When You’re ‘Too Functional’ to Have Your Mental Illness Taken Seriously

I’ve read countless articles, many on The Mighty, about the struggle of having an invisible illness and the way other people judge the “validity” of people’s conditions. I’ve also read about people who aren’t taken seriously when they express their most intimate, dark thoughts to family, professionals and friends.

I’m a psychologist. Not too long ago I was reunited with many other mental health workers (psychologists, psychiatrists, researchers and professors were in attendance.) The event was a presentation of a type of therapy and when the speaker began talking, he asked us how mental illness affects a person. Someone answered a person with a mental illness has difficulties and struggles with certain areas of his life. Another person answered that the mentally ill suffer greatly. And then a third person said mentally ill people don’t function in society. I was waiting for someone to refute this, but instead everyone nodded and the speaker actually agreed and said “very good.”

My heart was beating really fast. It was partly because I didn’t know these people very well and I was struggling a bit with social anxiety. I hadn’t contemplated speaking up. But my heart was also beating fast because I was angry. That statement and the fact it wasn’t even questioned is exactly the reason why “high-functioning” people with mental illnesses are sometimes not taken seriously.

I can be dying inside while going through the motions of the day. It’s not difficult for me to know how others expect me to act. Acting fine is a cognitive process. You can probably mention right now how an emotionally stable or “mentally sane” person is supposed to act. It really is simple. A generally accepted lifestyle is one where a person wakes up every day, looks presentable, takes care of stuff that needs to be taken care of, eats and goes to sleep. This can sometimes be done regardless of how you feel inside. To say it’s difficult is an understatement, but it’s not impossible.

These “high-functioning” people don’t do it because they want to fool others, they do it because they want to produce and be a part of society. They try so hard to beat their illnesses or disorders. They don’t want to rely on others to take care of them.

So when a “high-functioning” person asks for help or admits to himself and to someone else his struggles, it takes a lot of bravery. These people have worked every single day to build a “normal” world for themselves are terrified of admitting mental illness, and when they finally do and are met with rejection, little understanding and no empathy from a mental health worker, it is devastating.

My compromise with my career is very clear to me, but I have to admit I have been blessed (and cursed) to see this because I, myself, struggle with my own disorders.
If you struggle with not being taken seriously, my advice to you is to trust you know yourself so much more than anybody else. Nobody has the right to undermine your difficulties. If they do, it’s their issue. Keep looking for the person who listens to you and takes your feelings into account. Don’t feel demoralized or flawed. I know it’s a tough pill to swallow when you ask for help from a mental health worker who should be able to understand you but doesn’t. Again, this is a flaw in their own understanding of the human mind.

By the way, yes I did speak up. With a bit of a red face I refuted what they all agreed to and told them it’s a terrible mistake to discard the presence of a mental disorder in relation to the functionality of a person. I added functionality is sometimes a symptom, depending on the illness and the person.




Your tongue can tell a lot about your health from just the colour.

Just from how your tongue looks i.e size, texture and colour you can do a quick health diagnosis.

It’s always better to examine your tongue in the morning before brushing your teeth but do so in natural light.

The colour of the coating on your tongue may differ from the tongue colour.

A thin white coating that can be easily brushed off is considered normal.

Remember that the visual method of diagnosis doesn’t always give a 100% result.

Your tongue can be injured by aggressive food, bacteria can get into a wound and cause temporary irritation.

If you’re concerned about the colour of your tongue please seek expert advice.


Back-to-school health tips for your child

If you have any kids heading back to school this summer, you may be worrying about their health – both in the classroom and on the soccer or football field. Matthew Birkle, MD, an Urgent Care Physician at TriHealth Priority Care, shares a few tips for keeping your child healthy and safe during the next several months.

In the Classroom

Tip #1: Wash Your Hands and Don’t Share Drinks

The most common illnesses that go around, like persistent coughing, congestion, sore throat, or mononucleosis, are spread through the respiratory tract. “Wash your hands before you touch your face or eat, and don’t share your drinks, which is the number one thing for teenagers,” Dr. Birkle points out.

Tip #2: Stay Home and See Your Doctor

“Certainly, if you feel like your child is ill, contact your family doctor,” Dr. Birkle explains. Common symptoms that would warrant keeping your child home and scheduling an appointment with your doctor include:

· Nausea

· Vomiting

· Cough (persistent)

· Fever

On the Field Safety

Tip #1: Stay Hydrated

If your child participates in school-affiliated sports, they need to stay hydrated – especially during the late summer and early fall months. The amount of water your child should drink depends on their size and sweat rate, but it’s important to drink plenty of water throughout the day in order to avoid an episode of dehydration later.

Avoid drinks containing caffeine, such as tea or soft drinks or “energy drinks,” because they cause the body to release water. · Learn more about dehydration in our Health Library.

Tip #2: Watch for Repetitive Concussions

“If any head injury occurs, immediately evaluate the player for concussion with your coach or athletic trainer and see a sports medicine specialist if they have any concerns,” Dr. Birkle says. “Repetitive concussions, especially in football, need to be avoided. Soccer and football are also common activities involving head injuries.”

Signs and symptoms of a concussion include:

· Changes in mood

· Difficulty concentrating

· Dizziness

· Feeling groggy

· Getting headaches

· Losing balance

· Nausea

· Vision problems

· Slower reaction times

Every parent should be aware of Lindsay’s law, a new Ohio law for 2017. Lindsay’s law addresses the need to be aware of the risk factors for Sudden Cardiac Death in young athletes.



This Is What Happens When You Don’t Treat Your Chronic Ankylosing Spondylitis

Sometimes, you may think treating ankylosing spondylitis (AS) seems more trouble than it’s worth. And we understand. But at the same time, forgoing treatment can mean the difference between living a healthy, productive life and feeling left in the dark. Here are seven things that could happen if you bypass treatment.

1. You might end up with a deformed spine

AS mainly affects the spine. With repeated attacks of inflammation, your spine starts to lose its flexibility. As the disease progresses, moving your spine gets increasingly difficult. The less you move your spine, the stiffer it can get.

In the most severe cases, chronic inflammation causes the formation of extra bone between your vertebrae. In time, the vertebrae can become fused together. Once that happens, your ability to move is severely restricted.

Think about all the everyday tasks that require bending, stretching, or twisting. As for posture, curvature of your spine can leave you permanently stooped over. Fully straightening your spine is no longer possible.

AS medications are designed to control inflammation. Physical therapy can help keep your spine flexible. Following a complete treatment plan can help keep your spine flexible so you can avoid or delay this complication of AS.

Beyond this point, there are few options. A type of surgery called osteotomy might be able to straighten and support your spine. It’s a procedure in which a surgeon has to cut through your spine. For that reason, it’s considered high risk and is rarely used.

2. Multiple joints and ligaments can become damaged

AS is chronic and progressive. Over time, it can fuse your spine and sacroiliac (SI) joints, which are in your hips.

For 10 percent of people with AS, inflammation of their jaw becomes a problem. It’s potentially debilitating because it makes it hard to open your mouth enough to eat. This could lead to malnutrition and weight loss.

About one-third of people with AS develop problems with their hips and shoulders. Some may have damage to their knees.

Inflammation can also occur where ligaments attach to bone. This can affect your back, chest, SI joints, and pelvic bones. It can also create problems for your heels (Achilles tendonitis).

These issues can cause chronic pain, swelling, and tenderness, and keep you from getting a good night’s sleep. They can interfere with everything from bending to the inability to turn your head while driving. Mobility becomes a growing problem.

Untreated spine problems can have a serious impact on your quality of life.

Treatment for AS can help prevent permanent joint damage and fusion. Once you have severe damage to your hips or knees, your options are limited. You may need surgery to replace your damaged hip or knee with a prosthetic one.

3. You can develop osteoporosis

Another potential complication of AS is osteoporosis. This is a condition in which your bones become weak and brittle. It puts all your bones at risk of fracture, even without a fall or hard bump. This is particularly worrisome when it involves your spine.

With osteoporosis, you may have to curb some of your favorite activities. Regular visits with your rheumatologist will help identify osteoporosis as a problem early on. There are a number of effective treatments to help strengthen your bones and lower your risk of fracture.

4. You might have problems with your eyes

Inflammation can also cause problems with your eyes. Anterior uveitis (or iritis) is a condition in which the front of your eye gets red and swollen. It’s more than a cosmetic problem. It can also cause blurry or cloudy vision, eye pain, and light sensitivity (photophobia).

Unchecked, anterior uveitis can lead to partial or complete loss of vision.

Sticking to your treatment regimen and having regular visits with your doctor will help catch anterior uveitis before your eye suffers permanent damage. Prompt treatment from an eye specialist, or ophthalmologist, can help protect your vision.

5. You’re at higher risk of cardiovascular disease

Because AS is a chronic inflammatory autoimmune disease, it increases your risk of cardiovascular disease. Cardiovascular disease includes:

  • high blood pressure
  • irregular heartbeat (atrial fibrillation)
  • plaque in your arteries (atherosclerosis)
  • heart attack
  • heart failure

You can lower your risk of cardiovascular disease by adhering to AS therapy. This should include a balanced diet, regular exercise, and not smoking.

Because you’re at higher risk, it’s a good idea to see your doctor regularly. The sooner you catch the warning signs of cardiovascular disease, the sooner you can start potentially lifesaving treatment.

6. Chronic inflammation can result in diminished lung capacity

Chronic inflammation can prompt new bone growth and scar tissue where your ribs and breastbone meet. Just as it does to your spine, it can cause bones in your chest to fuse.

That makes it very hard for your chest to fully expand when you breathe. Chest compression can cause pain that worsens when you take a deep breath. Not being able to breathe easily strains even the simplest activity.

You can lower your chances of this complication by taking medications to control inflammation. A physical therapist can also help you perform deep breathing exercises to expand your ribcage.

7. There’s a potential for permanent disability

Any of the complications listed previously can leave you with permanent disabilities. Having just one can lead to:

  • inability to participate in your favorite physical activities
  • mobility problems
  • decreased ability to work
  • loss of independence
  • lower quality of life

The goal of AS treatment is to slow disease progression and prevent the types of complications that can lead to permanent disability. A rheumatologist experienced in treating AS can help devise a treatment plan based on your particular needs and preferences.



Rocker Dan Reynolds ‘grateful’ for struggles of arthritis condition

The singer wants fellow pain sufferers to realise things will get better.

Imagine Dragons frontman Dan Reynolds has drawn strength from his debilitating battle with chronic arthritis pain and used it as inspiration for the band’s new material.

The Radioactive singer spoke candidly to People magazine in November (16) about his struggles with ankylosing spondylitis (AS), a type of arthritis which causes long-term inflammation of joints in the spine.

Dan admitted the illness had plagued him during the group’s rise to fame, and really left him in a “bad place”, especially as the rockers worked on their 2015 album Smoke + Mirrors.

“Right at the beginning of Smoke + Mirrors was really when A.S. was rearing it’s head in a big way,” he recalls in a new interview with People. “It was the beginning of the disease in a lot of ways for me and learning to manage it. So physically I was in a quite a lot of pain, and mentally I was in a very bad place as well.”

Dan has since gotten to grips with the condition, which now allows him to better manage his symptoms, and as a result, he has been enjoying “a very healthy year” after much “physical and mental work”.

Fighting through the health struggle has made him a more positive person, and now he’s able to recognise it has only made him stronger.

“I’m grateful for it,” he says. “Looking back in this last year from a place of health, you’re able to have greater perspective and I’ve had more perspective to see that a lot of the great things in my life are due to struggle.

“A lot of my greatest strengths are due to my greatest weaknesses or flaws or physical ailments. It brought me discipline, gratitude and compassion.”

Dan channelled his emotions about his illness into the band’s new single Believer, making it a really personal track to perform.

“The song is about how pain made me a believer,” he shares. “It’s made me a believer in myself, it’s made me a believer in my art and work. I wouldn’t have my art if it wasn’t for pain. It takes somewhat of a healthy place to appreciate it because when you’re in the midst of it you don’t appreciate it. You’re just upset.”

Despite Dan’s health turnaround, he insists there are still days when he struggles with severe pain, but he is urging others suffering from similar ailments to keep pushing through.

“With depression or A.S., it’s not just a pit for the rest of your life or this downward spiral. It’s the beginning of something that is going to cause you to have to grow to make changes,” he concludes. “While it can seem bleak right when you’re diagnosed, there are management plans so that’s why it’s so important for it not to remain a hidden disease and that awareness is raised.”



Spine Concepts, Low Back Pain

Acute low back pain or low back pain with sciatica radiating to the lower leg and to the foot (Figure 1). They are initially treated conservatively for at least six weeks by physical therapy, anti-inflammatory medication and limited activity (as guided by the pain).


Doctors should treat the condition conservatively. Even if there is a large disc herniation on the MRI, unless the disc is central or causing a neurological deficit, they need wait at least six weeks before beginning a more aggressive treatment. 90% of patients will have symptoms that resolve in one month. Smoking, depression and vibrations will increase the incidence of low back pain (Figure 2).


Intradiscal pressure (IDP) will change depending on the position (Figure 3). The lowest pressure is measured while the patient is lying supine. The highest IDP is measured while the patient is sitting, leaning forward and holding weight.


If the patient is experiencing low back pain and there is a history of cancer, the doctor will need to get an x-ray and MRI, especially if the pain occurs during rest and at night (Figure 4)! In case of a renal tumor, the physician will probably need to do arteriography and embolization of the spinal lesion.


The spine is a common location for metastatic tumors. Metastases occur in the vertebral body and go to the pedicle. Loss of about 30%-40% of the bone mass must occur before the physician can detect the lesion on an x-ray. The loss of the pedicle bone will result in a “wink sign” (Figure 5).


What if the patient has an infection?
An infection will occur within the intervertebral disc space (Figure 6). The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels will be elevated. Only 50% of the cases will have a fever, and less than 50% of cases will have an elevated white blood cell (WBC) count. The physician will need to get a blood culture (this is positive in about 24% of the cases). They will also need to get an MRI and administer antibiotics as guided by the biopsy, culture and sensitivity.


If the patient has an epidural abscess, surgery will be performed, especially if there is deterioration of the neurological function (Figure 7). If there is an infection post-surgery, it may be diagnosed with a higher C-reactive protein (CRP).


Osteoporotic bone is at risk of fracture, beginning with the wrist, the spine and followed by the hip (Figure 8). So, if the patient has an osteoporotic spine, it will need to be treated before it leads to a hip fracture later on. One fracture of the spine will lead to multiple spine fractures. After one year of treatment with medication, the incidence of a vertebral fracture is decreased by 60%. After two years, the incidence of a vertebral fracture is decreased by 40%.


In general, when the patient has low back pain, it is necessary to treat the patient conservatively. The doctor does not need to get x-rays in the first 4-6 weeks unless there are “red flags” including: the patient is older, the patient has a metastatic tumor or history of cancer, infection is suspected, the patient has trauma or there is an osteoporotic fracture possibly due to steroid use.

The physician may see an x-ray that looks like ankylosing spondylitis (Figure 9). They will need to check the SI joint because ankylosing spondylitis begins at the SI joint. The may get HLA-B27 and will find that there are marginal syndesmophytes with diffuse ossification of the disc space without large osteophyte formation. Ankylosing spondylitis is different from Diffuse Idiopathic Skeletal Hyperostosis (DISH), which occurs in diabetics, in this case the physician will get an HbA1c. Syndesmophytes are non-marginal and have larger osteophytes. It is the DISH which will have flowing ossification along the anterolateral aspect of at least four continuous vertebra. DISH is not ankylosing spondylitis (Figure 10)!



An MRI of the spine will be obtained at a certain point, however, x-rays may be needed first. MRI results may be a problem! There are abnormal MRIs in asymptomatic patients (these are false positives). Approximately 35% of these false positives are seen in patients less than 40 years of age. 90% of positive MRIs in asymptomatic patients occur in patients over 60 years of age.

The second issue is the MRIs with gadolinium dye. Gadolinium will differentiate a disc from a scar. Both granulation tissue and the recurrent disc could look alike on a routine MRI. There will be contrast enhancement when there is granulation tissue because it is vascular. However, when there is a disc herniation, the dye will not enhance because the disc is a dead piece of tissue (avascular). When the doctor tries to differentiate between a recurrent disc and a scar, they will inject the dye and get the MRI. If there is a vascular enhancement, then it is granulation tissue and the patient will not need surgical intervention. If there is no enhancement, then it is a recurrent disc and it is avascular, which is why it does not enhance. If the recurrent disc is causing a lot of pain or symptoms to the patient, then the physician may need to discuss a repeated surgery with this patient.



Age does not affect disease activity, management in ankylosing spondylitis

Markers of disease activity and treatment trends appear to be similar among geriatric patients with ankylosing spondylitis compared with younger counterparts with the same condition, according to findings presented at the American College of Rheumatology Annual Meeting.

“Ankylosing spondylitis in the geriatric population tends to be underrepresented in the literature,” Ahmed Omar, MD, of the University of Toronto, told Healio Rheumatology. “But the geriatric population is increasing worldwide. We need more research into this patient population.”

Omar and colleagues collected data from a longitudinal, Toronto-based cohort of patients with spondyloarthropathies. Geriatric patients were categorized as those at least 65 years of age and non-geriatric patients were those younger than 65 years. Data from a tertiary care orthopedics clinic in Toronto were used as an age-matched geriatric control group of patients without ankylosing spondylitis (AS).

“It is important to point out that this study did not aim to specifically look at ‘late onset AS,’” Omar said. “We aimed to develop a profile of patients who have AS and happen to be elderly, whether they developed the condition early or later in their lives.”

The investigators compared clinical and laboratory data between cohorts.

A total of 890 patients with AS were identified; 48 patients were classified as geriatric. The non-AS geriatric comparison group included 322 patients with knee osteoarthritis (OA).

Preliminary comparisons between young and geriatric patients with AS demonstrated no differences in gender distribution, although geriatric patients with AS tended to be older at the time of diagnosis (P < .001). The younger population was diagnosed earlier than the elderly group, which may reflect greater disease awareness among physicians in recent years, according to the study results.

No differences in clinical activity were observed between the groups, including mean inflammatory markers or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Extra-articular manifestations were also similar between the geriatric and non-geriatric patients with AS.

No significant differences between the two groups were observed with regard to use of NSAIDs, disease-modifying antirheumatic drugs, corticosteroids and biologics, or in side effects associated with the agents. Investigators found 1% of patients in the geriatric group began biologic therapy at 65 years of age or older.

“Standard precautions regarding age-related pharmacokinetics still apply, but the results suggest it may not be necessary to avoid using certain immunomodulating agents in geriatric patients with AS,” Omar said. “In general, there may be a tendency to undertreat elderly patients due to concerns about drug-related side effects, but more research is required to better understand the way we can, and should, use these drugs in the elderly, as earlier trials tend to favor younger populations. Real-world, registry-based studies are a valuable resource that can help address some research questions, but we also need more prospective studies and clinical trials that cater to this specific age group.”

Mobility, as measured by the Bath Ankylosing Spondylitis Metrology Index (BASMI), and function, as measured by the Bath Ankylosing Spondylitis Functional Index (BASFI), were higher among geriatric patients with AS (BASMI, P < .001; BASFI, P < .04), indicating greater restricted spinal mobility and greater impact on function in the geriatric patient with AS. These patients were also more likely to have a history of physical trauma and/or injury (P = .03) and have a higher score on the SF-36 Health Survey. Quality of life scores were similar between groups.

There were more men in the group of patients with AS when the geriatric patients with AS and the geriatric patients with OA were compared. Patients without AS were more likely to smoke and have a history of diabetes (P = .04), as well as have greater functional disability scores. Rates of infection were similar between the groups.

“We show that geriatric patients with AS have similar treatment and disease activity parameters, but differ in a select few functional components and comorbidities when compared with the younger population,” the researchers wrote. “Further research into the geriatric AS population is needed to better define and manage this group’s specific needs.



Complex regional pain syndrome: a long overlooked condition

Complex regional pain syndrome (CRPS) is a debilitating condition that affects the limbs and can be induced by trauma or surgery. An article recently published in Burns & Trauma provides a comprehensive summary of this little known condition and gives an update on recent progress in treatment.

CRPS image full
Complex regional pain syndrome (CRPS) is a debilitating condition that has been studied since it was first described by Weir Mitchell in the 1860s. During the civil war, he had keenly observed a pattern of clinical signs and symptoms with much consistency, and termed it, rather innovatively, causalgia.

This is a condition, which we had come across in our formative years in medical school, but only recently did we see patients with this condition. Often, physicians found it difficult to characterize, which led to a late diagnosis. Furthermore, explaining to patients about the diagnosis proved equally challenging. In both instances, the ever-changing terminology and nosology of CRPS played a huge role.

Due to the multi- factorial nature of this condition, animal models that can simulate the disease process are lacking.

Over the years, the complex nature of CRPS has proved an enormous challenge for clinicians and researchers alike. Since the turn of the millennium, only two randomized, placebo-controlled trials have been conducted in the United States, both of which have demonstrated disappointing results. Due to the multi- factorial nature of this condition, animal models that can simulate the disease process are lacking, which is further compounded by our limited understanding of the mechanisms involved.

This has hindered the development of new therapies, leading clinicians to adopt a trial and error approach towards managing this syndrome. Hence, most studies evaluating novel approaches have been restricted to case series or small pilot studies. The recent declaration by the United States Food and Drug Administration of CRPS as an official disease has given us renewed hope, as this has been a catalyst for new drug development.

Recently, an article entitled “Complex Regional Pain Syndrome: A Recent Update” was published in Burns & Trauma, which provides a comprehensive summary of the latest developments in our understanding of CRPS. CRPS is now classified as Type I, which occurs due to noxious event in a disproportionate way in the absence of nerve injury. Meanwhile, Type II is characterized by a burning pain with features of allodynia and hyperpathia in the presence of nerve injury. Type I is more common, and can be attributed to differences in ethnic and socio-economic background.

Over the years, physicians have managed CRPS with physiotherapy and proper diet to alleviate the symptoms. Given the chronic pain the patients experience, many often seek psychiatric appointments to cope with the pain, and avoid long-term anxiety disorders. From a preventative perspective, the use of anti-oxidants is recommended by expert opinion. From our interactions with these patients, it became more evident that handling complications is as important as managing CRPS. A good example is the onset of osteoporosis, which compounds the pain these patients already experience and complicates both the diagnosis and treatment.

Given the chronic pain the patients experience, many often seek psychiatric appointments to cope with the pain.

Unraveling the complex pathophysiology of this condition enables us to develop better treatment methods. Although there has yet to be a successful treatment for CRPS to date, years of research have provided us with many valuable lessons and our understanding of this condition continues to grow. As with any pain-related condition, the patients are very diverse, in their presentation, underlying pathophysiology as well as their response to therapies employed. Hence, future work is still required to elucidate the subgroups of patients who would benefit the most from currently available treatment.

Given the complex nature of this syndrome, it is unlikely that targeting a specific mechanism will be effective. As with other chronic disorders, the future of CRPS treatment may lie in combination therapy and studies investigating this will be necessary. We hope that this update will serve its purpose well in updating the readers of the latest work on CRPS, and enable them to make informed decisions in their clinical approach.



Causes of Pelvic And Back Pain – Ankylosing Spondylitis


The most common cause of lower back and pelvic pain is lifting an object that is too heavy, according to the American Academy of Family Physicians. Traumatic injuries and certain medical conditions can also cause discomfort in these areas. A common pain-generator for both lower back and pelvis pain is the sacroiliac or SI joint–the joint between the sacrum and the innominates, or hip bones, at the base of the spine. Many conditions can cause pelvic and back pain.

Ankylosing Spondylitis

Ankylosing spondylitis can cause back and pelvis pain. According MedlinePlus, ankylosing spondylitis is a type of arthritis that affects the spine and other joints throughout the body. Ankylosing spondylitis causes swelling in the intervertebral discs, the spinal facet joints and the sacroiliac joints in the pelvis. Ankylosing spondylitis is an autoimmune condition, which means that it causes the immune system to attack the very tissues it should be protecting. Ankylosing spondylitis occurs more frequently in men than women. The condition is also more severe in men and tends to run in families.

Common signs and symptoms associated with ankylosing spondylitis include chronic back and hip pain and stiffness, a stooped posture, weight loss, anorexia or loss of appetite, eye inflammation and bowel inflammation.

Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction can cause back and pelvis pain. The website Spine Health states that dysfunction or aberrant motion in the sacroiliac joint may cause low back, pelvis and leg pain. While the exact cause of sacroiliac joint dysfunction-related pain is unclear, it’s believed that too little joint movement or too much joint movement plays a significant role. According to the site, Sports Injury Clinic, sacroiliac joint dysfunction can be caused by trauma, biomechanical problems, hormonal imbalances or inflammatory joint disease.

Common signs and symptoms associated with sacroiliac joint dysfunction include aching or sharp pain on one or both sides of the lower back, pain that radiates into the buttocks, difficulty performing certain activities of daily living such as putting on shoes or turning over in bed and tenderness in the ligaments surrounding the sacroiliac joints. Spine Health notes that sacroiliac joint dysfunction occurs most frequently in young and middle-aged women.


Pregnancy can cause back and pelvis pain. According to the American Pregnancy Association, pelvic and back pain are among the most common pregnancy-related conditions. The APA reports that between 50 and 70 percent of all pregnant women experience at least some back and pelvis pain during their pregnancy. Although back and pelvis pain can occur at any point during a pregnancy, it’s most common in the third trimester, when the weight of the unborn child is reaching its maximum.

According to the APA, there are five principle causes of back and pelvis pain during pregnancy, including ligament laxity due to increased hormone production, an altered center of gravity, additional body weight for the back to support, faulty posture and increased stress. Exercises approved by a qualified health care professional can help prevent or reduce pregnancy-related back and pelvis pain.



Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study

Background:Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting the spine in young adults. It is associated with excess cardiovascular and cerebrovascular morbidity.

Objective:To determine whether patients with AS are at increased risk for cardiovascular and cerebrovascular mortality.

Design:Population-based retrospective cohort study using administrative health data.

Setting:Ontario, Canada.

Patients:21 473 patients with AS aged 15 years or older and 86 606 comparators without AS, matched for age, sex, and location of residence.

Measurements:The primary outcome was a composite of cardiovascular and cerebrovascular death. Hazard ratios (HRs) for vascular death were calculated; adjusted for history of cancer, diabetes, dementia, inflammatory bowel disease, hypertension, chronic kidney disease, and peripheral vascular disease; and, among those aged 66 years or older, relevant drug therapies. Independent risk factors for vascular mortality were identified in patients with AS.

Results:The mean age of patients with AS was 46 years, and 53% were male. Patients and comparators were followed for 166 920 and 686 461 patient-years, respectively. Adjusted HRs for vascular death in AS were 1.36 (95% CI, 1.13 to 1.65) overall, 1.46 (CI, 1.13 to 1.87) in men, and 1.24 (CI, 0.92 to 1.67) in women. Significant risk factors for vascular death were age; male sex; lower income; dementia; chronic kidney disease; peripheral vascular disease; and, among patients aged 65 years or older, lack of exposure to nonsteroidal anti-inflammatory drugs and statins.

Limitation:Diagnosis codes for AS were not validated in Ontario.

Conclusion:Ankylosing spondylitis is associated with increased risk for vascular mortality. A comprehensive strategy to screen and treat modifiable vascular risk factors in AS is needed.