Health News Article | Reuters.com: "Individuals with depression often suffer from chronic physical pain and chronic pain sufferers are often depressed. A new study shows that both conditions should be tackled separately and independently from each other...
To investigate, they studied 53 patients with fibromyalgia, a condition characterized by widespread pain and tenderness to the touch, which is often accompanied by depression. They also studied 42 healthy controls.
Based on results of brain imaging studies and a thumbnail pressure test, the researchers found that fibromyalgia patients needed much less applied pressure to the thumbnail than healthy controls to activate neurons associated with acute pain. This heightened sensitivity to pain applied to fibromyalgia patients, regardless of whether or not they were depressed.
Additionally, according to the researchers, there was only a weak link between sensory regions of the brain associated with pain and emotional regions of the brain associated with depression.
While depression and pain often occur concurrently, that does not mean they're the same underlying problem and can be managed in the same way, Clauw said. Therefore, prescribing an antidepressant will not necessarily relieve the suffering of a depressed patient whose pain is not only real but also intensely physical, he and colleagues note."
Tuesday, May 31, 2005
Saturday, May 28, 2005
FibroHugs - Fibromyalgia Support and Awareness
FibroHugs - Fibromyalgia Support and Awareness: "Fibrohugs has become the largest interactive Fibromyalgia site that is truly designed for the entire Family. We accredit our constant growth to the Monitored Chats & Forums, Member Submissions, Research Results, Tons of Information, and the sincere unconditional love and support we offer each person that visits this site. We are run by people suffering with Fibromyalgia so we know exactly what you need, you need Fibro'Hugs'."
Low
Saturday morning and as P says I should be happy the weekend ( and thus himself) are here but feel pretty down.
Woke with a stye to pile on top of hayfever swollen eyes, lush, not...
Still off the booze though feel the ghost of temptation today. Will fight.
Interesting stuff on this board... which of my health care professionals are in the dark ages blaming it all on my mind and which , if any believe I have pain, tiredness, etc, etc, etc, etc ad infinitum?
HealthBoards - Anyone with severe back pain & breathing problems?: "Fibro-(FMS) characterized by pain amplification, musculoskeletal discomfort and systemic symptoms. It is a central nervous system sensitization. It may also be inherited, note the words, may be. It is NOT a musculoskeletal disorder, not progressive, not chronic myofascial pain, nor does mental illness have anything to do with it (although some professionals argue strongly that it does-they live in the fibro dark ages). Clinical evidence as old as 1995 shows that FMS represents a distinct rheumatic disorder and should not be regarded as a somatic illness secondary to psychiatric disorder. (Dunne, F. J. and C. A. Dunne, 1995)
Chronic Myofascial Pain (CMP)-Likely the most common cause of musculoskeletal pain in medical practice. Fascia (with the first syllable pronounced like the 'a' in fashion) is the sticky white film you see when skinning chicken you purchase at the store to eat) It gives shape to and supports all your body's musculature and is three-dimensional, holding in place all your organs and skeleton, too. Your muscles are all permeated with their own fascial network too. Kinda complex to explain."
Woke with a stye to pile on top of hayfever swollen eyes, lush, not...
Still off the booze though feel the ghost of temptation today. Will fight.
Interesting stuff on this board... which of my health care professionals are in the dark ages blaming it all on my mind and which , if any believe I have pain, tiredness, etc, etc, etc, etc ad infinitum?
HealthBoards - Anyone with severe back pain & breathing problems?: "Fibro-(FMS) characterized by pain amplification, musculoskeletal discomfort and systemic symptoms. It is a central nervous system sensitization. It may also be inherited, note the words, may be. It is NOT a musculoskeletal disorder, not progressive, not chronic myofascial pain, nor does mental illness have anything to do with it (although some professionals argue strongly that it does-they live in the fibro dark ages). Clinical evidence as old as 1995 shows that FMS represents a distinct rheumatic disorder and should not be regarded as a somatic illness secondary to psychiatric disorder. (Dunne, F. J. and C. A. Dunne, 1995)
Chronic Myofascial Pain (CMP)-Likely the most common cause of musculoskeletal pain in medical practice. Fascia (with the first syllable pronounced like the 'a' in fashion) is the sticky white film you see when skinning chicken you purchase at the store to eat) It gives shape to and supports all your body's musculature and is three-dimensional, holding in place all your organs and skeleton, too. Your muscles are all permeated with their own fascial network too. Kinda complex to explain."
Thursday, May 26, 2005
Thursday aches
Rizla provides "Inspiration comes from every experience of life"
Ripped stomach, but not as in six pack , just soooo sore. Couldn't sleep past 4am.
Upside, still off the booze and no immediate desires felt for a drink despite mothers visit and P fretting about looking after H while G is away...maybe should take him wandering to prevent him wandering.
Ripped stomach, but not as in six pack , just soooo sore. Couldn't sleep past 4am.
Upside, still off the booze and no immediate desires felt for a drink despite mothers visit and P fretting about looking after H while G is away...maybe should take him wandering to prevent him wandering.
Wednesday, May 25, 2005
Wednesday, still on the wagon....
...despite a visit from mother which prompted me to check up on fibro in childhood. No conclusive reports - as expected...
UpToDate Fibromyalgia in children and adolescents: " Fibromyalgia is a poorly understood disease characterized most frequently by chronic and diffuse musculoskeletal pain, severe fatigue, and non-refreshing sleep. Initially described in adults, the disorder also affects children and adolescents [1-4]. Physical examination reveals well-defined areas of the body that are especially sensitive to pressure, referred to as tender points. Affected individuals are predominantly female and in early adolescence at the onset of the disease. The disease may interfere with normal functioning and therefore needs prompt diagnosis and treatment."
We actually managed to talk briefly about some of the painful events of the past...may write tomorrow....
UpToDate Fibromyalgia in children and adolescents: " Fibromyalgia is a poorly understood disease characterized most frequently by chronic and diffuse musculoskeletal pain, severe fatigue, and non-refreshing sleep. Initially described in adults, the disorder also affects children and adolescents [1-4]. Physical examination reveals well-defined areas of the body that are especially sensitive to pressure, referred to as tender points. Affected individuals are predominantly female and in early adolescence at the onset of the disease. The disease may interfere with normal functioning and therefore needs prompt diagnosis and treatment."
We actually managed to talk briefly about some of the painful events of the past...may write tomorrow....
Do supplements help fibromyalgia?
Guaifenesin is one such remedy whose name crops up often. Various studies have been done, the one below concludes: "The guaifenesin treatment also has major psychological benefits. The main one being the ability to picture one's pains in a more optimistic positive light. One's normal response to pain is to reduce activity, as pain is usually a signal to the body that an injury has occurred. Unfortunately, inactivity leads to unconditioned muscles, which is a major problem in many people with fibromyalgia. Constant pain and inactivity can then lead to other problems, such as myofascial pain. Gentle exercies and stretching can be beneficial to both problems. If one is assured that pain is not indicative of an injury, one is more likely to keep active. While on the guaifenesin treatment, pain can be attributed to the reversal process, and is thus thought to be a good sign. Pain is less frightening. Combining this outlook, with increased physical activity, and a possible neurological effect on pain and muscles, could lead to a significant improvement of fibromyalgia."
The author does warn that it does not work for everyone.
The Role of Guaifenesin in Fibromyalgia.: "The Truths and Myths of the use of Guaifenesin for Fibromyalgia (or) Guaifenesin: One Medicine, Several Effects by Mark London"
The author does warn that it does not work for everyone.
The Role of Guaifenesin in Fibromyalgia.: "The Truths and Myths of the use of Guaifenesin for Fibromyalgia (or) Guaifenesin: One Medicine, Several Effects by Mark London"
Fibromyalgia Patients May Benefit From Cough Remedy, UF Study Finds
immunesupport.com: "The underlying cause of fibromyalgia remains unknown, but in the past 25 years substantial progress has been made toward understanding the mechanisms behind specific features of fibromyalgia, Staud said. One is central sensitization, a feature of many chronic pain conditions in which the central nervous system - the brain and spinal cord - somehow magnifies pain signals to abnormally high levels, said Staud, who is affiliated with UF's McKnight Brain Institute.
Central sensitization is associated with wind-up, a phenomenon in which repeated touches - even handshakes or pats on the back - generate lingering pain that increases with each new contact, he said. A normal form of achy, lingering pain known as secondary pain affects anyone who suffers an injury.
The UF researchers - Staud, neuroscientist Charles Vierck, Ph.D., psychologist Michael Robinson, Ph.D., and Donald Price, Ph.D. - were surprised to learn that dextromethorphan eased fibromyalgia patients' wind-up pain to the same degree it soothed secondary pain induced in healthy volunteers, Staud said. The results indicate a long-suspected cause of wind-up may not exist.
Previous studies at other institutions had shown that dextromethorphan blocks the action of a chemical messenger called N-methyl-D-aspartate, or NMDA, which relays pain impulses in the spinal cord. Many fibromyalgia researchers have theorized that wind-up is caused by abnormalities in the spinal-cord structures that process NMDA.
The UF results suggest those structures function normally but that pain impulses are more amplified in fibromyalgia than in healthy participants, Staud said.
'This has refocused much of our research now,' he said. Future UF studies will attempt to pinpoint where the pain impulses are originating. "
Central sensitization is associated with wind-up, a phenomenon in which repeated touches - even handshakes or pats on the back - generate lingering pain that increases with each new contact, he said. A normal form of achy, lingering pain known as secondary pain affects anyone who suffers an injury.
The UF researchers - Staud, neuroscientist Charles Vierck, Ph.D., psychologist Michael Robinson, Ph.D., and Donald Price, Ph.D. - were surprised to learn that dextromethorphan eased fibromyalgia patients' wind-up pain to the same degree it soothed secondary pain induced in healthy volunteers, Staud said. The results indicate a long-suspected cause of wind-up may not exist.
Previous studies at other institutions had shown that dextromethorphan blocks the action of a chemical messenger called N-methyl-D-aspartate, or NMDA, which relays pain impulses in the spinal cord. Many fibromyalgia researchers have theorized that wind-up is caused by abnormalities in the spinal-cord structures that process NMDA.
The UF results suggest those structures function normally but that pain impulses are more amplified in fibromyalgia than in healthy participants, Staud said.
'This has refocused much of our research now,' he said. Future UF studies will attempt to pinpoint where the pain impulses are originating. "
Monday, May 23, 2005
Monday....3 weeks, no booze...
...and still feel shit.
Bone tired, all sorts of joint and muscle pains, hayfever and now weepy every morning.
Being nagged to go back to docs ASAP...
Mother visiting Wednesday.
Weekend was difficult, went to Thirsk races so as to do something different and stay out of the flea pit etc...so what's the first thing P wants when we get to town and no taxi available... a drink in the flea pit, and then he couldnt understand why it was torture to me ..he asked so I told him and he didnt like it. Anyway, I stuck to blackcurrant then and on Sunday in the local - despite his "hints" that a drink might relax me.
Bloody hayfever on top!
Off to the gym to do (gentle) circuits - must take painkillers first.
Bone tired, all sorts of joint and muscle pains, hayfever and now weepy every morning.
Being nagged to go back to docs ASAP...
Mother visiting Wednesday.
Weekend was difficult, went to Thirsk races so as to do something different and stay out of the flea pit etc...so what's the first thing P wants when we get to town and no taxi available... a drink in the flea pit, and then he couldnt understand why it was torture to me ..he asked so I told him and he didnt like it. Anyway, I stuck to blackcurrant then and on Sunday in the local - despite his "hints" that a drink might relax me.
Bloody hayfever on top!
Off to the gym to do (gentle) circuits - must take painkillers first.
Friday, May 20, 2005
What Your Mental Health Worker Should Know About FMS and CMP
About FMS and CMP
What Your Mental Health Worker Should Know by Devin J. Starlanyl
This information may be freely copied and distributed only if unaltered, with complete original content including: © Devin Starlanyl, 2003.
Please read “What Everyone on Your Health Care Team Should Know.”
The combination of fibromyalgia syndrome (FMS) and chronic myofascial pain (CMP) can cause diagnostic confusion and complicate treatment. Central sensitization of FMS may be maintained by peripheral stimulation such as myofascial TrPs (Staud, Smitherman 2002; Borg-Stein 2002). Myofascial TrPs may be more painful due to the central sensitization of FMS. It is important that both conditions are addressed so that the cycle is interrupted. “The most aggressive challenges of the FMS concept have been from legal defenses of insurance carriers motivated by economic concerns. Other forms of critique have presented as psychiatric dogma, uninformed posturing, suspicion of malingering, ignorance of nociceptive physiology, and occasionally have resulted from honest misunderstanding” (Rau, Russell 2000).
Fibromyalgia is real. Your patient may have multiple hormonal and autonomic imbalances, leading to profound physiological and clinical consequences (Adler, Manfredsdottir, Creskoff 2002). It should not be taken lightly. It’s associated with dysautonomia (Raj, Bruillard, Simpson 2000). “Chronic imbalance of the autonomic nervous system is a prevalent and potent risk factor for adverse cardiovascular events, including mortality”(Curtis, O’Keefe 2002).
Myofascial trigger points (TrPs) are associated with autonomic concomitants, as well as proprioceptive disturbances (Simons, Travell, Simons 1999), and these and other TrP symptoms such as eye-twitching may be mistaken as psychogenic. Ask your patients about restricted range of motion with pain at the end of the motion, and the presence of nodules or painful lumps and ropy bands in their muscles.
Some TrP symptoms mimic neurological disorders (Simons, Travell, Simons 1999), and FMS symptoms can as well. Patients with specific patterns of referred pain, indication of nerve, lymph, or blood vessel TrP entrapment, or proprioceptive disturbances should be evaluated for CMP. Patients with diffuse body wide aches of long duration, and with allodynia and/or hyperalgesia should be evaluated for FMS (Starlanyl, Copeland 2001).
Think about how you would feel if you were no longer able to practice your profession . . . if you lost the ability to control your muscles, and sometimes even to think clearly . . . if you couldn’t function in your family role . . . if you were in severe pain, and your ankles were buckling, and you couldn’t even pick up a glass of water without spilling it, and yet your family, your friends and even your doctors thought you were crazy because you looked okay. This is what life is like for many people with FMS and CMP.
Acute pain that diminishes in the course of healing is something most of us can endure. Recurrent or persistent pain, especially when its cause is not recognized, can be intolerable (Gritchnik and Ferrante 1991; Hitchcock, Ferrell and McCaffery 1994). It can lead to frustration, depression, and progressive disability.
There is no specific personality type for patients with CMP (Nelson, Novy 1996) or FMS (Johannson 1993). These and many other studies indicate that “emotional disturbance in pain patients is more likely to be a consequence than a cause of chronic pain”(Gamsa 1990). Cognitive complaints are common in many chronic pain states. In FMS, these deficits are often called “fibrofog” and have been documented (Park, Glass, Minear et al. 2001).
Free-floating anxiety, panic attacks, rapid mood swings, irritability without known cause, difficulty concentrating, inability to recognize familiar surroundings can all part of fibrofog and may be due to neurotransmitter imbalance, but may be complicated by many factors. Pain processing eats up thought processing networks and thus interferes with thinking, reasoning, and remembering (Grisart and Plaghki, 1999).
Pain can disrupt cognitive performances that depend on intact speed and capacity of information processing (Grigsby, Rosenberg, Busenbark 1995). Fibromyalgia can cause slowed psychomotor speed in tasks that require sustained effort (Landro, Stiles, Sletvold 1997). “Sensory overload” is what I call the sense that information and other stimuli are coming so fast the brain can’t handle it. Some patients may go into a fugue state at this point, staring into space until the brain integrates the information. This can even happen during a conversation, mid-sentence. Simple tasks such as putting on socks can be interrupted by fugues, but the patient can often be taught to recognize them and push a mental reset button to resume activities or learn to close down some sensory input such as shutting off the radio or avoiding crowds and cities.
Patients may forget to do tasks they require to minimize physical symptoms. That, plus the additional stress brought about by fibrofog, can lead to flare. Although flare is part of FMS, myofascial TrPs can be activated or new ones can form at this time. Existing symptoms worsen, new symptoms may appear, and patients may require extra support, including bodywork and medication, until the central nervous system calms down. Perpetuating factors must be identified and brought under control.
Confusional states may be compounded by coexisting reactive hypoglycemia (RHG) (Hvidberg, Fanelli, Hershey, et al. 1996; Blackman, Towle, Lewis, et al. 1990; McCrimmon, Deary, Huntly, et al. 1996), a common perpetuator of both FMS and CMP. Chronic stimulation of the HPA axis, usually part of FMS, may contribute to the development of insulin resistance (Farias-Silva, Sampaio-Barros, Amaral et al. 2002). Check for the possible presence of RHG,insulin resistance or metabolic syndrome by asking about your patient’s diet and response to carbohydrates. If present, these conditions require immediate diet modification. In these cases, ensure sufficient protein intake and avoidance of excess carbohydrates in all meals and snacks.
What Your Mental Health Worker Should Know About FMS and CMP by Devin J. Starlanyl © 2003 Page 3
Fibrofog frustration can be doubly difficult for your patient because under its influence, the art of self-expression may be lost or damaged. Difficulty getting out known words, especially nouns and pronouns, difficulty distinguishing right from left and/or difficulty finding places or following directions and sequencing are common, as well as difficulty multitasking. Myofascial TrPs in the laryngeal muscles can create a slow, “halted” speech pattern, or garble sounds. Activation of other TrPs can cause the patient to appear clumsy, drop objects, or even fall down.
If your patient doesn’t show up on time for an appointment, it doesn’t necessarily signify that s/he is noncompliant. Your patient may simply be in a confusional state. Try to schedule appointments at the best time of day for the patient, and the same time every time, and teach patients with timing difficulties some memory aids. Patients experiencing fibrofog often take a hefty amount of abuse from people who are unaware of the reason behind their confused state of mind.
Neurotransmitters are imbalanced in FMS (Russell 1996) and in the endocrine system as well (Pillemer, Bradley, Crofford, et al. 1997). Too little serotonin may cause depression, but there may be many neurotransmitters,hormones and other informational substances imbalanced in FMS, and each of them can affect many others. Many of these informational imbalances may cause symptoms that appear psychological, and this may be part of the picture, but they may have a physiological basis as well.
Many patients with FMS and/or CMP have had repetitive trauma. Emotional symptoms as well as brain function may be affected whenever the cervical spine has been injured (Radanov, Bicik, Dvorak et al.1999). It doesn’t take a major auto accident to cause significant damage. Some brain-disconnects are a consequence of the trauma and not psychological at all (Radanov, Begre, Sturzeneggar et al. 1996).
Some researchers believe that impaired mental function in FMS is daytime sleepiness causing fatigue, in addition to the distraction of persistent pain (Cote, Moldofsky, 1997). Waking up feeling tired and unrefreshed may be a symptom of fragmented sleep disorder, which is common in FMS (Drewes, Gade, Nielsen et al.1995). Sleep deficit can further imbalance the HPA axis stress response (Meerlo, Koehl, van der Borght et al. 2002), so it is vital that this perpetuating factor be addressed. It is not enough that your patients spend eight hours in bed. When they wake, they need to have experienced restorative sleep. Question your patients carefully about sleep quality as well as quantity. They may need medication to regain restorative sleep, and it may take a while to find the right combination of medications, good sleep hygiene and diet that will allow this.
What Your Mental Health Worker Should Know About FMS and CMP by Devin J. Starlanyl © 2003 Page 4
Stress glucocorticoids affect memory acquisition and consolidation processes, as well as memory retrieval mechanisms (de Quervain, Roozendaal, and McGaugh, 1998). As the stress level goes up, fibrofog may rise. A few days of high cortisol levels at concentrations associated with physical and psychological stress can reversibly affect specific kinds of memory performance in even healthy individuals (Newcomer, Selke, Melson et al.1999).
Stress itself can be a major perpetuating factor for both FMS and CMP. Ask about over-the-counter supplements as well as prescribed medication, as they may have a profound psychological impact. For example, inositol may be of benefit for people with FMS and thyroid resistance but should not be taken patients who also have bipolar disorder because it will reverse the actions of lithium, carbamazepine and valproic acid (Williams, Cheng, Mudge et al. 2002).
Fibromyalgia is a disorder of the central nervous system (CNS). “Treatments for FMS should focus on interventions with direct or indirect effects on CNS functions that influence pain sensitivity” (Bradley, McKendree-Smith, Alarcon et al. 2002).
The most intensively studied medications that modulate neurotransmitters are psychoactive drugs. This does not mean that the patient’s condition is psychological. Take time to explain this to your patients. A written handout that the patient may show family members may be helpful to promote understanding.
Fibromyalgia patients usually need medication to help do what their bodies are not doing by themselves, just as diabetics may need insulin. More central acting medications that may be helpful to FMS patients are under development (Suzuki, Dickenson 2002). Patients with these conditions are often significantly under medicated for pain. The patient may pay for their doctor’s lack of current common chronic pain management practice. “Significant knowledge deficits regarding currently accepted principles of pain management practice as well as beliefs that could interfere with optimal care, mandate a need for educational interventions....
Unwarranted fear of addiction is a misunderstood and important concept that needs to be addressed” ( Lebovits, Florence, Bathina et al.1997).
Patients with FMS and CMP have symptoms that may be difficult to unravel and may take time and patience, but you can make a major impact on their lives. This can result in a “take up your bed and walk” phenomenon, and that is a rare enough experience in the medical world. Let’s make it more common.
References
Adler G.K, Manfredsdottir V.F., Creskoff F.W. 2002. Neuroendocrine abnormalities
in fibromyalgia. Curr Headache Rep 6(4):289-98.
Blackman, J.D., V.L. Towle, G.F. Lewis, J.P. Spire and K.S. Polonsky. 1990.
Hypoglycemic thresholds for cognitive dysfunction in humans. Diabetes 39:828–
835.
Borg-Stein J. 2002. Management of peripheral pain generators in fibromyalgia.
2002. Rheum Dis Clin North Am 28(2):305-17.
Bradley L.A., McKendree-Smith N.L. Alarcon G.S. et al. 2002. Is fibromyalgia a
neurologic disease? Curr Pain Headache Rep 6(2):106-14.
Curtis B.M., O’Keefe J.H. Jr. 2002. Autonomic tone as a cardiovascular risk factor:
the dangers of chronic fight or flight. Mayo Clin Proc 398-9;77(1):7-9.
de Quervain, D.J. Roozendaal B., McGaugh J.L. 1998. Stress and glucocorticoids
impair retrieval of long-term spatial memory. Nature 394(6695):787-90.
Drewes, A.M., K. Gade, K.D. Nielsen et al. 1995. Clustering of sleep electroencephalographic
patterns in patients with the fibromyalgia syndrome. Brit J
Rheumatol 34(12):1151–1156.
Farias-Silva E., Sampaio-Barros M.M., Amaral M.E. et al. 2002. Subsensitivity to
insulin in adipocytes from rats submitted to foot-shock stress. Can J Physiol
Pharmacol 80(8):783-9.
Gamsa, A. 1990. Is emotional disturbance a precipitator or a consequence of
chronic pain? Pain 42(2):183–195.
Grigsby, J., N.L. Rosenberg, D. Busenbark. 1995. Chronic pain is associated with
deficits in information processing. Percept Mot Skills 81(2):403–410.
Grisart, J.M., L.H. Plaghki.1999. Impaired selective attention in chronic pain
patients. Eur J Pain 3(4):325-333.
Gritchnik, K.P., F.M. Ferrante. 1991. The difference between acute and chronic
pain. Mt Sinai J Med 58(3):217–220.
Hitchcock, L.S., B.R. Ferrell, M. McCaffery. 1994. The experience of chronic nonmalignant
pain. J Pain Sympt Manage 9(5):312–318.
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Hvidberg, A., C.G. Fanelli, T. Hershey et al. 1996. Impact of recent antecedent
hypoglycemia on hypoglycemic cognitive dysfunction in nondiabetic humans.
Diabetes 45(8):1030–1036.
Johannson, V. 1993. Does a fibromyalgia personality exist? J Musculoskel Pain
1(3/4):245–252.
Landro, N.I., T.C. Stiles, H. Sletvold. 1997. Memory functioning in patients with
primary fibromyalgia and depression on healthy controls. J Psychosomatic
Research 42(3):297-306.
Lebovits A.H., Florence I, Bathina R. et al. 1997. Pain knowledge and attitudes of
health care providers: practice characteristic differences. Clin J Pain 13(3):237-
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McCrimmon, R.J., I.J. Deary, B.J.P. Huntly et al. 1996. Visual information
processing during controlled hypoglycaemia in humans. Brain 119(4):1277-1287.
Nelson, D.V., D.M. Novy. 1996. No unique psychological profile found for patients
with reflex sympathetic dystrophy or myofascial pain syndrome. Regional Anesth
21(3): 202–208.
Newcomer, J.W., G. Selke, A.K. Melson et al. 1999. Decreased memory
performance in healthy humans induced by stress-level cortisol treatment. Arch
Gen Psychiatry 56(6):527-33.
Pillemer S.R., Bradley L.A., Crofford L.J. et al. 1997. The neuroscience and
endocrinology of fibromyalgia. Arth Rheum 40(11):1928-1939.
Park D.C., Glass J.M., Minear M. et al. 2001. Cognitive function in fibromyalgia
patients. Arthritis Rheum 44(9):2125-33.
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variables in whiplash injury — a 2 year follow up with age, gender and education
pair matched patients. Pain 64(3):429-434.
Radanov, B.P., I. Bicik, J. Dvorak et al. 1999. Relation between neuropsychological
and neuroimaging findings in patients with late whiplash syndrome. J Neurol
Neurosurg Psychiatry 66(4):485-9.
Raj S.R., Bruillard D., Simpson C.S. 2000. Dysautonomia among patients with
fibromyalgia: a noninvasive assessment. J Rheumatol 27(11):2660-5.
Rau, C.L., Russell I.J. 2000. Is fibromyalgia a distinct clinical syndrome? Curr Rev
Pain 4(4):287-294.
What Your Mental Health Worker Should Know About FMS and CMP
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Russell I. J. 1996. Neurochemical pathogenesis of fibromyalgia syndrome. J
Musculoskel Pain 4(1-2):61-92.
Simons, D.G., J.G. Travell, L.S. Simons. 1998. Myofascial Pain and Dysfunction:
The Trigger Point Manual, Volume 1, edition II: The Upper Body. Baltimore:
Williams and Wilkins
Starlanyl, D.J., M.E. Copeland. 2001. Fibromyalgia and Chronic Myofascial Pain: A
Survival Manual. Oakland: New Harbinger Publications.
Staud R., Smitherman M.L. 2002. Peripheral and central sensitization in
fibromyalgia: pathogenic role. Curr Pain Headache Rep 6:259-266.
Suzuki R., Dickenson A.H. 2002. Neuropharmcologic targets and agents in
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What Your Mental Health Worker Should Know by Devin J. Starlanyl
This information may be freely copied and distributed only if unaltered, with complete original content including: © Devin Starlanyl, 2003.
Please read “What Everyone on Your Health Care Team Should Know.”
The combination of fibromyalgia syndrome (FMS) and chronic myofascial pain (CMP) can cause diagnostic confusion and complicate treatment. Central sensitization of FMS may be maintained by peripheral stimulation such as myofascial TrPs (Staud, Smitherman 2002; Borg-Stein 2002). Myofascial TrPs may be more painful due to the central sensitization of FMS. It is important that both conditions are addressed so that the cycle is interrupted. “The most aggressive challenges of the FMS concept have been from legal defenses of insurance carriers motivated by economic concerns. Other forms of critique have presented as psychiatric dogma, uninformed posturing, suspicion of malingering, ignorance of nociceptive physiology, and occasionally have resulted from honest misunderstanding” (Rau, Russell 2000).
Fibromyalgia is real. Your patient may have multiple hormonal and autonomic imbalances, leading to profound physiological and clinical consequences (Adler, Manfredsdottir, Creskoff 2002). It should not be taken lightly. It’s associated with dysautonomia (Raj, Bruillard, Simpson 2000). “Chronic imbalance of the autonomic nervous system is a prevalent and potent risk factor for adverse cardiovascular events, including mortality”(Curtis, O’Keefe 2002).
Myofascial trigger points (TrPs) are associated with autonomic concomitants, as well as proprioceptive disturbances (Simons, Travell, Simons 1999), and these and other TrP symptoms such as eye-twitching may be mistaken as psychogenic. Ask your patients about restricted range of motion with pain at the end of the motion, and the presence of nodules or painful lumps and ropy bands in their muscles.
Some TrP symptoms mimic neurological disorders (Simons, Travell, Simons 1999), and FMS symptoms can as well. Patients with specific patterns of referred pain, indication of nerve, lymph, or blood vessel TrP entrapment, or proprioceptive disturbances should be evaluated for CMP. Patients with diffuse body wide aches of long duration, and with allodynia and/or hyperalgesia should be evaluated for FMS (Starlanyl, Copeland 2001).
Think about how you would feel if you were no longer able to practice your profession . . . if you lost the ability to control your muscles, and sometimes even to think clearly . . . if you couldn’t function in your family role . . . if you were in severe pain, and your ankles were buckling, and you couldn’t even pick up a glass of water without spilling it, and yet your family, your friends and even your doctors thought you were crazy because you looked okay. This is what life is like for many people with FMS and CMP.
Acute pain that diminishes in the course of healing is something most of us can endure. Recurrent or persistent pain, especially when its cause is not recognized, can be intolerable (Gritchnik and Ferrante 1991; Hitchcock, Ferrell and McCaffery 1994). It can lead to frustration, depression, and progressive disability.
There is no specific personality type for patients with CMP (Nelson, Novy 1996) or FMS (Johannson 1993). These and many other studies indicate that “emotional disturbance in pain patients is more likely to be a consequence than a cause of chronic pain”(Gamsa 1990). Cognitive complaints are common in many chronic pain states. In FMS, these deficits are often called “fibrofog” and have been documented (Park, Glass, Minear et al. 2001).
Free-floating anxiety, panic attacks, rapid mood swings, irritability without known cause, difficulty concentrating, inability to recognize familiar surroundings can all part of fibrofog and may be due to neurotransmitter imbalance, but may be complicated by many factors. Pain processing eats up thought processing networks and thus interferes with thinking, reasoning, and remembering (Grisart and Plaghki, 1999).
Pain can disrupt cognitive performances that depend on intact speed and capacity of information processing (Grigsby, Rosenberg, Busenbark 1995). Fibromyalgia can cause slowed psychomotor speed in tasks that require sustained effort (Landro, Stiles, Sletvold 1997). “Sensory overload” is what I call the sense that information and other stimuli are coming so fast the brain can’t handle it. Some patients may go into a fugue state at this point, staring into space until the brain integrates the information. This can even happen during a conversation, mid-sentence. Simple tasks such as putting on socks can be interrupted by fugues, but the patient can often be taught to recognize them and push a mental reset button to resume activities or learn to close down some sensory input such as shutting off the radio or avoiding crowds and cities.
Patients may forget to do tasks they require to minimize physical symptoms. That, plus the additional stress brought about by fibrofog, can lead to flare. Although flare is part of FMS, myofascial TrPs can be activated or new ones can form at this time. Existing symptoms worsen, new symptoms may appear, and patients may require extra support, including bodywork and medication, until the central nervous system calms down. Perpetuating factors must be identified and brought under control.
Confusional states may be compounded by coexisting reactive hypoglycemia (RHG) (Hvidberg, Fanelli, Hershey, et al. 1996; Blackman, Towle, Lewis, et al. 1990; McCrimmon, Deary, Huntly, et al. 1996), a common perpetuator of both FMS and CMP. Chronic stimulation of the HPA axis, usually part of FMS, may contribute to the development of insulin resistance (Farias-Silva, Sampaio-Barros, Amaral et al. 2002). Check for the possible presence of RHG,insulin resistance or metabolic syndrome by asking about your patient’s diet and response to carbohydrates. If present, these conditions require immediate diet modification. In these cases, ensure sufficient protein intake and avoidance of excess carbohydrates in all meals and snacks.
What Your Mental Health Worker Should Know About FMS and CMP by Devin J. Starlanyl © 2003 Page 3
Fibrofog frustration can be doubly difficult for your patient because under its influence, the art of self-expression may be lost or damaged. Difficulty getting out known words, especially nouns and pronouns, difficulty distinguishing right from left and/or difficulty finding places or following directions and sequencing are common, as well as difficulty multitasking. Myofascial TrPs in the laryngeal muscles can create a slow, “halted” speech pattern, or garble sounds. Activation of other TrPs can cause the patient to appear clumsy, drop objects, or even fall down.
If your patient doesn’t show up on time for an appointment, it doesn’t necessarily signify that s/he is noncompliant. Your patient may simply be in a confusional state. Try to schedule appointments at the best time of day for the patient, and the same time every time, and teach patients with timing difficulties some memory aids. Patients experiencing fibrofog often take a hefty amount of abuse from people who are unaware of the reason behind their confused state of mind.
Neurotransmitters are imbalanced in FMS (Russell 1996) and in the endocrine system as well (Pillemer, Bradley, Crofford, et al. 1997). Too little serotonin may cause depression, but there may be many neurotransmitters,hormones and other informational substances imbalanced in FMS, and each of them can affect many others. Many of these informational imbalances may cause symptoms that appear psychological, and this may be part of the picture, but they may have a physiological basis as well.
Many patients with FMS and/or CMP have had repetitive trauma. Emotional symptoms as well as brain function may be affected whenever the cervical spine has been injured (Radanov, Bicik, Dvorak et al.1999). It doesn’t take a major auto accident to cause significant damage. Some brain-disconnects are a consequence of the trauma and not psychological at all (Radanov, Begre, Sturzeneggar et al. 1996).
Some researchers believe that impaired mental function in FMS is daytime sleepiness causing fatigue, in addition to the distraction of persistent pain (Cote, Moldofsky, 1997). Waking up feeling tired and unrefreshed may be a symptom of fragmented sleep disorder, which is common in FMS (Drewes, Gade, Nielsen et al.1995). Sleep deficit can further imbalance the HPA axis stress response (Meerlo, Koehl, van der Borght et al. 2002), so it is vital that this perpetuating factor be addressed. It is not enough that your patients spend eight hours in bed. When they wake, they need to have experienced restorative sleep. Question your patients carefully about sleep quality as well as quantity. They may need medication to regain restorative sleep, and it may take a while to find the right combination of medications, good sleep hygiene and diet that will allow this.
What Your Mental Health Worker Should Know About FMS and CMP by Devin J. Starlanyl © 2003 Page 4
Stress glucocorticoids affect memory acquisition and consolidation processes, as well as memory retrieval mechanisms (de Quervain, Roozendaal, and McGaugh, 1998). As the stress level goes up, fibrofog may rise. A few days of high cortisol levels at concentrations associated with physical and psychological stress can reversibly affect specific kinds of memory performance in even healthy individuals (Newcomer, Selke, Melson et al.1999).
Stress itself can be a major perpetuating factor for both FMS and CMP. Ask about over-the-counter supplements as well as prescribed medication, as they may have a profound psychological impact. For example, inositol may be of benefit for people with FMS and thyroid resistance but should not be taken patients who also have bipolar disorder because it will reverse the actions of lithium, carbamazepine and valproic acid (Williams, Cheng, Mudge et al. 2002).
Fibromyalgia is a disorder of the central nervous system (CNS). “Treatments for FMS should focus on interventions with direct or indirect effects on CNS functions that influence pain sensitivity” (Bradley, McKendree-Smith, Alarcon et al. 2002).
The most intensively studied medications that modulate neurotransmitters are psychoactive drugs. This does not mean that the patient’s condition is psychological. Take time to explain this to your patients. A written handout that the patient may show family members may be helpful to promote understanding.
Fibromyalgia patients usually need medication to help do what their bodies are not doing by themselves, just as diabetics may need insulin. More central acting medications that may be helpful to FMS patients are under development (Suzuki, Dickenson 2002). Patients with these conditions are often significantly under medicated for pain. The patient may pay for their doctor’s lack of current common chronic pain management practice. “Significant knowledge deficits regarding currently accepted principles of pain management practice as well as beliefs that could interfere with optimal care, mandate a need for educational interventions....
Unwarranted fear of addiction is a misunderstood and important concept that needs to be addressed” ( Lebovits, Florence, Bathina et al.1997).
Patients with FMS and CMP have symptoms that may be difficult to unravel and may take time and patience, but you can make a major impact on their lives. This can result in a “take up your bed and walk” phenomenon, and that is a rare enough experience in the medical world. Let’s make it more common.
References
Adler G.K, Manfredsdottir V.F., Creskoff F.W. 2002. Neuroendocrine abnormalities
in fibromyalgia. Curr Headache Rep 6(4):289-98.
Blackman, J.D., V.L. Towle, G.F. Lewis, J.P. Spire and K.S. Polonsky. 1990.
Hypoglycemic thresholds for cognitive dysfunction in humans. Diabetes 39:828–
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Borg-Stein J. 2002. Management of peripheral pain generators in fibromyalgia.
2002. Rheum Dis Clin North Am 28(2):305-17.
Bradley L.A., McKendree-Smith N.L. Alarcon G.S. et al. 2002. Is fibromyalgia a
neurologic disease? Curr Pain Headache Rep 6(2):106-14.
Curtis B.M., O’Keefe J.H. Jr. 2002. Autonomic tone as a cardiovascular risk factor:
the dangers of chronic fight or flight. Mayo Clin Proc 398-9;77(1):7-9.
de Quervain, D.J. Roozendaal B., McGaugh J.L. 1998. Stress and glucocorticoids
impair retrieval of long-term spatial memory. Nature 394(6695):787-90.
Drewes, A.M., K. Gade, K.D. Nielsen et al. 1995. Clustering of sleep electroencephalographic
patterns in patients with the fibromyalgia syndrome. Brit J
Rheumatol 34(12):1151–1156.
Farias-Silva E., Sampaio-Barros M.M., Amaral M.E. et al. 2002. Subsensitivity to
insulin in adipocytes from rats submitted to foot-shock stress. Can J Physiol
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Gamsa, A. 1990. Is emotional disturbance a precipitator or a consequence of
chronic pain? Pain 42(2):183–195.
Grigsby, J., N.L. Rosenberg, D. Busenbark. 1995. Chronic pain is associated with
deficits in information processing. Percept Mot Skills 81(2):403–410.
Grisart, J.M., L.H. Plaghki.1999. Impaired selective attention in chronic pain
patients. Eur J Pain 3(4):325-333.
Gritchnik, K.P., F.M. Ferrante. 1991. The difference between acute and chronic
pain. Mt Sinai J Med 58(3):217–220.
Hitchcock, L.S., B.R. Ferrell, M. McCaffery. 1994. The experience of chronic nonmalignant
pain. J Pain Sympt Manage 9(5):312–318.
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Hvidberg, A., C.G. Fanelli, T. Hershey et al. 1996. Impact of recent antecedent
hypoglycemia on hypoglycemic cognitive dysfunction in nondiabetic humans.
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Johannson, V. 1993. Does a fibromyalgia personality exist? J Musculoskel Pain
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Landro, N.I., T.C. Stiles, H. Sletvold. 1997. Memory functioning in patients with
primary fibromyalgia and depression on healthy controls. J Psychosomatic
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Lebovits A.H., Florence I, Bathina R. et al. 1997. Pain knowledge and attitudes of
health care providers: practice characteristic differences. Clin J Pain 13(3):237-
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McCrimmon, R.J., I.J. Deary, B.J.P. Huntly et al. 1996. Visual information
processing during controlled hypoglycaemia in humans. Brain 119(4):1277-1287.
Nelson, D.V., D.M. Novy. 1996. No unique psychological profile found for patients
with reflex sympathetic dystrophy or myofascial pain syndrome. Regional Anesth
21(3): 202–208.
Newcomer, J.W., G. Selke, A.K. Melson et al. 1999. Decreased memory
performance in healthy humans induced by stress-level cortisol treatment. Arch
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Pillemer S.R., Bradley L.A., Crofford L.J. et al. 1997. The neuroscience and
endocrinology of fibromyalgia. Arth Rheum 40(11):1928-1939.
Park D.C., Glass J.M., Minear M. et al. 2001. Cognitive function in fibromyalgia
patients. Arthritis Rheum 44(9):2125-33.
Radanov, B.P., Begre S., Sturzeneggar M. et al. 1996. Course of psychological
variables in whiplash injury — a 2 year follow up with age, gender and education
pair matched patients. Pain 64(3):429-434.
Radanov, B.P., I. Bicik, J. Dvorak et al. 1999. Relation between neuropsychological
and neuroimaging findings in patients with late whiplash syndrome. J Neurol
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Raj S.R., Bruillard D., Simpson C.S. 2000. Dysautonomia among patients with
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Russell I. J. 1996. Neurochemical pathogenesis of fibromyalgia syndrome. J
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Simons, D.G., J.G. Travell, L.S. Simons. 1998. Myofascial Pain and Dysfunction:
The Trigger Point Manual, Volume 1, edition II: The Upper Body. Baltimore:
Williams and Wilkins
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Staud R., Smitherman M.L. 2002. Peripheral and central sensitization in
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Suzuki R., Dickenson A.H. 2002. Neuropharmcologic targets and agents in
fibromyalgia. Curr Pain Headache Rep 6(4):267-73.
Williams R.S., Cheng L., Mudge A.W. et al. 2002. A common mechanism of action
for three mood-stabilizing drugs. Nature 417(6886):292-295.
Fibromyalgia & Chronic Myofascial Pain Syndrome (FMS MPS) D Starlanyl
Excellent website: Fibromyalgia and Chronic Myofascial Pain Syndrome
I am speechless...
Devin's Diagnostic: "Symptom List and Possible Causes
Childhood growing pains: [early TrPs]
'Traveling' nocturnal sinus stuffiness: [pterygoid, sternocleidomastoid, posterior digastric]
Allergies: (FMS)
Post nasal drip: (FMS), [pterygoid, sternocleidomastoid]
Drooling in sleep: [internal medial pterygoid]
Swollen glands: [digastric]
Difficulty swallowing: [digastric, pterygoid]
Dry cough: [lower end sternal sternocleidomastoid]
TMJ symptoms: [masseter, trapezius, temporalis, pterygoid]
Dizziness when turning head or changing field of view: [sternocleidomastoid], (H)
Runny nose: (FMS), [sternocleidomastoid, pterygoid]
Sore throat: [sternocleidomastoid, digastric, pterygoid]
Stiff neck: [levator scapulae]
Mold/yeast sensitivity: (FMS), (H)
Reflux esophagitis: [external oblique], (H)
Headaches/migraines: (FMS), [trapezius, sternocleidomastoid, temporalis, splenii, suboccipital, semispinalis capitis, frontalis, zygomaticus major, cutaneous facial, posterior cervical], (H)
Light and/or broken sleep pattern with unrefreshing sleep: (FMS)
Sweats: (FMS), (H)
Morning stiffness: (FMS), [multiple TrPs]
Fatigue: (FMS), [multiple TrPs], (H)
Shortness of breath: (FMS) [serratus anterior, diaphragm, other respiratory muscles], (H)
Painful weak grip that may let go: [infraspinatus, scaleni, hand extensors, brachioradialis]
Menstrual problems and/or pelvic pain: (FMS), [coccygeus, levator ani, obturator internus, high adductor magnus, abdominal obliques]
PMS: (FMS)
Loss of libido: (FMS)
Low back pain: "
I am speechless...
Devin's Diagnostic: "Symptom List and Possible Causes
Childhood growing pains: [early TrPs]
'Traveling' nocturnal sinus stuffiness: [pterygoid, sternocleidomastoid, posterior digastric]
Allergies: (FMS)
Post nasal drip: (FMS), [pterygoid, sternocleidomastoid]
Drooling in sleep: [internal medial pterygoid]
Swollen glands: [digastric]
Difficulty swallowing: [digastric, pterygoid]
Dry cough: [lower end sternal sternocleidomastoid]
TMJ symptoms: [masseter, trapezius, temporalis, pterygoid]
Dizziness when turning head or changing field of view: [sternocleidomastoid], (H)
Runny nose: (FMS), [sternocleidomastoid, pterygoid]
Sore throat: [sternocleidomastoid, digastric, pterygoid]
Stiff neck: [levator scapulae]
Mold/yeast sensitivity: (FMS), (H)
Reflux esophagitis: [external oblique], (H)
Headaches/migraines: (FMS), [trapezius, sternocleidomastoid, temporalis, splenii, suboccipital, semispinalis capitis, frontalis, zygomaticus major, cutaneous facial, posterior cervical], (H)
Light and/or broken sleep pattern with unrefreshing sleep: (FMS)
Sweats: (FMS), (H)
Morning stiffness: (FMS), [multiple TrPs]
Fatigue: (FMS), [multiple TrPs], (H)
Shortness of breath: (FMS) [serratus anterior, diaphragm, other respiratory muscles], (H)
Painful weak grip that may let go: [infraspinatus, scaleni, hand extensors, brachioradialis]
Menstrual problems and/or pelvic pain: (FMS), [coccygeus, levator ani, obturator internus, high adductor magnus, abdominal obliques]
PMS: (FMS)
Loss of libido: (FMS)
Low back pain: "
Fed up
Not because of not drinking but because of...
Pain.... sciatica like in right hip so have to roll out of bed, tendonitis like pain in right shoulder again with manky, weak arm to boot...plus hot needles into elbows and knees.
Fatigue... have absolutly had to go back to bed the past two afternoons and slept both times but still fell asleep early downstairs watching TV with P ...woke both following mornings about 6am so small consolation is that sleep pattern is not totally buggered again.
Can the above really be due to past drinking habits? Fibromyalgia seems a much closer fit....
Fibromyalgia: "Fibromyalgia
Fibromyalgia syndrome is a condition where pain occurs in muscles and surrounding structures without any obvious tissue damage. The pain is usually widespread and people often experience fatigue. Fibromyalgia affects mostly women, between the ages of 35 to 60 years, from all nationalities and culture groups. It can also affect children.
The symptoms of fibromyalgia can go up and down. Many people find the symptoms are at their worst first thing in the morning and last thing at night. The symptoms can be mild, moderate or severe. There may be extended periods of time - perhaps even years - when symptoms disappear. Other people have pain every day. Or there may be variations between these two extremes. It is thought that around three to five per cent of Australians suffer from fibromyalgia.
Symptoms - commonThe symptoms of fibromyalgia can vary widely from mild, moderate to severe. The most common symptoms include any of the following:
Fatigue and exhaustion.
Pain - which may present in a variety of ways (such as aching, burning, throbbing or stabbing). The pain may be generalised or localised.
Sleep disturbance.
Headaches.
Stiffness, usually worse in the morning.
Symptoms - other
Some people with fibromyalgia may also have other symptoms, such as irritable bowel syndrome, cystitis, and swelling and numbness or tingling in the arms and legs. These symptoms tend to be worse first thing in the morning and last thing at night. The symptoms may be present every day, or recur in bouts lasting days, weeks or months, or any variation in between."
Pain.... sciatica like in right hip so have to roll out of bed, tendonitis like pain in right shoulder again with manky, weak arm to boot...plus hot needles into elbows and knees.
Fatigue... have absolutly had to go back to bed the past two afternoons and slept both times but still fell asleep early downstairs watching TV with P ...woke both following mornings about 6am so small consolation is that sleep pattern is not totally buggered again.
Can the above really be due to past drinking habits? Fibromyalgia seems a much closer fit....
Fibromyalgia: "Fibromyalgia
Fibromyalgia syndrome is a condition where pain occurs in muscles and surrounding structures without any obvious tissue damage. The pain is usually widespread and people often experience fatigue. Fibromyalgia affects mostly women, between the ages of 35 to 60 years, from all nationalities and culture groups. It can also affect children.
The symptoms of fibromyalgia can go up and down. Many people find the symptoms are at their worst first thing in the morning and last thing at night. The symptoms can be mild, moderate or severe. There may be extended periods of time - perhaps even years - when symptoms disappear. Other people have pain every day. Or there may be variations between these two extremes. It is thought that around three to five per cent of Australians suffer from fibromyalgia.
Symptoms - commonThe symptoms of fibromyalgia can vary widely from mild, moderate to severe. The most common symptoms include any of the following:
Fatigue and exhaustion.
Pain - which may present in a variety of ways (such as aching, burning, throbbing or stabbing). The pain may be generalised or localised.
Sleep disturbance.
Headaches.
Stiffness, usually worse in the morning.
Symptoms - other
Some people with fibromyalgia may also have other symptoms, such as irritable bowel syndrome, cystitis, and swelling and numbness or tingling in the arms and legs. These symptoms tend to be worse first thing in the morning and last thing at night. The symptoms may be present every day, or recur in bouts lasting days, weeks or months, or any variation in between."
Thursday, May 19, 2005
Fibromyalgia & Chronic Fatigue Syndrome Specialists on Diet & Nutrition
immunesupport.com: Review of various (USA) "Diet & Nutritional Supplement Recommendations from Leading Fibromyalgia & Chronic Fatigue Syndrome Physicians by Lee Ann Stiff ImmuneSupport.com"
Stiff provides a comprehensive review of the theories of the leading Fibro specialists as to causes and related diet advice including supplements.
Some highlights include:
Charles W. Lapp, M.D.: PWCs do not tolerate several items: sugar, caffeine, alcohol, tobacco, and excitotoxins like MSG and aspartame (Nutrasweet, Equal). Saccharin (Sweet N’ Low) is satisfactory, however. These are remembered by the mnemonic SCATE. Many patients with loose stools may find that reducing dairy and gluten (wheat, barley, oats and rye) intake may help...
Mark J. Pellegrino, M.D., US leading experts on fibromyalgia. Dr. Pellegrino is the author of books and articles on FM, has FM himself, recommends specific dietary strategies for fatigue, namely a diet higher in protein and lower in carbohydrates...research supports that those with fibromyalgia have low or below normal levels of magnesium, thyroid, growth hormone, B-12 levels and serotonin, among others. If low or below normal deficiencies are identified, I recommend specific supplementation. For fatigue, I often recommend supplements that include magnesium and malic acid, colostrum, and NADH, among others. I also recommend specific dietary strategies for fatigue, namely a diet higher in protein and lower in carbohydrates...
Dr. Nicolson recommends a controlled diet, two-thirds of which is composed of vegetables, one-sixth starch and one-sixth protein. The vegetables should be green, orange, and yellow and the majority of vegetables eaten should be cooked. The starch should be whole grain and include complex carbohydrates. The protein can include chicken, fish, beans and lean, well-cooked meats. While some fruit is okay, a large concern of Dr. Nicolson is keeping dietary sugars low.
Stiff concludes: " talk to your healthcare provider or a qualified nutritionist familiar with FM and CFS about the changes you’d like to make in your own life. Will your most aggravating symptoms lessen or disappear altogether through changing your diet? You’ll never know until you try, but chances are, making simple changes to your diet and addressing your nutritional deficiencies will make you feel a whole lot better -- and will make your body stronger to continue on the road to wellness."
I personally am sure from a long process of ellimination that dairy and processed carbs are main culprits in worsening my fibromyalgia symptoms...i am curious to see how I will react to alcohol when I re-introduce it...18 days off the booze now....
Fibromyalgia hot books
Stiff provides a comprehensive review of the theories of the leading Fibro specialists as to causes and related diet advice including supplements.
Some highlights include:
Charles W. Lapp, M.D.: PWCs do not tolerate several items: sugar, caffeine, alcohol, tobacco, and excitotoxins like MSG and aspartame (Nutrasweet, Equal). Saccharin (Sweet N’ Low) is satisfactory, however. These are remembered by the mnemonic SCATE. Many patients with loose stools may find that reducing dairy and gluten (wheat, barley, oats and rye) intake may help...
Mark J. Pellegrino, M.D., US leading experts on fibromyalgia. Dr. Pellegrino is the author of books and articles on FM, has FM himself, recommends specific dietary strategies for fatigue, namely a diet higher in protein and lower in carbohydrates...research supports that those with fibromyalgia have low or below normal levels of magnesium, thyroid, growth hormone, B-12 levels and serotonin, among others. If low or below normal deficiencies are identified, I recommend specific supplementation. For fatigue, I often recommend supplements that include magnesium and malic acid, colostrum, and NADH, among others. I also recommend specific dietary strategies for fatigue, namely a diet higher in protein and lower in carbohydrates...
Dr. Nicolson recommends a controlled diet, two-thirds of which is composed of vegetables, one-sixth starch and one-sixth protein. The vegetables should be green, orange, and yellow and the majority of vegetables eaten should be cooked. The starch should be whole grain and include complex carbohydrates. The protein can include chicken, fish, beans and lean, well-cooked meats. While some fruit is okay, a large concern of Dr. Nicolson is keeping dietary sugars low.
Stiff concludes: " talk to your healthcare provider or a qualified nutritionist familiar with FM and CFS about the changes you’d like to make in your own life. Will your most aggravating symptoms lessen or disappear altogether through changing your diet? You’ll never know until you try, but chances are, making simple changes to your diet and addressing your nutritional deficiencies will make you feel a whole lot better -- and will make your body stronger to continue on the road to wellness."
I personally am sure from a long process of ellimination that dairy and processed carbs are main culprits in worsening my fibromyalgia symptoms...i am curious to see how I will react to alcohol when I re-introduce it...18 days off the booze now....
Fibromyalgia hot books
Wednesday, May 18, 2005
Alcoholism, Merck Manual plus...
THE MERCK MANUAL, Sec. 15, Ch. 195, Drug Use And Dependence< : "Alcoholism is considered a chronic illness of undetermined etiology, with an insidious onset and with recognizable symptoms and signs proportionate to its severity. Consumption of large amounts of ethanol usually causes significant clinical toxicity and tissue damage, physical dependence, and a dangerous withdrawal syndrome. The term alcoholism also refers to the social impairment in the lives of alcoholics and their families. Usually, both aspects of alcoholism are recognized simultaneously, but occasionally one predominates to the apparent exclusion of the other. Ethanol is dangerous partly because it is weak. A satisfactory dose is measured in glassfuls, not micrograms or milligrams. Repeated consumption exposes many cells to toxicity.
An alcoholic is identified by severe dependence or addiction and a cumulative pattern of characteristic behaviors. Frequent intoxication is obvious and destructive; it interferes with the ability to socialize and to work. Eventually, drunkenness may lead to failed relationships as well as job loss due to work absenteeism. Alcoholics may incur physical injury, be apprehended for driving while intoxicated, or be arrested for drunkenness. Alcoholics may seek medical treatment for their drinking. Eventually, they may be hospitalized for delirium tremens or cirrhosis. The earlier in life these behaviors are evident, the more crippling the disorder. Women alcoholics are, in general, more likely to drink alone and are less likely to experience some of the social stigmas."
The DT's: Delirium tremens usually begins 48 to 72 h after alcohol withdrawal, with anxiety attacks, increasing confusion, poor sleep (with frightening dreams or nocturnal illusions), marked sweating, and profound depression. Fleeting hallucinations that arouse restlessness, fear, and even terror are common. Typical of the initial delirious, confused, and disoriented state is a return to a habitual activity; eg, the patient frequently imagines that he is back at work and attempts to perform some related activity...
Detoxification: First, alcohol is withdrawn. After correction of nutritional deficiencies associated with excessive alcohol intake (see Thiamine Deficiency and Dependency in Ch. 3), the patient's behavior must be changed to achieve sobriety. Maintaining sobriety is difficult. The patient should be warned that after a few weeks, when he has recovered from his last bout, he is likely to find an excuse to drink. He should also be told that he may be able to drink in a controlled manner for a few days or, rarely, for a few weeks, but he will most likely drink without control again."
Detoxification and withdrawal. Treatment may begin with a program of detoxification, usually taking about four to seven days. You may need to take sedating medications to prevent delirium tremens or other withdrawal seizures.
Medical assessment and treatment. Common medical problems related to alcoholism are high blood pressure, increased blood sugar, and liver and heart disease.
Psychological support and psychiatric treatment. Group and individual counseling and therapy support recovery from the psychological aspects of alcoholism. Sometimes, emotional symptoms of the disease may mimic psychiatric disorders.
Sticky red blood cells?????
Alcoholism: "Laboratory Tests. Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. Certain blood tests, however, may provide biologic markers that suggest medical problems associated with alcoholism or indications of alcohol abuse:
Carbohydrate-deficient transferrin (CDT). This compound is a marker for heavy drinking and can be helpful in monitoring patients for progress towards abstinence.
Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive to alcohol and can be elevated after moderate alcohol intake and in chronic alcoholism.
Aspartate (AST) and alanine aminotransaminases (ALT). These are liver enzymes and are markers for liver damage.
Testosterone. Male hormone levels in men with alcoholism may be low. (Such results sometimes persuade men with alcoholism to seek help.)
Mean corpuscular volume (MCV). This blood test measures the size of red blood cells, which increase with alcohol use over time."
An alcoholic is identified by severe dependence or addiction and a cumulative pattern of characteristic behaviors. Frequent intoxication is obvious and destructive; it interferes with the ability to socialize and to work. Eventually, drunkenness may lead to failed relationships as well as job loss due to work absenteeism. Alcoholics may incur physical injury, be apprehended for driving while intoxicated, or be arrested for drunkenness. Alcoholics may seek medical treatment for their drinking. Eventually, they may be hospitalized for delirium tremens or cirrhosis. The earlier in life these behaviors are evident, the more crippling the disorder. Women alcoholics are, in general, more likely to drink alone and are less likely to experience some of the social stigmas."
The DT's: Delirium tremens usually begins 48 to 72 h after alcohol withdrawal, with anxiety attacks, increasing confusion, poor sleep (with frightening dreams or nocturnal illusions), marked sweating, and profound depression. Fleeting hallucinations that arouse restlessness, fear, and even terror are common. Typical of the initial delirious, confused, and disoriented state is a return to a habitual activity; eg, the patient frequently imagines that he is back at work and attempts to perform some related activity...
Detoxification: First, alcohol is withdrawn. After correction of nutritional deficiencies associated with excessive alcohol intake (see Thiamine Deficiency and Dependency in Ch. 3), the patient's behavior must be changed to achieve sobriety. Maintaining sobriety is difficult. The patient should be warned that after a few weeks, when he has recovered from his last bout, he is likely to find an excuse to drink. He should also be told that he may be able to drink in a controlled manner for a few days or, rarely, for a few weeks, but he will most likely drink without control again."
Detoxification and withdrawal. Treatment may begin with a program of detoxification, usually taking about four to seven days. You may need to take sedating medications to prevent delirium tremens or other withdrawal seizures.
Medical assessment and treatment. Common medical problems related to alcoholism are high blood pressure, increased blood sugar, and liver and heart disease.
Psychological support and psychiatric treatment. Group and individual counseling and therapy support recovery from the psychological aspects of alcoholism. Sometimes, emotional symptoms of the disease may mimic psychiatric disorders.
Sticky red blood cells?????
Alcoholism: "Laboratory Tests. Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. Certain blood tests, however, may provide biologic markers that suggest medical problems associated with alcoholism or indications of alcohol abuse:
Carbohydrate-deficient transferrin (CDT). This compound is a marker for heavy drinking and can be helpful in monitoring patients for progress towards abstinence.
Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive to alcohol and can be elevated after moderate alcohol intake and in chronic alcoholism.
Aspartate (AST) and alanine aminotransaminases (ALT). These are liver enzymes and are markers for liver damage.
Testosterone. Male hormone levels in men with alcoholism may be low. (Such results sometimes persuade men with alcoholism to seek help.)
Mean corpuscular volume (MCV). This blood test measures the size of red blood cells, which increase with alcohol use over time."
Herbal extract kudzu helps cut binge drinking
Health News Article | Reuters.com: "Reuters Health - Heavy drinkers who tried the herbal extract kudzu for one week downed fewer drinks than people who received an inactive placebo treatment, according to new study findings released Monday.
Study author Dr. Scott E. Lukas of McLean Hospital and Harvard Medical Center in Massachusetts explained that during the experiment, people drank their first beer right away, but were less likely to want more beer if they had taken kudzu the previous week.
"This means that the first beer must have satisfied their initial desire for alcohol," Lukas suggested.
He said that kudzu may also help deliver blood to the brain, making people more satisfied with less alcohol. "
...researchers asked 14 men and women who averaged 25 drinks per week to try either the concentrated kudzu for one week or a placebo drug. Then each participant visited a small studio apartment, complete with an entertainment center, where they had free access to alcoholic and non-alcoholic beverages for 90 minutes.
Participants had to place their drinks on a specially designed end table that measured how quickly they were downing the drink.
After 7 days on either kudzu or the placebo, each participant switched to the other for another 7 days, and returned to the studio apartment.
The investigators found that when people received kudzu, they drank 1.5 fewer beers during their time in the apartment, and took more, smaller sips to finish each drink."
Study author Dr. Scott E. Lukas of McLean Hospital and Harvard Medical Center in Massachusetts explained that during the experiment, people drank their first beer right away, but were less likely to want more beer if they had taken kudzu the previous week.
"This means that the first beer must have satisfied their initial desire for alcohol," Lukas suggested.
He said that kudzu may also help deliver blood to the brain, making people more satisfied with less alcohol. "
...researchers asked 14 men and women who averaged 25 drinks per week to try either the concentrated kudzu for one week or a placebo drug. Then each participant visited a small studio apartment, complete with an entertainment center, where they had free access to alcoholic and non-alcoholic beverages for 90 minutes.
Participants had to place their drinks on a specially designed end table that measured how quickly they were downing the drink.
After 7 days on either kudzu or the placebo, each participant switched to the other for another 7 days, and returned to the studio apartment.
The investigators found that when people received kudzu, they drank 1.5 fewer beers during their time in the apartment, and took more, smaller sips to finish each drink."
Incapacity benefit overhaul at heart of welfare reforms
SocietyGuardian.co.uk | Society |: "Tuesday May 17, 2005 "The government today confirmed it will push ahead with reform of incapacity benefit - the most costly and controversial budget in the welfare system.
The incapacity benefit bill will split the current benefit in two, with the bulk of less-sick claimants facing a financial cut if they fail to attend interviews designed to prepare them for work. The claimants with more severe conditions - roughly 20% of those on benefit - will be placed on a new higher rate."
How will this affect those with chronic fatigue, psychiatric and other similar illnesses?
The incapacity benefit bill will split the current benefit in two, with the bulk of less-sick claimants facing a financial cut if they fail to attend interviews designed to prepare them for work. The claimants with more severe conditions - roughly 20% of those on benefit - will be placed on a new higher rate."
How will this affect those with chronic fatigue, psychiatric and other similar illnesses?
Sunny Wednesday
and I have woken up knackered...
Nothing much to report from Dr's visit except that she signed me off for two months. Just keep on doing what I am doing..gym, eat healithly and not partake of the demon drink maintaining that drink is the likely cause of all my aches pains and tiredness... no mention of fibromyalgia. Next blood test end of June.
Have to admit to having indulged in a few more refined carbs than is probably good for me - joints today feel like pin cushions.
BLT - bum, leg, tum - class was a sweaty one yesterday but new gym is a huge improvment on the council and works out cheaper as the monthly £28 includes any classes I want to do and use of sauna.
P is continuing to be very supportive, he has only had three and a half pints of beer in the past few weeks.
Already fretting about mothers visit next week and all the questions I still have.
Nothing much to report from Dr's visit except that she signed me off for two months. Just keep on doing what I am doing..gym, eat healithly and not partake of the demon drink maintaining that drink is the likely cause of all my aches pains and tiredness... no mention of fibromyalgia. Next blood test end of June.
Have to admit to having indulged in a few more refined carbs than is probably good for me - joints today feel like pin cushions.
BLT - bum, leg, tum - class was a sweaty one yesterday but new gym is a huge improvment on the council and works out cheaper as the monthly £28 includes any classes I want to do and use of sauna.
P is continuing to be very supportive, he has only had three and a half pints of beer in the past few weeks.
Already fretting about mothers visit next week and all the questions I still have.
Tuesday, May 17, 2005
Tuesday - still no booze
Hmmm, weekend entries seem to have gone awol, anyway, joint pains and tiredness still cruel with added joys of hayfever on top. Sunday went to the Tree - blackcuuant for me, P had 2 limes and one pint. Reckons feeling not so grim Monday mornings helps....
I have also been very tetchy, impossible to say if that is anxiety, stress, withdrawal, new tablets or what..
Off to see Dr B (GP) in 10 minutes then to the gym for BLT so have to be brief.
I have also been very tetchy, impossible to say if that is anxiety, stress, withdrawal, new tablets or what..
Off to see Dr B (GP) in 10 minutes then to the gym for BLT so have to be brief.
Sunday, May 15, 2005
Drug and Alcohol Rehab and Treatment Alternatives...
Drug and Alcohol Rehab and Treatment Alternative at the St Jude Retreat House: "the treatment with the best overall score was by far brief intervention, followed by social skills training and motivational enhancements. Brief intervention is as simple as having the client agree to reduce his or her drinking or drugging or to refrain from drinking and drugging altogether. Motivational enhancement involves the client deciding what is important in his or her life and then adjusting his or her drinking and drugging accordingly. Both processes are far less confrontational than the methods generally employed in conventional treatment, and, actually, motivational enhancement is designed to be completely non-confrontational."
Sunday, still dry
Zero alcohol Thursday, Friday, Saturday and have still felt shite.
Mainly joint pain and sheer bone tiredness with low mood and sweats still. It really is such an effort to do anything...steeled myself to go to town yesterday with P as there was a fair bit of shopping needed and both thought getting out would be good for me.
My short fuse and extreme touchiness was a problem as he seemed to jump down my throat every time I said anything. But shopping done and a coffee and 2 blackcurrants for me two pints and an italian lager for him...things settled down, Maybe because he seemed to take on board how worried I am that my lack of libido along with the whole situation is going to destroy us.
Have been keeping to low carb, high fruit and veg apart from chinese take away treat last night but am probably drinking too much tea.
I must get things done ready for holidays...
Rizla quote: "Relax: the only person you can control is yourself."
Mainly joint pain and sheer bone tiredness with low mood and sweats still. It really is such an effort to do anything...steeled myself to go to town yesterday with P as there was a fair bit of shopping needed and both thought getting out would be good for me.
My short fuse and extreme touchiness was a problem as he seemed to jump down my throat every time I said anything. But shopping done and a coffee and 2 blackcurrants for me two pints and an italian lager for him...things settled down, Maybe because he seemed to take on board how worried I am that my lack of libido along with the whole situation is going to destroy us.
Have been keeping to low carb, high fruit and veg apart from chinese take away treat last night but am probably drinking too much tea.
I must get things done ready for holidays...
Rizla quote: "Relax: the only person you can control is yourself."
Thursday, May 12, 2005
Dry Tues & Wed
Somehow have not had time to update the past couple of days, must be all the appointments, new gym regime and maybe the good weather.
Back to see CBT nurse tuesday, seemed a little more sympathetic but still very keen to get me to the heavy counselling ASAP. She rang to ask and appointment is 16 weeks away. Conclusion today seemed to be keep on with more of the same, no alcohol although wine with meals on holiday got the nod, perhaps consider increased the anti depressants dose and that all my aches and pains are due to stress.
When I described the joint pains as "people sticking needles into me" the hallucinations/ schizo alarm visibly went off with her immediatly asking me who is sticking pins in me so I had to explain that is merely my description of the pains in my joints. Wonder what she would make of my T-Shirt of pain? A hair shirt perhaps???
I have signed up at the Ladies only gym and am confident that it is a good move. I feel much more at ease there and all classes are included in the monthly fee so it works out cheaper than the council gym & classes.
Have to go and choose some glasses today, my left eye is very short sigted. Hope they will help me line up the printer.
Hayfever is full on, had to buy anti-histamine eye drops, instant relief from swelling, running and pain.
Have kept to low carb - sweats and fibro pains are improving although feel 99% knackered.
Met P after gym/ work yesterday, he was obviously gagging for a pint so suggested it and went to Flea pit - blackcurrant for me - found it difficult that he seemed to want to stay longer than me especially after he accused me of being sarcastic when I tried to thank him for his support which had made possible a good day for me yesterday. Fair bit of "edge" wafting off him.
Our dentist really let himself down badly with his comments about the stains on my teeth having been there for years so the hygenist shouldn't be too bothered about them. To me that sums up the attitude of many in the health service.
Back to see CBT nurse tuesday, seemed a little more sympathetic but still very keen to get me to the heavy counselling ASAP. She rang to ask and appointment is 16 weeks away. Conclusion today seemed to be keep on with more of the same, no alcohol although wine with meals on holiday got the nod, perhaps consider increased the anti depressants dose and that all my aches and pains are due to stress.
When I described the joint pains as "people sticking needles into me" the hallucinations/ schizo alarm visibly went off with her immediatly asking me who is sticking pins in me so I had to explain that is merely my description of the pains in my joints. Wonder what she would make of my T-Shirt of pain? A hair shirt perhaps???
I have signed up at the Ladies only gym and am confident that it is a good move. I feel much more at ease there and all classes are included in the monthly fee so it works out cheaper than the council gym & classes.
Have to go and choose some glasses today, my left eye is very short sigted. Hope they will help me line up the printer.
Hayfever is full on, had to buy anti-histamine eye drops, instant relief from swelling, running and pain.
Have kept to low carb - sweats and fibro pains are improving although feel 99% knackered.
Met P after gym/ work yesterday, he was obviously gagging for a pint so suggested it and went to Flea pit - blackcurrant for me - found it difficult that he seemed to want to stay longer than me especially after he accused me of being sarcastic when I tried to thank him for his support which had made possible a good day for me yesterday. Fair bit of "edge" wafting off him.
Our dentist really let himself down badly with his comments about the stains on my teeth having been there for years so the hygenist shouldn't be too bothered about them. To me that sums up the attitude of many in the health service.
Monday, May 09, 2005
Research: Treating depression may not necessarily alleviate chronic pain
Clinical Psychiatry News: "Researchers recommend treating pain and depression independently after finding that the sensory regions of the brain associated with pain are only weakly correlated with the emotional brain regions linked to depression.
Reporting in the journal Arthritis and Rheumatism, Thorsten Giesecke (University of Michigan, Ann Arbor, USA) and colleagues say that their findings indicate that treating an individual's depression by prescribing an antidepressant medication that has no analgesic properties 'will not necessarily have an impact on the sensory dimension of pain...'
..the researchers interviewed 53 patients with fibromyalgia, a condition characterized by widespread pain and tenderness to touch, along with 42 healthy individuals, about the severity of their chronic pain and depressive symptoms.
In addition, both the fibromyalgia patients and controls participated in a pressure-pain sensitivity test, during which pressure was applied to the thumbnail.... significantly less pressure was needed to cause acute pain in the patients with fibromyalgia than was needed for controls. However, the investigators found that this heightened sensitivity to pain was unaffected by the extent of depressive symptoms or the presence of comorbid major depressive disorder.
Magnetic resonance imaging scans carried out before, during, and after the pressure-sensitivity tests showed that, while symptoms of depression and comorbid major depressive disorder were associated with the magnitude of pain-evoked neuronal activations in brain regions associated with emotional pain processing, they were not linked to the sensory aspects of pain processing, such as where the pain is and its intensity.
"It appears as though there are different and easily distinguished sensory and affective elements to each individual's pain experience," says the team. "There are strong data suggesting that these elements are somewhat independent of one another and respond differentially to both pharmacologic and nonpharmacologic interventions." "
Reporting in the journal Arthritis and Rheumatism, Thorsten Giesecke (University of Michigan, Ann Arbor, USA) and colleagues say that their findings indicate that treating an individual's depression by prescribing an antidepressant medication that has no analgesic properties 'will not necessarily have an impact on the sensory dimension of pain...'
..the researchers interviewed 53 patients with fibromyalgia, a condition characterized by widespread pain and tenderness to touch, along with 42 healthy individuals, about the severity of their chronic pain and depressive symptoms.
In addition, both the fibromyalgia patients and controls participated in a pressure-pain sensitivity test, during which pressure was applied to the thumbnail.... significantly less pressure was needed to cause acute pain in the patients with fibromyalgia than was needed for controls. However, the investigators found that this heightened sensitivity to pain was unaffected by the extent of depressive symptoms or the presence of comorbid major depressive disorder.
Magnetic resonance imaging scans carried out before, during, and after the pressure-sensitivity tests showed that, while symptoms of depression and comorbid major depressive disorder were associated with the magnitude of pain-evoked neuronal activations in brain regions associated with emotional pain processing, they were not linked to the sensory aspects of pain processing, such as where the pain is and its intensity.
"It appears as though there are different and easily distinguished sensory and affective elements to each individual's pain experience," says the team. "There are strong data suggesting that these elements are somewhat independent of one another and respond differentially to both pharmacologic and nonpharmacologic interventions." "
Monday,Monday
Still zero alcohol...
Quiet day, still ache all over and needles being continually inserted into various joints plus a heavy foggy head. Mixed up writing is still evident..the thought of words - or numbers - I want to write are in my head but come out of the pen scrambled, way weird...
Anyway, menu today...low income becoming evident.
Eggs, scrambled with tomato
Pear & nuts
Cold chicken & salad.
Quiet day, still ache all over and needles being continually inserted into various joints plus a heavy foggy head. Mixed up writing is still evident..the thought of words - or numbers - I want to write are in my head but come out of the pen scrambled, way weird...
Anyway, menu today...low income becoming evident.
Eggs, scrambled with tomato
Pear & nuts
Cold chicken & salad.
Sunday, May 08, 2005
Sunday, still dry
And that's not the weather which has thrown hail and thunder at us the past couple of days, but me. Achieved despite still feeling grim - low mood, uptight and pointless plus all the usual aches and pains. Knees are particularly exquisite this morning if you go for that sort of thing. Going upstairs is a chore but should feel better as the day goes by. Best time by far seems to be evenings for both mood and physical stuff...
However I took both co-prox and diclofenic at bedtime ...11 pm-ish, and fingers crossed, they seemed to help me sleep better, nightmares woke me and toilet trips but not pain or sweats so I will repeat tonight and hope
Seems I find the no booze far, far easier than does P, on his mind constantly although he has really made an effort the past couple of days.
Knackered all day, early night - 9pm
Menu
Zero alcohol
UK tea...
Blackcurrant & soda X 3 at Green Tree
Mushrooms and rye toast for breakfast
Roast chicken, stuffing, cabbage, peas and 2 small new potatoes
However I took both co-prox and diclofenic at bedtime ...11 pm-ish, and fingers crossed, they seemed to help me sleep better, nightmares woke me and toilet trips but not pain or sweats so I will repeat tonight and hope
Seems I find the no booze far, far easier than does P, on his mind constantly although he has really made an effort the past couple of days.
Knackered all day, early night - 9pm
Menu
Zero alcohol
UK tea...
Blackcurrant & soda X 3 at Green Tree
Mushrooms and rye toast for breakfast
Roast chicken, stuffing, cabbage, peas and 2 small new potatoes
Saturday, May 07, 2005
It's Saturday
4.30pm and just got round to starting this entry cos still fell like crap despite no alcohol since last Sunday.
Someone somewhere must have my voodoo doll out and is sticking long hot needles into my elbows, neck and wrists. They are also stretching and twanging rubber bands up my forearms. My pelvis is still stiff and I waddle untill they loosen up.
Mood is pretty snappy and low...easily weepy.
Had a poor nights sleep last night, went to bed ~ 11pm after P got back from H's and started waking waking regularly from midnight on, gave up and got up and 5.30 am, no way could I have got back to sleep but can feel the different depth of tiredness today.
P went to town for bits of shopping so have had v quiet day, were hoping to go for a walk but weather has turned stormy. Good news is that he offerred to buy himself soft drinks for his lunch hour to try to knock pints on the head. No real prompting from me for that one...
Menu
English brekkie....organic sausage, tinned toms, bacon and egg.
Finished cauli cheese for lunch....
Not hungry later when made dinner for P so had a couple of pears and handful of nuts. Maybe too much cauli as guts were rolling and gurgling alarmingly but mebeverine seems to be keeping irritable bowel symptoms to a minimum number of dashes a day.
Someone somewhere must have my voodoo doll out and is sticking long hot needles into my elbows, neck and wrists. They are also stretching and twanging rubber bands up my forearms. My pelvis is still stiff and I waddle untill they loosen up.
Mood is pretty snappy and low...easily weepy.
Had a poor nights sleep last night, went to bed ~ 11pm after P got back from H's and started waking waking regularly from midnight on, gave up and got up and 5.30 am, no way could I have got back to sleep but can feel the different depth of tiredness today.
P went to town for bits of shopping so have had v quiet day, were hoping to go for a walk but weather has turned stormy. Good news is that he offerred to buy himself soft drinks for his lunch hour to try to knock pints on the head. No real prompting from me for that one...
Menu
English brekkie....organic sausage, tinned toms, bacon and egg.
Finished cauli cheese for lunch....
Not hungry later when made dinner for P so had a couple of pears and handful of nuts. Maybe too much cauli as guts were rolling and gurgling alarmingly but mebeverine seems to be keeping irritable bowel symptoms to a minimum number of dashes a day.
Friday, May 06, 2005
Dentists day
P is off with me today for a trip to the Dentists. He is still saying that he is up for no booze for at least this weekend....
Good news is I slept much better last night only waking a couple of times - needed toilet - and also because of bad dreams. Bad news still feel like shite, knackered, achey and dis-cordinated.
Definite problems navigating the pavement traffic yesterday on top of dyslexic writing stuff (numbers and words) wrong words coming out my mouth or not finding words I want to say, eg names of people I know well...clumsiness and return of slight incontinence.
Looked at glasses as P needs new pair, made appt for me as I am overdue and also still worry about blurred vision and the visual disturbances Dr B thinks are visual migraines...buggers sto me doing anything much although it is a bonus that I no longer get pain and sickness with migraines...although have had a sub-migraine headache now for what feels like months but is probably only a few weeks...plus ca change...
Did finally ring my mother after putting it off cos of S not wanting her to know and give her hard time about breaak up...also finally told her I am off work and about meds change and upcoming therapy. Got the usual "lets hope they find out what is wrong with you....end for now.
Todays Menu
No alcohol
Spinach & garlic omelette for breakfast
Americano coffee & cantucinni biscuit at The Cafe
Cauliflower cheese ( soya spread for fat. soya milk, non dairy parmesan cheese.)
Pear & nuts
Tea, herb teas, water...painkillers (co-prox) for headache, joint and muscle pains.
Good news is I slept much better last night only waking a couple of times - needed toilet - and also because of bad dreams. Bad news still feel like shite, knackered, achey and dis-cordinated.
Definite problems navigating the pavement traffic yesterday on top of dyslexic writing stuff (numbers and words) wrong words coming out my mouth or not finding words I want to say, eg names of people I know well...clumsiness and return of slight incontinence.
Looked at glasses as P needs new pair, made appt for me as I am overdue and also still worry about blurred vision and the visual disturbances Dr B thinks are visual migraines...buggers sto me doing anything much although it is a bonus that I no longer get pain and sickness with migraines...although have had a sub-migraine headache now for what feels like months but is probably only a few weeks...plus ca change...
Did finally ring my mother after putting it off cos of S not wanting her to know and give her hard time about breaak up...also finally told her I am off work and about meds change and upcoming therapy. Got the usual "lets hope they find out what is wrong with you....end for now.
Todays Menu
No alcohol
Spinach & garlic omelette for breakfast
Americano coffee & cantucinni biscuit at The Cafe
Cauliflower cheese ( soya spread for fat. soya milk, non dairy parmesan cheese.)
Pear & nuts
Tea, herb teas, water...painkillers (co-prox) for headache, joint and muscle pains.
Thursday, May 05, 2005
A few months, weeks , days on
Not sure how long I have been signed off now...was hoping to feel at least a bit better by now but it doesn't seem to be the case. Sleep seems to have improved a little but patchy, night before last was abysmal, had to get up 'cos legs had "gone" and was tossing and turning then later was waking every hour and fully awake from 4am...
The "dyslexic" hand writing is still evident ...I know what I want to write but the letters of the words come out garbled or order of numbers, am having some trouble finding words again and the odd ones are also garbled when I talk... which isnt often given my isolated life.
Second visit (v quick because bus was v late) with Mrs B the CBT specialist Tuesday at the surgery... the emphasis was full on getting me to go to alcohol counselling with the underlying message that "everything" is linked to my drinking too much...she seemed to think that I met Pete for an alcoholic drink every lunch time. Truth is we maybe meet once a fortnight at lunch and I have soft drinks, blackcurrant or coffee sometimes if I can get him to go the The Cafe with me.
Weekends are my weak point. As we almost always fail to plan to do anything different we drift into "let's have just one" when out shopping and after a couple I want a couple more... physically however about 8 units max and off home to sleep for me nowadays so I am not able to drink to the excesses of my youth...
Right now (Thurs) I have had no alcohol since Sunday and feel like shite...full on muscle aches, sweats, headache, bone tired etc etc.Cold turkey symptoms or?????
Anyway, I have promised myself and told P that I intend to stay sober till next appointment next Tuesday, ie no alcohol at all. As always he said yeah, I'm with you on that....
Menu Del Dia
Alcohol: Zero
Breakfast: Scrambled eggs with asparagus & smoked salmon
Lunch: Pear...
Dinner: pan fried chicken (olive oil) with garlic, lardons and fresh herbs with steamed asparagus & 2 small new potatoes, stawberries & mixed berries with dairy free iced dessert
About 5 cups of tea, 1 americano coffee at the Cafe, 2 glasses blackcurrent & soda when wen to see Zoe. Lots of filtered water also.
The "dyslexic" hand writing is still evident ...I know what I want to write but the letters of the words come out garbled or order of numbers, am having some trouble finding words again and the odd ones are also garbled when I talk... which isnt often given my isolated life.
Second visit (v quick because bus was v late) with Mrs B the CBT specialist Tuesday at the surgery... the emphasis was full on getting me to go to alcohol counselling with the underlying message that "everything" is linked to my drinking too much...she seemed to think that I met Pete for an alcoholic drink every lunch time. Truth is we maybe meet once a fortnight at lunch and I have soft drinks, blackcurrant or coffee sometimes if I can get him to go the The Cafe with me.
Weekends are my weak point. As we almost always fail to plan to do anything different we drift into "let's have just one" when out shopping and after a couple I want a couple more... physically however about 8 units max and off home to sleep for me nowadays so I am not able to drink to the excesses of my youth...
Right now (Thurs) I have had no alcohol since Sunday and feel like shite...full on muscle aches, sweats, headache, bone tired etc etc.Cold turkey symptoms or?????
Anyway, I have promised myself and told P that I intend to stay sober till next appointment next Tuesday, ie no alcohol at all. As always he said yeah, I'm with you on that....
Menu Del Dia
Alcohol: Zero
Breakfast: Scrambled eggs with asparagus & smoked salmon
Lunch: Pear...
Dinner: pan fried chicken (olive oil) with garlic, lardons and fresh herbs with steamed asparagus & 2 small new potatoes, stawberries & mixed berries with dairy free iced dessert
About 5 cups of tea, 1 americano coffee at the Cafe, 2 glasses blackcurrent & soda when wen to see Zoe. Lots of filtered water also.
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