FibroDog Interview #1: Lily the Support Corgi

September 12, 2015September 15, 20159 Comments

FibroDog: Please tell us what type of animal you are, your age, and where you live.

My name is Lily. I am a 4 year old tri-color Welsh corgi living in Phoenix, Arizona.

Lily from alifewellred.com in her FibroDog interview for fibromyalgia and chronic pain support medeakarrfnp.com

Lily the Fibro Support Dog!

FD: Tell us about the human you support: are they male or female? Do you know how old they are? Do they call themselves a name? Like Mom or Dad or Sally or Fred?

My Mom’s name is Kristine. She is 48yrs old, I’d like to tell you how old that is in dog years, but I can’t count that high. My Mom is famous because she blogs at A Life Well Red on WordPress.

FD: Humans are always talking about something called a “Diagonal-orosis”. I think that means “what’s wrong with them”, but I’m not sure. Does your Mom have a “Diagonal-orosis?” Like “Fibro- mryalgeeya” or one those other things that makes her hurt or feel tired a lot? (Note from editor – FibroDog has trouble with big words sometimes – he means “diagnosis” and “fibromyalgia”, in case you couldn’t quite understand him.)

Mom has Fibromyalgia and Myalgic Encephalomyelitis (M.E.). Mostly she spends a lot of time at home with me, and walking around the house very slowly sometimes. We do go out in the backyard a lot though, where Mom watches me run back and forth chasing the birds off my lawn.

Lily from alifewellred.com guarding her yard in her FibroDog interview for fibromyalgia and chronic pain support medeakarrfnp.com

Guarding my lawn

FD: Wow, I’m not even going to try to pronounce that M.E. thing but it sounds pretty rough. What kinds of things do you do to help your Mom when she’s feeling sore or tired or sad from her fibro or M.E.?

When Mom feels especially bad, I give her a hug by nosing underneath her chin and pressing my furry body against her. She also seems to just enjoy watching me play around the yard, and nibble the ears off my stuffed dragon. She says it’s calming, but I think she’d feel better with a chew bone of her own to gnaw on.

FD: Your furry hugs sound awesome, I’ll bet they help your Mom a lot! What kinds of things do you try to avoid doing so your Mom doesn’t feel worse? (I know I accidentally broke my human Mom’s nose once when I was trying to give her a kiss, and that seemed to make her feel even worse for some reason, so I’m extra careful with kisses now). Are there things you have to be careful with so you don’t accidentally make her feel worse? Like not pawing at her too hard or not going potty in the living room when she’s having a bad day?

I’m only about 16 lbs, so I don’t hurt her too much when I perch on her leg to get a better view out the front window. My legs are pretty stubby too, so I can only get so high when I stand up to jump on her and say hi. I also try to be extra obedient on her ‘bad’ days and come inside the first three times I’m called instead of the usual seven.

FD: Wow, I’m impressed Lily, coming inside the first three times you’re called takes some serious commitment! I think I’ve got a ways to go in that department, but what I’m lacking in obedience I make up for in Snout. (At least that’s what Mom and Dad say all the time!) Is there anything else you or Kristine would like to say to our FibroFans out there about what they can do to be a more supportive friend?

The best thing I do for my human is be myself and give her all the furry love that’s in me! Yeah, I’m pretty awesome like that!

Lily & Kristine from alifewellred.com in her FibroDog interview for fibromyalgia and chronic pain support medeakarrfnp.com

Lily and Kristine

FD: Yeah you are pretty awesome Lily! Thank you so much for being my first furry interview, and you’re now officially part of my FibroDog Posse! (why don’t the humans spell it Pawsee?) I hope you don’t mind but I’ll be inviting some kitties and small humans to join the Posse, and possibly even a hedgehog, because FibroDog does not discriminate based on species or prickliness. (Although I have to admit I am rather curious about how that hedgehog manages to give soft fibro-snuzzles, I can’t wait to relay more details on that one!)

FibroDog p.s. – Special thanks to our human Moms Medea and Kristine for typing out our interview, because in case folks haven’t noticed, paws aren’t great for typing. I hope everyone enjoys reading my first interview, and if any other fibro support critters out there would like to be interviewed and join Lily and I in our Fibro Posse please leave your info below, or email my human Mom and Dad at fnpmedeakarr@gmail.com. And please check out Lily’s Mom’s blog A Life Well Red – once you read it it you’ll probably want to follow it. That’s what my Mom did.

xoxoxo Snout Out!

Fibromyalgia versus Myofascial Pain Syndrome (Part 1)

August 27, 2015August 27, 20152 Comments

These two conditions are frequently confused by both patients and medical providers. Many patients suffer from both of these conditions at the same time.

Fibromyalgia is defined by the American College of Rheumatology as a condition with widespread pain lasting over 3 months, with no other medical explanation for symptoms (citation below). The definition also used to include certain tender points located in specific places on the body, but this requirement was removed in 2010 because many fibromyalgia patients don’t have the specific tender points, or they only have them during flares, or they have them in different locations from the “classic” locations.

Fibromyalgia tender points map from ADAM.com

Tender points are basically areas of the skin that are extremely tender to light or moderate touch, that most people wouldn’t perceive as tender at all. There is nothing physiologically wrong with these tender regions, they are simply tender because the nervous system misinterprets the signals when these points are touched. The important thing is not specifically which areas are sensitive to touch, but the fact that there are multiple areas that are sensitive, with no known reason for them to be tender. In addition to the widespread pain and unusually tender areas, fibromyalgia patients also have fatigue, unrefreshing sleep, and a variety of other symptoms. These symptoms tend to wax and wane in flares. Sleep and central pain amplification are key factors in fibromyalgia, and addressing these issues is the mainstay of most fibromyalgia treatments.

Myofascial Pain Syndrome is a condition in which the patient has abnormal clumps of muscle fibers or knots or bands known as trigger points. (Not to be confused with tender points, more on this in a future post….) These trigger points “trigger” or “refer” pain to other locations in the body.

Trigger point – NOT a fibromyalgia tender point!

Trigger points can be felt in the muscle tissue, and the muscle fibers can be gradually remodeled or “released” using a combination of pressure, massage, stretching, and sometimes more invasive measures like electrotherapy, acupuncture, and injections. If you’ve ever had a knot in a muscle that “hurt so good” when it was massaged and sent pain into a distant area that was then relieved by the massage, then you know what a trigger point feels like. Trigger points are common causes of headaches, including migraines, sciatica, plantar fascia pain, and TMJ pain, among many other painful conditions.

Classic SCM trigger points (the “X’s”) radiate pain into the head and eye, causing migraine symptoms.

The good news is that once the trigger points are identified they are fairly simple to treat. The bad news is that trigger points are frequently missed because most medical providers aren’t trained to recognize them. So the two conditions both cause severe pain, but the reasons for the pain are very different. This was a very brief and oversimplified introduction to these challenging conditions, and in the next post I will go into more detail about the differences between tender points and trigger points and the different approaches needed to manage them. Stay tuned!

Resources:

Fibromyalgia and Chronic Myofascial Pain: A Survival Manual (2nd Edition). Jun 30, 2001. by Devin J. Starlanyl and Mary Ellen Copeland. This is my desert-island resource book, I keep copies at home and at my office. (FYI: This is an affiliate link, which means we get a small percentage of money if you purchase this book or any other product through this link, thank you in advance!)
Devin Starlanyl MD’s website at Sover.net
“The American College of Rheumatology

Preliminary Diagnostic Criteria for Fibromyalgia

and Measurement of Symptom Severity”, published in Arthritis Care & Research Vol. 62, No. 5, May 2010, pp 600–610 DOI 10.1002/acr.20140 © 2010, American College of Rheumatology.
Muscle Trigger Point Anatomy app for smartphones and tablets. The trigger point image above is from this app, and it has wonderful graphics with multiple views of the muscles and common trigger points, and their typical pain referral patterns.

Fibromyalgia versus Myofascial Pain Syndrome (Part 2) – What Can I do About It?

July 13, 2015August 24, 2015Leave a comment

Now that you know the difference between fibromyalgia and myofascial pain syndrome, and maybe you’re suspecting that you have one or the other or both, you are probably asking yourself “What next?” How are they treated?

First a recap: fibromyalgia is basically a syndrome of pain amplification and sensitivity, while myofascial pain syndrome is basically pain caused by tiny knots (trigger points) in the muscles. Fibro is more of a brain and nervous system problem, while myofascial pain is more of a muscle fiber problem. (Remember, I am really oversimplifying here to make this easy to grasp for folks without a medical background. There are many scientific articles and books available that go into more detail on these conditions, see references below.)

So as you can imagine, treating fibromyalgia is very different from treating myofascial pain. We honestly don’t understand much about fibromyalgia, although advances are being made every year. In my experience there are a variety of causes and types of fibro, so I tackle each case based on what seems to be causing it. Many times I’ll discover along the way that a patient doesn’t really have fibro at all, and instead has hypothyroidism, or chronic muscle pain and fatigue from perimenopause, or hypermobility syndrome causing constant strain on tendons/ligaments/connective tissue, or sleep apnea that causes fibro symptoms from years of poor sleep quality. If none of these are the case, and a patient really has fibromyalgia and no obvious other cause for their symptoms, then the general consensus is to address sleep, maximize serotonin levels in the brain, and find ways to “turn down the volume” of the overactive nervous system. This can be accomplished by various medications, supplements, exercise, acupuncture/Chinese herbs, electrotherapies/laser therapies, massage, etc. I am able to do many of these treatments in my medical practice, and I refer out for the ones I’m not trained in (acupuncture for example.) There are a lot of scams out there aimed at desperate fibro patients, so I am very cautious when it comes to new or unproven treatments, especially if they cost a lot of money. Keeping that caution in mind, however, I do believe if something has been proven to be safe and is relatively inexpensive it’s certainly worth a try if there’s a chance it could help!

Treating myofascial pain is much simpler in theory. It is usually just a matter of disrupting the trigger points/muscle knots, and stretching them out to prevent their return. Trigger points can be disrupted mechanically using massage or acupuncture or electrotherapies, or chemically using oral or topical or injected medications, and providers frequently use a variety of these methods. The tricky part is if the trigger points have been there for many years, or if there is a severe anatomical or other issue that tends to encourage them to return quickly. For example, some patients with hypermobility syndrome continually develop new trigger points and releasing them is a lifelong project, which can seem overwhelming at times. But most people can learn to treat their own trigger points using self massage tools, so they only need to seek professional help periodically.

Hopefully this series of articles helped to clarify the basic differences between fibromyalgia and chronic myofascial pain syndrome, and gave you some ideas about the treatment options available for both conditions. Please leave comments or questions below, and check out the following links for more useful info on both conditions.

National Fibromyalgia Association: http://www.fmaware.org

Devin Starlanyl MD: http://homepages.sover.net/~devstar/

Trigger Point Maps: http://www.triggerpoints.net/information