Teaching Heightens the Risk for Autoimmunity

Those of us with high-stress jobs have a greater risk of developing autoimmunity.  A 2001 mortality study investigated whether an association exists between teaching and death caused by autoimmune diseases.

Excess autoimmune disease mortality among school teachers

The study concluded that evidence had been found of "excess mortality from autoimmune diseases among teachers" and that "teachers experience an occupational exposure that increases risk of autoimmune diseases."

I first began noticing what I now realize were autoimmune symptoms in the first few years that I taught.  The job immediately began wearing me down.  In some ways, it has gotten easier.  Once I quit looking like I was in my 20s, which unfortunately didn't happen until I was around 38, students began respecting me at a much higher level.  It's crazy how much more respect students have when their teachers look more like their parents.

In other ways, teaching has become infinitely harder.  If I still had the lack of respect that I once did and had to deal with the additional modern demands of the job, I wouldn't be able to do it at all.  As it is, I'm finding it terribly difficult to keep going.

I teach at the high school level, and my job has become so all-consuming that I don't have much left for anything else.  I have managed to continue selling books on eBay and Etsy, but I haven't been able to do anything else in addition to that.  I am not reading and am not keeping up with most other things.

I can't get into the specifics of my situation, but I can tell you about the overarching problems.

Young people have an extremely short attention span.  That is, we all have a shorter attention span than we once did, due to social media and smart phones.  Teenagers know no other world.  All of my students were born after the first iPhone was released.

Students have changed profoundly since the pandemic.  We are still trying to claw our way out of that.

Students are blatantly cheating on everything with AI.  We can't prevent it.  When I confront a student who clearly cheated on a test by using AI, they tell me that the work is how their tutor showed them.  They don't understand how obvious it is that the work is AI and that no tutor would ever work a math problem the way that AI does.  The students would be better off admitting it, but no, they think they can deceive me.  What they get is a teacher who makes sure they are never able to use AI on a test again.  

Test days used to be great days when I could get a lot of grading done.  Test days are now extremely stressful, and I get nothing done.  Anyone who has managed to use AI on a past test is watched carefully, and I must be constantly vigilant to make sure students don't trick me.  For instance, a student might write problems down on a slip of paper, sneak it into their pocket, and then ask to go to the restroom.  If I don't ask for their phone, then the student might access AI with their phone while in the restroom and then write down all the correct answers for the test.

We are supposed to do everything on Chromebooks, but students don't learn well without paper and pencil.  Besides that, they cheat with AI on all digital work.

I have continued to use paper and pencil all along, despite the intense pressure to quit consuming paper.  It appears that people are finally realizing that doing everything on a screen has set us back greatly.  Technology is great, but it should be supplementary to learning that is done primarily with paper and pencil.

Most young people now have poor reading comprehension.  Even many young people who love to read have poor reading comprehension.  I have seen it firsthand in online discussion groups where youth can only read books at a surface level.  They have no idea of any nuance that is obvious to those of us who learned how to read long before social media existed.

We have a very severe teacher shortage in Oklahoma that is continuing to worsen.  This has been caused by all of the above plus the way we are treated by Oklahoma politicians.  You'd have to live here to understand how bad it truly is.  

Our Oklahoma Superintendent of Public Education from early 2023 to late 2025 treated teachers as if they were political activists whose sole purpose was indoctrinating children.  He called teachers unions "terrorist organizations."  He suspended teaching certificates of teachers who made statements on their social media that he didn't like.  He tried to take away the accreditation of school districts if he didn't like something they were doing.  If he were still the superintendent, I would not have included this paragraph as it would have been too dangerous.

Our state legislature continues to push out laws that make it worse.  One of their recent ideas was to use $25 million from the Oklahoma public teachers' retirement account to fund tax credits for private schools.  It probably sounds like I'm making this up.  

And there's a bunch of other stuff that they've done or attempted to do.  We feel like we are constantly under attack.

The severe Oklahoma teacher shortage has caused people to be hired to teach subjects for which they aren't certified.  For instance, a social studies teacher would be hired to teach math.  Yes, I'm serious.

When students have a teacher who isn't qualified, then they might not learn as well.  When the students go to the next course, the next teacher must teach them everything they didn't learn the year before plus all the new content.  That's a tall order.  

We keep being told to change what we're doing to some other method.  We get yanked one way, and then we're yanked back the other way.

Back about 15 years ago, a veteran teacher remarked that she had noticed that education goes in a circle.  She said that we continue to try new things and end up right back where we started, doing the same things over and over again.  I didn't have quite enough experience at that time to see it, but now I do.  Educators are constantly being forced to change to some great new idea, which is just a rehashing of some previous great new idea that didn't work any better than anything else ever has.  After a cycle of around 15 to 20 years, we end up right back where we started.  And the cycle continues.

The 2024-2025 school year broke me.  I would have retired in May 2025 if I had qualified.  This year is the very first year that I do qualify to take early retirement with reduced benefits.  It does please me to know that my retirement window has now opened.  I will have to work for three more years to qualify for full retirement benefits.  I am counting down by months and weeks.  Currently, I am at three years and one month.  Soon, I will be able to say "fewer than three years."  

Bad Reaction to Evoxac—Worsened Dry Eye and Decreased Thyroid Levels

My overall dryness has been worse since I had Covid for the second time in December 2024.  Early last year, I was prescribed pilocarpine and had a terrible allergic reaction.  

When I had a rheumatology appointment in October, I requested to try something other than pilocarpine.  I was prescribed Evoxac.  I was excited, since I've heard that it's great.

Evoxac definitely helped the dryness in my mouth.  The problem was that it made my dry eyes worse and caused me to have blurry vision in the evening.  I have had problems with my eyes since early 2025.  I had seen some improvement in the early fall, and Evoxac pretty much wrecked my eyes again.

I have always struggled with my electrolyte levels.  Two different blood pressure medications failed last year because they either dangerously lowered my electrolytes or threw off my levels.  I simply cannot get my blood sodium level above the lower boundary of the normal range.  One blood pressure medication caused my blood sodium level to fall close to a level that would have required hospitalization.

I believe Evoxac impacted my electrolytes.  I've noticed that I get insomnia whenever my electrolytes are off, and I did get insomnia soon after starting Evoxac.

On top of all the other side effects, I am pretty sure that Evoxac impacted my thyroid levels.  I can't have that.

I searched thoroughly online for confirmation that I wasn't the only person who's ever had these reactions to Evoxac.  It seems to be a miracle drug for just about everyone.  I created this blog because my condition just doesn't follow the same pattern as everyone else.  It's baffling.

I scoured the internet for information to substantiate what I believed was happening to me, and I found just about nothing.  This has happened so many times...

I finally turned to AI to see if I could get any confirmation.  Here, I include excerpts from some of my chats with Chat GPT.  These chats occurred over around a two-week-long period, as I tried to figure out why I was having so much trouble with a drug that helps so many people.

I would like for you to search for any adverse thyroid impacts caused by Evoxac.  I would also like you to search online for any anecdotal reports of thyroid levels that could be tied to Evoxac.

I could not find credible clinical case reports, label warnings, or pharmacovigilance signals that link Evoxac (cevimeline) to causing thyroid dysfunction or to interfering with levothyroxine absorption.

Are there any reports of Evoxac making the eyes dry or making them burn?

Yes—there are reports and side-effect listings showing that Evoxac (generic Cevimeline) can cause dry or burning eyes, or other ocular symptoms, though the data suggest these are less common compared to the beneficial effect of increased tears.

ChatGPT also stated:

While the original intent of the drug is to increase secretions (including for eyes) in conditions like Sjögren's syndrome (which cause dry eyes and dry mouth), the side-effect listings show that in some people, the effect may be paradoxical (or perhaps related to other ocular irritation) resulting in "dry, burning, itching" eyes.

Naturally, I would be one of those people.

I'm wondering if—since Evoxac helps the body secrete more moisture—that going off it could impact electrolyte levels and then as a result cause symptoms like a temporary headache.

Evoxac (cevimeline) does alter fluid balance slightly by stimulating glands throughout the body.

ChatGPT also said:

There's no evidence in studies or adverse event databases that stopping Evoxac causes measurable electrolyte disturbances (like hyponatremia or hypokalemia).

Huh.  That's what it thinks.  It should be noted that I didn't think much of ChatGPT's responses.  AI is unreliable, and ChatGPT acts just like a gaslighting doctor who doesn't believe that a patient is having certain side effects.  It was a few days after this exchange that I decided to corner it.

Evoxac is a cholinergic agonist.  What about this?  See link.

https://www.sciencedirect.com/science/article/abs/pii/0196978185901573

The link I gave ChatGPT goes to "Cholinergic and VIPergic effects on thyroid hormone secretion in the mouse."  The study concludes "that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade."  Since Evoxac is cholinergic, I felt I had my smoking gun.

ChatGPT, behaving in an incredibly dense fashion, continued its spiel about electrolytes, completely ignoring that the link is to a page about thyroid function being impacted by cholinergic agonists.  I continued in my quest to pin down ChatGPT.

I am referring to this excerpt:

"It is concluded that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade.  Furthermore, TSH-induced thyroid hormone secretion is more sensitive to inhibition with cholinergic stimulation than is VIP-induced thyroid hormone secretion."

And it seems like Evoxac can impact thyroid levels in some fashion.   Isn't that what this means?

Come on, ChatGPT, you can do it...

• Both stimulating and blocking cholinergic receptors can reduce baseline thyroid hormone release (T3/T4).
• When thyroid cells are stimulated by TSH (the pituitary signal to make thyroid hormones), adding cholinergic activation further inhibits that secretion—meaning acetylcholine-like drugs (such as muscarinic agonists) could dampen thyroid output.
• The inhibition didn’t apply equally to all hormonal stimuli: thyroid stimulation via VIP (vasoactive intestinal peptide) was less affected than TSH.

So yes—mechanistically, cholinergic stimulation can suppress thyroid hormone release under some conditions.

ChatGPT added:

In theory, Evoxac could exert a mild inhibitory effect on thyroid hormone secretion, at least transiently or in sensitive individuals.

That’s not necessarily the same as causing hypothyroidism—but if you already have borderline thyroid function or are on levothyroxine, this kind of interference could slightly alter your TSH–T4 feedback balance.

Precisely.  I quit Evoxac five days ago because it messed up the fluid balance in my body.  My eyes became much more dry with Evoxac.  They are now getting better.  Additionally, my thyroid due to Hashimoto's is extremely sensitive to any medication changes of any kind.  Since there is evidence that Evoxac could impact thyroid levels, I believe that happened to me during the two weeks that I took Evoxac.  I have mild symptoms of thyroid imbalance.   It will take my body a couple weeks to return to baseline.

As I recall, it took around six weeks for my eyes to recover from the Evoxac.  As far as my thyroid levels, I then caught a horrible virus and have still not recovered my thyroid levels as of late April 2026.  But I digress.  That debacle will be addressed in another post.

Anyway, I figured that I had one-upped ChatGPT with my final prompts.  Evoxac was terrible for my body, and I never want to try it again.  It really did help with dry mouth, and I noticed how my mouth was more dry as the medication wore off.  The benefit was not worth the negative symptoms.  I will just continue dealing with my dryness, hoping that one of the new Sjögren's drugs is approved in the next year.  With my luck, I'll be allergic to it.  Still, I can hope.

How Often to Wash Hair and What Helps My Dry Hair

I used to have oily hair and oily skin.  I was excessively oily, and it was annoying.  I'd love to be that way again.  I'd rather have too much moisture than not enough.

My hair is now extremely dry, just like the rest of me.  Sjögren's disease attacks all of the moisture-producing glands in the body, and it has caused my hair and skin to go dry.

I take a megadose of fish oil each day.  It mitigates the dryness to some degree, but I'm still very dry.

Before I started taking thyroid medication in 2014, my hair was thin and brittle.  I saw improvement with thyroid medication, and gradually more improvement over the years as I added supplements.

I saw even more improvement in my hair beginning in late 2022 when I was switched to Tirosint, which is hypoallergenic.  Still, my hair had lots of breakage, even though it was much better than it once was.

Back when I had oily hair, I always washed it every day.  That habit was so ingrained that I have continued to wash my hair every day all these years, even once it became dry.  I just don't feel clean unless I wash my hair.

For a number of years, I've tried to figure out ways to get my hair to be less dry.  All the common online advice says not to wash hair every day.  When I've tried that, my hair becomes even more dry.

I created this blog because most of the common advice found online doesn't help me at all, and the hair situation is a perfect example.  I finally figured out that my hair is less dry when I wash it every day, just like I've always done.

Do you know why?  The moisture-producing glands in my scalp produce almost no moisture at all.  I think it's a combination of my aqueous deficiency and damage to the sebaceous glands.

The act of washing my hair puts moisture in it.  It's so obvious now.  Washing my hair gets it completely wet.  I let it air dry so that more moisture stays in it.  My hair is nice and soft in the evening after I've washed it.  

Around the time I figured this out, I saw an article that was in line with my thoughts.

Washing Your Hair Once a Week May Not Be a Good Idea—Even If It Looks Clean

While some experts say that washing your hair once a week is fine as long as you use a good shampoo and your hair responds well to that frequency, there's another side to the argument.  If your hair is extremely dry and not washed often enough, it can lose its natural moisture with age.

That has been my observation.  I need to wash my hair every day. 

When I skip washing my hair, my hair becomes more dry as the days pass.  As my hair dries, it becomes more brittle and more prone to breaking.

The thickness of my hair has improved over the years as I've added additional omega-3 supplements.  I've noticed an especially positive hair change tied to when I started taking sea buckthorn oil in early 2024.  

The top six inches or so of my hair is shinier than the rest of my hair.  It has a different consistency, and there's much less breakage.  I believe that sea buckthorn oil is the reason why my recent hair growth is of higher quality.

Sea buckthorn has also improved the health of my gums.  My gums used to be swollen, which caused my teeth to be so tight that I couldn't floss.  I can now floss easily.

The most popular brand of sea buckthorn oil is SeabuckWonders, but I prefer Sibu.  The Sibu sea buckthorn oil smells better and has a nicer color than other brands.

I started using Nexxus Repair and Nourish Ultra Lightweight Hair Oil back in February.  The directions say that it can be applied to wet or dry hair.  Whenever I apply it to dry hair, my hair ends up looking greasy and stringy.  It does not absorb properly when applied to dry hair. 

I apply it to my hair right after I wash it when my hair is still wet.  By applying it when my hair is wet, the oil distributes evenly through the hair so that my hair isn't oily.  

I find that I can also apply the oil when my hair is in the early stages of drying where it is still quite damp.  If I apply it when my hair is over halfway dry, then my hair becomes oily and stringy.  So long as my hair is quite damp or wet, the oil works great.

There was a bit of a learning curve when first using the Nexxus oil, since I didn't know how much to apply.  The directions say to apply 2-3 drops.  The container has a pump, so they might mean 2-3 pumps instead.  

My hair is long, down to halfway down my upper back.  I put around 5-6 pumps in my palm, rub my hands together, and then apply on the lower half of my hair, being sure to get the ends.  I then repeat the process on the top part of my hair.  

My hair will always be below average, but at least I've seen improvement over the years.

Back to Work Autoimmune Flare (Fall 2025 Edition)

April 21, 2026 note:  This post was written on September 9, 2025, and I backdated it to fit in the proper chronology.  I teach at the high school level.  This school year has been massively stressful, and I am just now beginning to write posts on what has transpired.  This post is the beginning of the story, so here it is.

....................................................

Each year when school starts, I have an autoimmune flare.  I used to call it a "thyroid flare," since the symptoms were what I would expect from thyroid disease.  Unbeknownst to me, I also had Sjögren's disease, and I now know that some of my symptoms were caused by it, not just my thyroid.

I was diagnosed with thyroid disease in 2014 and with Sjögren's disease earlier this year.  However, I know that I had symptoms of both beginning at least 30 years ago.

My back-to-school flare typically consists of deep fatigue, aches and pains, and brain fog.  It becomes quite noticeable in the two to three weeks after I go back to work each August, and it lessens around the middle of October.

In the last few years, my thyroid hasn't flared as much.  My symptoms are now primarily that of Sjögren's disease.

Indeed, I believe that my thyroid is now completely stable.  I have been on the same dose of Tirosint for over two years.  The last time my thyroid autoantibodies were checked, they were much lower.  The autoantibodies are still out of range, so I still have active Hashimoto's.  However, my thyroid seldom swells up so it appears to be stable.

It is now my Sjögren's disease that flares, and it flares constantly just like my thyroid used to do.

I went back to work on August 7.  I did pretty well at first, but two weeks later, like clockwork, I started having flares.  I had a bad one on August 23 that lasted for around a week.  I am in another bad flare that just started on Sunday.

My lips are burning, and my sense of taste is more distorted.  My eyes are more dry.  I wake up each morning massively dehydrated with dry eyes and burning lips.  It's miserable.

....................................................

April 21, 2026 additional note:  I will detail later events in another post.  Here, I will just say that I did end up having a thyroid flare beginning in October and that the flare worsened throughout the winter months, caused by several escalating events.  My thyroid medication dosage has now been increased for the first time in nearly three years.

Dry Eyes Part 7: Restasis

Insurance companies really don't like paying for prescription eye drops.  They insist that the over-the-counter garbage is sufficient.  Most of the over-the-counter eye drops irritate my eyes.  The few that don't irritate my eyes aren't effective at helping the situation.

On July 2, I was finally prescribed Restasis.  I had to endure torture from late February until the beginning of July simply because my insurance uses step-therapy.  Once I had two failed attempts (punctal plugs and serum tears) to help my dry eyes, I was approved for prescription eye drops.  That should have happened in February.

I was told that Restasis would burn my eyes for a short time each time I used it.  I was also told that it would take several months to see results.  That is why the prescription eye drops should have been approved in February.

The first thing I did when I got home was to check online reviews of Restasis.  They weren't good.  Many people complained about how much Restasis burned their eyes.  Restasis helped some people... eventually.  Other people said that it never helped.

Since I had had six bad reactions to medication and treatments since January (hydroxychloroquine, pilocarpine, chlorthalidone, lisinopril, punctal plugs, and losartan), I was afraid of the Restasis. 

I mean... I was genuinely scared.  My eyes had been so horrible that I didn't want to use something that would make them burn even more!

I have been using ChatGPT this year as I have sought answers to my eye problem.  I am wary of ChatGPT.  The silly thing complements me all the time because I have such great ideas!  Sometimes I tell it the real situation, and other times I query in a general sense to prevent it from pandering to me.

I had already told it about Sjӧgren's, Hashimoto's, Covid, and what treatments had already been tried. 

I first asked, "How does Restasis work?"  It told me a bunch of stuff, including that it doesn't start working immediately.

I wrote, "I'm just afraid to start taking it because of how irritated my eyes have been for the last five months."

Among other things, ChatGPT told me this:

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Restasis works best in people with inflammation-related dry eye—which includes:

• Autoimmune disease-related dry eye (like from Sjogren’s),

• Neuropathic inflammation post-viral (like post-COVID),

• And possibly ocular surface nerve hypersensitivity where inflammation is contributing.

It may actually help reduce the irritation long-term, but only after that initial difficult period.

------------------------------------------------------

I verified through an online search that Restasis is prescribed for inflammation, so ChatGPT's response seems reasonable.

I then asked, "How long does the sensitive phase last?  How long do the drops sting the eye each time they are used?"

ChatGPT replied that the sensitive phase can last for 3 to 12 months and that the stinging is short-lived.  It also gave me some advice like to refrigerate Restasis and to use serum tears 15 minutes before Restasis.  

I picked up the Restasis on July 3.  My eyes were feeling overall pretty good that day, so I thought that I'd wait to try the eye drops.  I was quite fearful of trying Restasis. 

On July 4, I woke up and quickly determined that I wasn't going to have a very good day with my eyes.  I decided that I had nothing to lose.

The Restasis burned a little bit, but nothing like what people mention online.  Within an hour, I felt like my eyes were less irritated than they had been in... months.  I was perplexed, since Restasis is supposed to take months to work.  I considered that I might have been experiencing a placebo effect, but I quite frankly expected the Restasis to make my eyes worse.  I wasn't expecting sudden improvement, so I didn't think that I was manifesting a positive reaction.

Really, I was dumbfounded.

I searched online and found just a couple examples of people saying that Restasis helped immediately.  I decided to ask ChatGPT.  I didn't tell ChatGPT that I had already tried Restasis so that I wouldn't influence how it answered.  

I asked, "I understand that it takes at least two months for Restasis to help.  I saw a comment online where someone said that Restasis helped them immediately.  How often does that happen?"

This is what it told me:

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📊 How common is early relief from Restasis?

• In clinical studies and post-marketing reports, early relief (within days to 1 week) is uncommon, but not unheard of.

• Based on observational data and ophthalmology feedback:

  • Only about 5–10% of patients report early noticeable improvement in symptoms.

  • The majority notice changes between 1 and 3 months.

  • A subset (20–30%) see no benefit at all, especially if inflammation isn't the main driver.

---

💡 Why do some people feel better so quickly?

A few possibilities:

1. Inflammation was the primary cause, and their ocular surface responded rapidly to even low-dose immunomodulation.

2. Placebo effect + supportive treatments (e.g., artificial tears, cold storage, serum tears) created a synergistic improvement.

3. The Restasis may have reduced nerve irritation quickly by calming immune cells that were triggering sensory nerve endings—especially in people with milder SFN-related inflammation.

---

⚠️ But it's important to note:

• Most people with chronic or autoimmune-related dry eye need to wait at least 6–12 weeks to feel confident it’s working.

• Doctors usually recommend sticking with it for at least 90 days before deciding if it’s effective.

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I had already decided that my eye problem is inflammatory, at least the part since February.  There's also my aqueous deficiency from Sjӧgren's as well, but the rapid deterioration in my eyes was undoubtedly caused by the punctal plugs, other bad reactions, and likely Covid.  It seems logical that the Restasis could help me on a faster timeline because it would calm that inflammation.

By one week after starting Restasis, I felt that most of the damage caused by the punctal plugs had been reversed.  I still had periodic burning, which was a symptom that started with losartan, and my eyes were still quite dry.  After only one week of using Restasis, it was great that my eyes were mostly back to what they were before I got the punctal plugs.

I am now one month into Restasis.  My eyes are burning very little except for the burning I feel in the hour or so after I use Restasis each morning and evening.  I don't mind the burning as it feels like a therapeutic burning to me.  It's a mild burning that I rather like because it makes my eyes moist.  It makes me feel like the Restasis is doing good things to my eyes.

I look forward to using the Restasis each morning and evening.

My eyes are still quite dry and are still noticeably worse than before I had Covid in December.  The summer heat is really drying my eyes out.  I suspect that my electrolytes are still off from losartan.  It's going to take time, but I feel like the Restasis will gradually make my eyes better and better.

Also, I notice that I'm forgetting to use the hot compress on my eyes most days.  I'm not using eye drops quite as much, either.  My eyes are still dry, but they are slowly improving.

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Dry Eyes Part 6: Losartan, Flaxseed Oil, and Electrolytes

My eyes continued to be a problem, despite all of my futile efforts.  I also had a very annoying new symptom.  

In April, my eyes began burning, and I didn't know why.  Obviously, it was part of the problem, but why had they started burning after the punctal plugs were removed?

In May, the burning got worse.  I have been on thyroid medication since July 2014.  In May, my thyroid medication began making my eyes burn.  The burning would commence in the one to two hours after I took the thyroid medication and continued for at least a couple hours.  It was awful.

I knew that the problem wasn't the thyroid medication.  To clarify... the thyroid medication was undoubtedly causing the burning, but something else in my body had changed and was thereby causing the thyroid medication to do that.  I was pretty sure that the sodium in the thyroid medication was the problem.  It was like the sodium was hitting my eyes and making them burn.  My eyes had also started burning after I ate salty food.  That had never happened before.  

I had wondered about losartan because my eyes began burning within a couple weeks of starting losartan.  I finally realized that I needed to quit taking losartan to see if that was the problem.  I quit taking losartan on May 30.  I felt like my eyes improved some, but I wasn't sure if the losartan was the problem or not.

My appointment with my primary care physician was on June 5.  I told him that I had quit the losartan, that my eyes might or might not be better, and that I wanted to stay off of it for at least another couple weeks.  Additionally, my blood pressure wasn't spiking yet, and I would continue to monitor it.  He agreed.

My lab tests showed that my blood sodium had gone down some, and my blood potassium was on the high side.  Both were due to the losartan.

The eye burning caused by my thyroid medication gradually lessened.  Overall, my eyes began burning less.

By the middle of June, I thought I was improving, then I got worse again.  Why.....?

It was right at the end of June when I realized that I had run out of flaxseed oil around June 10.  I want to quit taking unnecessary supplements, so I chose not to continue.  I didn't think it was helping.

Since my eyes had worsened again, I concluded that it probably had helped.  I purchased more flaxseed oil and resumed taking it.  My eyes improved somewhat.  I concluded that I should continue flaxseed oil.

My eye appointment was on July 2.  I told my ophthalmologist that I was still worse than before I got punctal plugs, although I had improved somewhat since the plugs were removed.  

Back on February 26, my doctor said that my eyes had "some dryness."  This time, he said that they weren't that dry.  

I had been thinking for around a month that my eyes were inflamed from my December 16 Covid infection, and that the punctal plugs greatly aggravated the eye inflammation.  It didn't surprise me that my eyes weren't that dry overall.  But they sure have bothered me!

I was prescribed Restasis eye drops to use in addition to the serum tears.

Dry Eyes Part 5: Fish Oil Supplements

Once I quit using ointments with lanolin, my eyes seemed better, although I continued to struggle.

My Sjӧgren's has probably worsened, but I'm a bit perplexed.  My mouth dryness has been better, and I no longer get palpitations after I eat.

I continued to search online for remedies.  In my first post about my eyes, I wrote:

What I learned this weekend is that I need 2000mg to 4000mg combined of EPA and DHA.  The amount varies depending upon who is giving the advice, which is of course the problem with online advice.  It seems that people with dry eye need around 3000mg combined of EPA and DHA.  I've heard anywhere from 2000mg to 4000mg for Sjӧgren's.

In early June, I read more about omega-3 oils.  I read that people with rheumatoid arthritis (which I don't have) are recommended to take 4000mg to 5000mg combined of EPA and DHA.  I also saw some reports that people with Sjӧgren's could benefit from that same intake.

The quality of the fish oil matters, and the cheaper brands should be avoided.  Fish oil needs to be in triglyceride form, which is less likely to go rancid.  It should also be packaged in an opaque container so that it isn't exposed to light. An opaque container helps prevent the fish oil from going rancid.  Apparently, a lot of fish oil sold commercially is rancid.  

Even though I'd rather not have to pay for more expensive supplements, I also need for them to help me.  Taking rancid oil won't help.  I have read online that rancid fish oil can irritate the gut and promote inflammation.  My goal with fish oil is to reduce inflammation, not promote it.

I have taken Qunol fish oil for a number of years, and I feel like Qunol is a good brand.  However, I notice that the Qunol has an extremely strong lemon odor as compared to the two more expensive brands that I have tried.  This makes me suspicious about what they are covering with the lemon odor.  It's just too strong.  I am taking extra Qunol to use it up, and then I will take only the more expensive higher quality fish oil.

I switched to Sports Research Alaskan Omega-3 Fish Oil since it is slightly less expensive than Nordic Naturals.  Sports Research is said to be a high-quality brand.

I am also keeping my fish oil refrigerated to keep it from  going rancid.  If I'm going to take expensive fish oil, then I want to make sure that it is good quality.

Dry Eyes Part 4: Nighttime Eye Ointment

I purchased several brands of nighttime eye ointments back in February to see which one I liked best.  I had been using Retaine PM, and I thought it was quite good.

The other brands I tried were Systane, Soothe, and Refresh.  I wasn't that happy with any of them, but they seemed decent.

I used Refresh consistently for a few weeks, and I decided I would not purchase it again.  I feel like the tube design makes it too hard to get at the ointment as the amount remaining decreases.

Around April 18-20, I used Systane and noticed that my eyes felt worse the next day.  This gave me pause.  Could this have something to do with the odd fluctuation in symptoms?

I checked reviews, which are overall quite glowing.  I did find one where someone said that Systane irritated their eyes.  Someone else said that Systane made their eyes itch.  I wondered.

I switched to Soothe for a few days, and my eyes were somewhat better.  I wanted to be sure, so I decided to use Systane again.  On the night of April 23, I put Systane in my eyes and then got into bed.  Around five minutes later, both eyes were itching.  I was a bit horrified.  

I immediately got up and used eye drops to flush out my eyes.  At that point, I knew that Systane was a problem, but not necessarily the problem.

I checked the ingredient list.  Click on the image in order to see it clearly.

I saw Liquid Lanolin (3%).  That answered two questions in one.  My lips have been a problem for many years.  I cannot use any lip balms.  All of them burn my lips.  Around five years ago, I settled on Aquaphor.  It was great!  Until it wasn't...  One morning a few years ago, I woke up looking like a clown.  My lips were on fire, and I had a rash all around them.  I had to quit the Aquaphor and switch to just Vaseline on my lips.

The only thing in the Aquaphor that could have possibly caused a reaction was lanolin.  However, I read online at that time that very few people have a lanolin allergy.  Still, it seemed like I might.

The itchy feeling five minutes after putting Systane in my eyes was unmistakable.  It's now apparent to me that I do have a lanolin allergy.  That was my Aquaphor problem, and it's my Systane eye ointment problem as well.

I checked my other eye ointments.  Refresh has "lanolin alcohols" in it.  Really?  That would explain why I didn't think the Refresh was that great.

Soothe and Retaine PM don't have lanolin in them.  That's good to know.  I will stick to those two brands and will avoid the others.

After I figured this out, I put Retaine PM in my eyes and went back to bed.  I noticed the next day that my eyes felt much better.  I should never have purchased any other brands.  The first one I tried, Retaine PM, is the best one for me.

This didn't solve the entire problem, but avoiding lanolin in the eyes was a positive step towards improving my dry eye.

Dry Eyes Part 3: Serum Tears and Possible Anemia

On April 1, the skin around my right eye became swollen, and my eye hurt.  I decided that the punctal plugs needed to be removed.  They were removed on April 4.  My eyes immediately felt much better.  Oddly though, my discomfort began to return.  Some days were fine, and others not.  I couldn't understand it.  I realize that happens, but I felt like there was an odd pattern to it like something was causing it.  I couldn't put my finger on exactly what was causing it.  [I mentioned in a previous post that this is important.  I still couldn't figure it out.]

Meanwhile, I was prescribed serum tears.  I went to the lab on April 9 to have my blood drawn.  I ended up feeling quite tired—extremely so—for several days.  I knew that my tiredness was due to the blood loss.

I am borderline anemic and have been for many years.  The blood loss worsened my condition to where I really felt it.  While the serum tears were quite soothing, I continued to have trouble.  I read that serum tears can take several weeks before helping.

I continued to feel so very tired that I looked into the symptoms of anemia.  I discovered that anemia can cause dry eyes.  Oh!

I decided to start taking an iron supplement each day to see if that would help.  My tiredness improved.  I didn't notice anything different with my eyes, other than the usual variations, but I also knew that it could take some time.

My next regular doctor's appointment was in early June, and I felt like if I stuck with the iron until then, I could then see whether it helped. 

Also, I had a lot of discharge from my left eye.  It was most significant in the one week after the punctal plugs were removed.  Those things messed up my eyes.  On the day that I got the serum tears made, I had yellow mucus pooling in the inner corner of my eye and running out.  It was a bit disturbing.

Serum tears help with inflammation, so that I knew that I had the treatment I needed for the irritation.

On April 13 and 14, my eyes felt much better, although still dry.  I felt hopeful.  On April 15, they worsened considerably and continued to be quite bad on April 16 and 17.  I still felt like there was an odd pattern with something causing the change in symptoms.  I still couldn't figure it out.

I noticed that my eyelids were becoming more irritated and a little swollen near my meibomian glands.  My eyes were more inflamed, and I couldn't pinpoint why. 

I tried the eyelid wipes again, and it seemed that my eyes became worse.  I continued to feel that the eyelid wipes were an allergen.

By this point, I was quite frustrated.

Dry Eyes Part 2: Blood Pressure Medications

In late March, I began considering that blood pressure medications could be part of the problem.

I will start with the backstory, since it is relevant. 

I was on lisinopril paired with hydrochlorothiazide for around 8 years from around 2006 to July 2014.  I was fine on it at first, but towards the end, I coughed constantly.  The coughing impacted my quality of life, and I was switched to Bystolic.  Over the years, my blood pressure gradually increased, so I needed to be put on a secondary medication.

In November, it was suggested that we try chlorthalidone, which is a diuretic.  I was hesitant, because of my problem with coughing before and how excessively dry I am.  I agreed to try it, and I didn't cough, so I thought I was okay.  Unexpectedly, routine labs in early February showed that my electrolytes were dangerously low.  I was pulled off the diuretic.

Lisinopril without a diuretic was suggested.  I agreed, since the medication would not be paired with a diuretic.  At first, I thought I was fine, and I didn't realize anything was amiss.  In fact, I ignored the obvious due to my preoccupation with my eye trouble.

I detailed in my previous post my attempt to fix my eye trouble that began in late February.  I thought I had figured it out on March 23, but I worsened again.  It was on the morning of March 26—and not in relation to anything with my eye trouble—that I suddenly thought about how much I had been coughing.

I realized that I was taking lisinopril and that I was coughing uncontrollably.  The coughing was violent and caused loss of bodily functions.  Really awful coughing.  I was sure that it was worse than the coughing that I had previously while on lisinopril paired with hydrochlorothiazide.  I couldn't believe that I hadn't made the connection.  I had been so distracted by my eye condition that I hadn't realized that lisinopril was making me cough.

I now know that I cannot take lisinopril with or without a diuretic because of the coughing caused by it.  And to think it took me over a month to figure it out.

As soon as I realized that I was coughing too much, I typed up a message to my doctor explaining and requesting a change.  After I did that, I considered my eye situation.  Hmm...

I thought through the sequence of events.  I figured out that I took my first dose of lisinopril on February 17.  The coughing began around February 23, nearly one week later.  I believe the coughing worsened on February 24 and 25.  I know that the coughing became a problem early that week.

Once I worked that out, I came to a huge realization.  My eye appointment was on February 26, three days after I started coughing from the lisinopril.  I also recalled vaguely but without specifics that my eyes had worsened a little in the few days before my eye appointment.  They became dramatically worse immediately after my appointment.

It seemed that lisinopril could be what caused my eye trouble.  I would never have suspected that, since I previously took lisinopril for eight years with no eye trouble.

I quit taking the lisinopril as soon as I realized that it was the cause of my terrible cough.  I noticed that my eyes were immediately less dry.  I thought maybe I had figured it out, but no.  Once I started on losartan, my eyes became more dry again.

I did believe that the blood pressure medications were a part of the problem with my eyes, but I knew that something else was at play.  After all, I've been on blood pressure medication since around 2006 without the eye pain that just developed this year.