FIBROMYALGIA DOCTOR

From Fibromyalgia Specialist, Doctor Alan Weiss

Is it the chicken or the egg? Hormonal disruption is a common entity in patients with fibromyalgia and chronic fatigue. What we commonly see is often some combination of adrenal, thyroid, and reproductive hormone deficiency or excess.

And when it comes to the adrenal glands as opposed to an innate issue of the adrenal glands we see a problem with the regulation of this critical gland by the hypothalamus or pituitary gland.

And then comes the question, are these issues the trigger for the clinical problem or is the fibro or CFS causing the hormonal issue?

Whichever it is (and sometimes that is impossible to answer),  these issues  must be looked for and addressed.

Valuable tools to assess these questions include in-depth thyroid testing including thyroid antibody testing, salivary and urinary cortisol testing, and serum and urinary tests for testosterone, estrogen and progesterone (though there are many other hormones to consider).

Finally listening to the patients symptoms and being willing to provide a clinical trial of hormonal therapy may reveal a resistance to thyroid or adrenal hormone that conventional testing would never reveal.

Fibromyalgia Doctor Alan Weiss, an internist and owner of Annapolis Integrative Medicine, specializes in the diagnosis and treatment of patients with symptoms of fibromyalgia.

If you’ve been told you might have fibromyalgia, and would like to feel better, give Alan Weiss, MD a call at his clinic. He will treat you personally, listen closely to you, and help get healthy again.

Nutrition in Fibromyalgia and Chronic Fatigue Syndrome

It is critical that people dealing with Fibromyalgia and Chronic Fatigue optimize their nutritional status as much as possible. This specifically relates to getting the right amounts of the right kinds of vitamins, protein, minerals, fats, carbohydrates, as well as other types of nutritional supplements.

Why is this so critical?

First, people with poor nutritional status seem to be more likely to suffer from Fibromyalgia and Chronic Fatigue. And the stress and other issues that people with these diseases are confronted by makes maintaining optimal nutritional status more difficult and this makes getting well even more of a challenge.

So what specifically can be done?

In my practice I make sure that patients are on a broad spectrum multivitamin such as the Energy Revitalization System or Two a Day multivitamin from Designs for Health.

As well I always check and optimize the levels of the following nutrients:

• Iron-check Iron and Ferritin levels
• Vitamin B12
• Vitamin D-check 25 (OH) Vitamin D
• Magnesium-check RBC magnesium
• Protein and amino acids
• Calcium

If there is evidence of wide-spread nutritional deficiencies I will also use one of several in-depth nutritional tests such as SpectraCell’s MicroNutrient Testing or the Nutraval from Genova.

Intravenous therapies are sometimes the most effective route to getting people back to feeling well.

Finally optimizing gastrointestinal health and function is critical to restoring and maintaining nutritional status

The Primary Symptoms of Fibromyalgia

The hallmark fibromyalgia symptom (FMS) is widespread persistent aching in muscles, tendons and joints that is widely present in the body. This means that most people with FMS have pain on both sides of their body, as well as above and below the waist.

This pain often interferes with normal activities of life, and can cause restless broken sleep.

Other common symptoms of FMS include chronic sleep disruption, bowel issues typically called irritable bowel syndrome, brain fog, and symptoms of both thyroid and adrenal disruption, which can lead to significant fatigue, temperature regulation problems, and weight gain or loss.

If you have pain and these other symptoms it is important that you be seen by a physician to rule out other issues (like Lymes disease or Rheumatoid Arthritis) and get yourself on an aggressive treatment plan to begin to get well.

How do you know if you have Fibromyalgia?

I have many patients who come to my office having been told they have fibromyalgia who clearly do not, and patients who do have fibromyalgia who have been told they have some other condition.

In general, if you hurt all over and feel chronically and inappropriately tired, you may very well have fibromyalgia or chronic fatigue syndrome. Both are serious chronic illnesses that have specific criteria for diagnosis, but may be overlooked because blood tests are typically normal. Also, there is significant overlap between fibromyalgia and chronic fatigue syndrome with up to 70 percent of patients meeting the diagnosis for both.

The “official” diagnostic criteria from the American College of Rheumatology include:

• History of widespread pain that has been present for at least three months

Pain is considered widespread when all of the following are present:

1.       Pain is in both sides of the body

2.       Pain is above and below the waist

In addition, axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain)          must be present. Low back pain is considered lower segment pain.

• There is Pain in 11 of 18 tender point sites on digital palpation
  Definition: Pain, on digital palpation, must be present in at least 11 of 18 tender point sites (see diagram at end of this page)

As well, it is very common for people with fibromyalgia to have chronic sleep disruption, gastrointestinal problems such as chronic bloating, diarrhea and constipation, fatigue, and hormonal problems. Below is a table with frequency of symptoms in patients with fibromyalgia.

If you recognize yourself in this description I would recommend that you get evaluated, and realize that there is hope for substantial improvement and possibly cure.

In  future writings I will discuss these symptoms individually and discuss how to deal with them.

Fibromyalgia and Low Energy States: What They Are, How to Overcome Them

by Alan Weiss, M.D. Fibromyalgia Specialist

Of all the concerns and complaints that people bring to physicians, one of the most common is “I just don’t have enough energy to get through the day. Maybe I have fibromyalgia?” People often feel like they just have enough energy to get to work and come home, and collapse with the hope that tomorrow will be better.

How do you know if you are in a “Low Energy State”? Besides not having sufficient energy to make it through a regular day, you may feel like if you take on anything extra that would be the straw that breaks the “camel’s back”. You may find yourself not sleeping well, or simply not feeling rested after a night of sleep. You may be achy following any kind of exertion, which can also wipe you out for a few days.

Other features of Low Energy States are the inability to lose weight no matter what or how you eat, even if you get a bit more exercise than usual. Often when interviewed people will acknowledge a lowered libido, feeling cold, and intestinal symptoms such as bloating and constipation. People may notice problems with hair and nails, feelings of dizziness, and a whole slew of other symptoms.

Undoubtedly as people including physicians read the above paragraphs, a range of possible reasons such as Fibromyalgia, Chronic Fatigue, low thyroid, and depression, among others, emerge.

One approach to dealing with such a condition is to consider that when the human body has what it needs to work well and is relieved of what it does not need it will generally work well.

Any hormonal deficiency or excess can produce a Low Energy State. This includes not just the thyroid, but also the adrenals glands and sex hormones, especially testosterone, estrogen, and progesterone. While deficiencies of these are more commonly going to cause Low Energy States, excesses can also produce this situation.

Nutritional deficiencies can result in low energy. Most common of these are Vitamins B12 and D, as well as calcium and magnesium. Any significant electrolyte or mineral disturbance can create a condition of low energy, as can sleep disturbances, overmedication, and addictions to caffeine, foods, alcohol, or street drugs.

The common energy currency of the body is called ATP. ATP is produced in the mitochondria of each cell. Various supplements such as Ribose and Coenzyme q10 can help augment ATP production and thus energy availability.

One overlooked reason is the spiritual domain. When a person is living life with an ever-increasing mass of complaints, resentments, upsets, and regrets, the cumulative weight of the incomplete past will weigh a human being down in a way that will erode the life force very quickly.

Once  a person realized they are in a Low Energy State, going on a hunt with a wide net will often reveal the cause (or causes) of the issue. Then the healing can begin.

Thank you for reading my fibromyalgia blog,

Alan Weiss, M.D.

Thank you for viewing our Fibromyalgia Blog with the latest information and help with Chronic Fatigue Syndrome (CFS), and Fibromyalgia information, by Alan Weiss, MD

Almost all of us know someone, who experiences longstanding fatigue, chronic pain ranging from mild to severe. Often all the testing and lab work done by doctors is found to be “within normal limits”-in other words there is no clear explanation for the problem. They are told they have either chronic fatigue or fibromyalgia, are told there is no cause and no specific therapy.

Patients with these diagnoses are told to sleep more, use pain medicine, and decrease stress. This approach, while well-meaning, often does not make much of a difference. Sometimes people are even told “it is all in your head”. And with no “real” diagnosis to offer, the impact on people’s ability to perform their functions at home and work is impaired and creates confusion and despair for the person and the people around them.

I have been fortunate to work with many patients who suffer from these surprisingly common entities known as Chronic Fatigue Syndrome (CFS) and/or Fibromyalgia. While there is no specific lab test to confirm either of these illnesses, they are very real and affect millions of people in the United States.

What causes this disruption? One useful theory which has led to effective and safe treatments for these conditions is that as a result of some combination of chronic infections, acute or prolonged stress, nutritional deficiencies, hormonal disruptions and toxic exposures, the function of the master gland of the body (the hypothalamus) is impaired and  the glands controlled by the hypothalamus, including the thyroid and adrenal glands, function sub-optimally.  As well the brain sends pain signals where there is really no reason for the pain.

Severe disruptions in the quality and amount of sleep are common in people with CFS and Fibromyalgia. It becomes a chicken and egg phenomenon. Because these patients cannot sleep their body does not heal, causing persistence of pain which further aggravates the sleep disruption.

Addressing any deficiencies in a person’s nutritional and hormonal status, making sure they get a sufficient number of sleeping hours, and using prescription medications and natural approaches provides an effective approach to treating these conditions.

We also must take into account that what is “normal” for most people does not work best for all. Testing and treating for less obvious Vitamin B12 and thyroid problems is a perfect example of this. Optimizing a person’s nutritional status and repairing gut problems is a key aspect of this treatment protocol. Raising Vitamin D levels to high normal ranges can also make a big difference.

The good news is that by paying attention to each of these elements people can experience significant improvement in all of the symptoms they have. Often after literally years of suffering and being unable to participate in life they way they want people can return to life and experience wellness.

While these conditions are difficult and may seem hopeless there is an effective approach for dealing with both CFS and fibromyalgia.