Professional Patient

Can Fish Oil Reduce Sjogren's Syndrome Activity and Symptoms?

Many doctors now agree that omega-3 fatty acids (typically found in fish oil or flaxseed oil) can help reduce eye dryness associated with Sjogren's Syndrome. But can they do more? Omega-3s are often referred to as having anti-inflammatory properties, which makes many people who have autoiummune conditions like Sjogren's Syndrome wonder if omega-3s can reduce the "inflammation" behind autoimmune diseases.

Research has been spotty at best (a literature review from the Agency for Healthcare Research and Quality done in 2004 showed mixed or no results for use of omega-3s to treat rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease), although the medical field is finally catching up to this idea. For example, Dr. Michelle Petri, a lupus specialist at Johns Hopkins University, is about to begin a clinical trial asessing the efficacy of fish oil in lupus patients; and the National Center for Complementary and Alternative Medicine is currently running a study focusing on fish oil and borage oil in treatment of rheumatoid arthritis. However, I know many autoimmune patients who aren't waiting for research to confirm that omega-3s help reduce symptoms... they are on fish oil or flaxseed oil already.

I have considered fish oil or flaxseed oil for my eyes, and wondered about whether it would do anything for my Sjogren's. I tried fish oil pills briefly, but the nasty fish burps afterwards really turned me off. When my allergist recently told me there is anecdotal evidence that fish oil helps alleviate the symptoms of exercise-induced asthma, I decided it might be time to try it again.

I consulted with my rheumatologist about whether omega-3s might help my Sjogren's, and if so, what the proper dose would be. She referred me to a study in the Annals of the Rheumatic Diseases 2008;67:841–848 showing that low-dose omega-3s have beneficial effects on disease activity in patients with SLE and help protect them against the atherosclerosis typical in lupus patients. You can read a project abstract in PubMed, here: "A randomised interventional trial of omega-3- polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosus". Of course, there is no comparable study for Sjogren's patients yet.

The magic dose in the study was 1.8 g eicosapentanoic acid (EPA) and 1.2 g docosahexanoic acid (DHA) per day. Now I need to run to the store and see if I can get that more easily in pill form or liquid form. My initial research shows that you have to take a lot of pills each day to reach those totals. I'm hoping fish oil in liquid form will provide a more concentrated dose. A fair warning: the study showed that lower doses were not as effective in reducing the "oxidative stress" that contributes to heart and vascular disease in lupus patients.

Making the Most of What Remains/Michael J Fox on Oprah

On March 31, 2009, Oprah interviewed Michael J. Fox about his personal battle with Parkinson's disease. It was a terrific interview because he talked about health and illness and grieving and changing your life to what is. All in a very real but very moving way. He is wry, determined, fighting, and yet somehow at peace. And he said he is more now with Parkinson's than he ever was before it.

He explained that Parkinson's made his life change for the better.... he now appreciates every day, and drops anything for his children at any time because he knows family is the most valuable thing in his life.

He also talked about acceptance in a moving way. I have often realized, thanks to my health concerns, that life is about making the most of what you have (what remains) rather than pining for a time, a place, a family, and a body that lie in a distant past. And loss is inevitable... for anyone, not just someone who is ill. We are all at some point in our lives going to lose our looks, our "healthy" status, our ability to run and jump or hold small things or tilt our heads up to the sky. We are going to lose people we love, pets we love, jobs and homes that we love. We will find ourselves at times with few friends to lean on and little (if any) money in the bank. 

In the face of this transience, of not possessing the things and people in our lives forever... you can choose to cope in one of two obvious ways. You can resign in despair, steeled against a depressing stream of coming grief and loss, or you can choose to feel the freedom of living in the now. You can hide in bed, or see the beauty and peace in what you have today, the things that are all around you. Things you might take for granted as a healthier person who is occupied with career, achievement, acquisition, and the daily grind. 

Life throws all kinds of challenges at us that force us to re-envision ourselves to fit what we have in our hands to work with at the time. It's devastating sometimes, but it does give us a chance to practice just being ourselves and doing the best we can with what we have. Life is about making the most of whatever remains in our lives, be it energy, intelligence, money or love.

SSDI Lump Sum Payment - Passing Through to LTD Carrier

When you are awarded Social Security Disability Income, the Social Security Administration sends you a single, lump-sum payment for any back-owed benefits. This check can be enormous... tens of thousands of dollars. And it has no tax taken out of it, which bites you in the bum at tax time.

In my case, it wasn't even my money to keep... I have private long-term-disability (LTD) income from a plan at work. The terms of the LTD policy are that they (UnumProvident) reduce their monthly payment to me by the amount of my monthly SSDI benefit. They had not been doing this while I was waiting to get approved for SSDI (I didn't think it would happen, and I needed the money right then). So I had to send 95% of the check amount (approximately) to them. 

The real rub: depending on how you pay for LTD insurance, the monthly benefit you receive from an LTD plan may be tax-free. And mine was. But I had to pay them the back-owed amount with taxable income (the SSDI). Which bites. 

I asked my CPA, and she asked several peers, and they all agreed. While it defies logic that you should have to reimburse the LTD company with after-tax or taxable money even though the money you receive from the LTD plan is tax-free, there is NOTHING you can do on your tax return about this. No deduction, no credit, nothing. It sucks!

Which just goes to show - if you can manage it, you need to save some of your LTD/SSDI money for a rainy day - tax issues like this, overpayments (Unum recently told me they overpaid me $1600 and needed it back ASAP), sudden termination of benefit payments, etc.