Fibro Falling

“How did you break your ankle?”

I get asked that a lot: I’m still limping, 7 months later. I was walking in Bali and I fell. No motor bikes. No bicycles. No alcohol. No bumpy footpaths. No drugs. Just walking. I fell.

Gait and balance are severely impaired in women with fibromyalgia, according to “Altered Functional Performance in Patients with Fibromyalgia” published in the journal Frontiers in Human Neuroscience.

Only women were included in this study as the vast majority (80%-90%) of people affected by fibromyalgia are women. The study showed that walking speed was significantly reduced in women with fibromyalgia, compared to women without pain, probably due to the reduction in stride length and frequency.

When the researchers analysed the association of gait and balance impairment with functional performance and the level of pain, they found that high levels of pain, depression, stiffness, anxiety, and fatigue (DUH!) were the main parameters associated with reduced gait and balance.

Finally, the researchers reported that they observed an abnormal pattern of body sways during balance tasks in fibromyalgia patients. They thought this could be associated with changes in the motor control system, and might explain why fibromyalgia patients experience a higher rate of falls.

Overall, the findings highlighted the relevant role of postural control and balance for daily activity functioning in fibromyalgia patients.

So, I’m doing hydrotherapy, pilates, deep-water running, recumbent cycling and indoor rowing.

Bring on the strong core muscles, a 6-pack and balance!

Where, oh Where…?

So, I’ve spent most of the day looking at current research and trying to find something to write about; BUT it’s all so BLAH!

203. acupunctureYes, acupuncture has been found to help those suffering from FM – where’s the new information in that?

Yes, marijuana has been shown to help those suffering from FM – where’s the new information in that?

Yes, dysmenorrhea is especially common in FM – where’s the new information in that?

Obesity, tai-chi, hydrotherapy,  shiatsu, reflexology, yoga – it’s all the same…there is nothing new!

I’ve kept reading, checking Facebook, watching tweets and I can’t find anything! And, obviously, I have done nothing else to tell you about. So, I’m setting you a mission: can you find (somewhere, anywhere) something new about FM?

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Treat Your Pain

Many experts believe the best treatment for fibromyalgia is a multifaceted approach that combines medication with lifestyle changes and alternative treatments. And, it looks like Mommy and I have been left alone to learn how to manage/treat/cope/handle/survive (choose the most appropriate verb) my fibromyalgia. Having read lots of your stories and received plenty of advice, I am working on my own treatment plan – do I have a choice?

But what about if you’re new to all of this? Where do you even start?

A treatment plan gives structure to getting from here to there. Be realistic and (yes, you’re already probably sick of hearing this already) small steps! A treatment plan is different from devising goals because of its flexibility and internal exploration. In most clinical settings, a treatment plan review is done quarterly or even monthly. After each review, the plan is rewritten to meet current needs.

Start With a Diagnosis

There are no lab tests for fibromyalgia. Doctors diagnose it by considering criteria such as how long you’ve had pain and how widespread it is, and by ruling out other causes. This can be a long and complicated process because the symptoms associated with fibromyalgia can be caused by other conditions. So it’s best to see a doctor who is familiar with fibromyalgia – which can be easier said than done, sometimes!

Learn About Fibromyalgia Medications – You are YOUR Best Advocate!

Once you’ve been diagnosed with fibromyalgia, your doctor will talk to you about treatment options. Several types of medicines are used to help manage fibromyalgia symptoms such as pain and fatigue.

Three medications are FDA-approved to treat fibromyalgia:

  • Cymbalta (duloxetine): a type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI). Researchers aren’t sure how Cymbalta works in fibromyalgia, but they think that increasing levels of serotonin and norepinephrine help control and reduce feelings of pain.
  • Lyrica (pregabalin): Lyrica is a nerve pain and epilepsy drug. In people with fibromyalgia, it may help calm down overly sensitive nerve cells that send pain signals throughout the body. It has been effective in treating fibro pain.
  • Savella (milnacipran): Savella is also an SNRI. While researchers aren’t exactly sure how it works, studies have shown that it helps relieve pain and reduce fatigue in people with fibromyalgia.

Antidepressants are also sometimes prescribed to help people manage fibromyalgia symptoms:

  • Tricyclic antidepressants. By helping increase levels of the brain chemicals serotonin and norepinephrine, these medications may help relax painful muscles and enhance the body’s natural painkillers.
  • Selective serotonin reuptake inhibitors (SSRIs). Your doctor may prescribe one of these types of antidepressants by itself or in combination with a tricyclic antidepressant. SSRIs prevent serotonin from being reabsorbed in the brain. This may help ease pain and fatigue.

These medications are also sometimes prescribed for fibromyalgia:

  • Local anesthetics. Injected into especially tender areas, anesthetics can provide some temporary relief, usually for no longer than three months.
  • Anticonvulsants or seizure medications such as Neurontin are effective for reducing pain and anxiety. It is unclear how these medications work to relieve the symptoms in fibromyalgia.
  • Muscle Relaxants are occasionally prescribed to help alleviate pain associate with muscle strain in those with fibromyalgia.

Stay Active

Exercise is an important part of managing fibromyalgia symptoms. Staying physically active can relieve pain, stress, and anxiety.

The key is to start slowly. Begin with stretching and low-impact activities, such as walking, swimming or other water exercises, or bicycling. Low-impact aerobic exercises such as yoga, tai chi, or Pilates can also be helpful. Prior to starting any exercise routine, or if you want to increase the intensity of your exercise, talk with your doctor.

Physical Therapy

Physical therapy can help you get control of your illness by focusing on what you can do to improve your situation, rather than on your chronic symptoms.

A physical therapist can show you how to get temporary relief from fibromyalgia pain and stiffness, get stronger, and improve your range of motion. And she can help you make little changes, such as practicing good posture, that help prevent painful flare-ups.

Alternative Therapies

A number of popular fibromyalgia treatments fall outside the realm of mainstream medicine. In general, there hasn’t been extensive research on complementary and alternative medicine (CAM), but anecdotal evidence suggests that some may work. Always talk with your doctor before starting any alternative treatment.

Popular alternative treatments include:

  • Acupuncture. This ancient healing practice aims to increase blood flow and production of natural painkillers with thin needles inserted into the skin at strategic points on the body. Some studies report that acupuncture may help ease pain, anxiety, and fatigue.
  • Massage therapy. This may help reduce muscle tension, ease pain in both muscles and soft tissue,improve range of motion, and boost production of natural painkillers.
  • Chiropractic treatment. Based on spinal adjustments to reduce pain, this popular therapy may help relieve fibromyalgia symptoms.
  • Supplements. A number of dietary and other supplements are touted as treatments aimed at relieving fibromyalgia symptoms. Some of the most popular for fibromyalgia include magnesium, melatonin, 5-HTP, and SAMe, which may affect serotonin levels. However, results of studies on these supplements are mixed. Be sure to talk with your doctor before taking any supplements. Some may have side effects and could react badly with medication you are taking.
  • Herbs. As with supplements, scientific evidence for the effectiveness of herbs is mixed. A few studies have shown that St. John’s wort can be as effective as certain prescription medication for treating mild depression.

This is just a start – and you will probably need to tweak your plan as you go along, throwing out activities and treatments that don’t work for you, while grasping the positives with both hands. Remember, it may take a while to get where you want to be – it is all about experimentation (and just because something works for me does not mean it will work for you). Lastly, try not to get discouraged (Ha!) but we’re all here to support you.

A Balanced Body

Ahh…BodyBalance:

BODYBALANCE™ is the Yoga, Tai Chi, Pilates workout that builds flexibility and strength and leaves you feeling centred and calm. Controlled breathing, concentration and a carefully structured series of stretches, moves and poses to music create a holistic workout that brings the body into a state of harmony and balance.

The class started with a tai-chi warm-up…cool – I can handle that! Then, into some of the yoga moves that I had done previously. When we hit the downward dog,

I had to dodge Mommy’s dirty looks – what the hell have you gotten me into? Down into the plank – if looks could kill!

The Plank!

And onto the mat for the yucky part – pilates core workout! Guess what? I still haven’t developed any stomach muscles (ummm…and it seems neither has Mommy!) More yoga, some flowing tai chi and finishing with a 10 minute meditation to clear the mind.

(I haven’t gone into great detail because the class was definitely, as promised, a fusion of all three other classes: yoga, pilates and tai-chi as described in previous posts).

I must say that the final meditation was very much appreciated, as I dripped sweat onto my mat and waited to be scraped from the floor.

Earlier in the day, Mommy and I went to visit the doctor (rheumatologist #3). I tried to motivate him with the promise of fame, fortune and untold riches (He could be the One! The One who could show empathy! The One who could publish numerous journal articles! The One that all FM patients would seek!) Erm…it seems he wasn’t interested.

So, the plan is:

  1. maintain Lyrica dosage – 150 mg am & pm (til step 6);
  2. stop taking the Prednisolone (no weaning as I was only on it for a week);
  3. visit GP on Friday to start weaning off Sertraline (anti-depressant actually being used for depression) over the week;
  4. no anti-depressant for one week (should be some interesting posts that week!);
  5. start Cymbalta (until we find correct dose for my depression);
  6. reduce morning dose Lyrica;
  7. reduce evening dose Lyrica.

Of course, steps 6 and 7 will only be attempted if necessary; and step 5 may take quite a while. If at any stage, I find that everything feels better, then I’ll be leaving it as is. I have a follow-up appointment with Rheumatologist #3 in 3 months.

So it looks like it’s up to me and Mommy (and my poor GP – she doesn’t know yet! with as much input from you guys as you feel like giving) to discover the secret (at least, the one that works for me) behind managing the pain, fatigue and fog and returning to work.

Started One Place…Finished Elsewhere

And back from Pilates

…having first asked them to display some Awareness:

But this post isn’t about the Awareness Campaign, it’s about my lousy night’s sleep last night…you know that sleep where you feel that you’re only ‘drowsing’ (is that a real word?) in and out, where anything can and does wake you, where you open your eyes and you’re still too tired to move or get up but you can’t fall back to sleep properly, where it feels like hours but it’s only been 4 minutes since you looked at the clock, where you never feel refreshed; and where you still have highly vivid dreams.

I am assuming that all of this is because I didn’t take my zolpidem last night and went with the melatonin – but I fell asleep well enough, I just couldn’t stay asleep……And I’m so tired but, at least, I know why.

I have been involved in some very carefully plotted murders, ending up by me running into a court and interrupting, holding a milk carton, and telling them to wait in a very dramatic turn of events.Think black and white movie a la 12 Angry Men, but with loads of action scenes a la NCIS and Criminal Minds; then add strobe.

It’s very difficult to watch and it hurts my head and my eyes, but I can’t really do anything about it as it’s playing on the huge screen in my head.

I always wake up before I know what happens next – no matter how much I fight to get back to that place in the movie. I don’t know if I actually wake up or if I was dreaming in my dream of me dreaming and waking up. All I know is that when I finally wake up (properly), I feel like I have done some big time running and thinking!

It is with that background that I attended Pilates today. On my walk to the gym, my stomach muscles began protesting – how did they know where I was going? It’s been a week since the previous class, so I had thought that any left-over delayed onset muscle soreness would have disappeared – WRONG! the minute I tried to do anything from the table top position (hee! hee! aren’t I the expert?), my transversus abdominus and internal oblique muscles began to scream. I would have thought that I would have been able to do more (as compared the previous class) this week – WRONG again! Not only did everything hurt more but I seemed to be much more uncoordinated. My entire balance was off, way off! And the room was spinning before my eyes after every new movement.

Think this will turn me off it? Not yet, I’m going back Thursday evening – the stretching still felt amazing (at the time, anyway)!

Pilates Pleasure

Yesterday, I downloaded my FREE 14 day pass to the local gym (which is very local – it’s about 500 metres down the street!) and went to have a chat to a lovely lady about my condition and what her gym could do for me. We talked about the yoga and Pilates sessions; and we talked about what would happen after the 14 days was up. (I had to explain that I was absolutely broke and had to be very careful about where I chose to invest my limited funds.) Firstly, she gave me an extra week on my pass. Then she said that, if I find the classes are working for me, she could work out a special price so I could attend just those classes and not have to pay for the use of the entire gym. WOW! Nice lady!

To today:

Getting out of bed early, so my body will be functioning (not necessarily well), for a 9.20am Pilates class is not easy, but I’m motivated and I promised you guys a report…

So, I just got out of the shower (yes! I had a shower) after cooling down from the session. And I gotta say: Whoo Eee! (that’s a shout of glee!)Am I feeling energised! Already my muscles ache – but it’s a different sensation than the FM pain. It’s the pleasurable awareness that all my muscles are there and have been stretched and manipulated. (For those who don’t have sex very often, it’s sort of like the day after feeling…yeah, you feel tired and achy but hey! It was worth it and let’s do it again!)

Now I didn’t do that kind of stuff!

We did Mat-based Pilates (not so easy to get up off the floor at the end, though) – this is a series of exercises performed on the floor using gravity and your own body weight to provide the resistance. The central aim is to condition the deeper, supporting muscles of the body to improve posture, balance and coordination. By focusing on your core strength, you (supposedly) enhance the little muscles in the body so you’re better able to support the larger ligaments, tendons and joints. Pilates is a very intense stretching class that incorporates workouts for your abdominal, leg, arm and back muscles – I found the stretching remarkable (it was like my poor, exhausted muscles could finally open up and take a breath of fresh air) and it’s nice to know that I still have some flexibility. Strength-wise? I have none! Anything that involved holding up my own body – even standing on my tippy-toes – was challenging. But it’s only the beginning of my learning curve…

Pilates encourages you to think about how you perform everyday movements. It heightens your body awareness; it helps you ensure your body is working at its optimal level all the time. Pilates will give you more of a holistic result than most other exercises regimes. It will make you focus on your breathing which is great for improving circulation and relieving stress. It is alleged to be a fantastic way to balance out your health and wellbeing.

Pilates is actually great for people with injuries, weak muscles and particularly bad posture because it encourages you to strengthen your problem areas in a relaxed and low impact way. (NB: It is advisable that anyone with serious injuries consults their doctor or physio though. Pregnant women should also get the okay from their doctor before proceeding.)

Now, tomorrow (or maybe even later on today) I know I’m going to hurt – I’m hoping it is the spent muscle type of hurt and not the FM hurt (but I may be kidding myself – I’ll let you know then).

Joseph Pilate

But I’ll know exactly who to blame: Joseph Pilates developed the yoga-like moves to rehabilitate Second World War soldiers. He then modified the style for injured dancers and so the modern-day method was born.

I’m looking after the beautiful Z tomorrow too, so I had better not hurt too much – playing with Z involves at least one walk to the park and a lot of kicking (then chasing) a ball around. I then have hydrotherapy so the warm water will soothe my tired, spent, exhausted, weary, drained, fatigued, wiped out body.

From just sitting on the couch last week, I‘ve suddenly got a REALLY busy schedule!