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Ankylosing Spondylitis and Fatigue: Bill’s Story
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Bill Balderaz, a health care marketing executive in Columbus, Ohio, says his chronic back pain from ankylosing spondylitis (AS) subsides when he's giving one of his three children a piggyback ride. “The pressure on my back when I carry one of my kids actually lessens the pain and inflammation, and I don’t feel as tired either,” he says.
Balderaz’s statement is surprising, given that he was diagnosed with AS in 2011. A form of spinal arthritis, ankylosing spondylitis is marked by inflammation, pain, stiffness, and often extreme fatigue.
When his back does hurt, Balderaz gets so tired that he fears he literally may fall asleep at the wheel. And it’s a stifling type of fatigue, one that can't be helped by a cup of strong coffee or a few extra hours of sleep each night.
Ankylosing Spondylitis and Fatigue: More Than Just Feeling Tired
“In college I would fall dead asleep in class,” Balderaz says. This was before he was diagnosed with AS, and doctors at the time thought he could have narcolepsy, a sleep disorder marked by suddenly falling asleep during the day.
Although resistance exercise helps improve his pain and fatigue, sitting for long periods of time worsens it. That was the case when he was a student listening to a college lecture while sitting in a classroom desk, and it's true today when he's driving a car or sitting on a hard pew in church.
Fatigue and ankylosing spondylitis can go hand in hand, says Susan Goodman, MD, a rheumatologist with the Hospital for Special Surgery in New York City and an associate professor of medicine at Weill Cornell Medical College. “Fatigue is a manifestation of the inflammation,” she says. “Chronic pain is also exhausting, so if a person has ankylosing spondylitis and a lot of back or joint pain, he or she will be more tired in general.”
Research supports the connection between ankylosing spondylitis and fatigue. According to a study published in the journal "Clinical Rheumatology in May 2014, more than 73 percent of participants with AS experienced fatigue, as opposed to about 30 percent of participants without the condition. In addition, the study found that fatigue in ankylosing spondylitis often occurs with depression.
Fatigue with ankylosing spondylitis can also be a major quality-of-life thief, according to a study in the December 2013 issue of Clinical Rheumatology. People with AS and fatigue had more pain and were more likely to have inflammatory bowel symptoms.
Real-Life Ways to Cope With Fatigue From Ankylosing Spondylitis
Now approaching 40, Balderaz has learned a few things about living with ankylosing spondylitis and coping with AS-related fatigue. He and Dr. Goodman offer these tips:
Exercise helps.Unlike with some other types of back pain, exercise is beneficial for ankylosing spondylitis. It also helps improve your energy level. “I do resistance training with bands and kettle balls three or four times a week, with a big focus on strengthening my core,” Balderaz says.
Watch your diet.There's no anti-inflammatory diet per se, but Balderaz says he feels better when he cuts out processed foods and focuses on healthier food options.
Lose excess weight.Being overweight puts more stress on joints, and it can be exhausting to carry around all of those extra pounds, Goodman says, so losing excess weight can make a difference in AS symptoms.
Seek treatment for ankylosing spondylitis.This is the big thing, Goodman says. “The best way to manage all ankylosing spondylitis symptoms, including fatigue, is to aggressively treat the disease,” she says. Balderaz takes anti-inflammatory medications to keep his pain under control.
Get good sleep.Restorative sleep is good for everyone. The National Sleep Foundation recommends going to bed and waking at the same time seven days a week and avoiding distracting or worrisome activities or conversations before bed. It also helps to avoid heavy meals and caffeine later at night.
Listen to your body.Sometimes you can’t fight the fatigue, Balderaz says. “I’ve been driving and had to pull over so my wife could take the wheel.”
Fatigue can be a common challenge if you’re living with ankylosing spondylitis, but using these tips can help you feel more energetic. If you have AS and are struggling with fatigue, talk to your doctor about other strategies that might help.
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