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Thursday, December 5, 2013
Best environment for lupus patient
PLEASE HELP ME UNDERSTAND MORE ABOUT LUPUS. MY HUSBAND IS POSITIVE W/ LUPUS W/ VERY HIGH ANA (115). HE WANTS TO LIVE IN BACK IN HIS PROVINCE FOR FRESH AIR & FRESH FOOD & with his parents. BUT THE HOSPITALS THERE ARE BACKWARD & ILL-EQUIPPED. I WANT HIM TO STAY IN THE CITY NEAR A VERY GOOD HOSPITAL. BUT MY HUSBAND DOES NOT LIKE THE CITY PACE, LIFESTYLE & ENVIRONMENT. WE STAY IN THE CITY BECAUSE OF THE PRESENCE OF GOOD SCHOOLS FOR OUR CHILDREN. ALSO I HAVE AN ESTABLISHED BUSINESS IN THE CITY WHICH PROVIDES FOR MY FAMILY. PLEASE COUNSEL ME. WHERE SHOULD HE LIVE, NEAR A GOOD HOSPITAL BUT IN A CITY OR IN A CLEAN PROVINCE BUT DEVOID OF GOOD HOSPITALS?
First, high positive ANA is NOT diagnostic of lupus. High positive ANA can occur in several diseases and infections. So, before any decision is made about changing the life style it is very important to get a proper evaluation from an internist, and if suspected of lupus, from a rheumatologist. If the diagnosis turns out to be SLE, then questions arise as to which environment is better. To my knowledge there is no well-documented research that has addressed this question in entirety. In a study from India, positive ANA and lupus appeared to be more common in urban areas than in a rural population. However, there could be a number of factors that may have affected the data, and may have nothing to do with the `fresh air and food`. In general, a few factors in the environment affect patients with lupus: direct sun exposure on the face/body is not good; it is important to avoid infections; a good balanced diet - too much of meat or fats are NOT good; smoking and pollution MAY have an adverse impact. Because the disease may be long-standing in some individuals, it is very important to have a STRONG SOCIAL and FAMILY SUPPORT. And, most important of all, happiness cures half of the illness. Well, then happiness is a very complex process - one may feel happy by living in open areas with parents and other family, or one may feel happy by being able to send kids to a good school. Lupus can be a very simple problem, with occasional aches and pains or some skin problems, and people with such a type of lupus live a normal and productive life. On the other hand, some individuals may have very serious complications of this disease which may require close observations by a Doctor, preferably a specialist, who may not be close to a rural area, and sometimes, may require hospitalizations.
In summary, such decisions have to be very individualized. But, it is important not to make a decision in haste. Education about the illness may be the most important factor in making a decision. I usually suggest my patients get in touch with the local or national support groups, such as the Lupus Foundation of America and Arthritis Foundation. They have some booklets that describe various aspects of this illness in lay terms. After knowing more about the disease and his illness, he may have a better perspective, and may be able to take all other factors - kids, wife, school, hospital - into account before making a decision about the move.
Ram Raj Singh, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati