January 5, 2010

Salvation in Salivation

I started thinking about this post when my dry mouth was becoming particularly troublesome as winter finds yet another way to make me miserable.  Dry air from heaters, mouth breathing even more than usual due to a chronically stuff nose, and the brutal damage the cold, dry air (let alone wind!) does to my lips have often left me with a mouth and throat so dry, even I could swallow my throat walls would stick together.  (Have you ever tried to 'unstick' your throat?  It's freaky/annoying/next to impossible!)  Oh, and did I mention the split lips?  Yeah, reaaaal attractive.

Today, I was involved in two discussions on an SS support group on Facebook that dealt, in part, with progressing dry mouth.  So, here are my thoughts on dry mouth (actually, you've heard most of them already), along with some products and tips I've tried or want to try.

Medication: I would normally put this category last, but this time I think it might be more logical to list it first.
Evoxac and Salagen - these pharmaceuticals are somewhat new (last 5-10 years I think).  I was formerly a patient of the doctor instrumental in their creation, but he was an...ahem...hm...not good doctor (almost forgot this was a public forum) so I found a new one.  Under his "care", I tried these but did not end up staying on them.  For most people I've heard from and my experience, they do work.  They increase saliva production - often dramatically, and frequently have the added effects of tear and sweat production.  Sometimes, this is good... but again, according to my trial and most people I've heard from, it can be too extreme to tollerate.  The increased salivation often leads to excessive drooling (I felt nauseus from swallowing so much of it), and naturally the sweating can be problematic for some people.  Furthermore, when you take a dose (which, by the way, you have to keep increasing because your body quickly adjusts to the medication) it gives what I call a "kick in the face".  Within minutes, I quite literally felt like my face had been smashed - sinus pressure, headache, and the sudden tearing/salivating adds to the I've-been-beaten-up sensation.  Most of this does pass (the headache sometimes lingered for me), but happens again with the next dose, and ESPECIALLY if you were a few minutes late with the next dose.  Lastly, a clinical side effect of the drug can be racing heart/palpitations/etc, which are already a problem for me - and this definitely made mine worse.

Now, onto my more preferred ideas...
Dry Mouth Dental Care Products: Here, I'm referring specifically to over the counter products manufactured specifically for dry mouth relief.
Biotene Products -
  1. The brand Biotene markets an entire line of products for us dental-desert dwellers.  I use the gel-toothpaste...it takes a little getting used to because it doesn't foam (the ingredients that make normal toothpaste do that are damaging to dry mouths) and isn't as strong a flavor as traditional products, but that has its advantages too. 
  2. On some nights, I use the 'oral balance' gel.  It's nearly the same texture and flavor as the gel-toothpaste, but you simply apply a thin layer across your tongue and other tissue in your mouth (gums, cheeks) according to your personal needs.  It's definitely not an unpleasant taste, but I have to consciously avoid swallowing all of it.  That's why I use it right before bed, if I use it and stay awake I just keep downing it.  It took takes getting used to, and it's a little awkward to try to slime your mouth with a finger full of gel, but honestly not that big of a deal.
  3. Their gum is pretty good...again, not an overwhelmingly strong flavor (which I like), but if you have another gum you like I don't think I'd worry about switching.  Also, I always end up chewing 2 piecesat a time because they're small, and that with the fact that the packages don't contain many pieces can make it unnecesarily costly.
  4. While I haven't used their spray, I have tried another brand (see below), and I imagine they're similar.
  5. I would like to try the "liquid", if I do I'll let you know how that works out.
  6. I don't use their mouthwash, but mostly because I use one of the ACT ones and am happy with it.
Oasis - This competitor to Biotene makes a mouthwash and oral spray.  I've used the spray with some success (though I might try Biotene's to see if it's better), and the mouthwash with no real response at all.  I wasn't bad, but I wasn't terribly impressed.  I will warn you, though, the spray is VERY weird.  Not to be gross but the texture is thicker than you'd expect, more like real spit.  If/when you can get past that, you'll be fine.

Dry Mouth Discs - I've tried one brand, OraMoist, with no success.  Another brand, XyliMelt, has caught my eye lately, but don't know if I'll spend to try it anytime soon.  These odd products are disks, somewhat like an old-fashion cert mint but a bit smaller, which are designed to adhere to the roof of your mouth or inside your cheek.  In theory, they contain an ingredient which helps stimulate salivary production until they eventually disolve after a few hours.  I wonder if my dry mouth is too severe (or if the fact that mine is from damaged glands is a problem), because I didn't end up salivating much at all.  The disk just got kinda slimy until I finally got annoyed and pried it out, but I wonder if someone whose glands do still function would have had more success...maybe it was like trying to get blood from a stone.

Other Remedies: Here, I'm thinking about products or tricks that can help dry mouth but are not manufactured or marketed specifically for this purpose.  Also, I realize you've heard of many of these...bear with me.
Gum - Chewing gum is an excellent remedy.  Naturally, you should try to use sugar-free, but for one more reason than you might know - Xylitol, sometimes used as an artificial sweetner in gum, is known to have mouth-moistening effects!  The chewing motion stimulates glands through both motion and the signal it sends to your brain (your brain hears "I'm chewing -> food must be present -> to get the nutrients the food must be broken down -> send in the saliva!").  It can also help physically remove or inhibit plaque, dental debris, and general oral ick.

Hard Candy - Using the same general principles as chewing gum, sucking on hard candy can stimulate saliva production.  Again, if you can use sugar-free, you're in good shape, but I find it too tempting to use sugar-filled candy which is bad for both my teeth and waistline.  Side note - especially for those who also have the lovely GI side effects of SS, going with traditional red and white peppermints is great because the peppermint oil (look for the real thing) helps settle upset stomachs and aide in digestion.  I swear by this trick, especially when I've overeaten.

Water - Yep, sorry, it's still one of the best.  Drinking a lot of water helps flush out debris, inhibit plaque, and keep things from sticking together.  As you know, it probably won't help with the last part for long, though.

Salt Water Rinse - Every dentist's best friend, the warm-water-with-a-little-salt swish.  Put just enough salt in your room temperature water to begin to make it cloudy and do your best Listerine commercial impression.  The salt does actually help soothe irritated tissue, reducing burning, redness, swelling, and even helping to dull pain.  If you gargle too, you'll also give a karate chop to the bacteria in the back of your mouth/throat that cause bad breathe.  If you did it right, the water probably seemed a little gross because your tastebuds would actually prefer it saltier, but that can irritate instead of soothe.

Lip Balm - Ok so technically this doesn't touch dry mouth interiors, but don't neglect your lips.  They'll suffer faster and be sure to let you know it.  Dry lips are more suceptible to bacteria and viruses, and who needs a nasty cold sore.  According to my research, the same products that work best for our sensitive, damaged tissue (olive oil, beeswax, coconut or cocoa butters/oils) happen to be the ones found in all-natural balms.  So, I regularly peruse my drug store for the newest all-natural products to give them a shot.  A lot of people swear  by Bert's Bees, and with good reason.  Personally, my all time favorite is Lipsyl!  It's a lot like Bert's (beeswax based), but comes in a generous oval-shaped tube that more naturally accomodates lips, goes on smoother, lasts longer, and has the coolest little 'bee' on the slider bar.  It appeals to both the big and little kids in me:)

January 4, 2010

Sharing II's in the Workplace

I want to pose a train of thought and question to, well, anyone who reads this and is willing to share!

Ok so, I realize many II sufferers find themselves needing to drop to part-time work schedules, or even from the workforce altogether (or, as Julia mentioned in her blog seen here, become self-employed in the business of personal health promotion and care - that is, focused on improving their own health which is unto itself a real job).  If you are a person in this "unemployed" stage, I'm going to need you to think back to your 'working' days and/or consider what you'd do now with any gained knowledge you didn't have then.  If you are still in the workforce (full or part-time), feel free to chip in with what you did, wish you did, or plan to do.  And finally, if you are employed in an HR position and have professional insight, bring it on!

Personally, as you probably know by now, I finally graduated college in May, and in October began a fulltime position in auditing.  I knew I was getting into an active, stressful, fast-paced situation...and I anticipated running into some contradictions between this stress & schedule and my medical limitations.  (I just wanted you to know I'm not naive, haha.)  I didn't, however, anticipate that I'd be travelling 1/3 of the time (not far, a state away, but it's still out-of-town, staying in a hotel, packing and unpacking, and so on).  And, while I may have anticipated some issues that doesn't mean I know what to do about them as I run into them.  (For example, one site I sometimes go to is about 6-7 city blocks from the closest subway station which is nothing to my coworkers but too far for me in the winter doing overtime and lugging a computer and personal belongings.  Do I drive in and park, incurring high parking fees?  What if the firm doesn't agree to reimburse them?  And so on.)  Additionally, each client I work on comes with a different team of coworkers to cope with.  Some of them are great, most are pretty good, and a few are ... not.

Now, my firm is concerned with not just disability legislation, but also being disability friendly.  And I do believe they mean well.  But as is usually the case, they have plans in place for working with obvious, outward physical disabilities.  I'm not in a wheel chair, I don't use braces or a cane.  I have all my limbs as well as senses of sight and hearing.  Uh-oh, what do they do with me?!

I have been fairly open with the firm as a whole about my conditions...but take on the issue of telling each team of coworkers as its own case.  I usually have to tell all of them something...why I have to park close, or if we use my car to go to lunch and I have my handicapped tag down, or if I get crazy dizzy.  Sometimes I get into WHY these things happen, what my conditions are, and the like.  In fact, I prefer to explain a little more because it boosts understanding (the U in UII, afterall), and also lends credence to my claim ('I need a drink at my desk because half salivary glands don't work from Sjogrens' is received much better than 'I have a medical condition').  And now that we've covered the plan my pragmatic side developed, we reach the real-world application glitches.

The way I see it, I (as all II sufferers do) face these questions and more:
  • Do I insist on limitations and accomodations from the very beginning or try to push myself up front and then ask for accomodations only when I find myself needing them?  If I don't ask at first, I might not be taken seriously later or look like I'm trying to shirk my load.  If I put all my limitations on the table up front, I might look like I can't (or won't) do the job and there are plenty of 'legal' ways to get rid of me that don't mention disabilities.  Not to mention that it contradicts my "do what you can, while you can" motto from this earlier post.
  • Do I share my situation with everyone on the team, just the higher-ups, or just the people I work with most closely?
  • Don't I need to tell at least one person on the team, ESPECIALLY when travelling out of town, in case something happens to me?
  • Can I handle the possible reactions I could face?  After spending so much time primarily with people who generally understood and accepted my situation, I am sometimes shocked when I encounter a 'non-believer'.  And HOW should I handle these situations?  Do I confront the person with facts or is it more "professional" to keep my feelings to myself?  Let's face it, if gossip starts getting around that some people have trouble working with me in a group I'm doomed.
  • Do I say anything about travelling so much?  If so, to whom?  What do I want to propose as a solution (it's usually wise to have a proposed solution in mind if you're going to point out a problem)?  Around here, this can be complicated by the corporate culture, which very favorably views a willingness to be exceedingly flexible and while I'm willing, I'm just not that capable.
  • And naturally, the long term questions such as how long do I stay with the firm, what compromises am I willing to make for career advancement or can I content myself with falling 'behind' my peers on the corporate ladder but doing it in good health, and so on.
Right now, the travelling thing has been the issue wearing on me the most, though in a few days the example of driving and parking instead of taking public transportation will jump to the front.  In a number of weeks, I'll be returning to a situation where I'll be out of town for an extended time, working long hours, and dealing with some of the least receptive coworkers I've encountered so far...I have NO idea how I'll deal with that one.

I've looked into the firm's disabilities network (one of their "diversity networks"), and am drafting a message to the local contact.  I'm hoping they've encountered someone similar to me before and might have some protocols or ideas I didn't know about.  If not, I'll be back to these questions...do I continue to pursue accomodations?  And just what accomodations do I think would work out?  Oh bother...

So now that I've taken you on this little choo-choo train ride through my anxiety-ridden thoughts, I turn it all over to you.  What are your thoughts, reactions, stories, advice, or feelings?  I could really use some support and reminders that I'm not the first, last, or only one going through this.  Thanks in advance!