAMILY IT IS A TOUCHING FILM FOR THE WHOLE FAMILY.
AND I THINK IT ENCOURAGES ADOPTION TO ME...THERE ARE SO MANY KIDS THAT NEED HOMES (ANIMALS TOO)
DUMMY
THIS IS A GREAT FILM ABOUT FOLLOWING YOUR DREAMS. GROWING UP IS NEVER EASY. IT IS ENTERTAINING AND
FUNNY AS WELL AS TEACHING VALUES AND MORALS. I WOULD RECOMMEND THIS MOVIE TO THE WHOLE FAMILY
SLAMMIN SALMON
THIS IS A MOVIE ABOUT
sicknesses
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Lupus Information
by Michelle Petri, M.D., M.P.H.
* What are the Symptoms of Lupus?
* Is Lupus an Autoimmune Disease?
* What do we Know About Lupus?
* How is Lupus Managed and Treated?
The following is a transcript of a talk Dr. Petri gave at the British Columbia Lupus Society Symposium in November, 2002.
What are the Symptoms of Lupus?
First off, lupus is not rare. But we definitely need a spokesperson. We need someone famous to take on lupus as their cause.
The problem with lupus is, people can't tell how sick you really are. That's one of the reasons lupus doesn't get the respect it deserves. When my patients apply for disability, often they are turned down. One of the major things that happens in lupus is chronic fatigue, and there is no way to measure that.
Looking at the malar rash in lupus, how does a doctor know it isn't the worst acne? Because it spares the areas around the nose and under the nose that are shaded from ultraviolet light.
How do you know if it's lupus or another form of arthritis? Well, hopefully with diagnostic tests. In addition, the arthritis of lupus is not deforming. The ligaments and tendons around the joints loosen, but there is not permanent destruction of the bones.
Memory problems bother patients on a day-to-day basis. This is a huge problem, and we don't know why. In lupus patients, we are often overlooking fibromyalgia. Thirty percent of my patients have fibromyalgia. You are tired, you hurt, and nothing your doctor does helps. Fibromyalgia is not inflammatory. It is a resetting of the pain thermostat in the brain. I suspect it has more of an impact on your day-to-day life than your lupus, if your lupus is not flaring.
Another symptom is hair loss, called alopecia. In the discoid form of lupus, hair loss will be permanent. I have patients, 15 or 16, who will have to wear wigs the rest of their lives because their diagnosis was delayed and they already had permanent hair loss.
Did you know that one out of five women have a positive anti-nuclear antibody test? Having anti-nuclear antibody is very common, but the great majority of people will never get sick. This is why the diagnosis of lupus is not just based on the positive ANA test. Something else has to happen to prove the person really has lupus, like the skin rashes, the joint inflammation, the kidney disease, and the low blood counts.
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Is Lupus an Autoimmune Disease?
It turns out there are a lot of people who have an autoimmune disease that just affects one organ. A common example of this is autoimmune thyroid disease. I know that one out of every ten lupus patients has low thyroid. But most people who have thyroid disease have nothing else happen.
Did you know that doctors have just discovered that some very common chronic illnesses are autoimmune? Diabetes, for example, especially the juvenile form, is autoimmune.
Did you know that hardening of the arteries is autoimmune? Cholesterol lowering drugs called Statins, work not just because they lower cholesterol, but perhaps because they have an anti-inflammatory action. They prevent the plaque from rupturing and blocking the coronary arteries. So, it's fascinating how important autoimmune disease really is in many kinds of diseases.
Rheumatologists get involved when more than one organ is involvedwhat we call "systemic" illness. There is a kind of systemic illness called undifferentiated connective tissue disease. It's obvious to the physician that the person has an autoimmune problem, but they don't meet the definition for lupus or scleroderma or rheumatoid arthritis. For example, it could be a young woman who has a positive ANA and Raynauds. Or, it could be anyone who has a positive ANA or arthralgia, but we don't see swelling of the joints.
During the silicone breast implant controversy, it was thought that silicone might be causing illnesses like lupus and scleroderma. Then it was discovered that even women who had never had a silicone breast implant could get these mild forms of autoimmunity. In fact, five out of 100 women in the United States have these mild forms of systemic autoimmunity. Autoimmune diseases are not rare. If five percent of women have an autoimmune disease, that should be considered common. If we could just understand autoimmunity, it would have such a huge impact on the health of every country in the world. In the United States, there are 300,000 people with lupus. Worldwide, there are three million.
There are famous people with autoimmune disease. Barbara Bush and her husband, the ex-president George Bush, both had autoimmune thyroid disease. One of their sons had colitis. But the member of their family that got lupus was their dog, Millie. Dogs can get lupus. Vets can diagnose it because dogs can get the same malar rash that human beings do.
Now, Millie wrote a book about her life with lupus. It's a great story, because Millie had a successful pregnancy. So, I think it's a nice story to tell patients with lupus. Millie has since died of old age. The current dog in the White House, Spot, is Millie's grandson. But because Spot is male, he's unlikely to get lupus. We think the autoimmune story has ended!
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What do we Know About Lupus?
There are thousands of researchers worldwide trying to figure out lupus. The reason it's so complicated is because so many things contribute to getting lupusgenetics, drugs, infection, ultraviolet light, and hormones. Then we have the immune system. We don't really know what's going on in the immune system when people get lupus. There seem to be abnormalities in every single part of the immune system. So, what doctors measure is what comes out the other end.
When you develop lupus, you make antibodies against self. Your immune system goes doubly wrong when you have lupus because not only are you making antibodies against yourself, but your immune system doesn't work as well against infection. It's very unfair! But that's what lupus is all aboutantibodies against self. Now, your doctor measures those antibodies when making a diagnosis, but we also measure complementC3, C4 and total complement, because the complement proteins are used up in the blood when you have immune complexes. So, when your antibodies against yourself bind to your cell proteins, they form the "immune complex", and that complex activates complement. As complement is used up, the complement levels become low. Then, of course, we measure inflammation. Inflammation can be present without pain or other abnormal feeling. This is why ongoing surveillance is so essential when you have lupus. When I was chosen to serve on a committee of the American College of Rheumatology to give guidelines to physicians, we recommended that if you have lupus, you should be seen about every three months, even if you're feeling well.
Ten percent of lupus patients are male. The composition of lupus patients changes depending on what area you are in. It is more common in African-Americans and Asian-Americans in the United States. That probably represents genetic issues that are not yet understood.
Our average patient in the U.S. is diagnosed in their 20's and 30's. I suspect in Canada the age of onset might be a little bit later. In Sweden, for example, the age of onset for lupus is late 30's, early 40's. Now, if we could only understand those genetic influences!
I'm sure you ask yourself, What can I change in my lifestyle that can make my lupus go away? Studies of diet have not suggested any benefit at all. Another diet study was done on Omega 3 fatty acids. The study showed there was no benefit whatsoever.
Role of Estrogen
Don't you wonder why lupus is more common in women than men? Well, it turns out estrogen is very important in the development of lupus. In mice, things are so simple, that if you get rid of estrogen or give male hormone, you can stop lupus. Estrogen can actually activate the immune system in many different ways.
In the 1980's, it was discovered that women who have lupus are "super women." Their estrogen is metabolized using pathways, so the metabolites are still active. Not only is their estrogen working on their immune system, but the metabolized estrogen is as well. This was also true in their healthy, female family members. This may be one of the genetic predispositions to lupus. The metabolized estrogen still works on the immune system. Now, Doctor Lahita has suggested it may be possible to reverse these pathways. One way to potentially reverse these estrogen pathways is through diet changes. It was suggested that vegetables like broccoli and cauliflower might affect estrogen metabolism. This was finally tested in Boston. Half the lupus patients had the active ingredient in broccoli in pill form, while the other half took a placebo. It is possible to reverse these estrogen metabolism pathways. However, it made no difference on the activity of the lupus. We need further research in this area.
Many postmenopausal women with lupus wonder if they should take estrogen. Now, we're concerned for two reasons. One, if a woman is more likely to make clots because she has the antiphospholipid antibody, we don't want her to take estrogen because it further increases the risk of having a clot. We've also been concerned that estrogen in pill form might increase the risk of lupus flare-ups.
A study in the United States, called the "Safety of Estrogen Study," is currently underway and should be completed within a year. We will know if taking estrogen in pill form increases the risk of having a flare. Our impressionwithout the datais that the answer is probably no. This has been suggested in several studies, including one from Toronto. So, the use of HRT is probably not so bad if you don't have an antiphospholipid antibody.
The Women's Health Initiative study found that taking estrogen in pill form after menopause might increase heart disease. Since everyone with lupus is already at greater risk of heart disease, most lupus doctors are no longer giving hormone replacement therapy.
Genetic Risk
When you were first diagnosed, you may have wondered if your children would get lupus. The good news is that only two out of 100 children whose mother has lupus will get lupus. The genetic risk is small. It is not strictly a genetic disease.
In mice studies, over 100 different genes predispose to lupus. Some very important research reveals that once you have lupus, several hundred genes participate when you have a lupus flare up. So you can understand how daunting the task is, not just to identify the lupus genes, but to identify the genes that are activated when the lupus flares up. Those genes that are activated when lupus flares up are the genes that we have to control to keep lupus quiet. We have a lot of work ahead of us!
We do know that the same genes that are important in transplantationthe immune response genesplay a role in getting lupus. These are called the HLA genes. Did you know that doctors can almost predict which antibodies against self you will make, based on your immune response genes? If you were wondering why patient A with lupus makes antibodies to DNA and patient B makes antibodies to phospholipid and patient C makes antibodies to Ro, that's probably determined genetically.
The most important thing discovered about the genetic predisposition to lupus started out in mice. This is called "programmed cell death," or apoptosis. In all of us, billions of our cells die every day. We are supposed to be able to chew those cells up and dispose of them without our immune system knowing that anything has happened. We don't want our immune system recognizing our cells as they die. We want our immune system to be ignorant. It was discovered in a mouse model of lupus that one genetic mutation affecting programmed cell death was enough to cause lupus. It doesn't hold true in humans, though. But we know that programmed cell death is important in lupus because those proteins recognized as foreign by the lupus person's immune system are all exposed during cell death. In some way, programmed cell death is key in the onset of lupus.
We also know that it's very important when you have lupus to be able to get rid of those immune complexes. It turns out that some people genetically are going to be slower in getting rid of immune complexes. If you inherit one of these reasons to be slow in getting rid of immune complexes, you are much more likely to get lupus kidney disease.
Eventually, genetic research is going to be so helpful in determining not only what lies ahead, but what causes the disease. If we could understand the cause, we would be a lot smarter in developing new therapies.
Did you know we can prevent lupus in mice? This is one of the most important research studies ever done. In mice who are genetically predisposed to lupus, we can prevent lupus from starting by getting rid of the debris from the cells that have died before the immune system recognizes that debris as being foreign and starts the lupus antibody responses. We can do it in mice with a drug already available for human beings. That drug is called DNase. DNase helps children who have cystic fibrosis. Now, if we knew which of your children were genetically predisposed to get lupus, it might make sense to do a prevention trial with DNase. We are not there yet. Remember, we have to identify those 100 genes first. But we may already have a way to prevent lupus in the next generation. It worked in mice.
Enviromental Triggers
Genes aren't everything. Remember, only two percent of children get lupus if their mom had lupus. We know there are environmental triggers, the most common being ultraviolet light. Many people don't get lupus until they've had a bad sunburn. For most of you who have the lupus rashes, those are brought out by ultraviolet light. If you wear a hat with a brim and sunscreen, you are much less likely to get those rashes.
There are other triggers, including drugs. Be very careful about sulfa antibiotics. Why? Some people don't have lupus until they take these sulfa antibiotics. For people who are already diagnosed with lupus, about 25-per cent will have their disease get more active if they take a sulfa antibiotic. If you need antibiotics, make sure you ask your doctor to prescribe something other than a sulfa antibiotic.
There's also a problem with so-called "alternative medications." Why? Because they are not tested for either safety or efficacy. So, it's the lack of knowledge that is the problem. Surveys show 90-per cent of people take alternative medications. You take them because you hope that by experimenting you're going to find something that helps your lupus. It is an experiment, and it can go wrong.
Some of my patients, when admitted to hospital for a lupus flare, advised me that they had taken Echinacea. At first, I didn't think this could have caused a lupus flare, but after the second or third case, I said I'm going to do some research. It turns out, it has been known in Germany for many years that Echinacea can cause flares of autoimmune disease. If you live in Europe, it says right on the Echinacea label not to take it if you have autoimmune disease. So, after hospitalizing some of my patients with terrible kidney flare-ups who had taken Echinacea on a daily basis, I have now forbidden all my lupus patients from taking it. Maybe it would be okay for a few days to prevent a cold, but my patients were taking it everyday to try to prevent the next cold. Please be careful when taking alternative medications.
Now, if you smoke, you are more likely to get the worst kind of skin lupusdiscoid lupus. Also, plaquenil doesn't work very well. So, don't smoke. It's bad for your lupus. Set a day and quit!
Stressis that good for lupus? Of course not! Stress is not good for anything! But we know we're under more stress than ever before. Stress affects the neuroendocrine system that's supposed to keep autoimmunity quiet. What I ask my patients to do is to take a little vacation from stress one or two times a week. Go out for dinner, go to a movie, go shopping for shoeswhatever it is that relieves your stress. Just shut the door on your everyday life for a few hours a week.
Now, surgery is an example of a physical stress in a lupus patient. I sometimes get calls from surgeons of my patients saying the surgery went really well but, after the procedure, my lupus patient developed a fever. When the fever continued, they thought maybe it was the lupus. Nearly all of the time this is a lupus flare. So, whether it's mental or physical stress, it's not good for your lupus.
What about infection? We all believe infections have something to do with getting lupus. Our strongest proof is the data on monoEpstein Barr virus. In children who develop lupus, the association with Epstein Barr virus is astronomically high. In fact, we're at the point where we say a child will not get lupus unless the child has been exposed to Epstein Barr virus. But even in adults, there is still a strong association between having lupus and having been exposed to Epstein Barr virus. Should there be a vaccine for Epstein Barr that we could just use to vaccinate all of our children? We need to be careful. If an immune response to a virus can precipitate lupus, so might an immune response against an Epstein Barr virus vaccine.
There are vaccines we know are safe in lupus patients. The flu vaccine is safe. All lupus patients should get a flu vaccine. The pneumonia vaccine is safe for lupus patients, too.
Because lupus is so unpredictable, like multiple sclerosis, it's important to have social support. One of my studies found lupus patients who are married do much better because they have someone to be there during the tough times. No one thought that study was important but me, so it wasn't published!
Now, the bad news about lupus. Lupus has tripled since 1970. A study by the Mayo Clinic found there is just as much kidney lupus in the modern era as there was back in 1970. It probably means those environmental triggers are more common now than they were before.
Other interesting facts: the survival of lupus patients has dramatically increased. In 1953, four years after diagnosis 50-per cent of patients were dead. However, the survival of lupus patients plateaued in 1980, and there hasn't been any improvement since.The Center for Disease Control announced over the summer that the mortality of women with lupus had actually gone up. I can't understand that. However, it may be because patients with lupus are denied access to rheumatologists early on in their disease.
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How is Lupus Managed and Treated?
Did you know that one of the most common organs to be damaged when you have lupus are your bones? You must take calcium and vitamin D. If on prednisone, you need a bone density scan. If you have osteoporosis, you should be on medication to prevent fractures. Remember, you are the boss of your everyday life!
Prednisone is damaging. But without it, half of lupus patients died in four years. If you have to be on it for long periods of time, there are problems with it. Even low doses can lead to fractures and osteoporosis. Also, low doses of prednisone increase the risk of coronary artery disease. The main cause of death when you have lupus is cardiovascular disease. To prevent this, you must follow a low fat, low cholesterol diet. If you have high blood pressure, take your medicine. Do you know what your homocysteine is? It is a sulfur amino acid, and if you have a higher than normal level it is a risk factor for coronary artery disease and stroke. You can fix a high level by taking folic acida B vitamineveryday. So, you have to live with your lupus, but you can help to prevent complications.
Now, some of you have been damaged by a lupus antibodythe antiphospholipid antibody. Over time, one out of every two lupus patients will make these antibodies, at least temporarily. They have two namesanticardiolipin and lupus anticoagulant. For those of you who plan pregnancies, your doctor will check this because the antibodies can lead to miscarriage risk. (read more about lupus and pregnancy) They also contribute to clots in the veins and strokes and heart attacks. There are new data to suggest taking a baby aspirin every day can reduce your risk of a clot. So, you need to know if you have these antibodies, and if you do, talk to your doctor about aspirin. There are some data to suggest if you take plaquenil, you are less likely to have a blood clot.
We know lupus patients are much more likely to have risk factors for heart disease. Doctor John Esdaile proved that lupus itself is damaging the blood vessels. So this means doctors have to be stricter about controlling risk factors in a lupus patient than they do in someone else. Everybody is now aware of the huge risk of heart disease in lupus.
Plaquenil
One of the smartest things we do for lupus is use drugs that tone down the immune system but don't predispose to infection. Plaquenil is the key to trying to control lupus long-term because it's such a safe, long-term drug. In fact, a Canadian study revealed people who stay on plaquenil are less likely to have flare-ups and develop kidney lupus in the future. If you can tolerate plaquenil, stay on it. I call it lupus health insurance! IVIG is very safe too, if platelet counts are low.
DHEA
DHEA is a mild male hormone. I call this "The My Fair Lady" approach to lupus. Remember what Rex Harrison said... "Why can't a woman be more like a man?" Two U.S. studies have showed benefits, along with a study in Taiwan. In addition, it has been found that DHEA is very helpful for osteoporosis. However, the U.S. Food and Drug Administration did not approve it last year, but may in the next year-and-a-half or so. I expect if it's licensed in the United States, it will be licensed in Canada, too.
Anti-DNA Antibody Inhibitor (LJP394)
But some day, wouldn't you just like someone to make your lupus go away? We need to re-establish immune tolerance, because if we could prevent the immune system from acting against self, there would be no more lupus. There is a huge study of a compound called LJP394 to see if this can prevent the production of the anti-DNA antibodies in lupus. The hope would be that if you could get rid of the anti-DNA antibodies, people wouldn't get kidney disease. This study is not completed. But if that one works, the same company has developed a compound to see if they can get rid of the antiphospholipid antibodies. In mice, there are vaccines that have been very helpful in controlling lupus. Only in mice though.
CellCept (Mycophenolate Mofetil)
What about new drugs for people who have really bad lupus? For those of you who have kidney lupus there has been a tremendous amount of progress in a drug called CellCept--mycophenolate mofetil. It's not quite as strong as chemotherapy, but it works very well in people with kidney disease. It doesn't cause infertility. It is usually well tolerated. So at least there's an alternative for people with kidney lupus.
AntiCD40L
There was a compound called AntiCD40L that might have cured kidney lupus. It was briefly studied in the United States, and the people with kidney lupus who were taking it were doing very well. Those studies had to be halted because of an unsuspected side effectblood clots, strokes and heart attacks. It was almost therewe just hope the next time, there will be a compound that is efficacious and safe. This got everyone so excited, but it wasn't meant to be.
COX-2 Inhibitors
Now, what about borrowing from other diseases? We have to do a lot of that in lupus. In the United States, Celebrex®, an anti-inflammatory, is safer than the older drugs because of fewer ulcers and gastrointestinal bleeds. Is it safe to use in lupus? Well, there were blood clots in a small number of people who had antiphospholipid antibodies. I've asked rheumatolgists to be very careful before we introduce this compound widely for lupus.
What about some of the other arthritis medications? We already use methotrexate for our patients with skin disease and joint problems. There are other arthritis medications we can borrow from too.
Anti-TNF Therapy
But the big revolution in rheumatoid arthritis are the compounds that block tumor necrosis factora mediator of inflammation. Remicade® is one of these drugshorribly expensive though, one-thousand dollars U.S. per month. But the problem is that a rheumatoid arthritis patient taking one of these anti-TNF therapies can start to develop lupus antibodies. We are not anxious to introduce these compounds into widespread use in lupus, but there may be subsets of patients with lupus kidney disease who could benefit.
Chemotherapy
Now lets talk about chemotherapy, the gold standard for the worst lupus. Are there other ways to give chemotherapy, so you wouldn't have to give it once a month for six months and then for two more years every three months? An oncologist at Hopkins studied a disease called aplastic anemia, where the blood counts are so low the person has to have a bone marrow transplant. He asked, for the people who survived the transplant and did very well, whose immune system did they have? The donor's or their own? It turns out all the long term survivors had their own immune system. They hadn't been cured by the bone marrow transplant. The hypothesis is they were cured by the chemotherapy given before the bone marrow transplant. The oncologist gave the chemo for four days in a row and then never again. This oncologist decided to start treating aplastic anemia with four days of chemotherapy instead of doing bone marrow transplants. In the next 10 patients treated just with chemotherapy, seven out of 10 had a complete remission. Three did die of the aplastic anemia, but no one died of the four days of chemotherapy.
Now, these oncologists then asked me if perhaps they had a cure that might work on lupus. How can you go from aplastic anemia to lupus? Aplastic anemia is one of those localized autoimmune disorders, like thyroid disease. It's an autoimmune problem in just organ systemthe bone marrow. I wondered if any of my patients would die from the chemotherapy. They said it was highly unlikely because the white blood cell count is low for only about 14 days. During that period, the person is at risk for infection, but never again. So, for the last six years we've been testing four days of chemotherapy. The bad news is, not everyone goes into a remission. The good news is 40% do, and the remissions have lasted as long as five years!
An example, a patient with terrible kidney disease had four days of chemotherapy. Over the next 18 months, she gradually improved to the point where her lupus was in complete remission. She had a successful pregnancy. Now, of the 60% of the people who don't go into complete remission, half are much better. We've lowered their lupus burden, but we haven't gotten rid of it. Then, there are 25% of patients who have the same level of lupus activity. This is not a cure, but it's another way of thinking about the worst lupus.
Stem Cell Transplant
In Europe, the focus is on stem cell transplant. But stem cell transplant still gives the four days of chemotherapy. The only difference is that the 14-day period where the white blood count is low is shortened because they give the person back their own stem cells. Those stem cells multiply, so the white blood count goes back to normal faster. To give the person their own stem cells back, they have to give chemotherapy (cytoxan) an extra time at the beginning to mobilize the stem cells. So, the patient gets chemotherapy twiceonce to mobilize the stem cells and then the four days of chemotherapy to wipe out their current immune systems.
There were three deaths in the first 23 patients in Europeall of infection. Of the 20 who survived, we're not really clear how many are in remission. In January of this year, we were advised that 75% of people who had stem cell transplants had relapsed. This is not a cure.
Bottom line, we can't cure everybody with these very high powered protocols. But for some people who otherwise might die of terrible lupus, these are salvage protocols. I would not recommend them for people with mild or moderate lupus. These are for the people who are otherwise going to die or be permanently damaged.
Remember, human beings are not ultimately in charge. As we struggle with our day to day lives, we always ask a higher power for help, too. Medicine isn't going to do it all. But, some day, there is going to be a cure for lupus.
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All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.
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Systemic lupus erythematosus
Reviewed By Mark James Borigini Associate Clinical Professor of Medicine, University of California, I…rvine, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.more »
Definition
Systemic lupus erythematosus (SLE) is a chronic, inflammatory autoimmune disorder. It may affect the skin, joints, kidneys, and other organs.
Alternative Names
Disseminated lupus erythematosus; SLE; Lupus; Lupus erythematosus
Causes, incidence, and risk factors
SLE (lupus) is an autoimmune disease. This means there is a problem with the body's normal immune system response. Normally, the immune system helps protect the body from harmful substances. But in patients with an autoimmune disease, the immune system can't tell the difference between harmful substances and healthy ones. The result is an overactive immune response that attacks otherwise healthy cells and tissue. This leads to chronic (long-term) inflammation.
The underlying cause of autoimmune diseases is not fully known. Some researchers think autoimmune diseases occur after infection with an organism that looks like certain proteins in the body. The proteins are later mistaken for the organism and wrongly targeted for attack by the body's immune system.
SLE may be mild or severe enough to cause death.
SLE affects nine times as many women as men. It may occur at any age, but appears most often in people between the ages of 10 and 50 years. African Americans and Asians are affected more often than people from other races.
SLE may also be caused by certain drugs. For information on this cause of SLE, see drug-induced lupus erythematosus.
Symptoms
Symptoms vary from person to person, and may come and go. The condition may affect one organ or body system at first. Others may become involved later. Almost all people with SLE have joint pain and most develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees.
Inflammation of various parts of the heart may occur as pericarditis, endocarditis, or myocarditis. Chest pain and arrhythmias may result from these conditions.
General symptoms include:
* Arthritis
* Fatigue
* Fever
* General discomfort, uneasiness or ill feeling (malaise)
* Joint pain and swelling
* Muscle aches
* Nausea and vomiting
* Pleural effusions
* Pleurisy (causes chest pain)
* Psychosis
* Seizures
* Sensitivity to sunlight
* Skin rash -- a "butterfly" rash over the cheeks and bridge of the nose affects about half of those with SLE. The rash gets worse when in sunlight. The rash may also be widespread.
* Swollen glands
Additional symptoms that may be associated with this disease:
* Abdominal pain
* Blood disorders, including blood clots
* Blood in the urine
* Coughing up blood
* Fingers that change color upon pressure or in the cold
* Hair loss
* Mouth sores
* Nosebleed
* Numbness and tingling
* Red spots on skin
* Skin color is patchy
* Swallowing difficulty
* Visual disturbance
Signs and tests
The diagnosis of SLE is based upon the presence of at least four out of eleven typical characteristics of the disease. The doctor will listen to your chest with a stethoscope. A sound called a heart friction rub or pleural friction rub may be heard. A neurological exam will also be performed.
Tests used to diagnose SLE may include:
* Antibody tests, including:
o Antinuclear antibody (ANA) panel
o Anti-double strand (ds) DNA
o Anti-phospholipid antibodies
o Anti-smith antibodies
* CBC to show low white blood cells, hemoglobin, or platelets
* Chest x-ray showing pleuritis or pericarditis
* Kidney biopsy
* Urinalysis to show blood, casts, or protein in the urine
This disease may also alter the results of the following tests:
* Anti-SSA or -SSB antibodies
* Anti-thyroglobulin antibody
* Anti-thyroid microsomal antibody
* Complement components (C3 and C4)
* Coombs' test - direct
* Cryoglobulins
* ESR
* Rheumatoid factor
* RPR - a test for syphilis
* Serum globulin electrophoresis
* Serum protein electrophoresis
Treatment
There is no cure for SLE. Treatment is aimed at controlling symptoms. Your individual symptoms determine your treatment.
Mild disease that involves a rash, headaches, fever, arthritis, pleurisy, and pericarditis requires little therapy. Nonsteroidal anti-inflammatory medications (NSAIDs) are used to treat arthritis and pleurisy. Corticosteroid creams are used to treat skin rashes. An anti-malaria drug called hydroxychloroquine) and low dose corticosteroids are sometimes used for skin and arthritis symptoms.
You should wear protective clothing, sunglasses, and sunscreen when in the sun.
Severe or life-threatening symptoms (such as hemolytic anemia, extensive heart or lung involvement, kidney disease, or central nervous system involvement) often require treatment by a rheumatologist and other specialists. Corticosteroids or medications to decrease the immune system response may be prescribed to control the various symptoms. Cytotoxic drugs (drugs that block cell growth) are used to treat people who do not respond well to corticosteroids or who might require long-term use of high doses of corticosteroids.
Support Groups
For additional information and support, see lupus resources.
Expectations (prognosis)
The outcome for people with SLE has improved over recent years. Many of those with SLE have mild illness. Women with SLE who become pregnant are often able to carry the pregnancy safely to term and deliver normal infants, as long as there is no severe kidney or heart disease present and the SLE is being treated appropriately.
The presence of anti-phospholipid antibodies may increase the possibility of pregnancy loss.
The 10-year survival rate for lupus patients is greater than 85%. People with severe involvement of the brain, lungs, heart, and kidney do worse than others in terms of overall survival and disability.
Complications
Some people with SLE have deposits of antibodies within the cells (glomeruli) of the kidneys. This leads to a condition called lupus nephritis. Patients with this condition may eventually develop kidney failure and require dialysis or kidney transplantation.
Other complications include:
* Hemolytic anemia (destruction of the red blood cells)
* Infection
* Myocarditis (inflammation of the heart)
* Seizures
* Serositis: pleural or pericardial effusions (fluid around the lungs or heart)
* Thrombocytopenia (severely low blood platelets)
Calling your health care provider
Call your health care provider if you develop symptoms of SLE. Also, call if you have SLE and symptoms got worse or if new symptoms develop.
References
Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB. Kelley's Textbook of Rheumatology. 7th ed. St. Louis, Mo: WB Saunders; 2005.
Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001.
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Date Last Reviewed: 02/03/2009
Copyright: ADAM Health Illustrated Encyclopedia
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TABLE OF CONTENTS
* Definition
* Alternative Names
* Causes, incidence, and risk factors
* Symptoms
* Signs and tests
* Treatment
* Support Groups
* Expectations (prognosis)
* Complications
* Calling your health care provider
* References
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Lupus Information
by Michelle Petri, M.D., M.P.H.
* What are the Symptoms of Lupus?
* Is Lupus an Autoimmune Disease?
* What do we Know About Lupus?
* How is Lupus Managed and Treated?
The following is a transcript of a talk Dr. Petri gave at the British Columbia Lupus Society Symposium in November, 2002.
What are the Symptoms of Lupus?
First off, lupus is not rare. But we definitely need a spokesperson. We need someone famous to take on lupus as their cause.
The problem with lupus is, people can't tell how sick you really are. That's one of the reasons lupus doesn't get the respect it deserves. When my patients apply for disability, often they are turned down. One of the major things that happens in lupus is chronic fatigue, and there is no way to measure that.
Looking at the malar rash in lupus, how does a doctor know it isn't the worst acne? Because it spares the areas around the nose and under the nose that are shaded from ultraviolet light.
How do you know if it's lupus or another form of arthritis? Well, hopefully with diagnostic tests. In addition, the arthritis of lupus is not deforming. The ligaments and tendons around the joints loosen, but there is not permanent destruction of the bones.
Memory problems bother patients on a day-to-day basis. This is a huge problem, and we don't know why. In lupus patients, we are often overlooking fibromyalgia. Thirty percent of my patients have fibromyalgia. You are tired, you hurt, and nothing your doctor does helps. Fibromyalgia is not inflammatory. It is a resetting of the pain thermostat in the brain. I suspect it has more of an impact on your day-to-day life than your lupus, if your lupus is not flaring.
Another symptom is hair loss, called alopecia. In the discoid form of lupus, hair loss will be permanent. I have patients, 15 or 16, who will have to wear wigs the rest of their lives because their diagnosis was delayed and they already had permanent hair loss.
Did you know that one out of five women have a positive anti-nuclear antibody test? Having anti-nuclear antibody is very common, but the great majority of people will never get sick. This is why the diagnosis of lupus is not just based on the positive ANA test. Something else has to happen to prove the person really has lupus, like the skin rashes, the joint inflammation, the kidney disease, and the low blood counts.
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Is Lupus an Autoimmune Disease?
It turns out there are a lot of people who have an autoimmune disease that just affects one organ. A common example of this is autoimmune thyroid disease. I know that one out of every ten lupus patients has low thyroid. But most people who have thyroid disease have nothing else happen.
Did you know that doctors have just discovered that some very common chronic illnesses are autoimmune? Diabetes, for example, especially the juvenile form, is autoimmune.
Did you know that hardening of the arteries is autoimmune? Cholesterol lowering drugs called Statins, work not just because they lower cholesterol, but perhaps because they have an anti-inflammatory action. They prevent the plaque from rupturing and blocking the coronary arteries. So, it's fascinating how important autoimmune disease really is in many kinds of diseases.
Rheumatologists get involved when more than one organ is involvedwhat we call "systemic" illness. There is a kind of systemic illness called undifferentiated connective tissue disease. It's obvious to the physician that the person has an autoimmune problem, but they don't meet the definition for lupus or scleroderma or rheumatoid arthritis. For example, it could be a young woman who has a positive ANA and Raynauds. Or, it could be anyone who has a positive ANA or arthralgia, but we don't see swelling of the joints.
During the silicone breast implant controversy, it was thought that silicone might be causing illnesses like lupus and scleroderma. Then it was discovered that even women who had never had a silicone breast implant could get these mild forms of autoimmunity. In fact, five out of 100 women in the United States have these mild forms of systemic autoimmunity. Autoimmune diseases are not rare. If five percent of women have an autoimmune disease, that should be considered common. If we could just understand autoimmunity, it would have such a huge impact on the health of every country in the world. In the United States, there are 300,000 people with lupus. Worldwide, there are three million.
There are famous people with autoimmune disease. Barbara Bush and her husband, the ex-president George Bush, both had autoimmune thyroid disease. One of their sons had colitis. But the member of their family that got lupus was their dog, Millie. Dogs can get lupus. Vets can diagnose it because dogs can get the same malar rash that human beings do.
Now, Millie wrote a book about her life with lupus. It's a great story, because Millie had a successful pregnancy. So, I think it's a nice story to tell patients with lupus. Millie has since died of old age. The current dog in the White House, Spot, is Millie's grandson. But because Spot is male, he's unlikely to get lupus. We think the autoimmune story has ended!
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What do we Know About Lupus?
There are thousands of researchers worldwide trying to figure out lupus. The reason it's so complicated is because so many things contribute to getting lupusgenetics, drugs, infection, ultraviolet light, and hormones. Then we have the immune system. We don't really know what's going on in the immune system when people get lupus. There seem to be abnormalities in every single part of the immune system. So, what doctors measure is what comes out the other end.
When you develop lupus, you make antibodies against self. Your immune system goes doubly wrong when you have lupus because not only are you making antibodies against yourself, but your immune system doesn't work as well against infection. It's very unfair! But that's what lupus is all aboutantibodies against self. Now, your doctor measures those antibodies when making a diagnosis, but we also measure complementC3, C4 and total complement, because the complement proteins are used up in the blood when you have immune complexes. So, when your antibodies against yourself bind to your cell proteins, they form the "immune complex", and that complex activates complement. As complement is used up, the complement levels become low. Then, of course, we measure inflammation. Inflammation can be present without pain or other abnormal feeling. This is why ongoing surveillance is so essential when you have lupus. When I was chosen to serve on a committee of the American College of Rheumatology to give guidelines to physicians, we recommended that if you have lupus, you should be seen about every three months, even if you're feeling well.
Ten percent of lupus patients are male. The composition of lupus patients changes depending on what area you are in. It is more common in African-Americans and Asian-Americans in the United States. That probably represents genetic issues that are not yet understood.
Our average patient in the U.S. is diagnosed in their 20's and 30's. I suspect in Canada the age of onset might be a little bit later. In Sweden, for example, the age of onset for lupus is late 30's, early 40's. Now, if we could only understand those genetic influences!
I'm sure you ask yourself, What can I change in my lifestyle that can make my lupus go away? Studies of diet have not suggested any benefit at all. Another diet study was done on Omega 3 fatty acids. The study showed there was no benefit whatsoever.
Role of Estrogen
Don't you wonder why lupus is more common in women than men? Well, it turns out estrogen is very important in the development of lupus. In mice, things are so simple, that if you get rid of estrogen or give male hormone, you can stop lupus. Estrogen can actually activate the immune system in many different ways.
In the 1980's, it was discovered that women who have lupus are "super women." Their estrogen is metabolized using pathways, so the metabolites are still active. Not only is their estrogen working on their immune system, but the metabolized estrogen is as well. This was also true in their healthy, female family members. This may be one of the genetic predispositions to lupus. The metabolized estrogen still works on the immune system. Now, Doctor Lahita has suggested it may be possible to reverse these pathways. One way to potentially reverse these estrogen pathways is through diet changes. It was suggested that vegetables like broccoli and cauliflower might affect estrogen metabolism. This was finally tested in Boston. Half the lupus patients had the active ingredient in broccoli in pill form, while the other half took a placebo. It is possible to reverse these estrogen metabolism pathways. However, it made no difference on the activity of the lupus. We need further research in this area.
Many postmenopausal women with lupus wonder if they should take estrogen. Now, we're concerned for two reasons. One, if a woman is more likely to make clots because she has the antiphospholipid antibody, we don't want her to take estrogen because it further increases the risk of having a clot. We've also been concerned that estrogen in pill form might increase the risk of lupus flare-ups.
A study in the United States, called the "Safety of Estrogen Study," is currently underway and should be completed within a year. We will know if taking estrogen in pill form increases the risk of having a flare. Our impressionwithout the datais that the answer is probably no. This has been suggested in several studies, including one from Toronto. So, the use of HRT is probably not so bad if you don't have an antiphospholipid antibody.
The Women's Health Initiative study found that taking estrogen in pill form after menopause might increase heart disease. Since everyone with lupus is already at greater risk of heart disease, most lupus doctors are no longer giving hormone replacement therapy.
Genetic Risk
When you were first diagnosed, you may have wondered if your children would get lupus. The good news is that only two out of 100 children whose mother has lupus will get lupus. The genetic risk is small. It is not strictly a genetic disease.
In mice studies, over 100 different genes predispose to lupus. Some very important research reveals that once you have lupus, several hundred genes participate when you have a lupus flare up. So you can understand how daunting the task is, not just to identify the lupus genes, but to identify the genes that are activated when the lupus flares up. Those genes that are activated when lupus flares up are the genes that we have to control to keep lupus quiet. We have a lot of work ahead of us!
We do know that the same genes that are important in transplantationthe immune response genesplay a role in getting lupus. These are called the HLA genes. Did you know that doctors can almost predict which antibodies against self you will make, based on your immune response genes? If you were wondering why patient A with lupus makes antibodies to DNA and patient B makes antibodies to phospholipid and patient C makes antibodies to Ro, that's probably determined genetically.
The most important thing discovered about the genetic predisposition to lupus started out in mice. This is called "programmed cell death," or apoptosis. In all of us, billions of our cells die every day. We are supposed to be able to chew those cells up and dispose of them without our immune system knowing that anything has happened. We don't want our immune system recognizing our cells as they die. We want our immune system to be ignorant. It was discovered in a mouse model of lupus that one genetic mutation affecting programmed cell death was enough to cause lupus. It doesn't hold true in humans, though. But we know that programmed cell death is important in lupus because those proteins recognized as foreign by the lupus person's immune system are all exposed during cell death. In some way, programmed cell death is key in the onset of lupus.
We also know that it's very important when you have lupus to be able to get rid of those immune complexes. It turns out that some people genetically are going to be slower in getting rid of immune complexes. If you inherit one of these reasons to be slow in getting rid of immune complexes, you are much more likely to get lupus kidney disease.
Eventually, genetic research is going to be so helpful in determining not only what lies ahead, but what causes the disease. If we could understand the cause, we would be a lot smarter in developing new therapies.
Did you know we can prevent lupus in mice? This is one of the most important research studies ever done. In mice who are genetically predisposed to lupus, we can prevent lupus from starting by getting rid of the debris from the cells that have died before the immune system recognizes that debris as being foreign and starts the lupus antibody responses. We can do it in mice with a drug already available for human beings. That drug is called DNase. DNase helps children who have cystic fibrosis. Now, if we knew which of your children were genetically predisposed to get lupus, it might make sense to do a prevention trial with DNase. We are not there yet. Remember, we have to identify those 100 genes first. But we may already have a way to prevent lupus in the next generation. It worked in mice.
Enviromental Triggers
Genes aren't everything. Remember, only two percent of children get lupus if their mom had lupus. We know there are environmental triggers, the most common being ultraviolet light. Many people don't get lupus until they've had a bad sunburn. For most of you who have the lupus rashes, those are brought out by ultraviolet light. If you wear a hat with a brim and sunscreen, you are much less likely to get those rashes.
There are other triggers, including drugs. Be very careful about sulfa antibiotics. Why? Some people don't have lupus until they take these sulfa antibiotics. For people who are already diagnosed with lupus, about 25-per cent will have their disease get more active if they take a sulfa antibiotic. If you need antibiotics, make sure you ask your doctor to prescribe something other than a sulfa antibiotic.
There's also a problem with so-called "alternative medications." Why? Because they are not tested for either safety or efficacy. So, it's the lack of knowledge that is the problem. Surveys show 90-per cent of people take alternative medications. You take them because you hope that by experimenting you're going to find something that helps your lupus. It is an experiment, and it can go wrong.
Some of my patients, when admitted to hospital for a lupus flare, advised me that they had taken Echinacea. At first, I didn't think this could have caused a lupus flare, but after the second or third case, I said I'm going to do some research. It turns out, it has been known in Germany for many years that Echinacea can cause flares of autoimmune disease. If you live in Europe, it says right on the Echinacea label not to take it if you have autoimmune disease. So, after hospitalizing some of my patients with terrible kidney flare-ups who had taken Echinacea on a daily basis, I have now forbidden all my lupus patients from taking it. Maybe it would be okay for a few days to prevent a cold, but my patients were taking it everyday to try to prevent the next cold. Please be careful when taking alternative medications.
Now, if you smoke, you are more likely to get the worst kind of skin lupusdiscoid lupus. Also, plaquenil doesn't work very well. So, don't smoke. It's bad for your lupus. Set a day and quit!
Stressis that good for lupus? Of course not! Stress is not good for anything! But we know we're under more stress than ever before. Stress affects the neuroendocrine system that's supposed to keep autoimmunity quiet. What I ask my patients to do is to take a little vacation from stress one or two times a week. Go out for dinner, go to a movie, go shopping for shoeswhatever it is that relieves your stress. Just shut the door on your everyday life for a few hours a week.
Now, surgery is an example of a physical stress in a lupus patient. I sometimes get calls from surgeons of my patients saying the surgery went really well but, after the procedure, my lupus patient developed a fever. When the fever continued, they thought maybe it was the lupus. Nearly all of the time this is a lupus flare. So, whether it's mental or physical stress, it's not good for your lupus.
What about infection? We all believe infections have something to do with getting lupus. Our strongest proof is the data on monoEpstein Barr virus. In children who develop lupus, the association with Epstein Barr virus is astronomically high. In fact, we're at the point where we say a child will not get lupus unless the child has been exposed to Epstein Barr virus. But even in adults, there is still a strong association between having lupus and having been exposed to Epstein Barr virus. Should there be a vaccine for Epstein Barr that we could just use to vaccinate all of our children? We need to be careful. If an immune response to a virus can precipitate lupus, so might an immune response against an Epstein Barr virus vaccine.
There are vaccines we know are safe in lupus patients. The flu vaccine is safe. All lupus patients should get a flu vaccine. The pneumonia vaccine is safe for lupus patients, too.
Because lupus is so unpredictable, like multiple sclerosis, it's important to have social support. One of my studies found lupus patients who are married do much better because they have someone to be there during the tough times. No one thought that study was important but me, so it wasn't published!
Now, the bad news about lupus. Lupus has tripled since 1970. A study by the Mayo Clinic found there is just as much kidney lupus in the modern era as there was back in 1970. It probably means those environmental triggers are more common now than they were before.
Other interesting facts: the survival of lupus patients has dramatically increased. In 1953, four years after diagnosis 50-per cent of patients were dead. However, the survival of lupus patients plateaued in 1980, and there hasn't been any improvement since.The Center for Disease Control announced over the summer that the mortality of women with lupus had actually gone up. I can't understand that. However, it may be because patients with lupus are denied access to rheumatologists early on in their disease.
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How is Lupus Managed and Treated?
Did you know that one of the most common organs to be damaged when you have lupus are your bones? You must take calcium and vitamin D. If on prednisone, you need a bone density scan. If you have osteoporosis, you should be on medication to prevent fractures. Remember, you are the boss of your everyday life!
Prednisone is damaging. But without it, half of lupus patients died in four years. If you have to be on it for long periods of time, there are problems with it. Even low doses can lead to fractures and osteoporosis. Also, low doses of prednisone increase the risk of coronary artery disease. The main cause of death when you have lupus is cardiovascular disease. To prevent this, you must follow a low fat, low cholesterol diet. If you have high blood pressure, take your medicine. Do you know what your homocysteine is? It is a sulfur amino acid, and if you have a higher than normal level it is a risk factor for coronary artery disease and stroke. You can fix a high level by taking folic acida B vitamineveryday. So, you have to live with your lupus, but you can help to prevent complications.
Now, some of you have been damaged by a lupus antibodythe antiphospholipid antibody. Over time, one out of every two lupus patients will make these antibodies, at least temporarily. They have two namesanticardiolipin and lupus anticoagulant. For those of you who plan pregnancies, your doctor will check this because the antibodies can lead to miscarriage risk. (read more about lupus and pregnancy) They also contribute to clots in the veins and strokes and heart attacks. There are new data to suggest taking a baby aspirin every day can reduce your risk of a clot. So, you need to know if you have these antibodies, and if you do, talk to your doctor about aspirin. There are some data to suggest if you take plaquenil, you are less likely to have a blood clot.
We know lupus patients are much more likely to have risk factors for heart disease. Doctor John Esdaile proved that lupus itself is damaging the blood vessels. So this means doctors have to be stricter about controlling risk factors in a lupus patient than they do in someone else. Everybody is now aware of the huge risk of heart disease in lupus.
Plaquenil
One of the smartest things we do for lupus is use drugs that tone down the immune system but don't predispose to infection. Plaquenil is the key to trying to control lupus long-term because it's such a safe, long-term drug. In fact, a Canadian study revealed people who stay on plaquenil are less likely to have flare-ups and develop kidney lupus in the future. If you can tolerate plaquenil, stay on it. I call it lupus health insurance! IVIG is very safe too, if platelet counts are low.
DHEA
DHEA is a mild male hormone. I call this "The My Fair Lady" approach to lupus. Remember what Rex Harrison said... "Why can't a woman be more like a man?" Two U.S. studies have showed benefits, along with a study in Taiwan. In addition, it has been found that DHEA is very helpful for osteoporosis. However, the U.S. Food and Drug Administration did not approve it last year, but may in the next year-and-a-half or so. I expect if it's licensed in the United States, it will be licensed in Canada, too.
Anti-DNA Antibody Inhibitor (LJP394)
But some day, wouldn't you just like someone to make your lupus go away? We need to re-establish immune tolerance, because if we could prevent the immune system from acting against self, there would be no more lupus. There is a huge study of a compound called LJP394 to see if this can prevent the production of the anti-DNA antibodies in lupus. The hope would be that if you could get rid of the anti-DNA antibodies, people wouldn't get kidney disease. This study is not completed. But if that one works, the same company has developed a compound to see if they can get rid of the antiphospholipid antibodies. In mice, there are vaccines that have been very helpful in controlling lupus. Only in mice though.
CellCept (Mycophenolate Mofetil)
What about new drugs for people who have really bad lupus? For those of you who have kidney lupus there has been a tremendous amount of progress in a drug called CellCept--mycophenolate mofetil. It's not quite as strong as chemotherapy, but it works very well in people with kidney disease. It doesn't cause infertility. It is usually well tolerated. So at least there's an alternative for people with kidney lupus.
AntiCD40L
There was a compound called AntiCD40L that might have cured kidney lupus. It was briefly studied in the United States, and the people with kidney lupus who were taking it were doing very well. Those studies had to be halted because of an unsuspected side effectblood clots, strokes and heart attacks. It was almost therewe just hope the next time, there will be a compound that is efficacious and safe. This got everyone so excited, but it wasn't meant to be.
COX-2 Inhibitors
Now, what about borrowing from other diseases? We have to do a lot of that in lupus. In the United States, Celebrex®, an anti-inflammatory, is safer than the older drugs because of fewer ulcers and gastrointestinal bleeds. Is it safe to use in lupus? Well, there were blood clots in a small number of people who had antiphospholipid antibodies. I've asked rheumatolgists to be very careful before we introduce this compound widely for lupus.
What about some of the other arthritis medications? We already use methotrexate for our patients with skin disease and joint problems. There are other arthritis medications we can borrow from too.
Anti-TNF Therapy
But the big revolution in rheumatoid arthritis are the compounds that block tumor necrosis factora mediator of inflammation. Remicade® is one of these drugshorribly expensive though, one-thousand dollars U.S. per month. But the problem is that a rheumatoid arthritis patient taking one of these anti-TNF therapies can start to develop lupus antibodies. We are not anxious to introduce these compounds into widespread use in lupus, but there may be subsets of patients with lupus kidney disease who could benefit.
Chemotherapy
Now lets talk about chemotherapy, the gold standard for the worst lupus. Are there other ways to give chemotherapy, so you wouldn't have to give it once a month for six months and then for two more years every three months? An oncologist at Hopkins studied a disease called aplastic anemia, where the blood counts are so low the person has to have a bone marrow transplant. He asked, for the people who survived the transplant and did very well, whose immune system did they have? The donor's or their own? It turns out all the long term survivors had their own immune system. They hadn't been cured by the bone marrow transplant. The hypothesis is they were cured by the chemotherapy given before the bone marrow transplant. The oncologist gave the chemo for four days in a row and then never again. This oncologist decided to start treating aplastic anemia with four days of chemotherapy instead of doing bone marrow transplants. In the next 10 patients treated just with chemotherapy, seven out of 10 had a complete remission. Three did die of the aplastic anemia, but no one died of the four days of chemotherapy.
Now, these oncologists then asked me if perhaps they had a cure that might work on lupus. How can you go from aplastic anemia to lupus? Aplastic anemia is one of those localized autoimmune disorders, like thyroid disease. It's an autoimmune problem in just organ systemthe bone marrow. I wondered if any of my patients would die from the chemotherapy. They said it was highly unlikely because the white blood cell count is low for only about 14 days. During that period, the person is at risk for infection, but never again. So, for the last six years we've been testing four days of chemotherapy. The bad news is, not everyone goes into a remission. The good news is 40% do, and the remissions have lasted as long as five years!
An example, a patient with terrible kidney disease had four days of chemotherapy. Over the next 18 months, she gradually improved to the point where her lupus was in complete remission. She had a successful pregnancy. Now, of the 60% of the people who don't go into complete remission, half are much better. We've lowered their lupus burden, but we haven't gotten rid of it. Then, there are 25% of patients who have the same level of lupus activity. This is not a cure, but it's another way of thinking about the worst lupus.
Stem Cell Transplant
In Europe, the focus is on stem cell transplant. But stem cell transplant still gives the four days of chemotherapy. The only difference is that the 14-day period where the white blood count is low is shortened because they give the person back their own stem cells. Those stem cells multiply, so the white blood count goes back to normal faster. To give the person their own stem cells back, they have to give chemotherapy (cytoxan) an extra time at the beginning to mobilize the stem cells. So, the patient gets chemotherapy twiceonce to mobilize the stem cells and then the four days of chemotherapy to wipe out their current immune systems.
There were three deaths in the first 23 patients in Europeall of infection. Of the 20 who survived, we're not really clear how many are in remission. In January of this year, we were advised that 75% of people who had stem cell transplants had relapsed. This is not a cure.
Bottom line, we can't cure everybody with these very high powered protocols. But for some people who otherwise might die of terrible lupus, these are salvage protocols. I would not recommend them for people with mild or moderate lupus. These are for the people who are otherwise going to die or be permanently damaged.
Remember, human beings are not ultimately in charge. As we struggle with our day to day lives, we always ask a higher power for help, too. Medicine isn't going to do it all. But, some day, there is going to be a cure for lupus.
(top of page)
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Home : Disease and Conditions : Systemic lupus erythematosus
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Systemic lupus erythematosus
Reviewed By Mark James Borigini Associate Clinical Professor of Medicine, University of California, I…rvine, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.more »
Definition
Systemic lupus erythematosus (SLE) is a chronic, inflammatory autoimmune disorder. It may affect the skin, joints, kidneys, and other organs.
Alternative Names
Disseminated lupus erythematosus; SLE; Lupus; Lupus erythematosus
Causes, incidence, and risk factors
SLE (lupus) is an autoimmune disease. This means there is a problem with the body's normal immune system response. Normally, the immune system helps protect the body from harmful substances. But in patients with an autoimmune disease, the immune system can't tell the difference between harmful substances and healthy ones. The result is an overactive immune response that attacks otherwise healthy cells and tissue. This leads to chronic (long-term) inflammation.
The underlying cause of autoimmune diseases is not fully known. Some researchers think autoimmune diseases occur after infection with an organism that looks like certain proteins in the body. The proteins are later mistaken for the organism and wrongly targeted for attack by the body's immune system.
SLE may be mild or severe enough to cause death.
SLE affects nine times as many women as men. It may occur at any age, but appears most often in people between the ages of 10 and 50 years. African Americans and Asians are affected more often than people from other races.
SLE may also be caused by certain drugs. For information on this cause of SLE, see drug-induced lupus erythematosus.
Symptoms
Symptoms vary from person to person, and may come and go. The condition may affect one organ or body system at first. Others may become involved later. Almost all people with SLE have joint pain and most develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees.
Inflammation of various parts of the heart may occur as pericarditis, endocarditis, or myocarditis. Chest pain and arrhythmias may result from these conditions.
General symptoms include:
* Arthritis
* Fatigue
* Fever
* General discomfort, uneasiness or ill feeling (malaise)
* Joint pain and swelling
* Muscle aches
* Nausea and vomiting
* Pleural effusions
* Pleurisy (causes chest pain)
* Psychosis
* Seizures
* Sensitivity to sunlight
* Skin rash -- a "butterfly" rash over the cheeks and bridge of the nose affects about half of those with SLE. The rash gets worse when in sunlight. The rash may also be widespread.
* Swollen glands
Additional symptoms that may be associated with this disease:
* Abdominal pain
* Blood disorders, including blood clots
* Blood in the urine
* Coughing up blood
* Fingers that change color upon pressure or in the cold
* Hair loss
* Mouth sores
* Nosebleed
* Numbness and tingling
* Red spots on skin
* Skin color is patchy
* Swallowing difficulty
* Visual disturbance
Signs and tests
The diagnosis of SLE is based upon the presence of at least four out of eleven typical characteristics of the disease. The doctor will listen to your chest with a stethoscope. A sound called a heart friction rub or pleural friction rub may be heard. A neurological exam will also be performed.
Tests used to diagnose SLE may include:
* Antibody tests, including:
o Antinuclear antibody (ANA) panel
o Anti-double strand (ds) DNA
o Anti-phospholipid antibodies
o Anti-smith antibodies
* CBC to show low white blood cells, hemoglobin, or platelets
* Chest x-ray showing pleuritis or pericarditis
* Kidney biopsy
* Urinalysis to show blood, casts, or protein in the urine
This disease may also alter the results of the following tests:
* Anti-SSA or -SSB antibodies
* Anti-thyroglobulin antibody
* Anti-thyroid microsomal antibody
* Complement components (C3 and C4)
* Coombs' test - direct
* Cryoglobulins
* ESR
* Rheumatoid factor
* RPR - a test for syphilis
* Serum globulin electrophoresis
* Serum protein electrophoresis
Treatment
There is no cure for SLE. Treatment is aimed at controlling symptoms. Your individual symptoms determine your treatment.
Mild disease that involves a rash, headaches, fever, arthritis, pleurisy, and pericarditis requires little therapy. Nonsteroidal anti-inflammatory medications (NSAIDs) are used to treat arthritis and pleurisy. Corticosteroid creams are used to treat skin rashes. An anti-malaria drug called hydroxychloroquine) and low dose corticosteroids are sometimes used for skin and arthritis symptoms.
You should wear protective clothing, sunglasses, and sunscreen when in the sun.
Severe or life-threatening symptoms (such as hemolytic anemia, extensive heart or lung involvement, kidney disease, or central nervous system involvement) often require treatment by a rheumatologist and other specialists. Corticosteroids or medications to decrease the immune system response may be prescribed to control the various symptoms. Cytotoxic drugs (drugs that block cell growth) are used to treat people who do not respond well to corticosteroids or who might require long-term use of high doses of corticosteroids.
Support Groups
For additional information and support, see lupus resources.
Expectations (prognosis)
The outcome for people with SLE has improved over recent years. Many of those with SLE have mild illness. Women with SLE who become pregnant are often able to carry the pregnancy safely to term and deliver normal infants, as long as there is no severe kidney or heart disease present and the SLE is being treated appropriately.
The presence of anti-phospholipid antibodies may increase the possibility of pregnancy loss.
The 10-year survival rate for lupus patients is greater than 85%. People with severe involvement of the brain, lungs, heart, and kidney do worse than others in terms of overall survival and disability.
Complications
Some people with SLE have deposits of antibodies within the cells (glomeruli) of the kidneys. This leads to a condition called lupus nephritis. Patients with this condition may eventually develop kidney failure and require dialysis or kidney transplantation.
Other complications include:
* Hemolytic anemia (destruction of the red blood cells)
* Infection
* Myocarditis (inflammation of the heart)
* Seizures
* Serositis: pleural or pericardial effusions (fluid around the lungs or heart)
* Thrombocytopenia (severely low blood platelets)
Calling your health care provider
Call your health care provider if you develop symptoms of SLE. Also, call if you have SLE and symptoms got worse or if new symptoms develop.
References
Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB. Kelley's Textbook of Rheumatology. 7th ed. St. Louis, Mo: WB Saunders; 2005.
Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001.
1 2 3 Next Next
Date Last Reviewed: 02/03/2009
Copyright: ADAM Health Illustrated Encyclopedia
Licensed from:
Systemic Lupus Erythematosus News
* Black Americans With Lupus Have Better Response to Flu Vaccine
* Lupus, Rheumatoid Arthritis May Raise Risk of Abnormal Heart Rhythm
* Kidney Disease Could Be More Deadly for Kids With Lupus
Systemic Lupus Erythematosus Images
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Lupus, discoid - view of lesions on the chest
Lupus, discoid - view of lesions ...
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Lupus, discoid on a child's face
Lupus, discoid on a child's face
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Systemic lupus erythematosus rash on the face
Systemic lupus erythematosus rash ...
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Sunscreen Brand Used - Shannon's Story
Sunscreen Brand Used - Shannon's Story
TABLE OF CONTENTS
* Definition
* Alternative Names
* Causes, incidence, and risk factors
* Symptoms
* Signs and tests
* Treatment
* Support Groups
* Expectations (prognosis)
* Complications
* Calling your health care provider
* References
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asthma
random things
Dream Interpretation CHAPTER ONE
I have studied dreams for more than fifteen years. I have also read a lot of books about it. I can give you
some information that might help you in your endeavors. The base of all of this lies within the brain and
its mighty powers. The brain is mysterious and magical to me. It has the capabilities that are immeasurable to me.
It has information that we don't even realize in it. We can explore some of these through the miracle of
dreams. The mind is as vast as the universe to me. It is the most amazing part of our journey because we
use it for all things movement, thinking etc. It all starts with thinking. Therefore it all starts with the brain.
We can not move a muscle without the brain telling that muscle to move.
To interpret your dreams you must keep in mind that there are alot of different dreams . There are prophetic dreams
and ones that have no subconscious or clairvoyant meaning at all. In the hours of 2-7 am are the best time to realize
the deepest part of your sleep usually by this time your muscles are relaxed and digestion is done and you r mind is
at rest dreams that occur at this time are worth the interpretation usually.
Ususally reoccuring dreams have no real signifigance since it can usually be traced to events or people that trigger
some response. However; if the dream only occured two or three times then it should be taken seriously. If you
have over indulged in any way before your dream you must disreguard these ones because they are induced
from chemicals or food. Also, if you wake up and your arms asleep and you dream of your arm being cut off or
something similiar that also has no signifigance. The same goes for the sounds that surround you in waking .
In other words if there is a construction crew outside your window and you dream of something that mimics the
sound that also has no signifigance or a bell and then your friend says i stopped by but no one answered the door you
can not take that into an interpretation because its environmentally induced. Illness fever shock grievance or
any other situation that could induce some feelings should not be interpreted. Anything that can not be attributed
to external physical conditions should be taken more seriously than others.
The following dreams should.help you realize what category your particular dream is in and always remember
that the thing that stands out the most should be analyzed and interpreted.
Also, the common knowledge of up is good and down is bad is usually always the case but other things in the dream
should be taken into consideration.
PRECOGNITIVE - These fortell important events.
WARNING - Which tells of impending danger.
FACTUAL - Confirms a situation that the dreamer already knows about.
INSPIRATIONAL - This one helps you with a solution for personal or business problem.
Practice makes perfect when interpreting any dream. The more you do it the better you get at it (like any other SKILL)
Dream symbols are a language of the subconscious mind. Keep in mind if you are an observer in your
dream it is a warning dream. If the dreamer is actually performing a task that is a inspirational dream.
Anything shiny or clean or in GOOD condition is good. The opposite is also true. If the item of remembrance
is dull it likely in BAD condition then that is bad meaning obstacles or difficulties. If you the dreamer
dream of the Dr or illness then a check up is advised. Dreams that involve friends or family members
to which you are in good standing or get along with generally mean business advancement However if
a dream of someone you arent in good standing with the opposite is true.
Here is a quick example of interpreting a dream say you had a dream of a birthday party instead of just
looking up party you would look up balloons flowers or what ever the dream entailed before the actual interpretation
is made.If the dream is hazy or not all remembered it may not have any signifigance at all.
Aristotle said "the skilful interpreter of dreams is he who has the faculty of observing resemblances"
Herder the German Philosopher states that dreams are but the ideals of all poetic arts.
Jean Paul Richter thinks dreams are involuntary experiences leading to the composition of poetry.
Both of these authors concur with the great ones of the past such as ANietzsche, Kant, Novalis.
F.W. Hildebrandt wrote in 1875 " Dreams help us to inspect those hidden depths of existencewhich are mostly
out of our reach in waking hours. Dreams bring us such refined insight into self knowledge and revelations of half conscious
isposiitons and powers that upon waking,we may well admire the sharp eyed demon that helped us find the hidden
plot.A dream can warn us from within with the voice of a watchman stationed at the central observatory of our
spiritual life. And our dreams can also warn us of the dangerous steps we have already taken!"
Jung, who was a Brilliant Swiss Psychologist, pointed this out consicely when he stated "Visual images have the quality
of the human soul!" The mental images you can carry over the thresh holdof your consciousness are unimportant mites
when compared to the wealth of imagery. Every human emotion and experience can be reflected in dreams.
Artimedorus compiled his Oneiro - critica on this subject, it proved so popular that sixteen hundred years later its
first english translation had been reprinted thirty two times by the year 1800.
As I can see there have been many dream books in many different languages including but certainly not limited to
Hebrew, Egyptians, Assyrians, Babylonians, Latin,Arabic, Russian, French, and Italians.
Friedrich Hebbell, who was a dedicated student of dream problems, stated that "In dreams fantasy gets even with
shameless imp, Reason"
Cicero, the Roman author 106-43 BC wrote almost 2000 years ago "nothing can be so silly, so impossible,
or so unnatural that it cannot happen in a dream".
A young philosopher in 2000 named Gina Renee Raymond said "The coolest thing I can think of is that
we all write our own personal script every night in a dream we are the ONLY author, the ONLY writer,
the ONLY audience, and the ONLY producer of our own dreams. We all do this EVERY night!
The brain is AMAZING to me."
It is proven that we all dream every single night while we may not remember
them it is proven that we do indeed dream. How do we prove this by the heart rate and the R.E.M respiration and
brain waves these were proven by thousands of volunteers that proved that we dream when we sleep some of those
people did not remember dreaming even though the tests proved that they did. It was also thought that there is a
minimum of three and a maximum of nine throughout the night. Even babies as young as eight months old dream the
mentally challenged the low as well as high I Q s Low did not dream less than the high .
It seams to be universal. WE ALL DREAM!
Dream Interpretation CHAPTER TWO
Remember that even if the interpretation is not GREAT news there is time to change it. We have to be
aware of the dangers in the dream to look out for certain things in waking life. As you go through out this book
remember that sometimes your dreams mean nothing look through the first chapter and see if the dream
should be interpreted at all.
A's
abandonned
I have studied dreams for more than fifteen years. I have also read a lot of books about it. I can give you
some information that might help you in your endeavors. The base of all of this lies within the brain and
its mighty powers. The brain is mysterious and magical to me. It has the capabilities that are immeasurable to me.
It has information that we don't even realize in it. We can explore some of these through the miracle of
dreams. The mind is as vast as the universe to me. It is the most amazing part of our journey because we
use it for all things movement, thinking etc. It all starts with thinking. Therefore it all starts with the brain.
We can not move a muscle without the brain telling that muscle to move.
To interpret your dreams you must keep in mind that there are alot of different dreams . There are prophetic dreams
and ones that have no subconscious or clairvoyant meaning at all. In the hours of 2-7 am are the best time to realize
the deepest part of your sleep usually by this time your muscles are relaxed and digestion is done and you r mind is
at rest dreams that occur at this time are worth the interpretation usually.
Ususally reoccuring dreams have no real signifigance since it can usually be traced to events or people that trigger
some response. However; if the dream only occured two or three times then it should be taken seriously. If you
have over indulged in any way before your dream you must disreguard these ones because they are induced
from chemicals or food. Also, if you wake up and your arms asleep and you dream of your arm being cut off or
something similiar that also has no signifigance. The same goes for the sounds that surround you in waking .
In other words if there is a construction crew outside your window and you dream of something that mimics the
sound that also has no signifigance or a bell and then your friend says i stopped by but no one answered the door you
can not take that into an interpretation because its environmentally induced. Illness fever shock grievance or
any other situation that could induce some feelings should not be interpreted. Anything that can not be attributed
to external physical conditions should be taken more seriously than others.
The following dreams should.help you realize what category your particular dream is in and always remember
that the thing that stands out the most should be analyzed and interpreted.
Also, the common knowledge of up is good and down is bad is usually always the case but other things in the dream
should be taken into consideration.
PRECOGNITIVE - These fortell important events.
WARNING - Which tells of impending danger.
FACTUAL - Confirms a situation that the dreamer already knows about.
INSPIRATIONAL - This one helps you with a solution for personal or business problem.
Practice makes perfect when interpreting any dream. The more you do it the better you get at it (like any other SKILL)
Dream symbols are a language of the subconscious mind. Keep in mind if you are an observer in your
dream it is a warning dream. If the dreamer is actually performing a task that is a inspirational dream.
Anything shiny or clean or in GOOD condition is good. The opposite is also true. If the item of remembrance
is dull it likely in BAD condition then that is bad meaning obstacles or difficulties. If you the dreamer
dream of the Dr or illness then a check up is advised. Dreams that involve friends or family members
to which you are in good standing or get along with generally mean business advancement However if
a dream of someone you arent in good standing with the opposite is true.
Here is a quick example of interpreting a dream say you had a dream of a birthday party instead of just
looking up party you would look up balloons flowers or what ever the dream entailed before the actual interpretation
is made.If the dream is hazy or not all remembered it may not have any signifigance at all.
Aristotle said "the skilful interpreter of dreams is he who has the faculty of observing resemblances"
Herder the German Philosopher states that dreams are but the ideals of all poetic arts.
Jean Paul Richter thinks dreams are involuntary experiences leading to the composition of poetry.
Both of these authors concur with the great ones of the past such as ANietzsche, Kant, Novalis.
F.W. Hildebrandt wrote in 1875 " Dreams help us to inspect those hidden depths of existencewhich are mostly
out of our reach in waking hours. Dreams bring us such refined insight into self knowledge and revelations of half conscious
isposiitons and powers that upon waking,we may well admire the sharp eyed demon that helped us find the hidden
plot.A dream can warn us from within with the voice of a watchman stationed at the central observatory of our
spiritual life. And our dreams can also warn us of the dangerous steps we have already taken!"
Jung, who was a Brilliant Swiss Psychologist, pointed this out consicely when he stated "Visual images have the quality
of the human soul!" The mental images you can carry over the thresh holdof your consciousness are unimportant mites
when compared to the wealth of imagery. Every human emotion and experience can be reflected in dreams.
Artimedorus compiled his Oneiro - critica on this subject, it proved so popular that sixteen hundred years later its
first english translation had been reprinted thirty two times by the year 1800.
As I can see there have been many dream books in many different languages including but certainly not limited to
Hebrew, Egyptians, Assyrians, Babylonians, Latin,Arabic, Russian, French, and Italians.
Friedrich Hebbell, who was a dedicated student of dream problems, stated that "In dreams fantasy gets even with
shameless imp, Reason"
Cicero, the Roman author 106-43 BC wrote almost 2000 years ago "nothing can be so silly, so impossible,
or so unnatural that it cannot happen in a dream".
A young philosopher in 2000 named Gina Renee Raymond said "The coolest thing I can think of is that
we all write our own personal script every night in a dream we are the ONLY author, the ONLY writer,
the ONLY audience, and the ONLY producer of our own dreams. We all do this EVERY night!
The brain is AMAZING to me."
It is proven that we all dream every single night while we may not remember
them it is proven that we do indeed dream. How do we prove this by the heart rate and the R.E.M respiration and
brain waves these were proven by thousands of volunteers that proved that we dream when we sleep some of those
people did not remember dreaming even though the tests proved that they did. It was also thought that there is a
minimum of three and a maximum of nine throughout the night. Even babies as young as eight months old dream the
mentally challenged the low as well as high I Q s Low did not dream less than the high .
It seams to be universal. WE ALL DREAM!
Dream Interpretation CHAPTER TWO
Remember that even if the interpretation is not GREAT news there is time to change it. We have to be
aware of the dangers in the dream to look out for certain things in waking life. As you go through out this book
remember that sometimes your dreams mean nothing look through the first chapter and see if the dream
should be interpreted at all.
A's
abandonned
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