Seven DEADly Sins

Last Wednesday, I had to wake up early (for me) to go have a barium swallow (for my lap-band) and a booby ultrasound (again! I have cyst-y boobs). On my way there I had pins and needles (paresthesia) up and down my left arm and, especially, in my fingers. Okay, just a normal part of waking up with FM, I thought; except it didn’t go away like it normally does. And 5 hours later, my fingers (on my left hand) started twitching all by themselves – this had never happened to me before. Other than this I felt normal (or as normal as we can be). What am I supposed to do here? is this a stroke?

I google then go to a mirror: my face is normal, I can lift both arms above my head, and I can speak properly; so, it doesn’t sound like a stroke but what the hell is it? I’m not sure this is an emergency.

I call Mommy (who is still laid up in bed, with a bulging disc sitting on one of her nerves, after 2 weeks). She asks me the same questions about stroke symptoms. She’s not sure this is an emergency.

stroke

ambulanceThen I take her advice and call Nurse-On-Call, describing all my symptoms. Guess what? The nurse is not sure so she puts me through to 000 (911 or 999) and an ambulance. Over the phone, they’re not sure…so, with blazing lights and a screaming siren, an ambulance arrives at my place and takes me to the ER.

We’re probably more sufficiently in tune with our bodies than others to know when the pain is from FM, perhaps the result of cleaning the house a day or two before or eating that third chocolate, or if it’s something else. It’s when pain might signal something more serious that the internal dialogue begins:

“OK, this isn’t something to fool around with.”
“But is it an emergency?”
“And what if it is an emergency and you can’t tell?”
“I’ll give it one more hour.”
Etc…

So how can we tell? Here are 7 pains you should NOT ignore:

  • Worst Headache of Your Life

Get medical attention immediately. “If you have a cold, it could be a sinus headache,” says Sandra Fryhofer, MD, MACP, spokeswoman for the American College of Physicians. “But you could have a brain haemorrhage or brain tumour. With any pain, unless you’re sure of what caused it, get it checked out.”

Sharon Brangman, MD, FACP, spokeswoman for the American Geriatrics Society, says that when someone says they have the worst headache of their life, “what we learned in medical training was that was a classic sign of a brain aneurysm. Go immediately to the ER.”

  • Pain or Discomfort in the Chest, Throat, Jaw, Shoulder, Arm, or Abdomen

Chest pain could be pneumonia or a heart attack. But be aware that heart conditions typically appear as discomfort, not pain. “Don’t wait for pain,” says cardiologist Jerome Cohen, MD. “Heart patients talk about pressure. They’ll clench their fist and put it over their chest or say it’s like an elephant sitting on their chest.”

The discomfort associated with heart disease could also be in the upper chest, throat, jaw, left shoulder or arm, or abdomen and might be accompanied by nausea. “I’m not too much worried about the 18-year-old, but if a person has unexplained, persistent discomfort and knows they’re high risk, they shouldn’t wait,” says Cohen. “Too often people delay because they misinterpret it as [heartburn] or GI distress. Call 911 or get to an emergency room or physician’s office. If it turns out to be something else, that’s great.”heart attack

“A woman’s discomfort signs can be more subtle,” says Cohen, who is director of preventive cardiology at Saint Louis University School of Medicine. “Heart disease can masquerade as GI symptoms, such as bloating, GI distress, or discomfort in the abdomen. It’s also associated with feeling tired. Risk for heart disease increases dramatically after menopause. It kills more women than men even though men are at higher risk at any age. Women and their physicians need to be on their toes.”

Intermittent discomfort should be taken seriously as well.

The problem here, for us, is we have these kinds of pains all the time – sometimes it’s persistent and sometimes it’s intermittent. If you’re in ANY doubt as to the cause of your pain/discomfort, get medical attention IMMEDIATELY!

  • Pain in Lower Back or Between Shoulder Blades

“Most often it’s arthritis,” says Brangman, who is professor and chief of geriatrics at SUNY Upstate Medical University in Syracuse, N.Y. Other possibilities include a heart attack or abdominal problems. “One danger is aortic dissection, which can appear as either a nagging or sudden pain. People who are at risk have conditions that can change the integrity of the vessel wall. These would include high blood pressure, a history of circulation problems, smoking, and diabetes.”

  • Severe Abdominal Pain

stomach painStill have your appendix? Don’t flirt with the possibility of a rupture. Gallbladder and pancreas problems, stomach ulcers, and intestinal blockages are some other possible causes of abdominal pain that need attention.

  • Calf Pain

One of the lesser known dangers is deep vein thrombosis (DVT), a blood clot that can occur in the leg’s deep veins. It can be life-threatening. “The danger is that a piece of the clot could break loose and cause pulmonary embolism [a clot in the lungs], which could be fatal,” says Fryhofer. Cancer, obesity, immobility due to prolonged bed rest or long-distance travel, pregnancy, and advanced age are among the risk factors.

“Sometimes there’s just swelling without pain,” says Brangman. “If you have swelling and pain in your calf muscles, see a doctor immediately.”

  • Burning Feet or Legs

Nearly one-quarter of people who have diabetes are undiagnosed, according to the American Diabetes Association. “In some people who don’t know they have diabetes, peripheral neuropathy could be one of the first signs,” says Brangman. “It’s a burning or pins-and-needles sensation in the feet or legs that can indicate nerve damage.”

  • Vague, Combined, or Medically Unexplained Pains

Sounds like FM, right?

“Various painful, physical symptoms are common in depression,” says psychiatrist Thomas Wise, MD. “Patients will have vague complaints of headaches, abdominal pain, or limb pain, sometimes in combination.”

Because the pain might be chronic and not terribly debilitating, depressed people, their families, and health care professionals might dismiss the symptoms. “Furthermore, the more depressed you are, the more difficulty you have describing your feelings,” says Wise, who is the psychiatry department chairman at Inova Fairfax Hospital in Fairfax, Va. “All of this can lead the clinician astray.”

Other symptoms must be present before a diagnosis of depression can be made. “Get help when you’ve lost interest in activities, you’re unable to work or think effectively, and you can’t get along with people,” he says. “And don’t suffer silently when you’re hurting.”

He adds there’s more to depression than deterioration of the quality of life. “It has to be treated aggressively before it causes structural changes in the brain.”

Needless to say, my symptoms were not caused from a stroke. I sat in the ER waiting room with a(nother) cannula in my hand (REALLY OW!) for an hour and a half, alone (with all the other ER patients). After that time, I approached the nurse and said, “I came here because my symptoms indicated that there may be something life-threatening going on. Obviously, there isn’t or you guys would have dealt with me, right? So, I’m going home.”

I went to my GP the next day, with fingers and arm still tingling, but everything else was (and still is) fine; so she just told me if it gets worse or changes or there are more symptoms, come back to her or call an ambulance.

The paresthesia went away after 2 days and I am back to my normal FM-ridden self. BUT, please, if you have a new or unexplained pain, or even if you’re just in doubt, get medical attention.

emergency

 

And It All Comes Back to the Poo!

***This is NOT dinnertime reading! Do NOT read if you are easily offended, nauseous, or just don’t like to talk about bowel movements***

Isn’t it funny, we all go to the toilet, but we don’t like to talk about it, particularly number twos.

Today, I had a ‘normal’ bowel movement – but what is considered to be a ‘normal’ bowel movement?

A bowel movement should be soft and easy to pass, though some people may have harder or softer stools than others. In general, stool should be brown or golden brown, be formed, have a texture similar to peanut butter, and have a size and shape similar to a sausage. In many cases, a stool that varies a bit from this description is no cause for alarm, especially if it is an isolated incident.

It seems that most of us, especially those with IBS issues, never have a ‘normal’ bowel movement. In fact, our ‘normal’ is more likely to be those ‘really difficult to push out rabbit droppings type,’ or the ‘rush to the closest toilet explosion,’ or even the ‘my ass is dribbling type.’

Most of us who live with FM also have IBS. FM and IBS are co-diagnosed in up to 70% of FM patients. IBS (also known as irritable colon, spastic colon, mucous colitis, or spastic colitis) is a disorder of the bowel, or large intestine. It is characterized by severe abdominal pain and cramping, changes in bowel movements, and a variety of other symptoms.

It has been estimated that as many as two-thirds of all IBS patients have FM, and as many as 70% of FM patients may also have IBS. These statistics differ greatly from the corresponding rates in the general population, where only 10%-15% of individuals are estimated to have IBS. It is unknown if the two conditions are related symptomatically or causally, or if their frequent co-occurrence is merely a coincidence.

Adding pain killers to the mix can be frustrating and painful.

Now, the ‘really difficult to push out rabbit droppings type’ tends to be a constipation. Constipation means different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. This is called fecal impaction, a condition in which stool hardens in the rectum and prevents the passage of any stool.  According to reports in the Journal of Psychosomatic Research, constipation or infrequent stools occur in 30% of FM sufferers.

Constipation also can alternate with diarrhoea. Diarrhoea is an increase in the frequency of bowel movements, an increase in the looseness of stool or both. It is caused by increased secretion of fluid into the intestine, reduced absorption of fluid from the intestine or rapid passage of stool through the intestine. This is the other two types of (what I refer to as) our ‘normal.’

My point to all this crap (Ha! Ha! Lol!) is that I get used to the IBS stuff: I have cramps, I take Buscopan; I have diarrhoea for too long, I take Immodium; and, if I’m constipated, greasy fish and chips seems to do the trick. But when I have a ‘normal’ poo, it feels like it is dragging all my insides out with it. It’s tiring and it’s physically draining. It leaves my body feeling empty (but not in a good way!).

So, is this what ‘normal’ feels like?

Further Reading: 

 

Intestinal Fortitude

 

My stomach is NOT my friend! I am lucky enough to swing from constipation to diarrhoea in less than the blink of an eye.

Research findings from the Walton Centre in the UK report that the small bowel in FM sufferers (and when it comes to IBS, we are definitely sufferers!) shows overgrowth of abnormal bacteria. The study demonstrated an increased intestinal permeability that produces increased hyperactivity of the intestines. Intestinal permeability means abnormal substances gain access to the body and alter its immune function.

Constipation

According to reports in the Journal of Psychosomatic Research, constipation or infrequent stools occur in 30% of FM sufferers. Constipation is defined as having a bowel movement less than three times a week. Some individuals complain of abdominal pain and straining to move the bowels in conjunction with the constipation.

Diarrhoea

Clinical Nurse Specialist describes diarrhoea occurring in up to 90% of FM sufferers. Individuals describe a pressing urge to move the bowels as well as passage of unformed stool. Diarrhoea occurs along with high levels of anxiety. Reports in the Journal of Nutrition indicate ingestion of probiotics decreases the symptoms of diarrhoea.

Fecal Incontinence

The Journal of Psychosomatic Research reports 2% to 7% of individuals with FM report uncontrolled passage of stool. This fecal incontinence transpires frequently in concurrence with diarrhoea and creates major problems in daily life. If it has ever happened to you, you never want to leave the house again (or, at least, without knowing where the closest toilet is!)

gastroesophageal Reflux Disease

According to the Journal of Psychosomatic Research, gastroesophageal reflux disease describes the condition where food travels backward from the stomach into the oesophagus. The oesophagus is the tube connecting the mouth to the stomach. Characteristic symptoms of gastroesophageal reflux disease include epigastric pain, a sensation of fullness, and heartburn. gastroesophageal reflux disease and other intestinal problems occur in 50% of FM sufferers.

I have tried some (very expensive) probiotics without any improvement. Basically, I make sure that I have a constant supply of Imodium, Buscopan and Durolax on hand, at all times.

Has anyone found something that works (not just on symptoms)?

 

Day 4 without Cymbalta (and no other anti-depressant)!

Most of Day 4 was spent getting over my late-night visit to the Emergency Room for abdominal pain (not related to Cymbalta – before everyone starts their Cymbalta tirades (I think we get the idea now!)) and sleeping.

But, still too tired to think about a real post – although two good things came out of it:

  1. In comparison to the way I felt last night, Day 4 was actually quite a wonderful day – in comparison, I didn’t feel nearly as awful as I had felt crouched fetal style on a gurney, while the man next to me snored louder than my Mommy ever did (before her CPAP machine!)
  2. After leaving the hospital, I slept until family dinner-time. So day 4 really wasn’t so bad!

I’m really not a Disney character kind of person!

AND that means that there is only one more day until I can start my new/old anti-depressants.