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Sjogrens Topics => Living With Sjogren's => Topic started by: LilliaT on June 28, 2016, 10:24:10 AM

Title: what do you think might have "triggered" Sjogren's for you?
Post by: LilliaT on June 28, 2016, 10:24:10 AM
I might not be phrasing this exactly correctly, but do you have any thoughts or suspicions as to what might have "triggered" Sjogren's for you?  For example, I've read that some doctors believe that autoimmune disorders may be triggered (in people who are susceptible to them) by some kind of viral infection.  I've also seen a lot of posts by people speculating that some medication (e.g., Accutane), a surgical procedure, or some kind of traumatic injury might have been the triggering factor for them.   (These posts have also led me to wonder whether I should reconsider an upcoming surgical procedure that I had planned to undergo -- I have a small umbilical hernia that probably occurred when I was pregnant 9 years ago, and I'd been making arrangements for surgery to have it repaired.) 

Personally, I've been wondering Accutane might have been a factor for me.  I really regret taking it -- not just because of the side effects (which read very much like a list of Sjogren's symptoms), but because I probably didn't even really need it.  (I later realized that my occasional breakouts -- which were never even that bad -- were a reaction to gluten.  When I cut out gluten, my skin completely cleared up.  But that was after I'd already taken 2 courses of Accutane -- once 15 years ago, and once maybe 7 years ago.) 

I understand there's no way to know for sure, and that there are probably countless contributing factors for everyone.  But, just out of curiosity and in a totally non-scientific way, I was hoping to find out if other people had any thoughts about what might have triggered their autoimmune issues. 
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Navigator on June 28, 2016, 10:32:51 AM
Untreated very very low Vitamin D levels in blood, menopause and changes in hormone levels, stress.
Are my top three suspicions.  I already had one autoimmune disease diagnosed when I was 27 so I was already primed to develop something else.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: kimberly64 on June 28, 2016, 10:45:28 AM
Lyme disease.
Kim
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Jasper on June 28, 2016, 11:10:03 AM
While I am sure I was/am genetically predisposed to Autoimmune Diseases, I am fairly certain that Hepatitis C was the trigger for developing Sjogren's Disease (in me).
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Liz D. on June 28, 2016, 11:32:36 AM
I feel my trigger was the extreme stress I went through when my father died.

Liz D.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: felpeyu2 on June 28, 2016, 01:47:22 PM
I'd say mononucleosis was my trigger (I had mononucleosis at 23 years old).
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Carebear on June 28, 2016, 02:26:54 PM
Menopause at age 38, and my mom's passing away less than two years later.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Deb 27 on June 28, 2016, 04:30:44 PM
Lilla, in reading everyone's response, it seemed like I had something in common with almost all of them, so it's hard to say. I worked in health care, had exposure to a lot of viruses, I had subclinical Hepatitis B, mono, early menopause, and a ton of stress.  I also had a case of undiagnosed colitis for years. That screws with your immune system.  I also had other auto immune diseases like hashimoto's and morphea (scleroderma of the skin). Sorry I didn't have any one answer for you.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: warmwaters on June 28, 2016, 05:10:34 PM
I had a bad gastro infection with cDiff.  First time I had the profound fatigue was with that. The profound fatigue then started reoccurring several times over about 4 months, and then I went into "full blown" problems with Sjogrens, and was diagnosed shortly after.

I had dry eyes and mouth prior to this event, but they had been dismissed as "you are getting older" and "you are post menopausal" so it's hard to say if I already had some mild symptoms.  The dry mouth just meant I needed some extra water during the day, nothing severe.  Ditto with the eyes.

Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Lindabridge on June 28, 2016, 07:58:32 PM
I was diagnosed with a more rare autoimmune disease , relapsing polychondritis, about 20 years ago. I stayed on the standard regimen-- first prednisone, then two years of methotrexate. During this time I became cognizant that my flares were related to gastrointestinal issues. To make a long story short, I tested positive for intestinal permeability. My GI Doctor simply recommended that I eat more fiber, but that didn't help at all. After experimenting with several probiotics, which were all in the infancy stage at that time, I found one that did the trick. After one month, my symptoms were gone.

This year, about eight months ago, my symptoms reappeared after a long remission. I assumed that they were related to severe heartburn which would come on suddenly every afternoon towards dinner time. I resumed taking the same probiotic, as well as Nexium. The symptoms subsided.

In January of this year, I stupidly indulged my vanity and had cosmetic surgery which entailed a neck lift. The surgery went without any complications, and I look rested and younger. However, the stress of the surgery was too much for my body. By the end of January, I was experiencing all the classic symptoms of Sjogren's. I am seronegative,, but my rheumatologist put me on Plaquenil at the beginning of May.At the same time I started the " collagen cocktail." In all honesty, I feel less tired, and my eye burning is less severe. I don't feel as if someone put a blow torch to my eyes all day. But I still have the dry throat issues. I tried taking the wondrous probiotic that worked 20 years ago, but it was completely ineffective in my fight against Sjogren's

I am convinced that  the surgery triggered Sjogren's. Even though I was predisposed to autoimmune diseases, this trauma was the straw that broke the camel's back. I'm hoping that Plaquenil will stop the progression  of the disease, but I am still actively pursuing alternatives to it. I plan on trying other probiotics, or other digestive enzymes.

What worries me most is the possibility of contracting lymphoma. My submandibular glands are inflamed, and my salivary glands ache when I eat or drink certain things.
I haven't read of anyone else mentioning lymphoma on this forum.
Is this the elephant in the room?
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Tharrell on June 28, 2016, 08:30:58 PM
Mine started with a very bad flue followed by two bouts, or one that didn't go away, of impetigo. That was almost four years ago. Took three years till proper diagnosis!
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Dawnmist on June 28, 2016, 11:05:20 PM
Glandular Fever when I was 15. The illness knocked me out of school for a term, and then it "relapsed" with the fatigue knocking me out of school for the next 3 terms and never really went away...I just struggled on despite the fatigue/muscle pain/tendonitis attacks/inability to sleep decently/etc.

Sjogren's didn't get diagnosed - or treated - until I was 38. It took me saying to my then GP that I couldn't continue to live the way I was anymore and collating what my pain levels were over the course of a month rather than complaining of specific issues...only then did he think that maybe he should test whether there was anything autoimmune going on.

I got lucky - my blood tests scream Sjogren's. I dread to think where I'd be now if I'd been seronegative - the medications over the last year have made such a huge difference to my life!
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: gurs on June 29, 2016, 04:07:21 AM
Genetic disposition for certain. All my female cousins on my mom's side all have some form of autoimmune disease.
My sjogrens started right at puberty, if not sooner. I now remember back in grade school where I was so tired and fatigued all the time..always wanted to sleep. My mom said even as a baby/child, I always wanted to sleep. It was manageable until I had a hysterectomy 10 years ago and went into menopause....triggered of firestorm of Sjogrens/Lupus that has been a nightmare to say the least. I say genes and hormones, and infections are main triggers.

Gursie
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: SjoDry on June 29, 2016, 08:59:08 AM
Boniva

SjoDry
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: snoweye on June 29, 2016, 09:24:11 AM
Hi everybody,
This post will serve as my introduction. I am a 31 year old male from the UK. My username is Snoweye because there was a light dusting of snow in January when I went for a morning walk and my left eye started tearing excessively. That was when life really started to change.

I have mild suspicions that something autoimmune may have been developing for a long time. First of all, as a baby I received very little breast milk and throughout my childhood had many courses of antibiotics. A family friend told me that I often used to complain about being tired and cold as a young child. My muscles were always relatively stiff, then at age 19 I developed Raynaud's and started having periods of fatigue.

I will skip my twenties in the interest of brevity. My Sjogren's type symptoms started recently and suddenly at age 31 after following a very low carb ketogenic diet for about 9 months. I gradually slipped into this way of eating gradually because at least in the short term it helped my IBS reducing symptoms such as bloating and flatulence. At the end of the 9 month period my health seemed to deteriorate rapidly in a few short weeks, and then literally overnight everything got much worse. I have not be the same since. From that point, I have suffered from dry eyes, dry mouth, dysfunction of my sweat glands and a myriad of other issues that are all new to me.

Like many on this board, I am still struggling with a diagnosis.

Snoweye






Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: jazzlover on June 29, 2016, 10:55:34 AM
Lyme disease
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: bluegardenia on June 29, 2016, 02:10:20 PM
when i was a child i was always sick . they took away my tonsils whn i was eight, they used to do that very easily in 50 60 and before. it seems that this can lead to rheumatic desease. i descovered my positive reuma test just 20 years ago. since then i started to check anti ana and anti dna, once they were negative once positive then always pos anti ana. but no symptoms. sjogren arrived three years ago but my eyes were dry since ten years, nobody gave any importance to that, all my friends of my age have dry eyes... but then dry mouth arrived . im sure that the death of my father and most of all the death of my son  eight months after triggered sjogren. stress and pain.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: plusher on June 29, 2016, 05:47:01 PM
Hi,

I just joined this forum even though I've lived with Sjogren's since I was 12 (I'm 54 now). I wonder if my trigger may have been chicken pox at age 10, because I was a pretty healthy kid. No problems until my parotid glands started swelling at 12, not diagnosed until 22. I'm fortunate in that my symptoms have been limited to dryness of eyes, mouth, skin, etc., but I did develop lupus around age 40. Also, in the past couple of months, my eyes are much drier; I'm putting in drops every 15 min; perhaps due to aging (yay!) Seeing a corneal specialist regularly for the dryness.

I think Sjogrens is probably genetics (I'm adopted and have no biological info on my background) and a trigger. Seems we've all had different stressing triggers.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Carol101 on June 30, 2016, 07:40:31 AM
This is in response to lindabridge regarding lymphoma. I am most concerned about the lymphoma risk. I had breast cancer in the past, and I am already at an increased risk, just due to past chemotherapies. Salivary gland swelling (about 30% of pSS have this), and Cryoglobulinemic vasculitis are known risks  There are biomarkers (blood tests) they can follow to see if you are in the group of Sjogren patients that are at high risk. Some studies are dividing patients with these markers at the time of diagnosis, into high vs low risk. My concern with that is the time it takes so many of us to get diagnosed, some early, some much later. Do they stay stable over time or progress.? This group looks at blood work every 3- 6 months. See below.
One study used patients with chronic salivary gland swelling, mainly parotid gland, but also submandibular swelling lasting more than 2 months, as a criteria. They went on to subdivide those patients into having these biomarkers or not. These four serologic biomarkers were significantly associated with the presence of lymphoma, i.e., cryoglobulinemia, low c4, anti- ssb/ La, and leukopenia, Patients with chronic swelling and having 2 or more biomarkers had a 9 fold risk of lymphoma while having just one or zero had a 90 % negative predictive value for lymphoma. They are Looking at RF as well. Some researchers think this might be a simply cheap test to ascribe risk. I believe that is still being fleshed out.
These are the tests I plan to get.: C3, C4, Cryoglobulin, SPEP


http://www.rheumatologynews.com/specialty-focus/lupusconnective-tissue-diseases/single-article-page/acr-cryoglobulinemic-vasculitis-in-sjoegrens-linked-to-lymphoma-mortality/44b9eac347dacfc8145151cfbb6c656f.html
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: hopeforall on June 30, 2016, 08:14:10 AM
3 months back, I was prescribed an anti-viral. Within 2 days, I had a variety of side effects including irregular heart rates, nausea, chills, dry eyes and mouth. I stopped it immediately but the dry mouth and dry eyes have persisted ever since. I have been able to identify that the dry eyes are due to Meibomian Gland Dysfunction. I have also started having dry throat, legs/ arms falling asleep often.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Judie P on June 30, 2016, 02:04:14 PM
I always had constipation, digestive issues and sinus problems my entire life.  I am 65 now.  No autoimmune diseases run on either side of my family.  I had mononucleosis when I was 18.  I developed gastritis from that.  At 25, I had a female organ procedure done which turned into a ruptured appendix.  That turned into a blocked intestine.  I went into menopause at the age 52.  At the age of 57, I started getting my regular period again.  After hearing many different opinions on what was happening from cancer to polyps, I had a mine field of polyps removed at the age of 59.  They inserted a Mirena IUD for progesterone instead of me taking pills.  Up to that point and through the first year of insertion, I still bled and cramped, keeping me on Motrin 600mg every six hours to stop the bleeding and cramping.  After about a year of insertion, I began to feel my feet and ankles go numb.  I also noticed drying of the mouth, nose and eyes, about five days of every month.  By the time I was off of the motrin, my body was having numbing throughout and lots of digestive issues.   I kept thinking I had diabetes, but nothing showed.  I had a hair sample done by a not so reputable natureopath, who said my symptoms seem to be Parkinson's, because I was low on dopamine.  By this time, my stress level was so high and anxiety took over, that I thought I had MS or Parkinson's.  For the first five years of the IUD, my doctors told me I had chronic anxiety and did not have MS or Parkinson's.  It was not until last year that a kind Nurse Practitioner decided to run all the autoimmune tests.  My SS-A test was off the charts.

Where did mine start?  I think it is possible with the IUD (which I still have for six and a half years and will be speaking about to my nurse practitioner in two hours).
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Lindabridge on June 30, 2016, 03:46:30 PM
Carol,

Despite the fact that you are categorized as a "newbie," you seem to be familiar with quite a few tests and what they indicate.  I was an English teacher for many years, and my biology skills and knowledge are weak.

Can you explain the following to me?  Low C4, and anti La?  I have the results of my comprehensive blood testing and would like to see if I have any of these significant factors.  Since my parotid and submandibular glands have been swollen for months, you can imagine my concern about lymphoma. The good news is that I was diagnosed within a month of my symptoms first appearing.

Thanks.

Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: SjoGirl on June 30, 2016, 04:56:50 PM
A perfect storm - menopause, nasty viruses, extreme stress.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: jazzlover on June 30, 2016, 09:12:34 PM
Judie P .. look into copper imbalance
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Carol101 on July 01, 2016, 06:59:29 AM
Lindabridge,
I am a retired RN.  I have been researching to figure out my symptoms and hopefully see if there is a way to identify, as early as possible, some of the more serious complications that can accompany pSS.
C 4 is a protein in your blood. It is part of your complement system, which plays an important role in your immune system, Its job is to help kill disease causing bacteria and viruses. If you are a healthy person a low C4 level would indicate an active infection, unfortunately, in pSS and other autoimmune disorders it means your body is actively attaching itself, it is an indication of how sever the process is and inflammation. SS-B/La antibodies are found primarily in patients with Sjogren?s Syndrome or lupus erythematosus (LE), it is one of the tests used to diagnose pSS ( primary Sjogren's Syndrome). The other risk factor for lymphoma is finding Germinal Centers in the salivary glands from a lip biopsy. None of my blood tests are positive except for ANA. My salivary glands, both submandibular and parotid, have been slightly swollen for six months. I may ultimately need a biopsy, but will only get one from someone experienced that uses a pathologist familiar with looking for Germinal Centers.

Best regards,

Carol

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=complement_c4_blood

 http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81359
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Nomad on July 01, 2016, 11:02:15 AM
Mine has some similarities to other posts. 
Also "a perfect storm," situation.

I already had lupus for many years, but it seemed to be in remission.

Then, during a relatively short time the following things happened: my father died, I had big trouble at work with a crazy boss, and I quit, I had a dental procedure with an inexperienced dentist that went very wrong and my trigeminal nerve was damaged.  The pain was outrageous and basically permanent ...although I have more control.   I still take meds for it (TN) to this pday...four years later.

 Our first grandson was born.  I was expected to help our DIL, which was rough under those conditions.

Got a bunch of sinus infections in a row...now better (crossing myself)

This all happened in a little less than a year. 

Worsening dry eye and dry mouth throughout. Depression off and on (this is better today, thank goodness).

Then I got the dx of SS. 

If something makes sense to someone, please let me know.

***The time right before my dx was close to if not the worst time in my life...ESP with reference to stress.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Scottietottie on July 01, 2016, 11:58:47 AM
Pregnancy, post natal depression, parental deaths, menopause and I never was particularly healthy. Lots of childhood illnesses.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on January 25, 2017, 06:09:25 AM
this wasn't one of my most prominent triggers of chronic health problems---but one of the precipitators or environmental contexts for me the year everything started deteriorating for me on a number of levels is I was doing a diet from a place called the Diet Center in '89---and was on a very low carb diet and probably in ketosis---I noticed a few times back in my 20s that if I went on too restrictive of a diet that I would go into a strange state of discomfort that would take a while to come out of....hard to remember it all now but over the years I learned I have to stay clear of low carb food plans or start to get really uncomfortable physically and mentally. I have wondered if could have some obscure form of porphyria because of chemical sensitivities and when in certain flares it can be mitigated sometimes by increasing carbs (ie when still went out in the sun and heat and would get flared from that when got older having a shake or something could help relieve some of the fatigue/brain problems triggered).

----------
addendum 2-4-17: I was re-reading this thread, still haven't looked at all of it thoroughly but I want to add I think I must have been reading a couple of threads of forums because part of what prompted me to share that particular aspect of predisposing possible trigger events was that someone had written something similar prior and I could relate,had wondered if nutritional choices can be part of setting stage........at any rate I cannot on a quick look find any posts that seem to talk about carbs etc in this thread
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: belovedchaos1 on January 25, 2017, 08:38:33 AM
Reading everyone's responses are very interesting and heartfelt. Hug

Hmm - it's hard to say for me. I was very sickly when I was younger. In and out of hospitals and on antibiotics a lot back then. The first really big illness I caught was a super flu in my teens. Was bed ridden for a week... then in college I caught walking pneumonia, then a few years after that two boughts of strep in the same year. Lots of stress through out my life since I was little...so probably a little of everything I guess.  :-\
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Emics on January 25, 2017, 10:48:14 AM
Hmmm.... So different in my case. I am surprised reading all of you. I am 40. No autoimmune diseases in my family, I was a healthy baby and child, no diseases, few antibiotics, never cutaneous reactions, no allergies...

I have never felt fatigue, joint pain... (so far, I must admit I am scared because I dont know what will happen in the future).

When I was 34 I started with keratoconjunctivitis, corneal ulcers, very dry eyes. That point worsened my quality of life. No diagnosis in that moment, several ophtalmologist said it couldnt be Sjogrens because I was young. If I think about my past, I must admit that since my 20s I had dental issues even with a careful hygiene, needed to chew food for a long time and drinking lots of water to help, a "funny" shape in the edge of my tongue, and pain in my parotids with acid flavours: issues that currently I know are related to poor amounts of saliva flows. But you know, with that age you think everything is normal and I dont know how is the feeling in "somebody`s mouth".

I was diagnosed last year, as I told here. I was happily pregnant, everything was perfect but when I was in my 20th week an atrioventricular block was detected in my baby. It was lethal 3 weeks later. This is a very, very rare complication of being anti Ro positive (only 1-2% of anti Ro positive mothers have this risk). My level was 7200. I couldnt believe it. You can imagine the shock.

I dont know what triggered this stupid disease in me. I cant explain as you. I only remember when I was 20 a terrible influenza (or I thought it was influenza) that I felt like I was going to die. Maybe it wasnt influenza and it was a mononucleosis, and that`s the reason why I started to have slight symtomps, until my lacrimal glands were so hurt that I started with corneal ulcers 14 years later.

That?s my hypotheses.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Nomad on January 25, 2017, 12:07:25 PM
Probably the perfect storm situation.
I already had lupus...but it was basically in remission.
Then, I started catching viruses from our new grandson.
Also, tremendous BIG TIME over the top stress...father died, craziness on a job that I eventually quit, a dentist likely made a mistake in my care and I ended up with HEAVY DUTY nerve pain that they ended up calling "atypical trigeminal neuralgia," crazy trail of meds to find out what would help that extreme pain and had to take Percocet, money problems from having to quit my job without any plan.....It was a year from HEXX. Next thing I knew, I had worse and worse dry mouth and dry eyes.
Went to rheumatologist and viola.....


LOLOLOL....I see this is an older thread and I posted before, but said the same things. Do you think my story makes sense?
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Sharon on January 25, 2017, 12:19:55 PM
Accumulation of traumatic events.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: jazzlover on January 25, 2017, 04:38:12 PM
Emics .. I'm very sorry for the loss of your beloved baby.

Do you think you could have had Lyme disease? Are you in  a high risk area? Or did a lot of hiking or outdoor activities?
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Pete0211 on January 25, 2017, 05:00:02 PM
I wonder if the hyperparathyroid that I had for ~15 years played into mine.

I'm pretty sure EBV has played a role, since I had mono in 1989, and blood tests showed elevated virus results when I started with the Sjogren's symptoms.

I'm sure work related stress from an 18 month period of insane work hours factored into it a wee bit.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: irish on January 25, 2017, 05:07:02 PM
The parathyroid gland is a secreting gland so it could well be that it was affected by autoimmune disease. The thyroid gland is also a secreting gland as is the pancreas. Sort of hard to remember that it is more than the salivary glands. Irish
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Fanciefrancie on January 26, 2017, 02:38:41 PM
While nursing my 2 month old 3rd child I came down with a severe bacterial infection (mastitis)  in my breast.  Less than a month after I was feeling better I started having the brain fog, severe fatigue and bilateral migratory joint pain.  It wasn't until after my blood tests pointed to SJS that I realized I had been having dry eye and dry mouth for years but I always chalked it up to something else going on. 

I believe I have always been genetically predisposed and stress and infections trigger flares.  I also think hormones played a big part.  So many post partum and menopausal women seem to be stricken my autoimmune diseases. 

I will note, I also had shingles when I was in college due to stress.  There has to be a connection. 
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Sharon on January 26, 2017, 03:29:38 PM
Pete- I also wonder about the EBV connection.
I was Positive for active EVB in 2009 and "Borderline" ever since, so it never truly went away.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Sjogrensmum on January 26, 2017, 10:08:20 PM
My 12 year old daughter has recently been diagnosed with Sjogrens, its possible her trigger was glandular fever. However she's always been prone to infection and had her tonsils out at 6 years old so that could have triggered it or she may have always had underlying issues with it that may have gone unnoticed.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on January 27, 2017, 12:37:51 PM
 Another earlier precipitating factor way back also for me that I suspect could tie in was mono in my teens that seemed to recur several times for the next 5 years, and did get triggered by me going too low on carbs when I tired atkins diet back in the day, they thought maybe I had an enterovirus because mono not supposed to recur I guess. This was before the idea of Chronic Fatigue Syndrome had come about in the US.  But that dieting I did again when I was a little older that I mentioned earlier didn't help, something about too low of carbs makes me either sick or feel sick----unfortunately that seemed to trigger a gallstone + needing a cholecystectomy and I was never the same after that, had been pretty hearty and basically healthy and very active, there is more to the story involving a neck injury and I have seen some remote research that certain neck problems can trigger autoimmune issues because of the constant nervous system irritation and fight or flight mode...

I sort of got hosed both structurally and metabolically and probably virally....can't know if virus tied in too as precursor......symptoms of dryness didn't really become obvious until like 14 years into having chronic pain and fatigue. The body has such a complexities and I have found it quite a tangle to understand environmental, genetic and possibly infections issues that set the stage for it all..........
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Fanciefrancie on January 27, 2017, 08:31:06 PM
My 12 year old daughter has recently been diagnosed with Sjogrens, its possible her trigger was glandular fever. However she's always been prone to infection and had her tonsils out at 6 years old so that could have triggered it or she may have always had underlying issues with it that may have gone unnoticed.

I am so sorry to hear your young daughter was diagnosed.  Glad you are here to help find it more about this crazy and unpredictable disease.  She is blessed to have a caring mother like you! 
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: janny on January 27, 2017, 11:33:34 PM
Wow! Another perfect storm for me, too. I was extremely stressed in charge of planning my daughter's wedding, taking care of my dying mother in at-home hospice from COPD and had to spend numerous nights on the floor next to her bed listening to her oxygen and giving her breathing treatments 3x/night, was depressed and anxious and taking klonopin and numerous other antidepressants they were giving me and was diagnosed with interstitial cystitis, which was leaving me in pain constantly and on more meds! Before you  now it, my eyes started burning and then overnight my saliva dried up. I have gone over and over this in my mind and tried to figure out exactly which drug or event caused this, but I think it was just everything at once--oh yeah, also left out that I had just had my last period, so hormones no doubt played a part.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Maria3667 on January 28, 2017, 01:56:27 AM
I certainly think EBV played a major part as we all seem to have been infected in the past. Also for me Lyme infection even though I was treated within a week with AB.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: gurs on January 28, 2017, 04:53:42 AM
one word....HORMONES!!!!  my sjogrens symptoms started when I just started puberty around 12 years old. Then, after my hysterectomy 10 years ago, my Sjogrens has been out of control. I know so many things can trigger autoimmune. I just had a sinus surgery last august and Im still flaring big time from this as well. Im sure its different for all of us.

Gursie
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Wal on January 29, 2017, 03:36:39 PM
I went through some major family stressors in 2015. Within a few months I was sick with SS symptoms. So I feel stress was my trigger along with hormone changes.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on January 29, 2017, 03:44:28 PM
Probably the perfect storm situation.
I already had lupus...but it was basically in remission.
Then, I started catching viruses from our new grandson.
Also, tremendous BIG TIME over the top stress...father died, craziness on a job that I eventually quit, a dentist likely made a mistake in my care and I ended up with HEAVY DUTY nerve pain that they ended up calling "atypical trigeminal neuralgia," crazy trail of meds to find out what would help that extreme pain and had to take Percocet, money problems from having to quit my job without any plan.....It was a year from HEXX. Next thing I knew, I had worse and worse dry mouth and dry eyes.
Went to rheumatologist and viola.....



Nomad--could you tell me if you resolved your dental problem? I get  bad pain when have teeth issues....it can set off ICH headaches, spine pain, feet pain and eye pain etc and right now am dealing with that after having a crown put back on that fell off --an older crown that had been fine. I think either the tooth crackd in the process or she didn't get the bite right or she ground too much of it and its not covering my tooth well enough anymore. But it set off some other teeth now too so its going to be hard to ferret out.
I will send you PM too
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Sharon on January 29, 2017, 04:34:48 PM
Nomad and Wendy- This might be of interest to you:

http://www.rheumatologynetwork.com/news/periodontal-disease-and-ra-connection-no-longer-mystery?GUID=25557D86-DA87-429D-80DA-3FE11274AC49&XGUID&rememberme=1&ts=26012017
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on January 29, 2017, 07:09:41 PM
Nomad and Wendy- This might be of interest to you:

http://www.rheumatologynetwork.com/news/periodontal-disease-and-ra-connection-no-longer-mystery?GUID=25557D86-DA87-429D-80DA-3FE11274AC49&XGUID&rememberme=1&ts=26012017

wow thanks Sharon, that is great research to share and so new

I will show that to dental specialist I am going to see soon.........but if Sharon/anybody here has a science background and has any thoughts on how to put it in detailed civilian terms what the mechanism is there that translates to systemic pain with dental......would be interested, I think I get the gist of it but might be aspects I am missing because of limited bio educational background

did some searching and found this explains a bit, but I would like to find what more to do about it besides brushing flossing and regular dental care..........anyway thanks again Sharon!
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: araminta on January 30, 2017, 03:08:08 AM
My symptoms started two years ago after I got some flu type virus which made me feel very queasy.   My husband also caught it but got over it, however I went on and on feeling  under the weather, then I got labyrinthitis which last over 8 weeks, as well as being hit by extreme fatigue which came on very suddenly, dry sore eyes, dry mouth, rashes, mouth ulcers, etc. 

I'm still not sure if that was exactly the start of the problem, however, as several years before I had had dry eyes which had responded well at that time to flax oil.   Also I'd had a strangely dry nose for about a year before I caught the above mentioned virus.   And a few months before the virus I had a big emotional stress in my life.   So how do we ever sort all this out? :-\
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Nomad on January 30, 2017, 10:32:57 AM
Wendy...I had a bizarre series of events that just seem to have been one mistake after another in terms of my dental care. What happened next was I ended up with super bad nerve pain. I tried a root canal, but it didn't work. So, desperate to get the pain to stop, I agreed to have the tooth removed. The pain worsened. I also developed a fever at this point, but underwent a biopsy of the area and a very significant number of tests via bloodwork and no infection was ever found. I ended up seing an oral surgeon who was also an MD who told me to go to a neurologist.  I saw a neurologist who was very kind to me. We tried all sorts of meds. I am sensitive to meds, so that didn't go all that well. I ended up on a compounded cream that I have made for me that I rub on my facial nerve where the pain is. Since, the tooth was removed, I don't have tooth pain. It was three difficult years. The cream really helped. The last 3-6 months have been much better and I still use this facial cream, but less often. IMHO, I suspect that folks with AI issues are a little more prone to nerve pain....and it is imperative that we see top notch dental professionals. (I also sent you a pm)

Sharon...Thank you for that interesting and informative link!
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Judie P on January 30, 2017, 07:06:21 PM
Mono when I was 18.  I am also a DES Daughter.  Didn't get diagnosed until I was 64.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on January 31, 2017, 12:55:09 PM
Mono when I was 18.  I am also a DES Daughter.  Didn't get diagnosed until I was 64.

Judie, how does one find out if they are a DES baby?
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Judie P on January 31, 2017, 01:30:36 PM
Diethylstilbestrol (DES), formally known as stilboestrol (BAN), is a synthetic, non-steroidal estrogen of the stilbestrol group that was first synthesized in 1938.[1] It is also classified as an endocrine disruptor.  From about 1940 to 1971, DES was given to pregnant women in the mistaken belief it would reduce the risk of pregnancy complications and losses.
In 1971, DES was shown to cause clear cell carcinoma, a rare vaginal tumor in girls and women who had been exposed to this drug in utero. The United States Food and Drug Administration subsequently withdrew DES from use in pregnant women. Follow-up studies have indicated that DES also has the potential to cause a variety of significant adverse medical complications during the lifetimes of those exposed, including clear cell carcinomas. Individuals who were exposed to DES during their mothers' pregnancies are commonly referred to as "DES daughters".

Some studies say that autoimmune diseases are not connected to DES, as we are the exocrine system, not the endocrine system.   To find out you need to ask your mom if she took the drug while she was pregnant with you.  Also, there may be records, if she had miscarriages often.  Lots of love!
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on January 31, 2017, 02:44:36 PM
thanks Judy--yes I have been fascinated about DES for a long time after saw Docu in 90s where they had learned it changed things at DNA level and your children could inherit some of the same health concerns or mis-formed arms etc

I am old enough it could be issue....there isn't a way right now I could find out by record, people are passed etc, but I was curious if you meant there  was  a test that shows some way if you were exposed, I suppose that's unlikely

It makes sense it could be related to AI
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Lotus1 on January 31, 2017, 04:27:43 PM
I suspect dengue fever when I was 6 yrs old.
Sure I had sjogrens beginnings in high school.

Anyone I've seen for nutritional/natural treatment are adamant the digestive system is the problem.
However, they don't get it fixed.
I've heard the digestive system is blamed for a lot of illnesses.

Lindabridge, I had mild lymphoma removed from my left parotid (large salivary gland) oct 2015, radiation Feb 2016.
It seems I've permanent damage due to nerves being cut, couldn't avoid it, delicate surgery.
Trust your glands will be ok lymphoma wise.

Lotus1
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: WhatYouSjo on January 31, 2017, 09:14:22 PM
I have no family history, and as a youngish male don't fit the 'typical' demographic profile for SS.

I have long suspected that a bad tooth dating back over a decade was the culprit. I had multiple root canals over many years, and it was never quite right. I suspect that a bacterial infection lingered all those years, upsetting the balance of my immune system. During that time my eyes became more and more dry. Then, during a particularly stressful period, other symptoms (joint pain, fatigue, dry mouth) suddenly appeared. That was when I began searching for a diagnosis.

In hindsight, I wish I had pulled that tooth when it became clear that it was an ongoing problem, but my dentist advised against it.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: heidiaj on January 31, 2017, 11:01:14 PM
What a string of replies!!  Very interesting to read everyone's experience.  My heart goes out to all of you.  In 2007, I was hospitalized for a week with agranulocytosis.  My white blood cell count was almost nothing, to the point that they gave me a bone marrow biopsy in the ER, thinking I had leukemia.  I went in with a really bad sore throat that came on suddenly, and only went to the ER because it was a weekend, and I wanted to get on an antibiotic quickly (I was a caregiver to my elderly parents).  Once I was admitted, they did all kinds of blood work, and took me off all meds.  My hematologist felt the agranulocytosis was due to my being on the bipolar med Lamictal for the last month.  Once I was discharged, I needed to continue going to the hematologist until my blood returned fully to normal.  This is when I first tested positive for Sjogren's.  One of my subsequent rheumys said they felt that this trauma to my system was what led me to have Sjogren's.   I also had a hysterectomy about 9 years earlier (my mom said she felt I was never the same after this).  For three weeks after leaving the hospital, I ran a low grade fever every night, returning to the ER numerous times.  Finally they re-admitted me, and I was in for a week. It was the worst I've ever felt in my life...I feel it's the closest I ever was to death, and I've had a few near misses.  My best friend is an intensive care nurse, & she said they were "slamming me" with heavy duty antibiotics.  It seemed I had contracted e coli during my hospital stay (it happened to me again in 2011 after a bladder hemorrhage).  I was healthy enough as a kid until I had mono in college.  I got VERY sick with that and lost a LOT of weight.  Despite having chicken pox as a child, I also came down with shingles in my 40's (again, got VERY sick).  I have had way more than my share of stress as well.  I was in a very unhealthy marriage.  My mom, a therapist, once said, "the stress of a marriage is played out upon the woman's body."  Finally, here is a (VERY LONG!!) article about EBV.  It's worth a skim-through, because the writer definitely believes that there's a connection between EBR & AI stuff.
goop.com/the-medical-medium-and-whats-potentially-at-the-root-of-medical-mysteries/
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on February 01, 2017, 08:39:59 AM
What a string of replies!!  Very interesting to read everyone's experience.  My heart goes out to all of you.  In 2007, I was hospitalized for a week with agranulocytosis.  My white blood cell count was almost nothing, to the point that they gave me a bone marrow biopsy in the ER, thinking I had leukemia.  I went in with a really bad sore throat that came on suddenly, and only went to the ER because it was a weekend, and I wanted to get on an antibiotic quickly (I was a caregiver to my elderly parents).  Once I was admitted, they did all kinds of blood work, and took me off all meds.  My hematologist felt the agranulocytosis was due to my being on the bipolar med Lamictal for the last month.  Once I was discharged, I needed to continue going to the hematologist until my blood returned fully to normal.  This is when I first tested positive for Sjogren's.  One of my subsequent rheumys said they felt that this trauma to my system was what led me to have Sjogren's.   I also had a hysterectomy about 9 years earlier (my mom said she felt I was never the same after this).  For three weeks after leaving the hospital, I ran a low grade fever every night, returning to the ER numerous times.  Finally they re-admitted me, and I was in for a week. It was the worst I've ever felt in my life...I feel it's the closest I ever was to death, and I've had a few near misses.  My best friend is an intensive care nurse, & she said they were "slamming me" with heavy duty antibiotics.  It seemed I had contracted e coli during my hospital stay (it happened to me again in 2011 after a bladder hemorrhage).  I was healthy enough as a kid until I had mono in college.  I got VERY sick with that and lost a LOT of weight.  Despite having chicken pox as a child, I also came down with shingles in my 40's (again, got VERY sick).  I have had way more than my share of stress as well.  I was in a very unhealthy marriage.  My mom, a therapist, once said, "the stress of a marriage is played out upon the woman's body."  Finally, here is a (VERY LONG!!) article about EBV.  It's worth a skim-through, because the writer definitely believes that there's a connection between EBR & AI stuff.
goop.com/the-medical-medium-and-whats-potentially-at-the-root-of-medical-mysteries/

that is an interesting article, the intersect between objective science and the, I can't even think of right word to capture, but new age/alternative/holistic.......has always been an interesting line for me, to try to understand where "truth" lies....but always see some value in aspects of both
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: LilliaT on February 01, 2017, 12:13:14 PM
WhatYouSjo, did you ever end up having that tooth pulled?  I've also had ongoing issues with tooth that has a root canal, and I was told that I needed to decide whether to try to have the root canal redone or to have the tooth extracted and replaced with an implant.  As I've learned more about the effect that dental issues can have on the rest of the body, I've been wondering if it has anything to do with my Sjogren's-like symptoms.

Also, could I ask what the issues were with your root canals?  Did you have ongoing pain and discomfort afterward?  My root canal was about 8 years ago in a lower back molar.  There is some general discomfort (like a faint toothache), as well as occasional pain from warm foods/drinks.  The dentist and endodontist can't see any obvious cause for the discomfort  -- no infection or cracking -- although they say the root canal was badly done.

The upsetting thing is that, apparently, the tooth never needed the root canal in the first place.  I was seeing a new dentist about  10 years ago, and he convinced me that 2 teeth with old fillings needed root canals.  He did them himself (using what I later learned were outdated methods) and botched both.  (He later became infamous in the area for pushing unnecessary procedures on patients, and eventually went out of business.)  Since then, a couple of dentists have looked at my records from the time and questioned why the root canals were ever done -- because my teeth had been in great shape, there was no pain, and no sign of infection on the x-rays.  In trying to pad his wallet, the guy left me (and probably dozens of other patients) with years of dental issues.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on February 01, 2017, 01:04:06 PM
Lillia--really sorry to hear about your dental trauma. I am going to jump and share that I have had 3 root canals in the last 12 years and the first one took it seems, and he did use a little bit of older method but did it competently (it was the puff of smoke method) the 2nd two failed terribly.........and I got them both pulled and that was the solution. One of them however is starting to worry me a year later, there is either something wrong with the site of cavitation or a tooth next to the gap is cracked or not well. Its a 2nd to last molar and I didn't get implant or bridge because I want less involvement with dentists but now that am having pain there and in another tooth with old crown my hand is being forced to start figuring it out. 6 months ago I would have said just pull them and forget root canals--and I still doubt I will do root can again--but I am seeing that even once its pulled its not nec over...........
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Nymph on February 03, 2017, 02:51:23 AM
I am glad that this topic has reappeared, because it brought a revelation to me. My health started going downhill and I developed some of my autonomic symptoms, then some dryness, during my early 20s. I got sick at 21 with an infection that went undiagnosed. I developed a case of secondary lymphadonitis and ended up with some strong antibiotics for that. I was quite sick for about two months with another month of recovery time. Then I started college in Arizona and started having bothersome symptoms that I now associate with Sjogren's.

My revelation is that the initial infection was probably EBV. It fits the symptoms. And it makes sense with the known long-term complications and potential of EBV to set off autoimmunity. I don't know why I find this satisfying but it is.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: wendyoh on February 03, 2017, 07:58:22 PM
I agree Nymph. it is helpful to feel like you have some medical answers.....for me I think its because, even though I KNOW myself and that its not my personality to be sick, there is an invalidation in society sometimes to those chronically ill, hints that it might be more attitude or something than "real".....so I always feel better to get more pieces to the puzzle, even if that can't fix it.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: WhatYouSjo on February 04, 2017, 06:58:45 AM
LilliaT,

Your situation sounds very similar to my own, including your ongoing symptoms. In addition, there was a small dark spot under the tooth in X-rays that shouldn't have been there.

I did eventually have the tooth (a molar) removed. After my SS symptoms appeared, swelling began to grow under the tooth, with increased discomfort. I visited a new dentist who told me it needed to come out. When it was removed, I was told there was one of the worst infections they had seen underneath. I ended up with an implant, and haven't had any issues with it so far.

The process to get an implant was long and fairly costly, but in hindsight, I wish I'd done it earlier. I would recommend that anyone getting an implant go to an experienced periodontist even if the price is a little high; implants are not a good place to cut corners!
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: corrinzz on March 01, 2017, 07:49:30 PM
Newly diagnosed with Sjogren's after seeing my eye dr for severe dry eye. She sent me to a rheumatologist, as I have a history, 25 yrs ago, of Hodgkin's Lymphoma, stage 3B, which included a laparotomy to stage cancer and remove appendix, and then chemotherapy. Rheumatologist did a series of blood tests that confirmed Sjogren's. So for me, I can't help but think the Hodgkin's, or the treatment for, might have triggered Sjogren's. However, a year ago, I had ACDF (anterior cervical discectomy w/fusion) surgery on a herniated disc. I've also had 4 knee surgeries, tonsillectomy, a hysterectomy, and deal with some very stressful situations... so with all that, I wonder if my immune system has just taken a beating over the years and all of this history has triggered Sjogren's..?
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: LIZARD66 on May 10, 2020, 11:18:37 PM
I'm wondering if being on keto for the past 4 years has done it. That's how long I've also had some of my symptoms. :(
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: vrystaat on May 11, 2020, 05:48:43 PM
I have had SS since 1992, starting with a severe peripheral nephropathy (so-called Neuro-Sjögrens Syndrome).
Just prior to this owing to severe symptoms, I was diagnosed as Polyarteritis (another auto-immune disease).
This was incorrect.
My Labs showed a CPK of over 2500 units, but this was not specifically diagnostic to the Rheumatologists. A terrible mistake.

I did not get a diagnosis until much later (1998-2001). I was being seen at a University Clinic for years without a diagnosis, even though I saw several Rheumatologists (academic).
No diagnosis was ever made until a relative mentioned that I could have this condition. My daughter's research also pointed to this. All my laboratory tests were constantly negative.
Finally, I became very ill in 2001, and all my tests turned positive:

ANA, Rheumatoid factor, ESR high, a low number of white blood cells (leucopenia), C-Reactive Protein (CRP), positive monoclonal immunoglobulin proteins, and clinical signs of Sjögrens:
Extreme fatigue, dry eyes & dry mouth, difficulty chewing and swallowing, decreased sense of taste and smell, joint pain, and swollen glands.
SS-A (Ro) and SS-B (La) antibodies were never positive.

In 2001, my Creatinine phosphokinase started increasing again, and I experienced severe muscular pain & wasting.
I was therefore diagnosed as having Polymyositis, on top of the Sjögrens Syndrome. I was started on high doses of Prednisone, and later Cellcept.
Finally, after 5 years of requests by me, I was granted to receive IVIG.

This poor performance by Rheumatologists and other Physicians still leaves me astonished. I have improved by about 50% due to the IVIG.

As to the possible precipitating factors, I can suspect two episodes of Mononucleosis. But the main factor I think was my extremely stressful job, with lack of sleep and 50-75 hour work week.
My spouse was severely ill with a Borderline type Personality Disorder. This meant that my life was extremely abusive and stressful. I consider this a major factor in my illness.

I have shortened this story considerably.
Best wishes to all.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: deeindiana on May 12, 2020, 04:05:19 PM
I've always had symptoms of sjogrens but never put it all together. But eight months before I had my first real flare I got my first treatment of botox to smooth the wrinkles on my forehead. I've always wondered if that could have had anything to do with the disease suddenly kicking in. Probably not...but deep down I wonder.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: Judie P on May 20, 2020, 06:39:06 PM
I believe mine is from mononucliosis when I was 18.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: sunflower on June 15, 2020, 12:37:06 PM
I already had very dry eyes, but after my radiation for my breast cancer (2014) I developed the other sicca symptoms, peripheral neuropathy, etc.  It was then I began to research and suspect Sjogren's.  Autoantibody tests did not confirm it but more symptoms keep appearing.  Incidentally, my radiation site continues to be extremely tender, unheard of with radiation.

At the time of my breast cancer I had to go off estrogen so my long-standing menopause symptoms erupted with a vengeance.  And they continue (I'm 76).  So that may be a factor too.

Sunflower.
Title: Re: what do you think might have "triggered" Sjogren's for you?
Post by: peggyb on June 16, 2020, 02:47:10 AM
Oh what a relief to find this forum first of all! Much more helpful than the British one.

At 71 I've always been healthy apart from osteoarthritis which became a problem from about 10 years ago, though manageable. I had both hips replaced, the first in July 2018 and the second in February 2019. I was on the waiting list for quite a while so after I retired my main health concern was arthritic pain. But I truly was not aware of any SS symptoms before my operations.
I mentioned the dry mouth several times to various doctors and the dentist who said it would be the post op medication (codeine, ibuprofen and paracetamol) and more recently the GP who said sleeping on my back and central heating. SS and diabetes blood tests were negative.
I now have all the symptoms although thankfully not usually all at once and they do come and go.
So, could it have been the THRs responsible? Or did I simple not notice the gradual onset? Intrigued by others with dental problems,  as I've had difficulty here for years, and a dentist doing dodgy implants didn't help.
Sorry this is so long.