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This newsletter includes several items that we believe will be beneficial for our community of friends suffering from Oral Lichen Planus. I want to call your attention to the links and information on clinical trials we’ve listed below. 

The links provide an opportunity to search your area of the world to find out what is going on in the research area of various conditions -- including lichen planus. If you are unaware of what happens in clinical trials, the second link will give you some information on the three phases of clinical trials.
As we all know, the holiday season can be very stressful, especially for those who have any type of mucosal conditions such as lichen planus, pemphigus or pemphigoid, to mention just a few. The information on stress reduction may assist you in avoiding and controlling some of the high stress environments during this season. 
I hear from many patients during certain times of the year and the holiday season is the major time that patients seem to have the most problems with oral lesions. Please read the provided information and don’t hesitate to contact the support group with any comments or questions.
Dr. Terry Rees and I wish you all the best of the holiday season and a healthy and happy 2019. We are here for you and always available to assist you in any way possible. We have some new items planned for 2019 with new webcasts and current information for our subscribers.
The toys in the picture are from this year's college TOY DRIVE. Folks from all over the college contribute to the Community Partners of Dallas’ annual toy drive to help fulfill the wishes of Dallas County children in the care of Child Protective Services. 
Finally, please consider a gift to the Oral Lichen Planus Support Group. Every little bit counts for an effort that is totally volunteer based. Thanks so much!
Happy Holidays and Safe Travels!
Dr. Nancy W. Burkhart
What is new in research? Would I qualify for a clinical trial?
Research into many diseases is an ongoing process. We have many individuals who contact us from outside of the United States and a key question that is always asked is what oral lichen planus research is being conducted in my location? 
The Links
 The first link, from the National Institutes of Health, US National Library of Medicine, is a database of clinical studies conducted around the world. 
 The second link, from the Food & Drug Administration (FDA) is about the three phases of clinical trials. This information is useful for those who may have chronic problems with lichen planus and may want to participate in a trial in your area of the world. 
The third and final link - an article on oral lichen planus from the American Association of Oral Medicine, was prepared by Dr. Burkhart.
Coping with stressors
Nancy W. Burkhart, M.Ed., Ed.D., AAFAAOM
Why worry about your stress level?
What connection could your state of health have to do with stress?
The type of stress that is detrimental to your health is termed “unmanaged Stress” also “everyday stress” that we all encounter and it is universal. What is considered highly stressful to one person may be more of a positive challenge to someone else. Learning new coping skills to view stressors as more positive, can be beneficial. There could be an upside! Being diagnosed with a chronic disease state is stressful for patients.
It has been documented that centenarians view life as a challenge and tend to cope well with new problems that occur throughout life. When the sympathetic nervous system is in a state of chronic arousal, the body may reach what is termed “allostatic load” status. At an undetermined point, there is sheer overload in handling and processing the chronic stress.
The cumulative effect upon all organs/systems of the body may be detrimental. Researchers have reported that one of the worse types of stressors are those that make the person feel “out of control” with minor and major issues in their lives.The stress may be much worse when a person believes that whatever action they may take will not make a difference in the outcome (essentially, they have no control due to their actions).
Sometimes these factors are job-related pressures, family pressures, or health related issues that are already in play. Often situations involving severe grief and loss promote a long-term chronic type of stress. Losses come in many different forms such as the loss of a loved one, loss of pets, divorce, the loss of one’s identity or possibly even a job loss that was part of one’s identity.
Some of the diseases and disorders that have been implicated with regard to stress are:
Heart Disease
Immune suppression
Gastrointestinal disorders
Anxiety disorders
Certain cancers
Low back pain
Skin disorders (lichen planus, MMP and PV are such skin disease that also may have oral lesions)
General declines in health and possibly premature aging
Certain cancers that may be lifestyle related
Although, it is true that we do not know the cause of some chronic diseases, most practitioners and patients with many chronic diseases will tell you that they can document the development of lesions (both cutaneous and oral) when their stress levels increase. The information below provides some facts that we know occur in the body.
Mason differentiated between the arousal of the sympathetic adrenal-medullary system by the fight-flight response (based on work by Selye) and the pituitary adrenocortical response. It has been documented that if the sympathetic adrenal-medullary system is activated excessively, persistently and too often, illness and disease may occur. 
The release of catecholamines, epinephrine and norepinephrine by the adrenal medulla and/or sympathetic nerve endings is believed to induce many of the pathological states associated with psychological stress: increased blood pressure, cardiac arrhythmias and sudden death.
Stress and stress-related illnesses have been studied extensively in the last 30 years. The results clearly indicate that stress, especially chronic stress, may have profound effects on the body. The well-known Framingham, Mass. Heart Study identified the type A personality and associated it with a doubling of the risk of coronary heart disease in men and women. Animals subjected to repeated stress show significant decreases in the total number of mononuclear cells, especially T cells, in the spleen and blood. 
Chronic stress can cause a reduction in mitogenesis, alterations in lymphocytes, reductions in the ratio of T-helper cells to T-suppressor cells and an elevation in the number of natural killer cells.
Life events that produce chronic stress have been shown to have a wide range of effects on the body. Recently a major emphasis has been placed on the patient’s ability to cope with the chronic stress in daily life. Coping skills can be developed and learned. If this is a factor for you, seeing someone who can help you plan to increase your coping skill repertoire will help. 
Adverse life events have also been documented as occurring before the onset of functional abdominal pain, alopecia areata, headaches, cancer, heart disease, low back pain, and psoriasis.
How can you begin to lower your reaction to stress?
Start to assess your own everyday stress:
KEEP A JOURNAL. Writing brings your observations into focus. Additionally, writing is a stress-reducer on its own, and focus promotes a sense of well-being. Record your reactions to everyday events. For patients with chronic and intermittent diseases, a chronicle of daily events, foods consumed and anything that you come in contact with through the environment should be documented. When an outbreak occurs, you can begin to assess a connection that might be meaningful to you and one that you have not observed previously. Writing each day, can be calming for most people. Writing a few items about everyday occurrences such as items that made you happy, people who added positive thoughts to your life that day, events that made you feel grateful, how did these daily events add to your life purpose and maybe consider ways that thoughts/events that were not very positive can be reframed when they occur again. What caused you stress? What really made you happy?
OBSERVE PATTERNS IN YOUR OWN LIFE.Begin to review your journal periodically and observe items that do not promote a sense of well-being. These may be activities, people in your life that may be causing you undo stress, and continued thoughts of past events that may not have been beneficial to you (termed rumination).
OBSERVE PATTERNS THAT PROMOTE RELAXATION:What events bring you pleasure? When do you feel that you are at your best?
HOW DO YOU VIEW CHANGES IN YOUR LIFE? Results from studies indicate that individuals who view change as a life-challenge have what is termed “hardiness” and generally stay healthier. Additional studies have reported that patients who have “persistence” as a characteristic trait in everyday life tend to remain healthier as well.
DO YOU SEE THE GLASS AS HALF FULL OR HALF EMPTY?Individuals who are optimistic rather than pessimistic are more resilient and are able to cope with stress more favorably. Optimism, it is believed, can be learned.
Exercise has profound positive effects on the body and the mind. An exercise program that includes strength training, aerobic activity and meditation is optimal for anyone. 
Tai chi, Yoga, cycling, dance class, walking, running or any physical activity is beneficial. Select one that you like so that you will stick with it and continue to improve. Journal your progress and note your physical responses as you continue your journey.
To your health and happiness in 2019!!
References :
Mate G. When the body says NO. 2003, John Wiley & Sons, Inc. Hoboken New Jersey.
McGonigal K. The upside of stress. 2015. Penguin Random House LLC. New York.
McEwen B. The end of stress and we know it. 2002; Joseph Henry Press, Washington D.C.