Why she came to see me: Tracy didn’t need to tell me she was exhausted and uncomfortable when she arrived at my office. A previous patient of mine, she’d gone from robustly healthy to noticeably fatigued—something that was evidenced in the bags under her eyes, the slack state of her skin\ and the lack of pep in her step. In addition to the low energy she said she was experiencing, she also claimed to be suffering from “all over” aches and pains that ranged from moderate to severe. Reluctant to see yet another physician who would write her a prescription for pain medication and send her on her way, Tracy wanted to get to the root of her symptoms—and address them naturally.
How I evaluated her: As with all of my patients, I began with a comprehensive discussion about Tracy’s life and the symptoms that were distressing her. Nine months earlier, shortly after I’d seen her last, Tracy had been involved in a car accident. While the wreck wasn’t life-threatening—and no bones were broken—it had shaken her enough (literally) that she’d experienced a bout of “body aches” that were somewhat relieved through a combination of physical therapy and yoga.
But in the last four months or so, the pain had returned with a vengeance. With it arrived stiff joints, an increased need to urinate, persistent tension headaches, indigestion, the blues and extreme fatigue. What’s more, Tracy had become “frustratingly” forgetful, so much so that the older of her two children had recently commented on it. Part of her attributed this to being overworked and exhausted—her younger child was five, she ran an accounting company from home, and her life partner was often overseas for business—but another part of her worried that it was associated with her near-constant pain. “I hurt all over,” she said, “so much it’s become debilitating.”
On this note, we went a bit deeper. The two conventional physicians she’d seen about her issues had been dismissive: One had written her a prescription for Vicodin; the other had suggested it was psychological (and “not real”). Pain, I reminded her, is largely subjective—what one patient might rate a 10 another may characterize as a 3. To this end, I conducted an 18-point test—essentially, an exam that addresses 18 specific points (nine “pairs” that are on both sides of the body, both above and below waist) that, when pressed, produce tenderness and spread pain to other parts of the body.
To rule out the possibility of a urinary tract infection (and to address her frequent urge to urinate), I ordered a urine test. In addition, I performed a comprehensive hormone test to examine where her levels stood, as an imbalance could lead to some of the symptoms she was presenting. Finally, I ordered a blood test that would examine her Vitamin D levels, thyroid function and complete blood count.
What my evaluation revealed: Tracy’s urine and hormone tests were both normal; the same held true for her blood tests. On one hand, this was good news; on the other hand, the positive results, combined with Tracy’s widespread pain, fatigue, cognitive problems and other symptoms, indicated that her problem was something larger and more insidious: Fibromyalgia.
Fibromyalgia is a syndrome that impacts the muscles and soft tissues and creates the very symptoms from which Tracy was suffering. Affecting roughly 10 million Americans, it’s more common among women than men and, if not managed, can lead to the debilitation Tracy was experiencing. The reasons behind the syndrome vary but can include a genetic predisposition to the condition, psychological stress or physical trauma such as, yes, a car wreck. As I explained to Tracy, fibromyalgia is one of the most misunderstood, misdiagnosed and controversial conditions, chiefly because, again, pain is subjective and difficult to “test.”
As I also explained to Tracy, the pain she was feeling wasn’t likely because of silent breaks or muscle tears that had occurred in the accident—rather, they were due to the brain changes that are associated with the condition. Researchers believe that repeated nerve stimulation renders the brains of fibromyalgia sufferers to shift towards pain, as levels of the brain chemicals that signal pain—neurotransmitters—increase. Ultimately, this leads to heightened sensitivity to pain—and the “I hurt all over” feeling that Tracy had been enduring.
How I addressed her problem: While the FDA recently approved three drug treatments for fibromyalgia, I wanted to honor Tracy’s wish to treat her condition naturally. This meant that we would avoid the Western approach to fibromyalgia—the use of non-steroidal anti-inflammatory drugs, analgesics (pain killers), antidepressants, and tranquilizers—and take a holistic tactic instead.
We began with her diet. All of the foods Tracy relied on daily—milk with her cereal, oranges mid-morning, lunch meat on wheat toast for lunch, corn chips as an afternoon snack, a glass of wine with dinner—are believed to be inflammatory and can aggravate fibromyalgia symptoms. Instead, I urged her to fill her plate with antioxidant-rich vegetables and non-citrus fruits, complex carbs (such as quinoa and buckwheat), and foods with high levels of Omega-3s (such as salmon and walnuts), as they have been linked to pain relief and diminished “fibro fog”—the forgetfulness that Tracy had been living with. I further urged her to replace her nightly wine with non-caffeinated herbal tea and to avoid sugar, processed foods, soda and anything containing MSG.
We then turned to nutritional supplements. I encouraged Tracy to take Vitamin B12, because it is vital to keeping one’s pain-processing systems healthy. Based on my previous experience with other patients with fibromyalgia—as well as studies published in The Journal of Alternative and Complementary Medicine and Clinical and Experimental Rheumatology—I also recommended 5 grams of the naturally-occurring carbohydrate D-ribose three times a day and 1,000 mg of acetyl-L-carnitine. In addition, I suggested she take SAM-e, 800 mg a day, which has the potential to inhibit cytokines (proteins that cause inflammation) and boost one’s mood—an aspect that’s central to coping with the pain that arrives with the syndrome.
On the topic of mood, we also looked at ways to diminish Tracy’s depression, sleep well, deal with the frustration that arrives with a chronic condition like fibromyalgia and, most of all, handle stress. The benefits she’d previously seen with yoga immediately popped into mind, and she agreed to begin practicing again. I’m referring to restorative yoga—postures that are held in a relaxed and supported way for up to five minutes each. Other forms of yoga that are more vigorous would be out of the question.
I also urged her to prioritize self-care, including sleep hygiene, and to introduce acupuncture and shiatsu massage to her regime as both have had promising effects for those with fibromyalgia.
To this plan I also added Perineural Injection Treatment. Previously called Neural Prolotherapy, this cutting-edge treatment, originally developed in New Zealand, consists of a series of minute injections under the skin that specifically target sensitive nerves, or neurogenic inflammation, with 5% dextrose (medical-grade glucose). These injections not only aim to quench the pain—with relief lasting from four hours to four days—but also strive to end the “pain cycle” that’s associated with fibromyalgia. Non-toxic and minimally invasive, it can be a boon for people like Tracy whose aches have become as integral to their life as breathing. I did a series of injections, once a week for six weeks, and every week she had less and less pain in the areas that were treated.
The patient’s progress: Two months later, Tracy returned to my office with the spark in her eyes I’d seen when I first met her. Changing her diet and committing to a daily yoga practice had proven to be the most challenging—her exasperation with her diagnosis had, for a time, depressed her further—but within a week of our last consult, she’d approached her “new lifestyle” with the same vigor, enthusiasm and determination she put towards raising her children and running her business. The Perineural Injection Treatments had been especially beneficial, giving her a glimpse of a pain-free life and, thus, even more motivation to treat herself with as much care, gravity and devotion as she did her family. The pain of fibromyalgia, she said, was “waning more than waxing,” and her improved mood gave her the resilience to deal with those times when the aches inevitably came. Life was forever altered for her, to be sure, but she was well-equipped, ready and excited to face it.
I have had patients have resolution of symptoms of fibromyalgia but, with increased stress or another car accident/physical injury or trauma, get reaggravated and have symptoms again. For some patients, we simply control it; other patients have had total resolution. I’m one of them! If I eat certain foods, though, symptoms will come back.
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