All of this non-hip related stuff is going to be the end of me yet. I must whinge for a bit, so please skip this bit if you're bothered by it.
First my acid reflux was killing me and my throat was on fire, then it turned out I have one heck of a head cold. I must have looked quite the picture today as both of my bosses insisted that I leave work as soon as they saw me. So I've been sitting on the couch, watching the telly and relaxing.
Then, to add to this joy, my tooth that had the root canal on Saturday became more painful so my dentist is putting in a prescription for antibiotics because he thinks there's an infection. Which means I have to go out again, feeling like crap and being in more pain than anything. I'm almost on the verge of popping a pain pill, which is a desperate measure. But as they say, desperate times call for desperate measures.
Please, whomever put this curse on me, enough is enough, I can't take it anymore.
31 October, 2007
30 October, 2007
PT update
They worked me over pretty good last night. I was doing a 5 lb weight for the leg lifts with the stim - impressive since I wasn't able to do that before surgery. Also, S told me I can try walking everywhere with one crutch and see how that goes. He doesn't think I'm ready for no crutches, but I'll take what I can get. Lets hope I didn't just jinx myself!
29 October, 2007
6 week Post Surgery update
Well well my pretties, it's been one heck of a time these last few days! It's times like these that I wish there was a way to become the bionic woman. (The original, this new one is just not working for me).
To summarise the last few days:
Thursday I woke up with one killer of a sore throat. I am only too familiar with sore throats, and can tell what causes each one. This one seems to be from my never ending acid reflux. I have been taking meds for the acid reflux for a long time, and my doctor had wanted me to start reducing the amount this summer. However, when she found out that I was to have hip surgery and take anti-inflammatory meds, she said to keep taking the acid reflux pills. Anti-inflammatory drugs are the devils work in my book and I try to avoid them at all costs, but I didn't seem to have a choice following hip surgery so I just went with it. The tablets are 500mg of Naproxen, taken twice a day. I was getting by for the first month or so, but by last week my insides had had enough and conceded defeat. Which is why I woke up with a burning throat.
My throat continued to get worse as the days went on so that I barely slept on Friday and Saturday nights. I think the last Naproxen I took was on Thursday, and about a week prior I had cut my dosage down to one tablet at day because of the intense pain in my stomach I had been experiencing. I tried taking something to numb my throat but it doesn't seem to make a dent, and I also sound like I've smoked three packs a day for the last twenty years.
To add to all the fun, Saturday I had a dentist appointment. I thought it was just to touch up one of my teeth that he had bonded a few weeks ago because of my tooth sensitivity. But alas, I was wrong. Secretly I held this fear that I was going to be told I was wrong and I needed a root canal. Having had three, you get to know when it's that. But I was in denial. Or at least thought if I denied it enough it wouldn't come true. I guess it was no surprise when the dentist brought it up and asked if I thought it could be that, and he did some poking and feeling and decided that was the most likely cause of my continual pain. I was ready to cry right then and there. The last root canal I had was only a little over a year ago, and it was a complete nightmare. The pain from the treatment and my TMJ was enough to keep me at home with ice packs and pain pills. Thankfully this tooth only had one root, and was towards the front and so the dentist was able to do the first part straight away. I go back in two weeks for the second part. I won't even mention the financial issues, but to give you an glimpse last year I used up all my FSA in the first two months from the root canal and crown. Seriously, I am losing my mind. But wait, it gets better.
Yesterday my mother and I were going out to do my food shopping. My nephew wanted to come and was sitting in the back seat when I got in the front. He did or said something to make me turn and my right hip went POP! I think (and hope it's not my denial but true) it was just my IT band which has done plenty of popping before. Yesterday I had more pain in my hip than I have for a while. I am not sure if it was the popping or the additional moving around with my nephew all weekend and him sitting on my lap, or just a combination of both. I am still a bit sore today and have PT tonight, so will tell the boys about it and see what they have to say.
The words "never a dull moment" could not be truer for me if I tried.
To summarise the last few days:
Thursday I woke up with one killer of a sore throat. I am only too familiar with sore throats, and can tell what causes each one. This one seems to be from my never ending acid reflux. I have been taking meds for the acid reflux for a long time, and my doctor had wanted me to start reducing the amount this summer. However, when she found out that I was to have hip surgery and take anti-inflammatory meds, she said to keep taking the acid reflux pills. Anti-inflammatory drugs are the devils work in my book and I try to avoid them at all costs, but I didn't seem to have a choice following hip surgery so I just went with it. The tablets are 500mg of Naproxen, taken twice a day. I was getting by for the first month or so, but by last week my insides had had enough and conceded defeat. Which is why I woke up with a burning throat.
My throat continued to get worse as the days went on so that I barely slept on Friday and Saturday nights. I think the last Naproxen I took was on Thursday, and about a week prior I had cut my dosage down to one tablet at day because of the intense pain in my stomach I had been experiencing. I tried taking something to numb my throat but it doesn't seem to make a dent, and I also sound like I've smoked three packs a day for the last twenty years.
To add to all the fun, Saturday I had a dentist appointment. I thought it was just to touch up one of my teeth that he had bonded a few weeks ago because of my tooth sensitivity. But alas, I was wrong. Secretly I held this fear that I was going to be told I was wrong and I needed a root canal. Having had three, you get to know when it's that. But I was in denial. Or at least thought if I denied it enough it wouldn't come true. I guess it was no surprise when the dentist brought it up and asked if I thought it could be that, and he did some poking and feeling and decided that was the most likely cause of my continual pain. I was ready to cry right then and there. The last root canal I had was only a little over a year ago, and it was a complete nightmare. The pain from the treatment and my TMJ was enough to keep me at home with ice packs and pain pills. Thankfully this tooth only had one root, and was towards the front and so the dentist was able to do the first part straight away. I go back in two weeks for the second part. I won't even mention the financial issues, but to give you an glimpse last year I used up all my FSA in the first two months from the root canal and crown. Seriously, I am losing my mind. But wait, it gets better.
Yesterday my mother and I were going out to do my food shopping. My nephew wanted to come and was sitting in the back seat when I got in the front. He did or said something to make me turn and my right hip went POP! I think (and hope it's not my denial but true) it was just my IT band which has done plenty of popping before. Yesterday I had more pain in my hip than I have for a while. I am not sure if it was the popping or the additional moving around with my nephew all weekend and him sitting on my lap, or just a combination of both. I am still a bit sore today and have PT tonight, so will tell the boys about it and see what they have to say.
The words "never a dull moment" could not be truer for me if I tried.
24 October, 2007
Stoned
Well, at least that's how I think it would feel, as I don't really know. I had to take a pain pill today - not because of the hip, but my fibro if flaring up big time. Between this crap weather and lack of sleep I feel like I've been run over by a mack truck, who then reversed, did it again, and once more for good luck.
Good thing it's relatively quiet at work because I don't know how I'd pull it off. I actually cancelled my PT for this evening. There is no way in hell that I am going to be tortured by someone else anymore than I am being at present by my own body. Oh well, I guess sometimes you have to just say WTF and take some rest. I just hope the weather improves quickly, and that I get some decent sleep tonight. I hate taking these bloody pills!
Good thing it's relatively quiet at work because I don't know how I'd pull it off. I actually cancelled my PT for this evening. There is no way in hell that I am going to be tortured by someone else anymore than I am being at present by my own body. Oh well, I guess sometimes you have to just say WTF and take some rest. I just hope the weather improves quickly, and that I get some decent sleep tonight. I hate taking these bloody pills!
23 October, 2007
5 Weeks Post-Op
I apologise for my lack of attention to the blog, but life has been mostly dull as of late. Work is tiring and two days a week after work I have PT, so I don't get home till 8ish. Yesterday I left PT w/o icing - I was so hungry I said I'd do it at home, but had to go eat. An apple beforehand didn't cut it obviously.
The good news is they told me I can start putting more weight on my right leg when walking with both crutches, and I can use one crutch whilst I am home, but must use two when I'm out. The bad news is this means nothing to me because I've been very naughty and have been walking around my flat now for a couple of weeks without any crutches at all. I have no patience. I am able to get around from room to room but rest a lot in between. If my hip starts to hurt I just ice it. (Speaking of which, I think I've become an human icicle - all I do is ice all day long at work). I am not sure that I could go out and walk around all day without the crutches yet, I don't feel strong enough. I asked K last week at PT if he thought I'd be off of my crutches in a month, and he said yes. That is my goal because my first theatre tickets are in a month and there is no way I want to deal with crutches in a tiny seating area - so fingers crossed he's right.
I had been wearing my brace to and from work, especially to protect me on public transport because you would not believe how rude and obnoxious some people can be even when you are on crutches! I found that it helped them from not pushing into or leaning on my hip because if they did they'd get a big metal bit in theirs. Today I decided, mostly because I knew I was going to take a taxi both ways, to try it without the brace. It was ok, but I definitely felt a bit more sore. I'll have to see what I will do when taking the bus again.
As for my PT last night - they kicked it up a notch or two. I started doing leg lifts that I haven't done since before my surgery. I am definitely sore from them, but in an achy type of way, which is okay as it shows I am finally working some muscles. Better achy and sore than the old stabbing pain.
I did contact Dr. Kelly's office to see if I was to renew the anti-inflammatory meds. These are very bad for me because of my GERD, so was hoping to be able to stop. Unfortunately they want me to stay on them at least until my next appointment. I also mentioned the my left hip is snapping like crazy (IT band most likely) when I walk and they said they'd discuss that at the next visit. I seriously do not think I can go through this again, so I am praying that my left hip steps up and behaves itself and stops wanting the attention!
My biggest issue is still not being able to sleep. It's definitely been worse sine the surgery, and it's either the discomfort (the rest of me is in agony from the crutches and compensation) or the fear that I will sleep in a position that will be bad for my hip. Trust me, I wake up in pretzel positions on a regular basis so and I've already woken up at least once with my right hip in a very bad position. I've been needing to take my "magic" pills on a more regular basis, which is not good because even if I take them early evening, I am wiped out the next day. I am hoping this will all work itself out as I improve.
The one thing I am looking forward to this week is my appointment with my chiropractor. He has these wonderful masseuses that do Active Release Therapy and my back and neck are in desperate need of this. Thursday can't come fast enough!
The good news is they told me I can start putting more weight on my right leg when walking with both crutches, and I can use one crutch whilst I am home, but must use two when I'm out. The bad news is this means nothing to me because I've been very naughty and have been walking around my flat now for a couple of weeks without any crutches at all. I have no patience. I am able to get around from room to room but rest a lot in between. If my hip starts to hurt I just ice it. (Speaking of which, I think I've become an human icicle - all I do is ice all day long at work). I am not sure that I could go out and walk around all day without the crutches yet, I don't feel strong enough. I asked K last week at PT if he thought I'd be off of my crutches in a month, and he said yes. That is my goal because my first theatre tickets are in a month and there is no way I want to deal with crutches in a tiny seating area - so fingers crossed he's right.
I had been wearing my brace to and from work, especially to protect me on public transport because you would not believe how rude and obnoxious some people can be even when you are on crutches! I found that it helped them from not pushing into or leaning on my hip because if they did they'd get a big metal bit in theirs. Today I decided, mostly because I knew I was going to take a taxi both ways, to try it without the brace. It was ok, but I definitely felt a bit more sore. I'll have to see what I will do when taking the bus again.
As for my PT last night - they kicked it up a notch or two. I started doing leg lifts that I haven't done since before my surgery. I am definitely sore from them, but in an achy type of way, which is okay as it shows I am finally working some muscles. Better achy and sore than the old stabbing pain.
I did contact Dr. Kelly's office to see if I was to renew the anti-inflammatory meds. These are very bad for me because of my GERD, so was hoping to be able to stop. Unfortunately they want me to stay on them at least until my next appointment. I also mentioned the my left hip is snapping like crazy (IT band most likely) when I walk and they said they'd discuss that at the next visit. I seriously do not think I can go through this again, so I am praying that my left hip steps up and behaves itself and stops wanting the attention!
My biggest issue is still not being able to sleep. It's definitely been worse sine the surgery, and it's either the discomfort (the rest of me is in agony from the crutches and compensation) or the fear that I will sleep in a position that will be bad for my hip. Trust me, I wake up in pretzel positions on a regular basis so and I've already woken up at least once with my right hip in a very bad position. I've been needing to take my "magic" pills on a more regular basis, which is not good because even if I take them early evening, I am wiped out the next day. I am hoping this will all work itself out as I improve.
The one thing I am looking forward to this week is my appointment with my chiropractor. He has these wonderful masseuses that do Active Release Therapy and my back and neck are in desperate need of this. Thursday can't come fast enough!
16 October, 2007
4 weeks post op
4 weeks later and here's the scoop...
*I am still (frustratingly) on crutches. Most "normal" people would be off them by now, but because of multitude of issues, I am to stay on them for longer, though no one can seem to say when. The dr says "when I can walk with no pain and no limp". That being said, I have been wobbling around my flat w/o the crutches, and even did a silly thing and climbed the step stool so I could get my electric heater as it's been freezing in my flat. Stupid, yes, but I was desperate. One cannot describe how much I hate those bloody crutches, there are no words for it.
*Because of the crutches, my knees, shoulders, left hip and my hands/wrists have been beyond unhappy. This should not be taken by the average person as something they would experience, again it's just because of my other medical issues.
*Carrying packages is an issue when shopping, and I have been fortunate to have someone to help the last few weeks. This week is my first all by myself, and so far I have not had to go to the shops. My advice is to have someone stock up for you when they can.
*I can finally get my socks and shoes on w/o the assistance of the sock puller thingy and long shoe horn. I count this as a great accomplishment!
*I am still wearing my brace to and from places, but take it off when I am at work. The dr said that I should use this as long as I feel it is helping to support me. I had that reinforced on Friday night when I decided I was NOT going to wear my brace out, and only had a couple of blocks to walk. Unfortunately I had the wrong street in my head and we had to walk an extra long block up a hill. I was shot all around after that and my hip did hurt me for the rest of the weekend. To make up for it I stayed in and did nothing all day Sunday!
*Sitting all day is difficult, and I am meant to get up every 45 minutes to walk around. Getting up to use my crutches is the least appetizing thing I can think of, so it gets spaced out a bit more. I brought two ice packs with me to work and use them on and off all day long on both my hips to keep the swelling down.
*This week I start PT twice a week. I went last night and was pretty sore from the exercises and manual manipulation. The good news is I did 20 minutes straight on the bike!
*I was going to try to take the bus to and from work, but to be honest I have not made the best start with that. I am constantly exhausted so have been taking cabs, which is tres expensive, but sometimes more convenient than waiting and getting on and off multiple buses.
*Sleeping is still not great, but for me it never was. I have been taking pills to help sleep the last two nights, but on Fri and Sat did not need to as I was so tired, and had also drunk wine which helped!
That's about all I can think of now.
PS-I want to say a HUGE thanks to my friend T who spent last week looking after me, and was in all the way from Holland! I'm very lucky to have a friend like her.
*I am still (frustratingly) on crutches. Most "normal" people would be off them by now, but because of multitude of issues, I am to stay on them for longer, though no one can seem to say when. The dr says "when I can walk with no pain and no limp". That being said, I have been wobbling around my flat w/o the crutches, and even did a silly thing and climbed the step stool so I could get my electric heater as it's been freezing in my flat. Stupid, yes, but I was desperate. One cannot describe how much I hate those bloody crutches, there are no words for it.
*Because of the crutches, my knees, shoulders, left hip and my hands/wrists have been beyond unhappy. This should not be taken by the average person as something they would experience, again it's just because of my other medical issues.
*Carrying packages is an issue when shopping, and I have been fortunate to have someone to help the last few weeks. This week is my first all by myself, and so far I have not had to go to the shops. My advice is to have someone stock up for you when they can.
*I can finally get my socks and shoes on w/o the assistance of the sock puller thingy and long shoe horn. I count this as a great accomplishment!
*I am still wearing my brace to and from places, but take it off when I am at work. The dr said that I should use this as long as I feel it is helping to support me. I had that reinforced on Friday night when I decided I was NOT going to wear my brace out, and only had a couple of blocks to walk. Unfortunately I had the wrong street in my head and we had to walk an extra long block up a hill. I was shot all around after that and my hip did hurt me for the rest of the weekend. To make up for it I stayed in and did nothing all day Sunday!
*Sitting all day is difficult, and I am meant to get up every 45 minutes to walk around. Getting up to use my crutches is the least appetizing thing I can think of, so it gets spaced out a bit more. I brought two ice packs with me to work and use them on and off all day long on both my hips to keep the swelling down.
*This week I start PT twice a week. I went last night and was pretty sore from the exercises and manual manipulation. The good news is I did 20 minutes straight on the bike!
*I was going to try to take the bus to and from work, but to be honest I have not made the best start with that. I am constantly exhausted so have been taking cabs, which is tres expensive, but sometimes more convenient than waiting and getting on and off multiple buses.
*Sleeping is still not great, but for me it never was. I have been taking pills to help sleep the last two nights, but on Fri and Sat did not need to as I was so tired, and had also drunk wine which helped!
That's about all I can think of now.
PS-I want to say a HUGE thanks to my friend T who spent last week looking after me, and was in all the way from Holland! I'm very lucky to have a friend like her.
12 October, 2007
Magic pills
Don't know what I'd do without them. I finally got an half way decent night of sleep! Still v. achy today but at least the sun is coming out and (touch wood) it's not meant to rain till next week!
I will post a four week update on Monday, happy weekend!
I will post a four week update on Monday, happy weekend!
Article on Fibromyalgia that is very informative and thorough
Learning To Manage Fibromyalgia Syndrome
Darlene A. Clarke, R.N., M.S.N.President & Founder of the Northeast Ohio Branch of the EDNF. Darlene has Hypermobility Type EDS and Fibromyalgia Syndrome.
Individuals with EDS are often also diagnosed with Fibromyalgia syndrome. Fibromyalgia is a common and often disabling disorder whose cause remains obscure. Fibromyalgia frequently resembles other disorders such as rheumatoid arthritis and lupus. Individuals commonly complain of widespread muscle pain and tenderness, as well as fatigue and exhaustion after minimal exertion. A characteristically high “tender point” is evident. For individuals diagnosed with Fibromyalgia, learning to effectively cope with this disorder is essential to one’s emotional and physical health.
It's morning and as you awake you realize you are exhausted and you haven't even left the bed yet. The thought crosses your mind that for as tired as you are, you may as well have never gone to bed. You barely have enough energy to get out of bed and care for yourself, let alone being able to care for the children, or go to work or school. As you struggle to get out of bed, you realize that your body aches all over and you feel as if you are a 100 years old. You are stiff and can hardly move. What is wrong with you? After seeking one or more medical evaluations, you finally get the answer. Your physician informs you that you have Fibromyalgia syndrome. Such a big word that sounds ominous and must mean you have some dreaded problem. You have never even heard the term before.
So, what is Fibromyalgia syndrome?
Fibromyalgia syndrome is a common form of chronic, generalized muscular pain and fatigue. In some cases, the pain is so intense that it can be incapacitating.
1 Despite that Fibromyalgia does not result in serious, long–term target organ damage; it does have a negative impact on the quality of life similar to that of rheumatoid arthritis.
2 To effectively manage and cope with Fibromyalgia syndrome, it is imperative that one has a clear understanding of Fibromyalgia, its signs and symptoms, triggering factors and how it is treated and managed.
The term “Fibromyalgia” can be broken down into fibro (fibrous tissue), my (muscles), and algia (pain and tenderness). In Fibromyalgia there is pain in the muscles and fibrous connective tissues which comprise ligaments and tendons. Therefore, while Fibromyalgia feels like a joint disease, it affects muscles and their attachments to bone and joint deformity does not ensue.
3 Fibromyalgia can run in families, possibly suggesting an inherited predisposition. To date, the cause of Fibromyalgia is not known. It may lie dormant until it is triggered by an injury/trauma, stress, or a sleep disturbance. There are other theories as to what triggers Fibromyalgia. One theory is that the syndrome is caused by an infectious agent such as the influenza virus. Other suspected causes include extreme physical deconditioning of the nervous system brought on by a lack of exercise, and changes in muscle metabolism that can result in decreased blood flow to the muscles with fatigue and decreased strength the end results.
4 More recent research points to two key chemicals of the Central Nervous System that facilitate the regulation of pain messages transmitted to our brain. These two chemicals are substance P and serotonin. Substance P begins the pain–signal process following tissue injury. Serotonin reduces the intensity of pain signals in the transmission of pain and is very important in sleep regulation. Low levels of serotonin and elevated levels of substance P have been found in individuals with Fibromyalgia. These findings support the theories that individuals with Fibromyalgia have unusually high pain intensity messages transmitted to their brain as well as deficiencies in the inhibition of pain.
5 One clear fact remains: more research is needed on Fibromyalgia. Despite not being able to identify the exact cause of Fibromyalgia, individuals present with similar signs and symptoms.
Signs and Symptoms
Probably the most frustrating aspect of having Fibromyalgia syndrome, as in EDS, is that you “look healthy.” Compounded by the fact that test results are “normal,” it is difficult to convince others that something is wrong with you. Every X–ray and blood test your physician ordered has come back within normal limits. You embark down the path of self–doubt and frustration – is this pain real, or is it all in my head? Why is it so difficult to put a label to the signs and symptoms of Fibromyalgia?
Fibromyalgia is frequently misunderstood and confusing because the symptoms seen in this syndrome are also found in other conditions such as rheumatoid arthritis and lupus. Women are affected more than men and the symptoms usually occur first when an individual is between 20 and 40 years old.1 However, it must be noted that Fibromyalgia can sometimes affect children and the elderly.4 Recent research studies have established guidelines for diagnosing Fibromyalgia based on the presence of certain signs and symptoms.
Pain
The most common complaint from patients with Fibromyalgia is that they have diffuse “pain all over” – almost like the flu. Although in rarer cases, the pain is quite severe and disabling. More often, the symptoms often begin insidiously and may wax and wane in severity. In almost all cases, individuals complain of some degree of pain continuously. The pain is most often worse at “tender points” specifically located on the body. Fibromyalgia type pain generally is worse in the morning and late evening and often is associated with stiffness. Muscle groups that are used repetitively result in an increase in the level of pain you experience.
Fatigue and Sleep Disturbances
Have you ever awaked after sleeping and felt refreshed and rejuvenated? Most likely your answer would be “no.” Immense fatigue is frequently the debilitating aspect of Fibromyalgia. The fatigue may be exhibited as an overall tiredness and lack of energy, or as muscular fatigue and a lack of endurance. In either case, it can be difficult to perform activities of daily living such as caring for self or others, performing household chores, going shopping, or to function effectively at work. Keep in mind that it takes a tremendous amount of energy to deal with having chronic pain and this too can contribute to an individual’s fatigue.
Approximately 90% of individuals with Fibromyalgia complain of moderate to severe fatigue coupled with a lack of energy or the type of exhaustion that is found with a lack of sleep. In most cases, individuals wake up feeling tired even after sleeping all night. While their minds may be rested, their bodies feel as if they never went to sleep. Many are aware that their sleep has become lighter with frequent awakenings throughout the night. Scientific studies reveal that individuals with Fibromyalgia have abnormal sleep patterns and are deficient in Stage 4 sleep – the deepest stage.1,3,5 It is important to note that a secondary Fibromyalgia syndrome can occur with any connective tissue disease (EDS included) and may not necessarily be related to sleep disturbances.6
Central Nervous System Symptoms
As in other chronic illnesses, mood and mental changes can occur in individuals with Fibromyalgia. Many individuals feel “blue” or “down,” although only about 25% are clinically depressed. In most cases, depression and/or anxiety tends to follow the onset of Fibromyalgia symptoms and may be the result of Fibromyalgia and not the cause of it.3
People with Fibromyalgia may also experience numbness and tingling in their hands, arms, face, feet and legs. These symptoms can also be found in other disorders and usually require numerous tests before the diagnosis of Fibromyalgia is reached by a physician.
Other Problems
Muscular as well as migraine headaches are common in Fibromyalgia. Abdominal bloating, pain, alternating diarrhea and constipation are also commonly seen. They resemble irritable bowel syndrome or “spastic colon” in nature. Similar bladder spasms and irritability results in urinary urgency and frequency. The skin and circulatory system are sensitive to moisture and temperature changes resulting in temporary changes in skin color.2,3
Clinical Diagnosis
Currently, no definitive laboratory tests exist to make the diagnosis of Fibromyalgia. Rather, the diagnosis is made by a physician after obtaining the individual’s medical history and performing a complete physical examination.
A hallmark of Fibromyalgia syndrome is reduced pain thresholds at designated tender points, demonstrated upon palpation.2 According to the American College of Rheumatology, the diagnostic criteria for Fibromyalgia includes: a). widespread diffuse pain that has been present for at least three months and b). pain that is present in 11 of the 18 bilateral tender point sites (see figure 1) when 4 kg of force is applied by digital palpation.1,2,7 Recall your response the first time your physician palpated these 18 “tender points.” Did you say “ouch,” flinch, make a facial grimace, and attempt to withdraw away from your doctor or even jump? These are the usual responses elicited by an individual with Fibromyalgia. Frequently, patients are shocked by the level of pain they experience when these areas are palpated. Now that you know how Fibromyalgia is diagnosed, let’s look at the common triggering factors of Fibromyalgia.
Common Triggers of Fibromyalgia
Three common factors seem to trigger a flare in Fibromyalgia symptoms, physical factors, emotional factors and environmental factors. Keep in mind that your Fibromyalgia can become aggravated by these factors alone or any combination of these factors.
Physical Factors
Several physical factors can aggravate your Fibromyalgia. Infections are one type of physical factor that can produce the most profound exacerbation of Fibromyalgia symptoms. The second type of physical factors deal with ergonomics. The positions we maintain our bodies in has a direct correlation to the pain associated in Fibromyalgia. For instance, do you have a job that requires you use repetitive movements all day? Are you required to work in one spot with your arms elevated above your work surface? Do you need to remain in one position (i.e., standing, sitting or driving) for prolonged amounts time? If you answered “yes” to any of the above questions, you will be able to relate to the pain that results from maintaining your muscles in a sustained isometric position for any length of time. Ergonomics also plays an important role at home. It’s often difficult for someone with Fibromyalgia to push a vacuum cleaner, wash walls, paint or prepare meals. These tasks require the use of shoulder muscles to maintain arms in extension at some level in front of our body. What generally happens is that an ache begins in the neck, shoulders and upper back. The ache rapidly turns into pain that elevates in intensity as it slowly radiates up and down the back. You feel as if you can’t maintain your arms in this position any longer, and you quickly return your arms to your sides as you wait for the pain to slowly ebb away. Most, if not all of you, can relate to this all too familiar type of pain.
Emotional Factors
Stress is something that each of us has to deal with on a daily basis. Unfortunately, emotional stress is a prominent factor aggravating Fibromyalgia. We are faced with stressful situations at home, work, school, driving your car on the highway etc. It isn’t difficult to identify situations that aggravate your Fibromyalgia symptoms – that’s the easy part of the equation. The trick is to avoid or attempt to modify any stressful situation.
It is extremely difficult to deal with those situations in which any stressor is unrelenting. These types of situations can present themselves in the home with family members or in the workplace with coworkers or supervisors. In these situations, one must look at not only the circumstance, but how you react to the stressor. Ultimately, it comes down to dividing these stressful situations into two categories: those that you have control over and those you have absolutely no control over. In circumstances that you have no control over, it is imperative that you learn to alter your response to those particular situations. Save your energy for those battles that you can emerge victorious.
Environmental Factors
How many times have you been able to predict the approaching weather without having looked at a weather map? Probably too numerous to count. You feel like you are a human barometer with the ability to predict weather changes before they occur. Most likely you have found that when the barometric pressure drops, it is followed by rain, cold, snow, and fog – all of which aggravate your symptoms.
Many individuals with Fibromyalgia report that certain types of artificial lighting, cold drafts or irritating noises often result in a flare of their muscle pain. When was the last time that you were able to enter a pool that wasn’t heated? Just a guess, but it was probably many years ago. Most individuals with Fibromyalgia do not tolerate swimming in cold or cool water. We are usually found in the heated pools that others say are “too hot to swim in” or in hot tubs. The goal is to determine what factors aggravate your Fibromyalgia and either eliminate them if possible or at least modify them. Now that you know what factors can trigger your Fibromyalgia, let’s look at how it is treated and managed.
Treatment and Management
Since Fibromyalgia’s definitive cause is not known, current treatments are focused on relieving painful symptoms, not necessarily curing them. Additionally, the treatment program prescribed by your physician will be individualized to address your specific needs.
Numerous treatments have been employed over the years for Fibromyalgia. No one method has been entirely successful, but several methods will be prescribed by your physician in an attempt to control your symptoms. A sense of overwhelming relief comes with the validation of your symptoms and a diagnosis. Just knowing the name of your condition will not be enough though. Your physician and healthcare team will educate you and your family about Fibromyalgia. Specifically, you’ll be informed about your prognosis, possible causative factors, the aspects of treatment and specific body mechanics techniques. This education will prove invaluable to you. If you are taught about what to expect and how to deal with flare–ups, you will be able to control your Fibromyalgia. The goal of education is to moderate the effects of Fibromyalgia on your life. Only then will Fibromyalgia not become your entire life.
Medications may be prescribed by your physician to control pain and improve deep Stage 4 sleep. If pain is prominent, your doctor may prescribe a low dose of an analgesic or nonsteroidal anti–inflammatory drug, although most nonsteroidal anti–inflammatory drugs are marginally beneficial and carry the risk of side–effects that outweigh their benefits. Therefore, you will be most likely instructed to use over the counter medications such as acetaminophen, aspirin or ibuprofen to relieve pain and reduce stiffness. If you are currently on a nonsteroidal anti–inflammatory drug to help manage your EDS, your physician will likely instruct you to take acetaminophen, not ibuprofen or aspirin, to control your pain.
To improve Stage 4 sleep, your physician may prescribe low doses of tricyclic antidepressants (Elavil, Sinequan) or the muscle relaxant cyclobenzaprine (Flexeril). These drugs are structurally similar and they block the re–uptake of the neurotransmitters that regulate deep Stage 4 sleep.3,8. These medications carry the risk of potential side–effects which include: drowsiness, weight gain, dry mouth and constipation to name a few. Do not be discouraged if you do not respond to the first medication(s) prescribed. Your doctor may need to adjust dosages or change drugs to achieve an improvement.
Individuals with Fibromyalgia should practice good sleep hygiene to promote sleep. Bedtime rituals can relax you in preparation of sleep. These bedtime rituals can include: taking a warm bath or shower, reading a novel, watching a relaxing television program or listening to soothing music which can promote sleep. Attempt to follow a regular sleep schedule and go to bed at the same time each day. Sleep eight hours nightly if possible. Avoid alcohol, caffeine and tobacco before retiring – they will disturb your sleep. Also abstain from taking midday naps.
Exercise is a key element in Fibromyalgia management. Your physician will recommend that you slowly increase your aerobic fitness with structured, low impact activities such as swimming, water aerobics, walking, or riding a stationary bicycle.2,3,7,8 Research has indicated that aerobic exercise improves sleep, enhances endorphin release and has antidepressant effects.2 It is important to check with your physician to ensure that the exercise program you have chosen is not contraindicated in your specific type of EDS. Remember to always stretch your muscles before engaging in any aerobic activity. Increase your exercise program gradually to reduce the chance of injury. As you continue to exercise, you’ll notice that you feel better, have more endurance and experience a reduction in Fibromyalgia symptoms. It’s worth the possible pain and fatigue felt initially to achieve these end–results.
Always practice proper body mechanics and apply ergonomic principles at home, work and at rest. These techniques will prevent injury and reduce flare–ups of Fibromyalgia symptoms.
Your doctor may prescribe various physical therapy treatments. Possible treatments include: massage, heat or ice applications, ultrasound or whirlpool therapy and microvoltage electrical stimulation. These are all passive physical therapy techniques with varying results from individual to individual. These treatments are usually prescribed for flare–ups and are employed for short periods of time.3,8
Taking Control of Fibromyalgia
You can engage in several actions that will help you gain control of your Fibromyalgia. First and foremost, listen to your body. Identify those triggers that aggravate your symptoms and then avoid or at least minimize them. Get your stress level under control by practicing relaxation techniques. Relaxation techniques are primarily effective for chronic pain and have many benefits. Relaxation techniques enable you to reduce anxiety, pain and stress, reduce muscle tension pain and relieve the helplessness and depression associated with chronic pain. Despite having chronic pain and fatigue, learn to develop a positive attitude. Remember that if you have a constant negative attitude, your Fibromyalgia symptoms will exacerbate. Look for the good in every situation – it’s there, but you may need to look closely.
Eat healthy and avoid fat in your diet. Excess weight is detrimental to your body and can aggravate your symptoms. Eating properly also maintains your health and avoids illness. Keep in mind that an illness (i.e., cold, flu, bacterial infection etc.) can be a triggering factor for your symptoms.
Educate yourself, family and healthcare providers about Fibromyalgia syndrome. Remember that knowledge is a powerful weapon in coping with any chronic illness. Knowledge also helps you to take control of your Fibromyalgia and reduce the exacerbation of its symptoms.
Lastly, seek support from others with Fibromyalgia. Check with your physician, healthcare institution, and within your local community for a Fibromyalgia support group. It is extremely beneficial to receive support and understanding from others who have the same type of problems from Fibromyalgia as you do. Connecting with a support group also helps you and your family to cope with having a chronic illness. And who knows, maybe someday you will have the opportunity to offer support to someone else just diagnosed with Fibromyalgia. I guarantee it will be one of the most gratifying and fulfilling experiences of your life.
Conclusion
Receiving a diagnosis of Fibromyalgia syndrome is an important first step in managing this condition. It is not the last step though! It is imperative that you have a clear understanding of Fibromyalgia, its signs and symptoms, triggering factors and treatments. Learning to effectively cope with this disorder is essential to one’s emotional and physical health. It is only then that you will be able to manage your Fibromyalgia and prevent it from becoming your whole life. While there isn’t a cure for Fibromyalgia, there are treatments that are effective in managing its symptoms. There is life after finding out you have Fibromyalgia. Tomorrow will be better and holds the possibility of a cure!
References
1 Fan, P.T., & Blanton, M.E. (1992). Clinical features and diagnosis of Fibromyalgia. Journal of Musculoskeletal Medicine, 9(4), 24–42.
2 Wilke, W.S. (1996). Fibromyalgia: Recognizing and addressing the multiple interrelated factors. Postgraduate Medicine, 100(1), 153–170.
3 Arthritis Foundation, Inc. (1995) Fibromyalgia Syndromes, 1–12.
4 Dunkin, M.A. (1993, September–October). Fibromyalgia: Out of the Closet. Arthritis Today, pp. 24–28.
5 Dunkin, M.A. (1997, September–October). Fibromyalgia: Syndrome of the ’90s. Arthritis Today, pp. 41–47.
6 Ignatavicius, D.D., Workman, M.L., & Mishler, M.A. (1995). Medical–Surgical Nursing (2nd ed.). Philadelphia: W.B. Saunders Company.
7 Goldberg, D.L. (1990) Fibromyalgia and chronic fatigue syndrome: Are they the same? Journal of Musculoskeletal Medicine, 7(5), 19–28.
8 Sherman, C. (1992) Managing fibromyalgia with exercise. The Physician and Sports Medicine, 20(10), 166–172.
Darlene A. Clarke, R.N., M.S.N.President & Founder of the Northeast Ohio Branch of the EDNF. Darlene has Hypermobility Type EDS and Fibromyalgia Syndrome.
Individuals with EDS are often also diagnosed with Fibromyalgia syndrome. Fibromyalgia is a common and often disabling disorder whose cause remains obscure. Fibromyalgia frequently resembles other disorders such as rheumatoid arthritis and lupus. Individuals commonly complain of widespread muscle pain and tenderness, as well as fatigue and exhaustion after minimal exertion. A characteristically high “tender point” is evident. For individuals diagnosed with Fibromyalgia, learning to effectively cope with this disorder is essential to one’s emotional and physical health.
It's morning and as you awake you realize you are exhausted and you haven't even left the bed yet. The thought crosses your mind that for as tired as you are, you may as well have never gone to bed. You barely have enough energy to get out of bed and care for yourself, let alone being able to care for the children, or go to work or school. As you struggle to get out of bed, you realize that your body aches all over and you feel as if you are a 100 years old. You are stiff and can hardly move. What is wrong with you? After seeking one or more medical evaluations, you finally get the answer. Your physician informs you that you have Fibromyalgia syndrome. Such a big word that sounds ominous and must mean you have some dreaded problem. You have never even heard the term before.
So, what is Fibromyalgia syndrome?
Fibromyalgia syndrome is a common form of chronic, generalized muscular pain and fatigue. In some cases, the pain is so intense that it can be incapacitating.
1 Despite that Fibromyalgia does not result in serious, long–term target organ damage; it does have a negative impact on the quality of life similar to that of rheumatoid arthritis.
2 To effectively manage and cope with Fibromyalgia syndrome, it is imperative that one has a clear understanding of Fibromyalgia, its signs and symptoms, triggering factors and how it is treated and managed.
The term “Fibromyalgia” can be broken down into fibro (fibrous tissue), my (muscles), and algia (pain and tenderness). In Fibromyalgia there is pain in the muscles and fibrous connective tissues which comprise ligaments and tendons. Therefore, while Fibromyalgia feels like a joint disease, it affects muscles and their attachments to bone and joint deformity does not ensue.
3 Fibromyalgia can run in families, possibly suggesting an inherited predisposition. To date, the cause of Fibromyalgia is not known. It may lie dormant until it is triggered by an injury/trauma, stress, or a sleep disturbance. There are other theories as to what triggers Fibromyalgia. One theory is that the syndrome is caused by an infectious agent such as the influenza virus. Other suspected causes include extreme physical deconditioning of the nervous system brought on by a lack of exercise, and changes in muscle metabolism that can result in decreased blood flow to the muscles with fatigue and decreased strength the end results.
4 More recent research points to two key chemicals of the Central Nervous System that facilitate the regulation of pain messages transmitted to our brain. These two chemicals are substance P and serotonin. Substance P begins the pain–signal process following tissue injury. Serotonin reduces the intensity of pain signals in the transmission of pain and is very important in sleep regulation. Low levels of serotonin and elevated levels of substance P have been found in individuals with Fibromyalgia. These findings support the theories that individuals with Fibromyalgia have unusually high pain intensity messages transmitted to their brain as well as deficiencies in the inhibition of pain.
5 One clear fact remains: more research is needed on Fibromyalgia. Despite not being able to identify the exact cause of Fibromyalgia, individuals present with similar signs and symptoms.
Signs and Symptoms
Probably the most frustrating aspect of having Fibromyalgia syndrome, as in EDS, is that you “look healthy.” Compounded by the fact that test results are “normal,” it is difficult to convince others that something is wrong with you. Every X–ray and blood test your physician ordered has come back within normal limits. You embark down the path of self–doubt and frustration – is this pain real, or is it all in my head? Why is it so difficult to put a label to the signs and symptoms of Fibromyalgia?
Fibromyalgia is frequently misunderstood and confusing because the symptoms seen in this syndrome are also found in other conditions such as rheumatoid arthritis and lupus. Women are affected more than men and the symptoms usually occur first when an individual is between 20 and 40 years old.1 However, it must be noted that Fibromyalgia can sometimes affect children and the elderly.4 Recent research studies have established guidelines for diagnosing Fibromyalgia based on the presence of certain signs and symptoms.
Pain
The most common complaint from patients with Fibromyalgia is that they have diffuse “pain all over” – almost like the flu. Although in rarer cases, the pain is quite severe and disabling. More often, the symptoms often begin insidiously and may wax and wane in severity. In almost all cases, individuals complain of some degree of pain continuously. The pain is most often worse at “tender points” specifically located on the body. Fibromyalgia type pain generally is worse in the morning and late evening and often is associated with stiffness. Muscle groups that are used repetitively result in an increase in the level of pain you experience.
Fatigue and Sleep Disturbances
Have you ever awaked after sleeping and felt refreshed and rejuvenated? Most likely your answer would be “no.” Immense fatigue is frequently the debilitating aspect of Fibromyalgia. The fatigue may be exhibited as an overall tiredness and lack of energy, or as muscular fatigue and a lack of endurance. In either case, it can be difficult to perform activities of daily living such as caring for self or others, performing household chores, going shopping, or to function effectively at work. Keep in mind that it takes a tremendous amount of energy to deal with having chronic pain and this too can contribute to an individual’s fatigue.
Approximately 90% of individuals with Fibromyalgia complain of moderate to severe fatigue coupled with a lack of energy or the type of exhaustion that is found with a lack of sleep. In most cases, individuals wake up feeling tired even after sleeping all night. While their minds may be rested, their bodies feel as if they never went to sleep. Many are aware that their sleep has become lighter with frequent awakenings throughout the night. Scientific studies reveal that individuals with Fibromyalgia have abnormal sleep patterns and are deficient in Stage 4 sleep – the deepest stage.1,3,5 It is important to note that a secondary Fibromyalgia syndrome can occur with any connective tissue disease (EDS included) and may not necessarily be related to sleep disturbances.6
Central Nervous System Symptoms
As in other chronic illnesses, mood and mental changes can occur in individuals with Fibromyalgia. Many individuals feel “blue” or “down,” although only about 25% are clinically depressed. In most cases, depression and/or anxiety tends to follow the onset of Fibromyalgia symptoms and may be the result of Fibromyalgia and not the cause of it.3
People with Fibromyalgia may also experience numbness and tingling in their hands, arms, face, feet and legs. These symptoms can also be found in other disorders and usually require numerous tests before the diagnosis of Fibromyalgia is reached by a physician.
Other Problems
Muscular as well as migraine headaches are common in Fibromyalgia. Abdominal bloating, pain, alternating diarrhea and constipation are also commonly seen. They resemble irritable bowel syndrome or “spastic colon” in nature. Similar bladder spasms and irritability results in urinary urgency and frequency. The skin and circulatory system are sensitive to moisture and temperature changes resulting in temporary changes in skin color.2,3
Clinical Diagnosis
Currently, no definitive laboratory tests exist to make the diagnosis of Fibromyalgia. Rather, the diagnosis is made by a physician after obtaining the individual’s medical history and performing a complete physical examination.
A hallmark of Fibromyalgia syndrome is reduced pain thresholds at designated tender points, demonstrated upon palpation.2 According to the American College of Rheumatology, the diagnostic criteria for Fibromyalgia includes: a). widespread diffuse pain that has been present for at least three months and b). pain that is present in 11 of the 18 bilateral tender point sites (see figure 1) when 4 kg of force is applied by digital palpation.1,2,7 Recall your response the first time your physician palpated these 18 “tender points.” Did you say “ouch,” flinch, make a facial grimace, and attempt to withdraw away from your doctor or even jump? These are the usual responses elicited by an individual with Fibromyalgia. Frequently, patients are shocked by the level of pain they experience when these areas are palpated. Now that you know how Fibromyalgia is diagnosed, let’s look at the common triggering factors of Fibromyalgia.
Common Triggers of Fibromyalgia
Three common factors seem to trigger a flare in Fibromyalgia symptoms, physical factors, emotional factors and environmental factors. Keep in mind that your Fibromyalgia can become aggravated by these factors alone or any combination of these factors.
Physical Factors
Several physical factors can aggravate your Fibromyalgia. Infections are one type of physical factor that can produce the most profound exacerbation of Fibromyalgia symptoms. The second type of physical factors deal with ergonomics. The positions we maintain our bodies in has a direct correlation to the pain associated in Fibromyalgia. For instance, do you have a job that requires you use repetitive movements all day? Are you required to work in one spot with your arms elevated above your work surface? Do you need to remain in one position (i.e., standing, sitting or driving) for prolonged amounts time? If you answered “yes” to any of the above questions, you will be able to relate to the pain that results from maintaining your muscles in a sustained isometric position for any length of time. Ergonomics also plays an important role at home. It’s often difficult for someone with Fibromyalgia to push a vacuum cleaner, wash walls, paint or prepare meals. These tasks require the use of shoulder muscles to maintain arms in extension at some level in front of our body. What generally happens is that an ache begins in the neck, shoulders and upper back. The ache rapidly turns into pain that elevates in intensity as it slowly radiates up and down the back. You feel as if you can’t maintain your arms in this position any longer, and you quickly return your arms to your sides as you wait for the pain to slowly ebb away. Most, if not all of you, can relate to this all too familiar type of pain.
Emotional Factors
Stress is something that each of us has to deal with on a daily basis. Unfortunately, emotional stress is a prominent factor aggravating Fibromyalgia. We are faced with stressful situations at home, work, school, driving your car on the highway etc. It isn’t difficult to identify situations that aggravate your Fibromyalgia symptoms – that’s the easy part of the equation. The trick is to avoid or attempt to modify any stressful situation.
It is extremely difficult to deal with those situations in which any stressor is unrelenting. These types of situations can present themselves in the home with family members or in the workplace with coworkers or supervisors. In these situations, one must look at not only the circumstance, but how you react to the stressor. Ultimately, it comes down to dividing these stressful situations into two categories: those that you have control over and those you have absolutely no control over. In circumstances that you have no control over, it is imperative that you learn to alter your response to those particular situations. Save your energy for those battles that you can emerge victorious.
Environmental Factors
How many times have you been able to predict the approaching weather without having looked at a weather map? Probably too numerous to count. You feel like you are a human barometer with the ability to predict weather changes before they occur. Most likely you have found that when the barometric pressure drops, it is followed by rain, cold, snow, and fog – all of which aggravate your symptoms.
Many individuals with Fibromyalgia report that certain types of artificial lighting, cold drafts or irritating noises often result in a flare of their muscle pain. When was the last time that you were able to enter a pool that wasn’t heated? Just a guess, but it was probably many years ago. Most individuals with Fibromyalgia do not tolerate swimming in cold or cool water. We are usually found in the heated pools that others say are “too hot to swim in” or in hot tubs. The goal is to determine what factors aggravate your Fibromyalgia and either eliminate them if possible or at least modify them. Now that you know what factors can trigger your Fibromyalgia, let’s look at how it is treated and managed.
Treatment and Management
Since Fibromyalgia’s definitive cause is not known, current treatments are focused on relieving painful symptoms, not necessarily curing them. Additionally, the treatment program prescribed by your physician will be individualized to address your specific needs.
Numerous treatments have been employed over the years for Fibromyalgia. No one method has been entirely successful, but several methods will be prescribed by your physician in an attempt to control your symptoms. A sense of overwhelming relief comes with the validation of your symptoms and a diagnosis. Just knowing the name of your condition will not be enough though. Your physician and healthcare team will educate you and your family about Fibromyalgia. Specifically, you’ll be informed about your prognosis, possible causative factors, the aspects of treatment and specific body mechanics techniques. This education will prove invaluable to you. If you are taught about what to expect and how to deal with flare–ups, you will be able to control your Fibromyalgia. The goal of education is to moderate the effects of Fibromyalgia on your life. Only then will Fibromyalgia not become your entire life.
Medications may be prescribed by your physician to control pain and improve deep Stage 4 sleep. If pain is prominent, your doctor may prescribe a low dose of an analgesic or nonsteroidal anti–inflammatory drug, although most nonsteroidal anti–inflammatory drugs are marginally beneficial and carry the risk of side–effects that outweigh their benefits. Therefore, you will be most likely instructed to use over the counter medications such as acetaminophen, aspirin or ibuprofen to relieve pain and reduce stiffness. If you are currently on a nonsteroidal anti–inflammatory drug to help manage your EDS, your physician will likely instruct you to take acetaminophen, not ibuprofen or aspirin, to control your pain.
To improve Stage 4 sleep, your physician may prescribe low doses of tricyclic antidepressants (Elavil, Sinequan) or the muscle relaxant cyclobenzaprine (Flexeril). These drugs are structurally similar and they block the re–uptake of the neurotransmitters that regulate deep Stage 4 sleep.3,8. These medications carry the risk of potential side–effects which include: drowsiness, weight gain, dry mouth and constipation to name a few. Do not be discouraged if you do not respond to the first medication(s) prescribed. Your doctor may need to adjust dosages or change drugs to achieve an improvement.
Individuals with Fibromyalgia should practice good sleep hygiene to promote sleep. Bedtime rituals can relax you in preparation of sleep. These bedtime rituals can include: taking a warm bath or shower, reading a novel, watching a relaxing television program or listening to soothing music which can promote sleep. Attempt to follow a regular sleep schedule and go to bed at the same time each day. Sleep eight hours nightly if possible. Avoid alcohol, caffeine and tobacco before retiring – they will disturb your sleep. Also abstain from taking midday naps.
Exercise is a key element in Fibromyalgia management. Your physician will recommend that you slowly increase your aerobic fitness with structured, low impact activities such as swimming, water aerobics, walking, or riding a stationary bicycle.2,3,7,8 Research has indicated that aerobic exercise improves sleep, enhances endorphin release and has antidepressant effects.2 It is important to check with your physician to ensure that the exercise program you have chosen is not contraindicated in your specific type of EDS. Remember to always stretch your muscles before engaging in any aerobic activity. Increase your exercise program gradually to reduce the chance of injury. As you continue to exercise, you’ll notice that you feel better, have more endurance and experience a reduction in Fibromyalgia symptoms. It’s worth the possible pain and fatigue felt initially to achieve these end–results.
Always practice proper body mechanics and apply ergonomic principles at home, work and at rest. These techniques will prevent injury and reduce flare–ups of Fibromyalgia symptoms.
Your doctor may prescribe various physical therapy treatments. Possible treatments include: massage, heat or ice applications, ultrasound or whirlpool therapy and microvoltage electrical stimulation. These are all passive physical therapy techniques with varying results from individual to individual. These treatments are usually prescribed for flare–ups and are employed for short periods of time.3,8
Taking Control of Fibromyalgia
You can engage in several actions that will help you gain control of your Fibromyalgia. First and foremost, listen to your body. Identify those triggers that aggravate your symptoms and then avoid or at least minimize them. Get your stress level under control by practicing relaxation techniques. Relaxation techniques are primarily effective for chronic pain and have many benefits. Relaxation techniques enable you to reduce anxiety, pain and stress, reduce muscle tension pain and relieve the helplessness and depression associated with chronic pain. Despite having chronic pain and fatigue, learn to develop a positive attitude. Remember that if you have a constant negative attitude, your Fibromyalgia symptoms will exacerbate. Look for the good in every situation – it’s there, but you may need to look closely.
Eat healthy and avoid fat in your diet. Excess weight is detrimental to your body and can aggravate your symptoms. Eating properly also maintains your health and avoids illness. Keep in mind that an illness (i.e., cold, flu, bacterial infection etc.) can be a triggering factor for your symptoms.
Educate yourself, family and healthcare providers about Fibromyalgia syndrome. Remember that knowledge is a powerful weapon in coping with any chronic illness. Knowledge also helps you to take control of your Fibromyalgia and reduce the exacerbation of its symptoms.
Lastly, seek support from others with Fibromyalgia. Check with your physician, healthcare institution, and within your local community for a Fibromyalgia support group. It is extremely beneficial to receive support and understanding from others who have the same type of problems from Fibromyalgia as you do. Connecting with a support group also helps you and your family to cope with having a chronic illness. And who knows, maybe someday you will have the opportunity to offer support to someone else just diagnosed with Fibromyalgia. I guarantee it will be one of the most gratifying and fulfilling experiences of your life.
Conclusion
Receiving a diagnosis of Fibromyalgia syndrome is an important first step in managing this condition. It is not the last step though! It is imperative that you have a clear understanding of Fibromyalgia, its signs and symptoms, triggering factors and treatments. Learning to effectively cope with this disorder is essential to one’s emotional and physical health. It is only then that you will be able to manage your Fibromyalgia and prevent it from becoming your whole life. While there isn’t a cure for Fibromyalgia, there are treatments that are effective in managing its symptoms. There is life after finding out you have Fibromyalgia. Tomorrow will be better and holds the possibility of a cure!
References
1 Fan, P.T., & Blanton, M.E. (1992). Clinical features and diagnosis of Fibromyalgia. Journal of Musculoskeletal Medicine, 9(4), 24–42.
2 Wilke, W.S. (1996). Fibromyalgia: Recognizing and addressing the multiple interrelated factors. Postgraduate Medicine, 100(1), 153–170.
3 Arthritis Foundation, Inc. (1995) Fibromyalgia Syndromes, 1–12.
4 Dunkin, M.A. (1993, September–October). Fibromyalgia: Out of the Closet. Arthritis Today, pp. 24–28.
5 Dunkin, M.A. (1997, September–October). Fibromyalgia: Syndrome of the ’90s. Arthritis Today, pp. 41–47.
6 Ignatavicius, D.D., Workman, M.L., & Mishler, M.A. (1995). Medical–Surgical Nursing (2nd ed.). Philadelphia: W.B. Saunders Company.
7 Goldberg, D.L. (1990) Fibromyalgia and chronic fatigue syndrome: Are they the same? Journal of Musculoskeletal Medicine, 7(5), 19–28.
8 Sherman, C. (1992) Managing fibromyalgia with exercise. The Physician and Sports Medicine, 20(10), 166–172.
Just finished reading this interesting article
Pain & the Hypermobility Syndrome by Prof R Grahame CBE, MD, FRCP, FACP University College Hospital, LONDON.
When the Hypermobility Syndrome was first put on the medical map in 1967, it was defined as the presence of musculoskeletal symptoms (predominantly pain) occurring in otherwise healthy individuals. Thirty years down the line we now think that there are probably two types of hypermobility.
The first is a milder type occurring in people whose joints are just like everyone else's but which have the capacity to move more than most people's joints. The other, a more marked form, has features that suggest that it may be part of an inherited connective tissue disorder similar to the hypermobile form of the Ehlers-Danlos Syndrome, formerly called EDS III. It probably is EDS. At the present time we simply do not know for certain whether or not HMS is merely a less severe type of EDS III. Pain can occur in other forms. For the rest of this article, in order to avoid confusion, I will refer to it as one condition, the HMS/EDS. There are many people with joint hypermobility in the community who experience no (or very little) pain. Most of them probably do not even know that they are hypermobile at all. Then something happens, and they start getting pains for the first time in their lives. Usually unexpected exercise or a change of job or lifestyle provokes the onset of pain. When ever symptoms commence, and irrespective of the cause of the hypermobility, the term 'Hypermobility Syndrome' is used to describe the condition. Hypermobile people without pain are just called hypermobile people.
A little known fact is that hypermobility occurs in many individuals in a few joints only. It does not necessarily have to affect all one's joints. Even hypermobility in a single joint can cause pain and/or instability in that joint; the diagnosis is still Hypermobility Syndrome (HMS/EDS).
People are born hypermobile. It is in their genes. It is the way they are made. So how is it that people with hypermobility can be literally fine for decades, only to be laid low from widespread pain, often out of the blue, which may make its unwelcome appearance during childhood, adolescence, or adult life? To explain these curious and seemingly inexplicable happenings, we postulate that the affected person, in this case the hypermobile person, had an inbuilt weakness of her (it is usually a 'her' but not always) strength-providing collagen or similar protein. This weakness renders body tissues less robust and hence less able to stand up to the physical strains of everyday life. We can explain a lot of the pain that arises on the basis of a series of (often quite minor) injuries that occur whenever there is a mismatch between the physical demands on one hand, and the strength of the parts being asked to perform them on the other. There is a whole host of painful injuries that can result, ranging from dislocations to fractures, disc prolapse, ligament sprains, muscle strains, pulled tendons (like tennis elbow or plantar fasciitis), etc.- conditions that can happen to anyone, but which occur more easily in those with the HMS/EDS. If one only knew one's strength (or lack of it), one should be able, in theory at least, to stay within the safety margin and thereby protect oneself from injury. Up to a point this is so. Many people with the HMS/EDS are able to modify their lifestyle and do just that. Others find it more difficult.
A joint that is beginning to wear starts to lose its cartilage or gristle, which is essential for the smooth movement between the adjoining bones. This wear heralds the onset of osteoarthritis, a condition painful in its own right. It is a very common form of arthritis in middle and old age, and one to which hypermobile people seem to be prone, in many cases at an early age. It is important to establish as far as possible to what extent the pain is due to trauma/overuse or to early onset osteoarthritis, as the treatment is very different. The emphasis with the former is on prevention, while with the latter it is on treatment by one form or another.
However, neither susceptibility to injury or overuse (repetitive injury), nor osteoarthritis, explains all the pain that is felt in the HMS/EDS. There is more to it than that. And here we get into a rather grey area, where there is more speculation than fact.
Let us try to piece the jigsaw together. Pain is something we feel. Even if it has a physical cause, as it undoubtedly has in the HMS/EDS, it is still a subjective experience. It is often accompanied by an intense sense of exhaustion. the severity of the pain we feel is greatly influenced by our state of mind. If we are upset or agitated it tends to increase. If we are content, relaxed or just happy it tends to diminish. The HMS/EDS people are often in the former category, and for good reason! Lack of understanding of the condition is widespread, and this, coupled with failure to receive adequate treatment for relief of symptoms, leads to frustration, resentment, anger (and lots more emotions which I could list but readers know them all only too well!) and, ultimately depression. These emotional influences can amplify pain, but they do not cause it.
Another piece of the jigsaw is a mysterious condition called fibromyalgia. This condition causes widespread chronic pain in muscles and is identified by the finding of multiple 'tender points' at specific sites in the body. For years the debate has raged as to whether it is a physical disease affecting the muscles, or whether it is an emotional disorder. The prevailing view is that it is probably some form of distress signal that can arise in people with a number of different and unrelated conditions. How this relates to hypermobility is that it has been shown that hypermobility and fibromyalgia occur together in the same person more often than one would expect on the basis of a chance happening. It does not mean that they are part of the same condition. It would, indeed be very unlikely that what is clearly an acquired disorder (fibromyalgia) could be an integral part of what is clearly a genetic one (HMS/EDS). More likely, the fibromyalgia should be regarded as a signal emanating from a distressed HMS/EDS person. But fibromyalgia occurs only uncommonly in the HMS/EDS. We must look further afield.
It seems quite likely that there may be a totally different explanation for the burden of pain borne by people with the HMS/EDS.
Here are two clues:
The first clue relates to the sense called proprioception, which means knowing where parts of one's body are in space. If you close your eyes and somebody bends your finger for you or picks your arm up, you know immediately how far your finger is bent or where your arm now is. That is because you have good proprioception. Scientists have shown that people with the HMS/EDS are not quite as good as other people in knowing exactly where their fingers or arms etc are in space. This could lead to a further increase in the risk of injury.
The second clue is the discovery that patients with the HMS/EDS for some
reason do not appear to experience the full anaesthetic affect of lignocaine injections when these are given for dental purposes, minor surgery or for epidural anaesthesia (I wonder how many readers are nodding their heads as they read this!).
At the present time we do not know quite what either of these clues means or whether they relate to one another. But they do suggest that people with the HMS/EDS, in addition to their proneness to injury, dislocation and osteoarthritis, may also have a fault in the way their pain signals are picked up for onward transmission to the brain, where they reach consciousness. Research work is in progress to try to sort out this enigma. Much more needs to be done. Watch this space!
Readers will know that many conventional methods of treatment, of the kind offered for rheumatic complaints in general, are not particularly helpful in the HMS/EDS. Physiotherapy still carries the best prospect for pain relief, and it is encouraging that more physiotherapists are training in methods that are helpful in this condition. Another noteworthy development is the network of units throughout the country that are offering pain management programmes, an approach which has been shown to be beneficial in the HMS/EDS where intractable pain is present.
Source: http://www.hypermobility.org/
When the Hypermobility Syndrome was first put on the medical map in 1967, it was defined as the presence of musculoskeletal symptoms (predominantly pain) occurring in otherwise healthy individuals. Thirty years down the line we now think that there are probably two types of hypermobility.
The first is a milder type occurring in people whose joints are just like everyone else's but which have the capacity to move more than most people's joints. The other, a more marked form, has features that suggest that it may be part of an inherited connective tissue disorder similar to the hypermobile form of the Ehlers-Danlos Syndrome, formerly called EDS III. It probably is EDS. At the present time we simply do not know for certain whether or not HMS is merely a less severe type of EDS III. Pain can occur in other forms. For the rest of this article, in order to avoid confusion, I will refer to it as one condition, the HMS/EDS. There are many people with joint hypermobility in the community who experience no (or very little) pain. Most of them probably do not even know that they are hypermobile at all. Then something happens, and they start getting pains for the first time in their lives. Usually unexpected exercise or a change of job or lifestyle provokes the onset of pain. When ever symptoms commence, and irrespective of the cause of the hypermobility, the term 'Hypermobility Syndrome' is used to describe the condition. Hypermobile people without pain are just called hypermobile people.
A little known fact is that hypermobility occurs in many individuals in a few joints only. It does not necessarily have to affect all one's joints. Even hypermobility in a single joint can cause pain and/or instability in that joint; the diagnosis is still Hypermobility Syndrome (HMS/EDS).
People are born hypermobile. It is in their genes. It is the way they are made. So how is it that people with hypermobility can be literally fine for decades, only to be laid low from widespread pain, often out of the blue, which may make its unwelcome appearance during childhood, adolescence, or adult life? To explain these curious and seemingly inexplicable happenings, we postulate that the affected person, in this case the hypermobile person, had an inbuilt weakness of her (it is usually a 'her' but not always) strength-providing collagen or similar protein. This weakness renders body tissues less robust and hence less able to stand up to the physical strains of everyday life. We can explain a lot of the pain that arises on the basis of a series of (often quite minor) injuries that occur whenever there is a mismatch between the physical demands on one hand, and the strength of the parts being asked to perform them on the other. There is a whole host of painful injuries that can result, ranging from dislocations to fractures, disc prolapse, ligament sprains, muscle strains, pulled tendons (like tennis elbow or plantar fasciitis), etc.- conditions that can happen to anyone, but which occur more easily in those with the HMS/EDS. If one only knew one's strength (or lack of it), one should be able, in theory at least, to stay within the safety margin and thereby protect oneself from injury. Up to a point this is so. Many people with the HMS/EDS are able to modify their lifestyle and do just that. Others find it more difficult.
A joint that is beginning to wear starts to lose its cartilage or gristle, which is essential for the smooth movement between the adjoining bones. This wear heralds the onset of osteoarthritis, a condition painful in its own right. It is a very common form of arthritis in middle and old age, and one to which hypermobile people seem to be prone, in many cases at an early age. It is important to establish as far as possible to what extent the pain is due to trauma/overuse or to early onset osteoarthritis, as the treatment is very different. The emphasis with the former is on prevention, while with the latter it is on treatment by one form or another.
However, neither susceptibility to injury or overuse (repetitive injury), nor osteoarthritis, explains all the pain that is felt in the HMS/EDS. There is more to it than that. And here we get into a rather grey area, where there is more speculation than fact.
Let us try to piece the jigsaw together. Pain is something we feel. Even if it has a physical cause, as it undoubtedly has in the HMS/EDS, it is still a subjective experience. It is often accompanied by an intense sense of exhaustion. the severity of the pain we feel is greatly influenced by our state of mind. If we are upset or agitated it tends to increase. If we are content, relaxed or just happy it tends to diminish. The HMS/EDS people are often in the former category, and for good reason! Lack of understanding of the condition is widespread, and this, coupled with failure to receive adequate treatment for relief of symptoms, leads to frustration, resentment, anger (and lots more emotions which I could list but readers know them all only too well!) and, ultimately depression. These emotional influences can amplify pain, but they do not cause it.
Another piece of the jigsaw is a mysterious condition called fibromyalgia. This condition causes widespread chronic pain in muscles and is identified by the finding of multiple 'tender points' at specific sites in the body. For years the debate has raged as to whether it is a physical disease affecting the muscles, or whether it is an emotional disorder. The prevailing view is that it is probably some form of distress signal that can arise in people with a number of different and unrelated conditions. How this relates to hypermobility is that it has been shown that hypermobility and fibromyalgia occur together in the same person more often than one would expect on the basis of a chance happening. It does not mean that they are part of the same condition. It would, indeed be very unlikely that what is clearly an acquired disorder (fibromyalgia) could be an integral part of what is clearly a genetic one (HMS/EDS). More likely, the fibromyalgia should be regarded as a signal emanating from a distressed HMS/EDS person. But fibromyalgia occurs only uncommonly in the HMS/EDS. We must look further afield.
It seems quite likely that there may be a totally different explanation for the burden of pain borne by people with the HMS/EDS.
Here are two clues:
The first clue relates to the sense called proprioception, which means knowing where parts of one's body are in space. If you close your eyes and somebody bends your finger for you or picks your arm up, you know immediately how far your finger is bent or where your arm now is. That is because you have good proprioception. Scientists have shown that people with the HMS/EDS are not quite as good as other people in knowing exactly where their fingers or arms etc are in space. This could lead to a further increase in the risk of injury.
The second clue is the discovery that patients with the HMS/EDS for some
reason do not appear to experience the full anaesthetic affect of lignocaine injections when these are given for dental purposes, minor surgery or for epidural anaesthesia (I wonder how many readers are nodding their heads as they read this!).
At the present time we do not know quite what either of these clues means or whether they relate to one another. But they do suggest that people with the HMS/EDS, in addition to their proneness to injury, dislocation and osteoarthritis, may also have a fault in the way their pain signals are picked up for onward transmission to the brain, where they reach consciousness. Research work is in progress to try to sort out this enigma. Much more needs to be done. Watch this space!
Readers will know that many conventional methods of treatment, of the kind offered for rheumatic complaints in general, are not particularly helpful in the HMS/EDS. Physiotherapy still carries the best prospect for pain relief, and it is encouraging that more physiotherapists are training in methods that are helpful in this condition. Another noteworthy development is the network of units throughout the country that are offering pain management programmes, an approach which has been shown to be beneficial in the HMS/EDS where intractable pain is present.
Source: http://www.hypermobility.org/
11 October, 2007
Again with the lack of sleep
Yesterday I had another PT appointment. I was pretty knackered before I even got there. I sit mostly at work but was told to move around every 45 minutes, which I am sure has stretched out to longer. I just don't have the energy as the crutches are wiping me out and killing my hands. When I left for PT, the timing was bad as all the cabs were "off duty". I was ready to cry until finally a nice cabbie that was off duty stopped to ask where I was going and he was kind enough to give me a lift. The walk to PT from my office is about two long blocks and four short blocks, but there is NO WAY I could have made that on crutches. I am so tired from the crutches, I think you really expend a lot more energy with them than just walking normally.
Pain and torture was excruciating yesterday. I did the bike for 15 minutes, and then some internal rotation and kneeling on the table. When K, one of my PT's, came over, I told him that my psoas has been REALLY tight and driving me nuts. His response was that we have to keep it tight per the Dr. I said yes I know that but the Dr also said that he wants it to move smoothly, not just get stuck with extremely limited ROM. I understand it's a fine line, but I can't have this feeling forever because it will drive me nuts, but I also don't want the laxity to get to where it was before the surgery. I'm losing my mind. So K massaged the psoas and then all of the scars, and started stretching me A LOT more than has been done. It was uncomfortable but bearable, until all of a sudden I had a shooting pain down the outside of my hip. I don't know what triggered it but it lasted about 5-10 minutes as was horrible. After that and some manual resistance exercises with K I did the electrical stim for about 10 minutes and then iced. I am spending about 2 hours from start to finish there.
After I finally changed and got all of my things together, I went down to go home. I didn't even entertain the thought of a cab as it was rush hour so was beyond pleasantly surprised when I reached the corner and saw an available one. He was so nice he even got out to open the door for me. It was such a relief to not have to take the bus home. I was a zombie by the time I got back to my flat so ordered some (not very healthy) dinner but I didn't care. I spent the evening on the couch and then decided to take a muscle relaxer for my psoas. I must have been in more pain all over than I thought because that didn't even knock me out. My fibro is flaring up something awful with this crappy weather and my whole body is aching, which is why I didn't sleep. When the alarm went off this morning and could barely move. I can't say "when I woke up" because I had been up for ages. It took me an hour or so to just get up to get to the loo. Thankfully my friend T is staying with me this week and was able to help get me sorted and then we took a cab down to work.
So I am sitting here taking a break and have ice on both my hips, but wish I had more ice packs for my hands and shoulders. I wish I could have just stayed in bed today but will go home straight after to rest and will try my "magic pill" tonight so hopefully some sleep will be in order.
Next week I start PT twice a week, G-d give me strength!
Pain and torture was excruciating yesterday. I did the bike for 15 minutes, and then some internal rotation and kneeling on the table. When K, one of my PT's, came over, I told him that my psoas has been REALLY tight and driving me nuts. His response was that we have to keep it tight per the Dr. I said yes I know that but the Dr also said that he wants it to move smoothly, not just get stuck with extremely limited ROM. I understand it's a fine line, but I can't have this feeling forever because it will drive me nuts, but I also don't want the laxity to get to where it was before the surgery. I'm losing my mind. So K massaged the psoas and then all of the scars, and started stretching me A LOT more than has been done. It was uncomfortable but bearable, until all of a sudden I had a shooting pain down the outside of my hip. I don't know what triggered it but it lasted about 5-10 minutes as was horrible. After that and some manual resistance exercises with K I did the electrical stim for about 10 minutes and then iced. I am spending about 2 hours from start to finish there.
After I finally changed and got all of my things together, I went down to go home. I didn't even entertain the thought of a cab as it was rush hour so was beyond pleasantly surprised when I reached the corner and saw an available one. He was so nice he even got out to open the door for me. It was such a relief to not have to take the bus home. I was a zombie by the time I got back to my flat so ordered some (not very healthy) dinner but I didn't care. I spent the evening on the couch and then decided to take a muscle relaxer for my psoas. I must have been in more pain all over than I thought because that didn't even knock me out. My fibro is flaring up something awful with this crappy weather and my whole body is aching, which is why I didn't sleep. When the alarm went off this morning and could barely move. I can't say "when I woke up" because I had been up for ages. It took me an hour or so to just get up to get to the loo. Thankfully my friend T is staying with me this week and was able to help get me sorted and then we took a cab down to work.
So I am sitting here taking a break and have ice on both my hips, but wish I had more ice packs for my hands and shoulders. I wish I could have just stayed in bed today but will go home straight after to rest and will try my "magic pill" tonight so hopefully some sleep will be in order.
Next week I start PT twice a week, G-d give me strength!
09 October, 2007
Snail
Today was my first day back at work. I am not even done with the day but am pretty wiped out. NYC buses really need to get their act together. Why do they all have to hang out for a coffee klatch and then at the same time all arrive? I waited for almost half an hour for the 5th ave bus today. During that time my left hip started to kill and my back hurt from my bag, which has turned into an intense neck pain now. So frustrating. At least it didn't rain on me, though it looks like the heavens are going to open up at any time. But I still feel like a snail going at this pace. I am normally a very quick walker, so it is so frustrating!
My office is being amazingly understanding and letting me come in a little late this week, which helps to take the pressure off. And most of the bus drivers, whilst they can't tell time, are very patient with me boarding the bus. I am hoping each day just get a bit easier.
Pain in the right hip has been tolerable, and I haven't (touch wood) had the need to take a pain pill in a few days. I did take a muscle relaxer last night because my psoas has been so tight for the last few days. I notice it especially when I walk.
As for PT, they couldn't get me a late appointment for this week, so I rang yesterday to see if they could squeeze me in, but no luck. I rang back asking if there was anything all week, and they said possibly on Wednesday but they'd get back to me. I still haven't heard so will ring them shortly. I don't really want to miss PT at the fourth week out. I did have my appointments booked for the next four weeks so at least I don't have to worry about that.
PS - just heard from the PT dude and thankfully they can get me in tomorrow at 4pm, so am relieved about that.
My office is being amazingly understanding and letting me come in a little late this week, which helps to take the pressure off. And most of the bus drivers, whilst they can't tell time, are very patient with me boarding the bus. I am hoping each day just get a bit easier.
Pain in the right hip has been tolerable, and I haven't (touch wood) had the need to take a pain pill in a few days. I did take a muscle relaxer last night because my psoas has been so tight for the last few days. I notice it especially when I walk.
As for PT, they couldn't get me a late appointment for this week, so I rang yesterday to see if they could squeeze me in, but no luck. I rang back asking if there was anything all week, and they said possibly on Wednesday but they'd get back to me. I still haven't heard so will ring them shortly. I don't really want to miss PT at the fourth week out. I did have my appointments booked for the next four weeks so at least I don't have to worry about that.
PS - just heard from the PT dude and thankfully they can get me in tomorrow at 4pm, so am relieved about that.
07 October, 2007
The Surgical Record
The HSS Operative Record
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
One step forward, two steps back
At least that is what it feels like at times. I have slept the last two nights but only because I've taken my "magic" pills. I am trying to get as much sleep as possible to get ready for next week.
My mother and I did a 'test run' to the office on Friday. I was originally going to do it during rush hour, but since I hadn't slept that night and was so sick from the pain killers, it was delayed for a few hours. We ended up leaving about 12.10 pm from the flat. I had to walk one block to the crosstown bus, take that to 6 long blocks to the Park, and then switch to a downtown bus. There was a lot of traffic from road works. We finally reached my stop, got off and walked a block and a half to the office. The whole trip took over an hour. I was pretty wiped out when we got to the office, but at least I made it. I waited there for a bit to see one of my coworkers who was out to lunch, and also thought to ring Dr. Kelly's office to see if they had the surgical report yet. After a couple of calls they finally faxed it to me. I will see if I can post it as the PDF or will have to retype it all. I was also extremely relieved to find out that my bosses will be out on Monday and that M arranged for me to work from home. It felt like a stay of execution - not that work is horrid, just getting there at present is quite a workout.
After we left the office we stopped to get something to eat, I had just a little as I was still queasy from the pain meds, and then we took the bus up Madison. It was not even rush hour but the bus, when it finally did show up, was absolutely packed. No matter when I take this bus line it seems to always be delayed and always be packed like a sardine can. I had to ask a not very happy looking girl to get up so I could sit down. Unfortunately my mother had to stand and I felt so bad, she was getting jostled all about. Some woman decided to step on my right foot with all of her weight for a minute or so, she seriously wouldn't move, put all of her weight on it, till I finally let out with an expletive! My toe throbbed for over an hour. It's like constantly getting beat up, no matter how hard you try.
Yesterday was a bit of a late start, but we didn't have any place to go so it was ok. I had some pictures from my Gran's flat that we needed to hang so we did that. A friend was meant to come by but never heard from her so we went across the street to Starbucks and sat outside for a couple of hours, then I tried to walk around a little bit. I am still wearing my brace as I feel much more secure with it and the doctor told me that I should wear it as long as I feel so. We ended up going to a German restaurant near me, and even though it was early the place was very crowded as it is Oktoberfest. It was pretty good but very expensive. And it also delayed my return to my flat. I normally love my flat but am so tired of it.
Think I will go eat some breaky and do my PT. I have to go shopping later to get lunch supplies for the week also. My mother is going home today and I am stressed about that. She has been a life saver these last few weeks. I wish I had some dosh so I could send her on a well deserved and earned holiday, this year has been rough for her, not even including my surgery. I should start playing the lottery! My friend T is meant to stay with me tonight and for at least part of the week, so I won't be completely alone which is good. I am getting around better in the house but I still feel better if someone is around for the time being. It's all so stressful.
On one other note, this has been a very difficult recovery, not just the hip itself, but all of my other body issues (hands, shoulders, etc). I would like to thank those people who spent time with me. Even a brief visit was such a welcome break from the monotony of this slow recovery - so just wanted to say thank you.
My mother and I did a 'test run' to the office on Friday. I was originally going to do it during rush hour, but since I hadn't slept that night and was so sick from the pain killers, it was delayed for a few hours. We ended up leaving about 12.10 pm from the flat. I had to walk one block to the crosstown bus, take that to 6 long blocks to the Park, and then switch to a downtown bus. There was a lot of traffic from road works. We finally reached my stop, got off and walked a block and a half to the office. The whole trip took over an hour. I was pretty wiped out when we got to the office, but at least I made it. I waited there for a bit to see one of my coworkers who was out to lunch, and also thought to ring Dr. Kelly's office to see if they had the surgical report yet. After a couple of calls they finally faxed it to me. I will see if I can post it as the PDF or will have to retype it all. I was also extremely relieved to find out that my bosses will be out on Monday and that M arranged for me to work from home. It felt like a stay of execution - not that work is horrid, just getting there at present is quite a workout.
After we left the office we stopped to get something to eat, I had just a little as I was still queasy from the pain meds, and then we took the bus up Madison. It was not even rush hour but the bus, when it finally did show up, was absolutely packed. No matter when I take this bus line it seems to always be delayed and always be packed like a sardine can. I had to ask a not very happy looking girl to get up so I could sit down. Unfortunately my mother had to stand and I felt so bad, she was getting jostled all about. Some woman decided to step on my right foot with all of her weight for a minute or so, she seriously wouldn't move, put all of her weight on it, till I finally let out with an expletive! My toe throbbed for over an hour. It's like constantly getting beat up, no matter how hard you try.
Yesterday was a bit of a late start, but we didn't have any place to go so it was ok. I had some pictures from my Gran's flat that we needed to hang so we did that. A friend was meant to come by but never heard from her so we went across the street to Starbucks and sat outside for a couple of hours, then I tried to walk around a little bit. I am still wearing my brace as I feel much more secure with it and the doctor told me that I should wear it as long as I feel so. We ended up going to a German restaurant near me, and even though it was early the place was very crowded as it is Oktoberfest. It was pretty good but very expensive. And it also delayed my return to my flat. I normally love my flat but am so tired of it.
Think I will go eat some breaky and do my PT. I have to go shopping later to get lunch supplies for the week also. My mother is going home today and I am stressed about that. She has been a life saver these last few weeks. I wish I had some dosh so I could send her on a well deserved and earned holiday, this year has been rough for her, not even including my surgery. I should start playing the lottery! My friend T is meant to stay with me tonight and for at least part of the week, so I won't be completely alone which is good. I am getting around better in the house but I still feel better if someone is around for the time being. It's all so stressful.
On one other note, this has been a very difficult recovery, not just the hip itself, but all of my other body issues (hands, shoulders, etc). I would like to thank those people who spent time with me. Even a brief visit was such a welcome break from the monotony of this slow recovery - so just wanted to say thank you.
05 October, 2007
Learning the limits
Yesterday was my third PT appointment. We didn't seem to do as much as the last two, which was okay with me since various parts of my body, sans the right hip, were killing me. One of the PT guys showed me how to wrap my wrists for extra support because my hands are killing me with the crutches. I know it seems all I do is whinge, but this process is getting the better of me. Dr. Kelly was meant to talk to the PT guys about how he wants me to proceed, but it seemed no one had spoken to him so I had to ask them to contact him so we're all on the same page. One of the PT guys did not seem to think it was such a good idea to return to work on Monday, but I really don't have a choice. Mostly I am going mad just sitting here. He is afraid I will do too much and flare up with the various multitudes of bodily issues I have. I guess we'll have to just see how it goes and I will just have to do what I can.
I had it in my head since earlier this week that after PT I would take my mother out for a well deserved lunch at a favourite little bistro that was not too far from the PT office. Unfortunately once I get something into my head that's it. And that was where it all went wrong.
After PT we went to my bank on the corner and then walked a few blocks to the restaurant. Looking back we really should have taken a taxi, but I am so frustrated from not going anywhere that I decided I was going to do it all by myself. I admit it, I am an idiot.
Thankfully there was a table free when we got there, and we had a lovely lunch with a little wine. My right hip started hurting then. After lunch we were going to try to take the bus back but I was too tired and we were very lucky that a cab was free, as most were off duty at that time.
I was so knackered from this trip that I ended up passing out for a while when we got home. I did the Game Ready for my right hip and that helped for a little bit but my psoas was really hurting as well as my right knee and left hip. This kept me up for a while and I ended up taking a pain killer so I could hopefully get some sleep. I eventually did fall asleep for a little bit, but have now been up since around 5 am. I took another pain killer around 6 am and am very loopy and queasy from it. I haven't been this out of it from them for a while, I guess I had started to get used to them but now that I've been not taking them regularly I am more affected.
I was hoping to do a test run to the office during rush hour this morning with my mother, but I am definitely not up for it now. Hopefully later on we will be able to do it.
I had it in my head since earlier this week that after PT I would take my mother out for a well deserved lunch at a favourite little bistro that was not too far from the PT office. Unfortunately once I get something into my head that's it. And that was where it all went wrong.
After PT we went to my bank on the corner and then walked a few blocks to the restaurant. Looking back we really should have taken a taxi, but I am so frustrated from not going anywhere that I decided I was going to do it all by myself. I admit it, I am an idiot.
Thankfully there was a table free when we got there, and we had a lovely lunch with a little wine. My right hip started hurting then. After lunch we were going to try to take the bus back but I was too tired and we were very lucky that a cab was free, as most were off duty at that time.
I was so knackered from this trip that I ended up passing out for a while when we got home. I did the Game Ready for my right hip and that helped for a little bit but my psoas was really hurting as well as my right knee and left hip. This kept me up for a while and I ended up taking a pain killer so I could hopefully get some sleep. I eventually did fall asleep for a little bit, but have now been up since around 5 am. I took another pain killer around 6 am and am very loopy and queasy from it. I haven't been this out of it from them for a while, I guess I had started to get used to them but now that I've been not taking them regularly I am more affected.
I was hoping to do a test run to the office during rush hour this morning with my mother, but I am definitely not up for it now. Hopefully later on we will be able to do it.
01 October, 2007
Catch 22
I am going off of my mind! I am so bloody bored I could scream. The problem is anytime I try to move around more, my hands and hips and shoulders get very upset with me and start to complain in intense anger. There is no winning in this situation. I did cave and take another pain pill today, though it was the first time since Friday.
I had to go back to the dentist today for some work and he shot me up with three injections in my mouth! I am the queen of torture at this point. After we went to get my new specs and then I was dreading coming home so much I rang one of my close friends who happily had just gotten home, so we popped over there for a nice visit.
I took another magic pill last night and slept fairly decently. I have been having the most bizarre nightmares for the last few weeks, it must be all the stress and drugs. But at least I got some sleep so I won't complain.
My mother and I have been trying to suss out how I can do all sorts of 'little' things that you take for granted by myself, as next week I have to return to work and will not have her around to help. You don't realise how much it truly is the small basic things. For example, getting a sock on my right foot is a nightmare. Thankfully my mother found this sock aid pull on she had bought for my dad when he had hip replacement surgery and it seems to work. Washing and drying my lower legs is another difficult task. I finally sussed out how to get lotion on my lower right leg - with my left foot! I'm getting quite creative. Quite a learning experience for sure! I keep trying to do more and more myself without overdoing it at the same time. Opening doors though is one thing that is very difficult, so not sure how that is going to work. Oh well, onward and upward as they say.
I had to go back to the dentist today for some work and he shot me up with three injections in my mouth! I am the queen of torture at this point. After we went to get my new specs and then I was dreading coming home so much I rang one of my close friends who happily had just gotten home, so we popped over there for a nice visit.
I took another magic pill last night and slept fairly decently. I have been having the most bizarre nightmares for the last few weeks, it must be all the stress and drugs. But at least I got some sleep so I won't complain.
My mother and I have been trying to suss out how I can do all sorts of 'little' things that you take for granted by myself, as next week I have to return to work and will not have her around to help. You don't realise how much it truly is the small basic things. For example, getting a sock on my right foot is a nightmare. Thankfully my mother found this sock aid pull on she had bought for my dad when he had hip replacement surgery and it seems to work. Washing and drying my lower legs is another difficult task. I finally sussed out how to get lotion on my lower right leg - with my left foot! I'm getting quite creative. Quite a learning experience for sure! I keep trying to do more and more myself without overdoing it at the same time. Opening doors though is one thing that is very difficult, so not sure how that is going to work. Oh well, onward and upward as they say.
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