Have you ever had the flu? I am sure many of you have. Do you remember that severe achiness throughout every muscle of your body? Do you remember having the type of pain where your skin feels sensitive to the slightest touch? Of course you remember not wanting to get out of bed because of the severe fatigue associated with feeling so sick. Well, Fibro pain often feels a lot like that. The difference however, is that with Fibro the pain doesn’t last only a few days or even a week. It is daily, chronic and unrelenting. For those of you who are fortunate enough to have never had a flu, maybe you have pulled a muscle at the gym. Have you ever strained a hamstring or maybe your low back and felt muscle spasm as a result? Even those of you who have been fortunate enough to have never strained a muscle may have experienced the muscle fatigue and achiness from just working out. You would then understand that really achy feeling you have in your muscles the day after you exercise hard. You wake up that morning and feel really sore and stiff. You can barely move your muscles and you may even have difficulty getting out of bed. You hurt so much you don’t even want to go to work but then again you know that the next day you will feel better. You may take a hot shower, stretch a bit and feel somewhat relieved. In a certain way, having that type of “post exertional” soreness can actually feel good because you know that you have worked your muscles sufficiently to be able to see and feel results. You also realize that within the next day or two you will be back to 100% and actually feeling stronger and healthier than ever. What a difference this type of pain is from Fibro.

The muscle pains and other symptoms I just described are only a very small portion of all the symptoms one can experience with Fibro. Unfortunately someone with Fibromyalgia, unlike the person who has the flu or the person who strains a muscle, cannot look forward to feeling “normal” within the next few days. That is where pain crosses a certain threshold and we begin to define it as “suffering”. When a person injures themselves and or experiences an acute pain, the mind is able to process the injury and realize that it will be a temporary condition. An example of this would be someone who stubs their toe. They may yell and scream and hop around for a few minutes but as soon as the initial pain fades a bit, their mind assesses the injury and they then realize that it will soon get better. That is acute pain and even if the toe were fractured, the mind can deal with that knowing that in a few weeks relief will come and all will again be back to normal. That is true “pain” and even though it can be severe, it is not really considered “suffering”. Suffering comes from having unrelenting pain and often not having a full understanding as to the reasons why. It is difficult for the mind to accept this type of pain. You didn’t strain your back, you don’t have the flu and you didn’t stub your toe. Also, it is not going away. It is there every day. To compound all this, many patients that have Fibromyalgia often get little understanding or support from those most important in their lives. Maybe this is because their condition is even more confusing for those around them that have little if any idea what kind of pain they are feeling. Also people with Fibro often look well enough so they often are not even beleived. This combination of having unremitting severe pain and also not being given any credence or understanding is what often leads a Fibro patient to go from pain to true suffering. Suffering can lead to secondary depression which will likely increase the already existing symptoms. This is such a viscous cycle and is the main reason why I feel education, advocacy and understanding is vital for not only those that have Fibromyalgia but for those who mean the most to them. The people that love those with Fibro must understand what they are going through. This point can not be stressed enough.

On a positive note, there are many things Fibro sufferers can do to help manage their conditions and lead healthier, happier lives. Most of our patients at FibroCareCenter that are motivated enough to make certain lifestyle changes and follow our specific recommendations often find they will have less pain, less flares and better overall control of their condition. I have always believed that “knowledge is power” and I want all Fibro sufferers to know that the downward spiral of symptoms and suffering can be reversed.

People that suffer with Fibromyalgia have a low threshold and most often a very high tolerance to pain. This is partly true because they have been found to have greatly increased levels of substance P in the cerebral spinal fluid. Substance P is a neuromodulator (a substance that changes neurotransmitter effectiveness) that allows us to perceive a stimulus as painful. It is interesting to mention that there are actually some rare medical conditions where substance P is very low or completely absent and a person feels little or no pain. That may initially seem like a blessing but actually it can be very dangerous because there is then no “warning pain” when a critical condition requiring treatment exists in the body. Can you imagine how serious it would be for someone with acute appendicitis to not feel any pain and have the appendix rupture?

Obviously having a normal level of substance P is the ideal situation where your body tells you exactly what it should be feeling and pain is perceived at the appropriate level. Take a look at the illustration below and you will get a general idea how Substance P works. You can see that the transmission of nerve impulses and pain is quite intricate and involves many more chemicals but Substance P plays a very important role.

Now with elevation of Substance P, as in Fibromyalgia, a sensation that should be perceived as normal is felt as painful. The term for this condition of increased pain perception is hypergesia. Sometimes even a light touch on the skin can feel like burning and I have seen many patients that can’t even stand to have the bed sheets touch their legs at night. In Fibro patients a relatively minor muscle strain due to over exertion will often cause a totally inappropriate severe level of pain and then cause unnecessary muscle splinting and spasm which then has a downward spiraling effect. The body over responds due to an inaccurate pain signal caused by high substance P and starts what I call the “cascading of symptoms”. One simple strain becomes a serious of pains that can sometimes throw the Fibro patient into a severe flare.

So does this mean that Fibro patients are weak? Does it mean that we are just being hysterical with the pain and over reacting? No, actually it is usually the complete opposite. Here is where the definitions of threshold vs. tolerance become very important. Fibro patients do feel pain sooner and at inappropriate levels but, for most of us, we have incredibly high pain tolerances. The reason for this is because Fibro patients deal with some level of pain all the time. I guess you can say that we grow more accustomed to living with pain. Most Fibro patients that I counsel and treat have a remarkable way of dealing with levels of pain that would drive a “NON Fibro” person absolutely insane. This is one of the main reasons that it makes me frustrated when I hear people that obviously do not understand Fibromyalgia say that Fibro patients are just being weak or wimpy. Considering what level of pain Fibro patients need to deal with, it is surely one of the worst things you can say to them. If those accusers ever woke up in a Fibro body for even 1 day, they would likely run to the ER or beg their doctor for some heavy duty narcotics. The thing is this: Fibro people have grown accustomed to living and dealing with pain and most often accept the lower to moderate levels in silence. That is where the high tolerance comes in to play. I often tell people that we look at most of our pain like we would view “elevator music”. It just is a low level background noise and we learn how to still have a life and accept or even ignore it. Usually it is just the severe flares that make most Fibro patients really complain but at that level the pain can be completely intrusive and there is no way one can ignore it.

It would really make things a whole lot easier if the people around us that do not have Fibromyalgia could understand the difference between the two terms threshold and tolerance. Most Fibro patients are not looking for sympathy; they are just seeking understanding. I have personally observed the supreme importance of a good support system in all of my Fibro patients. You can’t expect true support unless the ones that are most important to us understand that we are coming from a position of strength, not weakness.

I have also examined, treated, advised and counseled hundreds of patients at FibroCareCenter and have observed the results by being able to follow most of those patients for many years. I hope this doesn’t seem like boasting when I make the claim that this gives me a very big advantage and also a rather unique perspective when it comes to assessing what the long term prognosis is with patients that suffer from Fibromyalgia.

Now I realize this may seem like a generalization but it is definitely my absolute observation that most of my Fibro patients are more “health savvy” than the average patient. Sometimes this is because they were undiagnosed for so long and or “blown off” by several doctors therefore had to do extensive research on their own to figure out what was going on and what to do about it. Other times it is out of sheer desperation due to the severity of their symptoms and lack of relief found with their current therapy. Local Fibromyalgia support groups, the National Fibromyalgia Association and many other organizations have been a huge help for those looking to become proactive and more educated about Fibro. The internet has also been an extremely valuable tool for those patients as long as they understand that they must go to “reputable” sites and not believe the hype that some sales sites push. Because of these reasons many of my Fibro patients have come to understand their conditions better than their own doctors. Unfortunately this can sometimes become a wedge in the doctor patient relationship. This becomes especially apparent if the doctor is unwilling to listen to what the patient has learned because they believe that they must know better. Doctors should always understand that being a “team player” is incredibly important with Fibro and that the patient who has done their research often can teach them a thing or two. After all, they have a lot at stake and pain is an incredible motivator to educating oneself. How often I hear from my patients “If only my doctor walked a day or two in my shoes they would understand”.

My point with this is that when people are “health savvy” and proactive, as with most of my Fibro patients, they often begin to lead healthier lifestyles. In actuality they are often forced because that is the only way for them to find true relief. People with Fibromyalgia usually realize that they need to eat better, reduce stress, rest more and adapt a “system” where they prevent or at the very least minimize their flares. This way of living is obviously more conducive to the avoidance of even more serious illnesses in the future. I am sure you understand this principle I am speaking of. It should be very obvious that good nutrition, being proactive and educated about health, sleeping or resting better, exercising correctly, taking the appropriate nutritional supplements and also understanding what is normal or abnormal for your own body will always lead to decreasing the risk of severe illness.

I would love to see some long term study that helps me back up my theory but I truly believe that this seems totally logical and should be apparent. While dealing with my many Fibromyalgia patients I spend a great deal of time explaining and educating them. I try to encourage them to see the bright side of this condition, as difficult as that may seem during times of severe pain. There often can’t be a 100% cure with Fibromyalgia but that does not mean that healing cannot take place. It certainly doesn’t mean that one is doomed to a lifetime of pain and frustration. When we fully understand what is necessary to manage this condition and help live a more comfortable and complete life we often become healthier overall. With this healthier lifestyle comes more balance and a fuller, richer life. To use a much overplayed cliche’ “whatever doesn’t kill you will make you stronger”. Well, with Fibromyalgia I have found this to be incredibly true with the vast majority of my patients. Once a complete understanding takes place and stronger attitudes develop, a much better sense of control arises. If people are willing to then let go of the negative side of Fibro and not dwell on certain issues that may still be frustrating, a much happier fulfilled life is possible.

Many research studies that show that Malic Acid can help people that suffer from this type of pain associated with muscle and tissue hypoxia. Malic acid is found not only in food but also is synthesized through the (Krebs) cycle. In a study on the effect of the oral administration of malic acid to rats, a significant increase in anaerobic endurance was found. Interestingly, the improvement in endurance was not accompanied by an increase in carbohydrate and oxygen utilization, suggesting that malic acid has carbohydrate and oxygen-sparing effects. In addition, malic acid is the only metabolite of the citric acid cycle positively correlated with physical activity. It has also been demonstrated that exercise-induced mitochondrial respiration is associated with an accumulation of Malic acid.

Because of the compelling evidence that Malic acid plays a central role in energy production, especially during hypoxic conditions, Malic acid supplements have been examined for their effects on FM. Subjective improvement in pain was observed within 48 hours of supplementation with 1200 – 2400 milligrams of Malic acid, and this improvement was lost following the discontinuation of malic acid for 48 hours. While these studies also used magnesium supplements, due to the fact that magnesium is often low in FM patients, the rapid improvement following malic acid, as well as the rapid deterioration after discontinuation, suggests that malic acid is the most important component. This interesting theory of localized hypoxia in FM, and the ability of malic acid to overcome the block in energy production that this causes, should provide hope for those afflicted with FM.

With the vast majority of my Fibro patients I recommend that they supplement with approximately 1500 – 2000mg of Malic Acid and 500 -750mg of Magnesium daily. Magnesium should not only aid with muscle spasm but does help patients obtain a better quality sleep. Because of this I prefer not having them obtain a combination supplement but rather take their Malic and Magnesium seperately. Malic acid can be split up 3 times per day but the bulk of their Magnesium supplement should be taken approximately 1 hour before sleep.

I often use an expression when talking with my patients “knowledge is power”. When a person does not fully understand what is going on, there is often some fear. Fear is stressful and stress can either delay or stop any healing from taking place. This is a known physiological fact and that is why I become concerned when I hear of patients not having a full understanding of their conditions. It is also one of the main reasons why I spend a great deal of my time in the office explaining and teaching my patients exactly what is going on when they have any kind of pain. It may be a patient with Fibromyalgia or it may be a patient with a sprained lumbar spine. In either case the need to fully understand what is going on is very important.

It is truly amazing how the human mind works. The brain controls the body and thoughts have an enormous effect on brain chemistry. A very simple example of this is how quickly adrenaline is released when someone is frightened. In Fibro as in many other health issues, chemistry plays a key role in what direction the condition will take. This is the main reason why I am concerned about the communication that takes place between patients and their health care providers. When a doctor is “dismissive” of a patient’s symptoms, it is understandable that they are sure to feel an enormous amount of frustration. On the other hand, a doctor who paints a picture of “gloom and doom” or scares a patient into unnecessary testing is certainly going to cause fear and make matters worse.

I am going to make a statement that I am fairly confident is accurate; most of you who read this site are already pretty educated when it comes to Fibromyalgia. Some of you have researched this condition for quite some time and know most of the latest studies. You are to be commended and you are surely on your way to finding the proper way to manage your condition. Now, how do you bring a physician on board with you? All patients sometimes need to be reminded that they are the ones that are hiring the doctor not the other way around. You need open dialog with your doctor where questions and answers are shared. You also need enough time given for this to occur. It may be a good idea when making your initial appointment to state that you have or think you may have Fibromyalgia. You should then ask if the doctor sees patients with Fibromyalgia and if so, will there be a sufficient amount of time during the initial visit to discuss your concerns. When a Fibro patient schedules an appointment in our office they are told that they will be with the doctor for 60 to 90 minutes.

Remember “knowledge is power” and you are the “captain of your own ship”. For some of you that may be an overwhelming feeling, however, the more control you have over this condition, the more empowered you will become.

Bananas are not only rich in potassium with about 450mg each but they also have 33mg of magnesium which has shown to be a very important mineral in those that have Fibromyalgia. They help strengthen the stomach lining and also help with indigestion. This is important for those Fibro sufferers that have problems with the absorbtion of nutrients. Bananas produce a thicker mucus barrier in the stomach lining that protects against stomach acids. They also contain protease inhibitors that help reduce H Pylori bacteria that has been shown to cause ulcers.

Ingredients:

3 very ripe bananas (4 if smaller)
1/2 cup honey
3 tablespoons canola oil or extra light virgin olive oil
1 teaspoon pure vanilla extract
1 1/2 cups organic whole wheat flour or white whole wheat flour
1 1/2 teaspoons baking soda
1 1/2 teaspoons cinnamon
1/4 teaspoon salt
3/4 cup chopped walnuts

Instructions:

1. Heat the over to 350 degrees F. Lightly oil or spray a muffin pan
2. Mash the bananas, mix with honey, oil and vanilla extract
3. Stir together the flour, baking soda, cinnamon and salt. Add the nuts
4. Blend the two mixtures together and spoon about 1 – 1 1/2 tablespoon into each muffin section
5. Bake for approximately 25 minutes on upper rack of oven. Check after 20 minutes by inserting a toothpick in 1 muffin. When toothpick is clean, muffins are done.

Isn’t it sad that several years ago, many in the medical community refused to accept FMS as a “real” diagnosis? For me on a personal level it was merely annoying but, on a professional level, it became extremely frustrating to be diagnosing patients every single day that were misdiagnosed by the so called “experts” for a long time. It is even worse that many of these patients that were misdiagnosed were being told that there was “nothing wrong” or the problem was “in their head”. This often resulted in patients seeking a second, third, fourth or even a fifth opinion and having test after test repeated. This is so frustrating, especially with all of us thinking now about health care costs. Can you imagine how much unnecessary spending was done just due to ignorance, or dare I say arrogance?

So after years of my having to convince many patients that they indeed did have Fibromyalgia after their doctors pretty much dismissed them, I thought maybe we were finally on the way to a better level of understanding. This was because of all the recent campaigns, advocacy and even advertisements centered around Fibromyalgia. I guess it was naive of me to believe that with the FDD approval of specific meds for Fibro i.e. Lyrica, Cymbalta and Savella that the medical opinions would change. Then again I should realize that in order for that to happen, providers would have to admit that all the patients they “blew off” were in actuality really suffering from something they should have diagnosed. What an interesting dilemma the health care profession faces. Do they admit that they were wrong for all those years and swallow their pride or do they continue to ignore those patients that suffer from Fibro and preserve their egos at the peril of the patient?

It is unfortunate but lately I am still seeing much of the latter. Almost every single day at least 1 or 2 of my Fibro patients comes in and tells me that their PCP told them that they “don’t believe in Fibromyalgia”. The definitive word there is “believe”. This is absolutely amazing with the research that is now available to every health care provider. Is it possible that they are living in the Stone Age or maybe just haven’t kept up with all the latest studies done by the American Pain Society, The National Fibromyalgia Association, The American Arthritis Association, The National Institute for Neurological Diseases, The American College of Rheumatology or several other organizations? Most of these studies have been widely published in their best medical journals.

I actually think that it is not lack of information because they are all required to have continued education and even if it’s not the subject that is being taught at their seminars, the journals and the pharmaceutical reps are certainly providing them with plenty of information. That is why I am frustrated and upset. I have to assume that is isn’t ignorance but pure pride that keeps some doctors from admitting they were wrong.

Now, what should you do if you suspect that you have Fibromyalgia and your doctor says you don’t? In my opinion and what I tell my patients, that all depends on what their doctor says and how they explain their findings in their case. After all, there are many times that other conditions mimic the symptoms of Fibro. Tests may indicate that you indeed have something else easily treatable in which case your doctor was correct in saying you do not have Fibromyalgia. Then there is the other situation where your doctor may say those words “I do not believe in Fibromyalgia”. Maybe the tests came back negative and your symptoms are totally related to Fibro and your doc says they don’t “believe” in it. Well…that is where I tell my patients to run. It would be a terrible mistake to stay with any doctor who says they don’t “believe” in Fibromyalgia. Fibromyalgia is NOT a religion. It is a health condition like any other. Does your doctor then not believe in Multiple Sclerosis? How about Irritable Bowel Syndrome or Migraine Syndrome? After all, they are also syndromes that you cannot see on X-ray or blood tests. So, I tell the patient if they don’t believe in Fibro, you should not believe in them. It is then time to find another doctor, pure and simple. I know it may be difficult for some people to switch doctors but it is crucial for those of you that fall into this category with those disbelieving doctors. The 2 main obvious reasons for finding someone who understands and believes is because there is no way you can get well if you remain undiagnosed and also the fact that your doctor is totally out of touch. As stated before they are either too proud to admit that they were wrong for all those previous years of having a dismissive attitude toward Fibromyalgia patients or they just are not up on the latest studies. In either case, isn’t it reason to leave and find someone that will not only diagnose you correctly but also really understand?

Growth hormone is not only important during our childhood but we need it as adults to help tissue heal. That is why the deepest levels of sleep are known as the levels of “restorative” sleep. When we move and exercise there are small microscopic changes or breakdowns in our muscles. These microscopic changes in people with normal growth hormone levels heal rapidly and there is no true discomfort. With FMS and lower levels of somatomedin C (HGH), the tissue doesn’t heal readily. Stiffness, pain and muscle fatigue result and this has a cascading effect on a person’s overall activity level. This is one of the main reasons why many with FMS become deconditioned. It is not because they are lazy or don’t want to exercise: it is because they truly can’t. It just hurts too much. The “post exertional soreness” that non fibro people feel after a “good” workout at the gym goes away in a day. In actuality many people even enjoy that slight soreness that happens after a “good workout” because they know that in a day or so, they will feel great again and be ready to hit the gym. Sadly this is often not the case for those with FMS.

In my office, I constantly see this as a major point of confusion even with many health care providers who wrongly minimize the patient’s true condition and dismiss them by suggesting that they are deconditioned and just need to exercise more. This point has become extremely irritating to me because I hear it repeated so often. With Fibro patients, less is more. If a patient with low HGH is told to work out harder in order to get in better condition, they will likely find themselves not only frustrated but often in a severe Fibro Flare. Only a patient with FMS can know the real frustration that comes when a health care provider or maybe a spouse thinks that they are lazy for not working out. This is the reason why there are times when I ask patients if they would like to bring their spouse along so that I can explain some of the true “chemical” reasons why people with FMS can’t just “work through the pain”.

So how does one go about getting a more restorative sleep and help boost their levels of HGH? Well, first and foremost, they should realize that it is not the quantity of sleep as much as the quality. Getting into those deep levels of sleep is what is most important because that is when most of our brain chemistry is manufactured. I realize that there are many prescription sleep aids that are now on the market and although they will make you sleep, they don’t seem to provide a “normal” pattern and subsequently do little to change HGH levels.

In my practice I first suggest a patient take 5HTP, which is a precursor to tryptophan. I also often will recommend 3mg. of melatonin 30 minutes before sleep. Both of these products are natural and help the body get into a “normal” cycle or pattern of sleep.

Another incredibly beneficial aid to good restorative sleep is meditation and deep breathing techniques. This does more than just relax a person but helps to set the stage for someone to enter stage 4 delta sleep more readily. Again, this is the most important level of sleep for those needing an increase in those all important neurochemicals like HGH. I will often advise people to listen to some guided imagry CDs or download the CDs unto their IPODS. We recommend many meditative CDs offered through our Amazon A-store.

Though this is a very brief discussion of the science of sleep and the connection it has to FMS, I wanted to at least make people aware of that very important connection. I encourage you to become a member of our site as we will be getting into much more detail on this and more Fibromyalgia topics in our forums, our chats and podcasts.

Ingredients:

4 Bosc pears
2 cups apple juice
1 cinnamon stick
2 cloves

Preheat oven to 400. Cut a thin slice off the bottom of each pear to help keep them standing upright in a baking dish. Pour fruit juice into the pan. Add cinnamon stick and cloves. Roast the pears, basting every 15 minutes, until tender and brown. Place pears on serving plate and use liquid from pan to drizzle on top.

Ingredients:

4 skinned boneless chicken breasts
3 ounces of low sodium chicken stock
3 tablespoons of grated Locatelli or Parmesan cheese
3/4 cup of plain low fat yogart
1 tablespoon of brown mustard
1 heaping tablespoon of flour

Arrange 4 boneless chicken breasts in a baking dish. In a seperate bowl mix the flour and yogart together and then add all other ingredients. Stir until mixture is well blended. Evenly spoon the sauce over the checken breast and cook in a preheated 350 degree over for approximately 1 hour or until the chicken is cooked.