Socializing with an Invisible Illness

Dedicated to Jillian for giving me the idea to write this article. Thank you.

Image taken from Imgur years ago.



Socializing is hard enough when you are a healthy, human being. You could be shy or nervous to talk to others. However, with a chronic, invisible illness, it's even harder. Imagine having that nervousness and shyness leading to vomiting, intestinal spasms, bloating, and many other things but the main culprit is fatigue.

Image taken from Imgur years ago.



So, what are some activities that you can do when you have a chronic invisible illness?

Personally, what I like to do is to invite my friends over for a board game night or for a movie night. We can have themed movie nights, like a Nicholas Cage movie night where we all sit around and riff the movies, or a serious movie night, watching a recently released movie on Blu-Ray. My friends and I really love board games, and I have a cabinet full. Usually, though, we will find ourselves in a game of Cards Against Humanity. If my friends cannot come over, I may call one of them on Skype or Hangouts and watch a movie with a person that way (we would be watching it at the same time at our respective houses) and talk to each other through the computer. I vomit with my Gastroparesis, so I am always conscious enough to ask my guests if vomiting will make them vomit. I really don't want to start a vomiting conga line in my house. If I get a yes to this question, I still have my Emesis Bags handy, but will try to run to the bathroom, if I can. Some people are really sensitive to others getting sick, so I'm always sure to double check. I might order them food or have snacks ready for them when they come over, but I can not partake. I usually just sip on a soda during the game or movie.





Recognize Your Limitations

I recognized my limitations early on. I cannot go out to restaurants, hike like I used to, go to movies, go bowling, etc. I consider that chapter in my life closed when it comes to socialization in a setting like that. I have to be creative and come up with new ways to socialize because of my vomiting and Gastroparesis. It doesn't mean that I cannot socialize, it is just that I can no longer socialize in those ways. I know that not everyone with Gastroparesis vomits, so individually, you have to recognize what your limitations are in order to work with them, and not against them, so you do not make yourself even more sick.





Video Gaming is Great for Good Gastroparesis Days

If I am having a good Gastroparesis day, then I usually play on my Xbox One, logging into the internet, and play with other people in my game. I can socialize with those people because I have a headset for gaming that has a microphone, which is my way of reaching others in the game, and depending on the game being played, being able to plan a coordinated attack. This also helps me deal with pent up aggression and negative feelings, because I can take it out on killing zombies in my game. That sounds hideous written down, but it really does help me. Additionally, playing the game with other people online helps me to build new friendships and to be able to talk to others. It's a nice escape from watching Netflix all day. Plus, I get to meet new people and maybe even learn new things about the game I'm playing that I did not know before.

Image taken from Imgur three years ago.




Coloring is Good for Stress

Coloring has been a good stress relief for me. I have always loved to color. There are a lot of different coloring groups on Facebook now, as well as websites, Facebook pages, and blogs. You could challenge your friends to a coloring contest and compare each other's work on Skype or Google Hangouts (if you cannot leave your house and if they cannot come over), and have someone predesignated as the judge. You could do those competitions for fun or maybe real prizes if you are feeling confident. You could have your friends come over and you could all color together. It's an activity that is easy, stress relieving, and is fun for everyone involved.



Movie(s) Night!

I mentioned this above because it is something my friends and I like to do. You can have your friends over for a movie night, or if you are feeling well enough, you can go to a friend's house for a movie night. It can be themed or not. It is all up to you. You can be just as creative as you want to be with it. I mentioned above we had a Nicolas Cage night because we like to make fun of some of his bad movies, in our personal opinions, and we love to watch his better movies. My friends and I have a tradition of having a scary movie themed night once every weekend in October. I love to have serious movie nights of movies just released on Blu-Ray that I haven't seen yet, and I love to re-watch favorites. Sometimes, my friends and I (even my husband and I will do this) download Rifftrax (which are the guys who did Mystery Science Theatre 3000) and listen to Rifftrax accompany the movie we are watching. It is a ton of fun and sometimes, I have issues trying not to stop laughing. My friends and I also had our own riffs to accompany the movie. This way, I can stay at home, but still be social.

Image taken from Imgur years ago.






Board or Card Game Nights

I mentioned above that my friends and I like to play Cards Against Humanity and board games. I have a china cabinet stacked with board games because I am a board game collector. I will say that I think my favorite game is Cards Against Humanity because it is SO funny! I always make anyone new playing the game to make their own card for my deck. However, if Cards Against Humanity is too dirty for you, an alternative is Apples to Apples, which is just as funny. My friends like to play Catan. I am not so crazy about that board game because it reminds me a bit of Monopoly, and leads to arguments. I love games like Trivial Pursuit. It all depends on your tastes and your friends' tastes on what board games or card games you play, but it's still a fun way to socialize when you cannot leave your house. With board games and card games, there are just so many options to choose from, so boredom is never an option.



A Knitting or Crocheting Circle

If you knit or crochet, you could ask your friends to come over and do that activity together while listening to music or the TV. I love to knit but I do not knit traditionally. I use a Knifty Knitter where I wrap the yarn around pegs and then pull them through. I mostly make scarves. It isn't hard to learn or do. I can make a scarf in three days, if I put my mind to it. I can do it while watching TV or just sitting around the house. It gives me something to do. This is definitely something you can do with your friends or if you want to do it on your own, that is fine too. There are lots of Youtube videos to teach you how to use the knifty knitter, as well as showing you different stitches, and different patterns you can do. Yarn for projects like this is also fairly cheap. I get the thicker yarns if I am making a scarf, and a counter to press if I want to make the scarf multi-colored. I have friends who have knitting circles. It is a very relaxing hobby.

Scarves that I have made for friends. I made my husband a Gryffindor scarf from Harry Potter.

Image Source on the image.



Arts and Crafts

My friend Denise loved to make cards. She would make homemade cards and send them out to people. My mother makes jewelry. If a lot of your friends do arts and crafts, and you have no knowledge of how they do their projects, invite them over and have them teach you. Additionally, you may be able to teach your friends some of the arts and crafts that you do in your spare time. You could found an arts and crafts circle that meets once a week. That might help with socialization and also help keep you occupied during the week so that you do not dwell on your stomach or pain. There are several groups on Facebook, Pinterest, Yahoo Groups, and Google Plus dedicated to arts and crafts. It might be nice to have the ability to learn something new, something you did not know before might be something you really like and take up as your own hobby. You and your friends could develop a schedule of meet ups and then present what you have finished and/or ask for help with projects.




Having People Stay Over

You could call your friends and set up a date and time for them to sleep over. You can be as creative with this as you want to, from putting tents up in your backyard to turning your living room floor in pillows and sheets. You can gossip with your friends and get caught up on what has been happening while you are at home and just spend some quality time with you friends. This way, you do not have any stress put upon you because you are not in public, and you do not have to worry about finding a bathroom. It helps you catch up and still be active in your friends' lives, even though you are at home.




Starting a Book Club or Movie Club

I started a group like this on Facebook Books, TV, and Movie Club where you can assign a book, TV show, or movie to your friends, give an amount of time for everyone to finish it, and then discuss it together. You can do this via Skype or Google Hangouts, etc if you cannot meet in person. In addition to that, you can recommend different TV shows, books, or movies for your friends to watch and they can recommend things back to you so that you have something new to do at home. It is a fun way to talk about a show, book, or movie without spoiling anything for your friends. Furthermore, it helps you socialize when you are too sick to leave your house. It's something I really like to do because I love movies. I also love to read. I've had books recommended to me that are out of my comfort zone, that I would not have heard of or read without my group on Facebook, and surprisingly, I found I really liked that suggestion. It helps you explore new avenues of genera you might not have thought of.






Take Online Classes

There are free online classes that you can take at some colleges. This would help you to make new friends without leaving your house. You can also increase your education at the same time! It would help to occupy your time so that you are not home alone, with temptations to be stressed or depressed. Colleges have free classes on a variety of topics, so pick one that you are really interested in. There are other places other than colleges that offer free classes, but you would have to look around for it. You can do anything you put your mind to. But, it would help to expand your circle of friends and you never know, some of the people in your online class might be in the same position you are.






Join Support Groups or Online Groups with Your Similar Interests

There are lots of support groups online now for invisible illnesses. However, you don't just have to join a support group for your illness - there are other groups based on similar interests, like crafts, for example. I would recommend joining a support group for your illness because it helps to have people who understand you, and you need a safe environment to vent in and ask questions. There are also all sorts of groups online for hobbies, and by joining those groups, you may learn new things about your hobby you did not know before. It could be a lot of fun! You would definitely meet new people in both kinds of groups and that will help you socialize if you are like me, and at home a lot. No one should be alone. In this day and age with social media and the Internet, no one should be alone at all. So, search whatever hobby you are interested in among the groups and see which groups fit you best. Do not forget that you can join more than one group.

Image taken from Imgur three years ago.





There are other ideas on this site I found, but a lot of these I have already covered off of the top of my head: https://undiagnosedwarrior.org/tag/socializing-with-chronic-illness/


This article talks about keeping friends with an invisible illness from The Mighty: https://themighty.com/2016/04/making-and-keeping-friends-with-chronic-illness/

This is another great article about how pain affects your relationships and what to do about it: http://princessinthetower.org/how-chronic-pain-affects-your-friendships-and-what-to-do-about-it/


This is a previous article I wrote on how to keep busy in a hospital that has ideas that might help you format them in a way to socialize with your friends: http://www.emilysstomach.com/2014/02/how-to-pass-time-in-hospital.html

Image taken from Imgur years ago.



I'm sure there are many other things you can do to socialize with friends and make new friends, but this is a good list to get you started. I have done all of the above and wanted to share it with everyone so that you do not feel alone. I know that invisible illnesses can be so isolating. It is very hard for me to leave the house because I vomit. I have wonderful friends who come over and spend time with me, and I skype my family, who live two hours from me, to catch up on the family and what is going on there. I hope this helps you. If you have any more suggestions to add to the list, feel free to comment. I will gladly keep adding to this list as I learn more things to do when you're stuck at home.

Brain Fog: What It Is, Causes, Symptoms, Treatments

We all know that feeling; We try to talk to others and cannot find the words. We forget the words we want to say, or know the words we want to say but cannot seem to spit them out. We forget activities and memories. We forget what we need to do unless we write it down. It is VERY frustrating to everyone involved.

Source: Imgur



My husband will get very frustrated with me, because unless I religiously write things down, I forget things all of the time. He has a trip he's going on for work next week, actually, and I forgot the conversation we had about it when he told me he was going. Now, I write in my Gastroparesis Journal constantly and I use my Google Calendar to remind myself of appointments, when my husband has work out of town, birthdays, and everything that's important to me. I love Google Calendar because they will send you reminders like text messages, emails, and popups.

I have to make lists of things I need to do that day. My memory used to be amazing, but since I was officially diagnosed with Gastroparesis, my memory is NOT what it used to be. I could remember dates without issue, remember to go to the pharmacy, and that kind of thing. Now, it is like I have no short term memory and my long term memory seems blocked, most of the time. I cannot even tell you all of what I posted on Facebook yesterday, for instance.

I wanted to research into what causes memory loss, which I call "GP Brain," others call it "Brain Fog," and if there is any hope of reversal. I do know that I need to recognize my limitations, now that I have it, and try to adjust accordingly. I ask others to be patient with me and explain my situation a little bit to them. I carry notebooks and my journal in my purse. And, like I said, I use Google Calendar. It is hard to adjust when you had an excellent memory before, but life is about adjustments and it isn't always fair. You need to find what works for you.

Source: http://edoriumjournals.com/blog/brain-fog-get-rid/ They state, "When it comes to the brain, the urgency and importance of the issue increases manifold because life productivity takes a serious hit if the brain isn’t functioning at its optimal best. A muddled sensation though normal at occasional times, chronic forgetfulness or mental slowness is not and therefore, one should not take brain fog lightly at all."





What Is Brain Fog?


According to the Edorium Journal, they describe these issues at the cause for Brain Fog:

"With the progression of age the deterioration of memory is the norm, a part of the natural process of life. However, the slow fading of memory is sometimes aggravated in the prime of life and even young people at times, experience clouded feelings and momentary lapses in thinking. This phenomenon is commonly known as brain fog or brain fatigue. However, this is not a mental disorder or a medical condition in any sense rather it is a term to explain certain symptoms that can affect a person’s ability to think clearly.

Whenever someone experiences forgetfulness, feels utterly confused while tying up thoughts, or has disorganized thinking, or has inability to focus or is hard pressed to put their thoughts into words, they are experiencing brain fog. This fatigue of the brain can be caused or exacerbated by certain conditions or situations. An understanding of the common triggers that cause brain fog is necessary to avoid its occurrences as well as to maintain good health practices. A clear-thinking and healthy brain is the pre-requisite to a healthy living.

Whenever someone experiences forgetfulness, feels utterly confused while tying up thoughts, or has disorganized thinking, or has inability to focus or is hard pressed to put their thoughts into words, they are experiencing brain fog. This fatigue of the brain can be caused or exacerbated by certain conditions or situations. An understanding of the common triggers that cause brain fog is necessary to avoid its occurrences as well as to maintain good health practices. A clear-thinking and healthy brain is the pre-requisite to a healthy living."

Source: Imgur



What Are The Symptoms of Brain Fog?


Additionally, according to Edorium Journal,

"This mental fog or cognitive dysfunction as it is also known shows a number of symptoms.

1. low energy or tiredness, including chronic fatigue syndrome,

2. irritability due to inability in concentration,

3. poor working memory causing hindrance in executive functions,

4. decreased ability in memorizing or remembering things,

5. impaired or delayed information processing ability,

6. dwindling motivation due to mental confusion, etc."

Source: Located at the bottom of image.




These indicators point towards the clouding of consciousness whereby an inflammation of the brain due to certain underlying causes prohibits us from enjoying the benefits of a fully-functional brain. If these causes are ascertained then the affects of brain fog are reversible. The most important and also the most common causes of brain fog can be enumerated as the following:


1. A lot of women find it difficult to remember things or process information swiftly during pregnancy. Carrying and nurturing a baby changes the body in a lot of ways and certain chemicals, hormones, etc released during this period to nourish the baby may bring on problems associated with memory.

2. Poor diet is a major reason affecting the brain and there are certain food elements that are not brain-healthy and we should be aware of these. [See my article on Malnutrition here and what it can do to the body: http://www.emilysstomach.com/2013/06/information-about-malnutrition.html]

3. Eating for a healthy functioning brain is simple and should principally consist in avoiding excess sugar and extra calories. Also, half of your daily food intake should ideally include fruits and vegetables. Nutritional deficiencies such as, Vitamin B12 deficiency lower brain functioning ability. [See my article on Vitamin Deficiencies and what they can do here: http://www.emilysstomach.com/2013/06/the-impact-of-vitamin-deficiencies.html]

4. Neurological and vascular problems such as caused by diseases like, Multiple Sclerosis.

5. Medication induced after-effects and side-effects such as cancer treatment related or anti-cholinergic drugs, etc.

6. Autoimmune, infectious, psychiatric illnesses also debilitate brain performance.

7. Lifestyle factors including sleep disorders, alcohol abuse, depression, etc."

Source: Imgur





How Do You Cope With Brain Fog?

Like I said before, I carry around a GP Journal I write things in, I also have a smaller notepad to write things down, and I use Google Calendar. Everyone is different, so you will have to find a method that works for you. I will try to list as many ideas as I can to help.

Molly's Fund has wonderful ideas below on how to cope with Brain Fog.

Source: http://www.mollysfund.org

Edorium Journal suggests doing these things to cope with Brain Fog,

"Now that the causes are known, actionable steps to combat brain fog can be clearly undertaken. In case of diseases, symptomatic treatments and other alternative steps to naturally prevent the progression of disease can assist in preventing brain fog. Also, an overall strategy for a healthy brain should leverage diet, exercise, food and supplements together. There are a number of things that can be done to improve brain power even socialization helps in sharpening the intellect.

Although at times people experiencing brain fog are too depressed and poorly motivated to initiate changes or take up improvement steps. In such cases, first comes a proper sleep. Proper and plenty of sleep gives the brain time to clean up residual debris of the thinking day, consolidate the memories of the day and create new brain cells to replace the ones lost during the day. Thus, boosting cognitive function and performance, brain hormonal balance and resulting in a rested person. It’s not just a proverb when they say, you should sleep on it.

Lastly, exercise to release endorphins and eliminate the free radicals, and meditate to relieve stress. These gems should help you banish brain fog effectively."

"The Mighty," suggests seventeen phone applications that can help you with Brain Fog here: https://themighty.com/2017/08/apps-brain-fog-organization/.

One of my friends wrote an article in "The Mighty" regarding brain fog, which you can find here: https://themighty.com/2019/05/what-brain-fog-is-like/?fbclid=IwAR1hMd8mDYPscpINaUbDXsAYHO_qlVT_rN_18WdnF56LLILPNHB0Ui6RJfc


Here are some natural treatments regarding Brain Fog,

The source and for more natural treatments on how to help Brain Fog, can be found here: https://draxe.com/brain-fog/.



And finally, if you have an invisible illness, some of these treatments for Brain Fog might be similar to the ones above but I wanted to share it anyway. This is from "Fibromyalgia News Today" and they recommend this: https://fibromyalgianewstoday.com/2017/05/25/9-ways-manage-brain-fog/.

Source: Imgur





In Conclusion:


I know that with an invisible illness, like Gastroparesis, it's really hard for us to eat as some of these helpful hints suggest. I would recommend talking with your doctor about Brain Fog, because we are all different. What works for someone else may not work for me. I have to come up with a mixture of suggestions that might work for me, personally. I usually write out questions for the doctor before I go, so I don't forget anything. I make notes as he talks to me as well. Also, I put a magnetic shopping list on the fridge so that my household can write stuff down as we use it, instead of making a list from scratch when we need to go to the store. That helps me so much and takes the pressure off of any of us if we did it as a mass list, because we would all forget things.

I hope this article will help you understand Brain Fog a bit better. It's frustrating to go through and hard to deal with, but it is something that can be dealt with. If you battle Brain Fog, just know that you are NOT alone. Just stay strong and keep your chin up. I will try to update this article as I learn more, so that you can keep updated on new treatments, symptoms, or any changes.

How to Obtain Domperidone and Information About The Medication

I have seen this question in a lot of groups. I wanted to share the information I had on it, so that it might help someone else.

Information can be found with the FDA/DEA because I am not a physician.



If your physician wants to prescribe Domperidone, then according to the FDA (https://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/approvalapplications/investigationalnewdrugindapplication/ucm368736.htm), they should print out this packet:

The link above to the FDA is the link to this packet to print out.

Gastroparesis' Effects on Dental Health

A lot of people do not realize that Gastroparesis can really effect your dental health. I brush my teeth and use mouthwash, although I do not floss as much as I should. I also vomit a lot with Gastroparesis, and most of what I vomit is stomach acid. Stomach acid, in itself, is rough on your teeth because it strips the enamel from your teeth and it makes your teeth weaker. It also opens your teeth up to cavities and to breakages, because they are not as strong and protected without the enamel.

To say the least, it has been rough on mine and I have been throwing up for years. This year, however, I have broken three teeth - I broke two back molars three days ago. I thought I had only broken one, but as it turns out, I broke another molar. I went to the dentist today and they could not save the very lower left back molar I broke, because once they cleared the cavity out, there was not enough tooth left to even salvage. They could save the other molar, though, by bone grafts and an implant. This is a VERY expensive treatment. I'm very lucky I have dental insurance, and they do cover implants which is quite rare, but I still have to pay out of pocket and it is going to be a bill over a thousand dollars. Most people cannot afford treatments like this. I'm fortunate I can.

The Process:

Source: https://bio.libretexts.org/@api/deki/files/9107/OSC_Microbio_24_02_ToothDecay.jpg?revision=1&size=bestfit&width=1053&height=597


But, I wanted to write this article to bring awareness to the fact that Gastroparesis can cause other secondary issues. We do not just suffer from Gastroparesis and what it does to us - the vomiting, cramping, pain, the inability to digest food, etc. It can also cause issues that people would not think of - like dental issues or back problems. I'm going to focus on the dental issues in this article, since I'm dealing with just those issues right now.

Source: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3YcoIA8FyOyqbOnnGk3KZhImmdwH9c2g3GIBJjRRqk5Vm1bb9xDcVub2qIy6VBdRJDTXrH-DWv5R8tSa7hxwRSqUCuOS9QnRnSilS-LoFYo7qq5QVCX8WLx-6XAQwbn3dolPi_KheR69f/s1600/imagesBTT6Y8H7.jpg




According to Decisions in Dentistry (http://decisionsindentistry.com/article/dental-implications-gastroparesis/),

"Oral health professionals should be prepared to identify clinical findings associated with diagnosed or undiagnosed gastric diseases, dietary habits and psychological disorders (such as bulimia) that may result in vomiting and reflux. Gastric fluids are composed of hydrochloric acid, which may have a pH of 1.0 to 2.0.1 These strong acids can soften enamel and dentin, increasing the risk of tooth surface loss caused by bruxing, toothbrushing, or consuming hard or abrasive foods.2 In addition to the intrinsic effects of gastric fluids, erosive tooth wear may also be related to the extrinsic dietary acids found in many foods and sugar-sweetened beverages.3 As such, when erosion is detected, oral health professionals should identify its etiology and institute behavioral and preventive strategies to manage it.4 Gastroparesis is one example of a gastric condition that can have significant oral health consequences. In order to help guide clinicians toward effective management strategies, this article presents a case study of erosive tooth wear attributed to this condition.

Gastroparesis is a chronic gastrointestinal motility disorder characterized by delayed gastric emptying;5 patients experience partial paralysis of the stomach, which results in food retention in the stomach for extended periods. Symptoms include nausea, vomiting and bloating.5,6 Patients with gastric disorders who seek medical treatment are provided with dietary counseling and may be prescribed medications to alleviate symptoms. When taking medical histories, oral health professionals should ask if the patient has been diagnosed with gastroparesis or other gastric disorders in order to plan appropriate treatment.7


CASE REPORT

For example, the medical history of a woman with the chief complaint of extremely sensitive teeth revealed a diagnosis of gastroparesis. The patient was taking esomeprazole and omeprazole, both of which are proton pump inhibitors that suppress production of gastric acids. In addition to the pain and functional difficulties her dentition was causing, the patient was self-conscious about her smile (Figure 1). A comprehensive examination revealed erosion with dentin exposure, staining, decalcification, noncarious cervical lesions and gingival recession. These were noted in her record. The patient’s gingival display was adequate and within normal limits. A caries risk assessment was completed and, due to low salivary pH and hyposalivation, her risk level was deemed high.

The patient in this case report presented with erosion and dentin exposure, which made her self-conscious about her smile.
FIGURE 1.The patient in this case report presented with erosion and dentin exposure, which made her self-conscious about her smile.
A treatment plan was formulated and discussed with the patient. A diagnostic wax-up of the proposed occlusal scheme was completed (Figure 2). Oral hygiene instructions were presented. The patient was prescribed a high-fluoride toothpaste and given xylitol mints and oral spray containing a pH-neutralizing agent.8 The patient was also counseled about dietary habits. Additionally, the oral side effects of her gastroparesis medications — including decreased salivary flow leading to xerostomia — were discussed.

FIGURE 2. A diagnostic wax-up of the proposed occlusal scheme was created.**
FIGURE 2. A diagnostic wax-up of
the proposed occlusal scheme was
created.
FIGURE 3. A splint was fabricated at the new vertical dimension of occlusion.
FIGURE 3. A splint was fabricated
at the new vertical dimension of
occlusion.
FIGURE 4. Temporary splinted composite onlays were placed at the new vertical dimension of occlusion.
FIGURE 4. Temporary splinted
composite onlays were placed at the
new vertical dimension of occlusion.

After reevaluating the patient’s caries risk level, an esthetic treatment plan was formulated. Lithium disilicate onlays were planned for teeth #18, #19, #20 and #29. Lithium disilicate crowns were planned for teeth #21, #28, #30 and #31. These all-ceramic crowns have high success rates.9 Composite buildups were planned for teeth #22 through #27. Because the patient’s periodontal condition was stable, with no biologic width problems, crown lengthening and gingivectomy were not required. The decision was made to increase the vertical dimension of occlusion due to the loss of tooth structure during conservative preparation.10

FIGURES 5A and 5B. The posterior teeth and quadrants were prepared to receive lithium disilicate onlays and crowns.
FIGURES 5A and 5B. The posterior teeth and quadrants were prepared to receive lithium disilicate onlays and crowns.
The patient accepted the proposed treatment plan. A smile design was completed based on the wax-up, and the patient was eager to begin treatment. Before preparing the teeth, the patient was placed in temporary splinted composite overlays at the new vertical dimension of occlusion (Figure 3 and Figure 4). The patient adapted well to these changes.

FIGURES 6A through 6C. Posterior lithium disilicate onlays and crowns are ready to be delivered.
FIGURES 6A through 6C. Posterior lithium disilicate onlays and crowns are ready to be delivered.
With the new vertical dimensions of occlusion, the maxillary anterior teeth were prepared for crowns. Anterior teeth #6 to #11 were prepared, impressed and temporized for lithium disilicate restorations. At the next appointment, lithium disilicate crowns were applied to teeth #6 through #11. The patient indicated she was pleased with the esthetic result. At the following appointments, posterior quadrants were prepared and restored sequentially, using bonded lithium disilicate onlays and crowns (Figures 5A and 5B; Figures 6A through 6C). Composite buildups were completed on the lower anterior teeth #22 through #27. The treatment eliminated the patient’s dentinal hypersensitivity and improved oral function and appearance (Figures 7A and 7B).

FIGURES 7A and 7B. The patient reported being pleased with the final results. The therapy eliminated hypersensitivity and improved oral function and appearance.
FIGURES 7A and 7B. The patient reported being pleased with the final results. The therapy eliminated hypersensitivity and improved oral function and appearance.



DISCUSSION AND CONCLUSION

As noted, dental professionals should be able to identify dental erosion and erosive tooth wear,11,12and be adept at recognizing the signs of dental erosion, determining the etiology, and discussing clinical findings with patients. Sensitive findings in the medical history, such as the effects of eating disorders (e.g., anorexia or bulimia), should be handled cautiously.7 Patients who are unaware that gastric acid may cause erosion should be referred to their physician for additional diagnostic testing. Patients should also be educated about the risks acid reflux poses to oral and systemic health. In cases in which it is determined that erosive tooth wear is due to dietary habits, patients should be advised to limit their intake of acidic foods and beverages.13 They need to understand that it is far better to manage tooth surface loss early, as opposed to taking a 'wait-and-watch' approach that may lead to more extensive and expensive restorative dentistry.

These patients should be placed on a frequent recare schedule that includes regular caries risk assessment, monitoring of dietary acid intake, and reinforcement of preventive strategies. This will help to support patients’ oral health, as well as restoration stability and longevity.

Even though the etiology of dental erosion is multifactorial, clinicians should be able to identify possible causes and discuss these with patients. Oral health professionals should also work with patients’ physicians to ensure appropriate counseling and treatment. In addition to managing erosive tooth wear, it is important for dental team members to understand the need to educate patients about the causes of erosion — and what can be done to prevent its potentially damaging oral health consequences.



KEY TAKEAWAYS

Whether the result of gastric disease, dietary habits or psychological disorders (such as bulimia), the introduction of gastric acids into the oral cavity can have negative ramifications for oral health.
Potential consequences include softening of enamel and dentin that increases the risk of tooth surface loss caused by bruxing, aggressive toothbrushing, or consuming hard or abrasive foods.2
When erosion is detected, oral health professionals should seek to identify its etiology, and institute behavioral and preventive strategies to manage it.4
When taking medical histories, dental professionals should ask if the patient has been diagnosed with gastric disorders in order to plan effective treatment.7
As appropriate, patients who are unaware that gastric acid may cause erosion should be referred to a physician for additional diagnostic testing. Patients should also be advised about the risks acid reflux poses to oral and systemic health.
These patients should be placed on a frequent recare schedule that includes regular caries risk assessment, monitoring of dietary acid intake, and reinforcement of preventive strategies.


ACKNOWLEDGEMENT

The authors would like to thank Susan Do, DDS, for providing the images.



REFERENCES

Moazzez R, Bartlett D. Intrinsic causes of dental erosion. Monogr Oral Sci. 2014;25:180–196.
Ranjitkar S, Smales RJ, Kaidonis JN. Oral manifestations of gastroesophageal reflux disease. J Gastroenterol Hepatol. 2012;27:21–27.
Barbour ME, Lussi A. Erosion in relation to nutrition and the environment. Monogr Oral Sci. 2014;25:143–154.
Lussi A, Caravalho TS. Erosive tooth wear. A multifactorial condition of growing concern and increasing knowledge. Mono Oral Sci. 2014;25:1–15.
Camilleri M, Grover M, Farrugia G. What are the important subsets of gastroparesis? Neurogastroenterol Motil. 2012;24:597–603.
Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L, American College of Gastroenterology. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37.
Lussi A. Dental erosion clinical diagnosis and case history taking. Euro J Oral Sci. 1996;104:191–198.
Bellamy R, Harris R, Date RF, et al. In situ clinical evaluation of a stabilized stannous fluoride dentifrice. Int Dent J. 2014;25:197–205.
Christensen GJ. The all-ceramic restoration dilemma: where are we? J Am Dent Assoc. 2011;142:668–671.
Spear FM, Kokich VG, Marhew D. Interdisciplinary management of anterior dental esthetics. J Am Dent Assoc. 2006;137:160–169.
Barbour M, Lussi A, Shellis R. Screening and predication of dental erosion. Caries Res. 2011;45(Suppl 1):24–32.
Hellwig E, Lussi A. Oral hygiene products, medications and drugs — hidden etiologic factors for dental erosion. Monogr Oral Sci. 2014;25:155–162.
Cochrane NJ, Cai F, Yuan Y, Reynolds EC. Erosive potential of beverages sold in Australian schools. Aust Dent J. 2009;54:238–244.
The authors have no commercial conflicts of interest to disclose.

Featured photo by ERAXION/ISTOCK/ GETTY IMAGES PLUS

From Decisions in Dentistry. February 2017;3(2):28–31.
**SIDENOTE: You can see the figures and diagrams by clicking on the link above."

My friend Robin decided to go with an implant instead of a crown. She said that even stomach acid (GERD or if you vomit it up) can still get under a crown and decay your tooth.

She says about her x-ray (pictured above),

"Tooth on left has a crown-decay under gum. Tooth on right has filling- decay under gum line. That foreign object is a Bicon Implant. Stomach acid ate my teeth from under gum line. Mine is from acid backwash at night"

Source: http://www.familyhealthonline.ca/fho/dental/_images/DH_senstiveTooth.gif

Source: http://www.indysouthportdental.com/wp-content/uploads/2015/04/stages-of-tooth-decay-Indianapolis.jpg

Source: https://i.pinimg.com/736x/42/68/b6/4268b600521918f495ab86259ffdb372--medical-dental-dental-hygiene.jpg

"You call it a cavity. Your dentist calls it tooth decay or dental caries. They're all names for a hole in your tooth. The cause of tooth decay is plaque, a sticky substance in your mouth made up mostly of germs. Tooth decay starts in the outer layer, called the enamel. Without a filling, the decay can get deep into the tooth and its nerves and cause a toothache or abscess." This is according to Medline Plus (https://medlineplus.gov/toothdecay.html).

Source: http://kitsfamilydental.com/wp-content/uploads/2017/05/Sensitive-Teeth.jpg



The article above had the conclusion that,

"Even though the etiology of dental erosion is multifactorial, oral health professionals should be able to identify possible causes and discuss these with the patient. Educating patients on causes of dental erosion is important in clinical practice. Oral health professionals should work with patients' physicians to ensure proper counseling and treatment management. In particular, dental hygienists can play a key role in the identification and management of severe erosive tooth wear."

So, what that means for us Gastroparesis warriors is that we are just going to have to stay away from acidic foods (if you can tolerate them), and continue to brush/floss daily. We should go in for regular cleanings but be sure to tell the hygienist or dentist you have Gastroparesis, even if you have to explain it to them. If you can get your medical records from your GI to bring with you to the dentist, they may have a better idea of where your treatment is at and what you are doing - what medications you could be on that might help erode enamel/teeth quicker, and that sort of thing. It's important to call the dentist as soon as a tooth starts bothering you. Do not wait, because if you wait, it could break like mine did, or be a lot more expensive to fix in the long run. So basically, all we can really do is stay on top of our dental health, which is hard since we have SO MUCH to keep up with health wise - records, doctor's visits, and so on. But, I haven't been able to find too many articles about tooth decay and Gastroparesis except for the one study above. I hope this helps you some. If I learn more, I will update this article.

Source: https://image.slidesharecdn.com/oralhygiene-151122062237-lva1-app6891/95/oral-hygiene-8-638.jpg?cb=1448173461




Malnutrition and Vitamin Deficiencies Can Lead To Tooth Decay

Source: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvHQJLTkabFSHHVqk1RR61PO1QcVaE2OvcKbeuNzvOvOFKguzcjNyf0fiCKfs8vcA3JFIrV56DZ2sYClrzXGlln_R1FoI7YugcL-y21bysU8hHptBVy43y5tcyOOixEJCfYYkJkIN1N2Zk/s400/vitaminc.jpg

I've written an article on Vitamin Deficiencies here: http://www.emilysstomach.com/2013/06/the-impact-of-vitamin-deficiencies.html

Source: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiufzbGJmKwBj-tZDftB0AORJlgXaorzVNiYBsCSbq-dVJ-GYE06O0JwqnRMGWyS88mS3mLQgAKN_yAZGawKmyb6orW87a1YFOiYX3jcLDCwU9zMu5Ri4GsHBPw9kssu4aKKWY5chrEyy1h/s1600/936816_663318470351393_1531403978_n.jpg

I've written an article on Malnutrition here: http://www.emilysstomach.com/2013/06/information-about-malnutrition.html

Dysautonomia and Gastroparesis

Source: http://blog.brightlifedirect.com/wp-content/uploads/2016/09/dysautonomia-umbrella.jpg

I have noticed in my support groups that a lot more people are being diagnosed with POTS and Dysautonomia. I have been asked if it is related to Gastroparesis, since they were diagnosed with the others after the initial diagnosis of Gastroparesis. I wanted to write an article on POTS and Dysautonomia to not only help those newly diagnosed, but to explain the connection between the two and Gastroparesis. I especially wanted to write about Dysautonomia because October is Dysautonomia Awareness Month.

Source: http://i.pinimg.com/originals/79/6a/64/796a643254abfaed18b12779a5b90a1d.jpg



So, what is Dysautonomia?

According to the Cleveland Clinic (http://my.clevelandclinic.org/health/articles/dysautonomia ,

"What is Dysautonomia?

Dysautonomia refers to a disorder of autonomic nervous system (ANS) function that generally involves failure of the sympathetic or parasympathetic components of the ANS, but dysautonomia involving excessive or overactive ANS actions also can occur. Dysautonomia can be local, as in reflex sympathetic dystrophy, or generalized, as in pure autonomic failure. It can be acute and reversible, as in Guillain-Barre syndrome, or chronic and progressive. Several common conditions such as diabetes and alcoholism can include dysautonomia. Dysautonomia also can occur as a primary condition or in association with degenerative neurological diseases such as Parkinson's disease. Other diseases with generalized, primary dysautonomia include multiple system atrophy and familial dysautonomia. Hallmarks of generalized dysautonomia due to sympathetic failure are impotence (in men) and a fall in blood pressure during standing (orthostatic hypotension). Excessive sympathetic activity can present as hypertension or a rapid pulse rate.



Is there any treatment?

There is usually no cure for dysautonomia. Secondary forms may improve with treatment of the underlying disease. In many cases treatment of primary dysautonomia is symptomatic and supportive. Measures to combat orthostatic hypotension include elevation of the head of the bed, water bolus (rapid infusion of water given intravenously), a high-salt diet, and drugs such as fludrocortisone and midodrine.




What is the prognosis?

The outlook for individuals with dysautonomia depends on the particular diagnostic category. People with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration have a generally poor long-term prognosis. Death can occur from pneumonia, acute respiratory failure, or sudden cardiopulmonary arrest.




What research is being done?

The NINDS supports and conducts research on dysautonomia. This research aims to discover ways to diagnose, treat, and, ultimately, prevent these disorders.




Organizations

National Dysautonomia Research Foundation

P.O. Box 301
Red Wing, MN 55066-0301
ndrf@ndrf.org
www.ndrf.org
Tel: 651-327-0367
Fax: 651-267-0524

National Organization for Rare Disorders (NORD)

55 Kenosia Avenue
Danbury, CT 06810
orphan@rarediseases.org
www.rarediseases.org
Tel: 203-744-0100; Voice Mail: 800-999-NORD (6673)
Fax: 203-798-2291

Dysautonomia Foundation

315 W. 39th Street
Suite 701
New York, NY 10018
info@familialdysautonomia.org
www.familialdysautonomia.org
Tel: 212-279-1066
Fax: 212-279-2066

Familial Dysautonomia Hope Foundation, Inc. (FD Hope)

121 South Estes Drive
Suite 205-D
Chapel Hill, NC 27514-2868
info@fdhope.org
www.fdhope.org
Tel: 919-969-1414

The Multiple System Atrophy Coalition

9935-D Rea Road
Charlotte, NC 28227
vjames@msacoalition.org
www.multiple-system-atrophy.org
Tel: 866-737-5999

Dysautonomia Youth Network of America, Inc.

1301 Greengate Court
Waldorf, MD 20601
info@dynainc.org
www.dynainc.org
Tel: 301-705-6995
Fax: 301-638-DYNA

Source: National Institutes of Health; National Institute of Neurological Disorders and Stroke NINDS

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/11/2015...#6004"

Source: http://7468669c0013a7dae459-4d0fcf8d315d40f305ee2ebb6c32f79c.ssl.cf1.rackcdn.com/6071847_1445348729.4079_updates.jpg

Source: http://image.slidesharecdn.com/dysautonomia-100311124144-phpapp01/95/dysautonomia-6-728.jpg?cb=1268311395

Source: http://i.ytimg.com/vi/i-FtCGrXvTs/maxresdefault.jpg

Source: http://image.slidesharecdn.com/18dysautonomiaeps2016breakoutpresi-ii-160127175513/95/syncope-and-dysautonomia-4-638.jpg?cb=1453917438

Source: http://www.facebook.com/photo.php?fbid=10212997873295898&set=pcb.828771880581405&type=3&theater&ifg=1

Source: http://i.pinimg.com/736x/53/ec/4e/53ec4e9eb210e4519bf341f2da2accab--crps--days.jpg