The Joys (and Downsides) of Crocheting

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Courtesy of Invisible Zee

Courtesy of Invisible Zee

Lately I’ve been trying to decide what I can do while I’m laying or sitting around, other than watch Netflix. Even though I’m fatigued, I can only sleep so much, so I end up awake but unable to actually do anything useful. Plus, I’ve developed the habit of always needing to move some part of my body because standing or sitting still 1) makes my pain “louder” since nothing’s distracting me and 2) increases my pain and stiffness. If I’m not moving or doing something, therefore, I usually end up snacking, which provides a repetitive and ongoing action for my hands. My snack of choice for the last several months has been Sour Patch Kids (SPK). And I’m being generous in calling it a snack because it’s just candy and does not fall into any food group. Obviously, eating a bag of SPK a day is unhealthy so I figured I could give my hands something else to do so that I wouldn’t turn to SPK or other snacks. I wanted it to be something constructive and useful but something that wouldn’t tire me out either. So, I decided to learn how to crochet.

And let me tell you, crocheting is absolutely the new love of my life, after God, my husband, and my mother of course! 🙂 I didn’t really expect to enjoy it this much but I’m completely enthralled by it. It gives my hands a useful compulsion to engage in and I can make things that have actual functionality! BUT, I’ve noticed that after a couple of hours of pretty continuous crocheting, the knuckles in my fingers that are closest to my nails and the muscles and joints connecting my thumbs to my palms are pretty sore. And it doesn’t help that, as a beginner, I sometimes make my stitches to tight and that makes it hard to push the hook through. And as someone who’s always held pens and pencils very tightly, I tend to hold the tools and fabric tighter and tighter until eventually even my shoulders have hunched up. I periodically remember to relax and loosen up, but I never fail to tense up again. I’m hoping that once I get better at it, I won’t make it so hard to push the hook through my work, but I don’t know how to retrain myself not to tense up. I’ll have to do some investigating into alternatives and aids, but in the meantime, I’m still in love with crocheting and won’t be giving it up despite the downsides. It’s still better than stuffing my face with SPK and chips!

As for the fatigue, I’m hoping that a rheumatologist can help me with that, but I’m still caught up in trying to get my shoulder issue diagnosed and physical therapy for my knee started. As always, though, I will keep trudging on, with Jehovah God’s help and the support of my family.

Fibromyalgia Syndrome–Treatment Options

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How Can the Symptoms Be Managed?

Without a cure for FMS, one might wonder if there’s any hope at all for fibromyalgia sufferers. The answer? YES, there is! Though there is not yet a cure, many options are available for successfully treating or managing the symptoms of FMS. The overly goal, though, can be characterized as avoiding your triggers, whether they are symptoms, like sensitivity to touch, or activities, like repetitive lifting, that will flare-up your fibro pain. Here is an overview (more detailed posts are under the section “Treatment Options”):

Medication

There are currently 3 medications that are approved by the United States Food and Drug Administration for treating fibromyalgia pain:  Lyrica (pregabalin) in 2007, Cymbalta (duloxetine) in 2008, and Savella (milnacipran) in 2009. Exactly how these medications work in the body is not known (sounds counterintuitive doesn’t it; how can you make something but not know how it works??), but the following are scientists’ most educated guesses on the subject.

Lyrica is an anti-seizure medication that works by blocking signals to the brain, which in the case of FMS are pain signals sent to the brain by overactive nerves in the muscles. Similar to Lyrica is Neurontin (gabapentin), which works in the same way.

Cymbalta and Savella are both antidepressants in the class of serotonin and norepinephrine reuptake inhibitors (SNRIs). Serotonin is a neurotransmitter and hormone that your body produces for use in mood regulation and pain perception and norepinephrine is a neurotransmitter and hormone that impacts your brain’s fight-or-flight response, pain perception, moods and emotions, and cognition. SNRIs work to prevent the reuptake–the re-absorption of secreted neurotransmitters–of serotonin and norepinephrine, thereby increasing their amounts and allowing them to continue helping to improve depression, anxiety, and even the brain’s reception of pain. Similar to Cymbalta and Savella are Elavil (amitriptyline), Flexeril (cyclobenzaprine) (also a muscle relaxant), and Effexor (venlafaxine).

Other drug options are opioid analgesics like Ultram (Tramadol) that can help with pain , dopamine–a neurotransmitter and hormone similar to serotonin and norepinephrine but also affecting cognition, motivation, sleep, and memory– enhancers that can help with pain, and muscle relaxers like Flexeril that ease muscle tension and spasms. Even non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen as well as topical muscle pain relievers like lidocaine, capsaicin, menthol, or camphor (often used to treat pain from arthritis) can also ease FMS pain and pain-increasing symptoms. Sleeping medications like Desyrel (trazodone) or Ambien (zolpidem) and serotonin boosters and alerting medications like Zoloft (sertraline) and Nuvigil (armodafinil) may also be prescribed for help with sleep disorders and difficulties and fatigue.

I currently take the max dose of Lyrica for pain and it has helped a lot with my overall, non-acute pain. I am also trying Pristiq (desvenlafaxine), an SNRI class anti-depressant, to help with fatigue and depression, but it’s not working. My fatigue has actually gotten worse. I’m thinking about asking my doctor for an alerting medication like Nuvigil or Provigil instead. As needed, I will take Flexeril for muscle spasms and muscle pain caused by tension or overworking.

Physical Therapy (aka Physiotherapy) and Exercise

Physical therapy (PT) is mainly the use of manual therapy and exercise to increase mobility, strength, flexibility, endurance, and balance, relieve pain, and reduce joint swelling, especially after an injury. Manual therapies used in physical therapy include manipulation (applying various levels of pressure to the joints with the hands or a specialized device), mobilization (slowly applying measured movements to the bones and joints to move them back where they are supposed to be), and massage (applying various levels of pressure to the soft tissues). Additional techniques used in physical therapy are water therapy, electrical stimulation, the application of heat or cold possibly with water (hydrotherapy), and ultrasound. At-home exercises such as stretching, walking, and core strengthening are usually prescribed by physical therapists to supplement their treatment.

Since FMS is a nerve pain disorder and not an actual “physical” disorder (in the sense that nothing is physically wrong or injured), how can physical therapy and exercise be beneficial to FMS sufferers? Well, physical therapy can improve your muscle flexibility, relax muscle tension, and teach you how to use your muscles more efficiently, thereby minimizing the tension, stiffness, and guarding that result from and further cause FMS pain. Also, as with other chronic pain illnesses such as arthritis, regular movement is known to help with fibromyalgia pain whereas inactivity perpetuates it. These benefits will also help prevent future physical injuries which would trigger more pain.

Interestingly, some of our FMS tender points can also be myofascial trigger points (tight, hypersensitive nodules found in the muscle and connective tissue throughout it that are painful and refer pain to other areas) and PT can provide myofascial release and other trigger-point therapies (injections, stretching with heat, and topical medication).

Soon, I’ll be starting physical therapy for the cartilage loss in my right knee and then, hopefully, for my right shoulder, whatever is wrong with it.

Complementary and Alternative Therapies

Complementary therapies are those used in conjunction with conventional medicine–medication, surgery, and some manual therapies–while alternative therapy is used in place of conventional medicine. Complementary and alternative medicine (CAM) can be very beneficial to fibromyalgia sufferers and includes:

  • chiropractic therapy–manipulation and adjustment of the body’s musculoskeletal structures, such as the spinal column, to correct structural alignment and relieve nerve pressure and muscle tension;
  • osteopathic manipulative treatment (OMT) or osteopathic manipulative medicine (OMM)–a gentler and more ranged form of chiropractic;
  • massage therapy, particularly acupressure and deep tissue–manipulation of the body’s soft tissues, muscles, tendons, and ligaments to release tension and pressure as well as reduce stress and anxiety;
  • acupuncture–the insertion of very thin needles into the skin and underlying tissues at specific points on the body to increase blood flow and the natural production of the neurotransmitters that decrease pain;
  • movement therapies (in other words, exercise)–physical activities such as yoga, tai chi, aerobics (especially water aerobics in a warm pool aka water therapy/hydrotherapy), and dance-based exercises to promote a wide range of physical benefits like increased flexibility, strength, stamina, balance, and circulation and reduced pain and stress; a caution:  several of these CAM therapies have religious roots and spiritual overtones so if you are uncomfortable with this, please do more research into the therapy that interests you and the motives and beliefs of the specific practitioners that employ it;
  • relaxation techniques–techniques such as breathing exercises, progressive muscle relaxation, guided imagery, biofeedback, and aromatherapy that can help you relax emotionally and physically and reduce and manage stress; and
  • improving or adjusting diet, taking nutritional supplements, and taking herbal remedies which can relieve IBS reactions, improve sleep, improve fatigue, and even reduce pain; a caution–nutritional supplements and herbs can have reactions with prescription medications so consult with your doctor and/or pharmacist before adding anything new.

As you know, I currently see a chiropractic (though I think she also used osteopathic techniques) because when certain things like my hip or my vertebrae come out of alignment, I definitely notice resulting increases in pain. She also helps a bit with muscle tightness and knots, but I think a massage therapist might be better for that. Once I start physical therapy and get some of their recommendations, I intend to ease into an exercise regimen. My chiropractic has given me two nutritional supplements:  MyoCalm PM to relax my muscles before bedtime, thereby making it easier to get comfortable and go to sleep, and FibroPlex to generally help with fibro pain an symptoms (I think…). Additionally, to help me fall asleep and stay asleep, I take melatonin, valerian, and a homeopathic oral spray with flower essences. This combo certainly aids in falling asleep but for some reason even on the best of nights I wake up at least twice during the night. For fatigue, I’ve tried a ginseng complex but it doesn’t seem to do anything. I also drink Tension Tamer tea for sleep and Fast Lane tea for energy from Celestial Seasonings Teas of the Hain Celestial Group in Colorado. Fast Lane, with 10 mg of caffeine more than a regular cup of coffee, is the only thing I’ve tried that has helped me wake up and get up in the morning (unless my fatigue is flaring up, like it is now). The last things I occasionally use are the topical pain relievers Sombra Warm Therapy (with camphor and menthol), Thera-gesic (with menthol and methyl salicylate), and stick-on heat patches as front line defenses for when I’m starting to have a lot of shoulder, back, or neck pain.

There are so many options available out there, but what works for one person does not always work the same way for someone else, so ALWAYS DO YOUR RESEARCH and consult with your doctor(s) before adding a new therapy to your treatment regimen. And always start slow and ease yourself into it. What treatments work for your fibromyalgia or chronic pain?

Fibromyalgia Syndrome–Diagnosis and Prognosis

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How Is It Diagnosed?

According to the American College of Rheumatology, only 2-4% of people are diagnosed with fibromyalgia, so you may wonder, how does such an uncommon disorder get diagnosed? The answer? Not easily. Fibromyalgia shares many symptoms in common with other chronic pain disorders and diseases, such as chronic fatigue syndrome, hypothyroidism, rheumatoid arthritis, lupus, among others. Therefore, it can be misdiagnosed without thorough testing and investigation. Many of the similar conditions can be tested for in the blood, whereas fibromyalgia cannot, so one of the first steps might be to rule out other causes for your pain with blood tests such as a complete blood count (CBC) panel or a thyroid function test.

To specifically “test” for fibromyalgia, a doctor would see if your pain is widespread (in all 4 quadrants of your body), what kind of pain you feel, whether you experience significant fatigue, and whether you’ve had cognitive difficulties. He or she should also perform a physical examination, taking the time to press firmly on the various 18 tender points set forth by the American College of Rheumatology, pictured above. It is generally said that if 11 or more of the points are indeed tender, without causing radiating pain as an indication of trigger points rather than tender points, then the patient had fibromyalgia syndrome, but if you experience less than this, it does not mean that you do not have FMS. Finally, whether or not your symptoms or pain have been consistently present for at least 3 months will need to be determined. These have been the guidelines for diagnosing FMS since 1990.

In 2010, preliminary changes to the diagnostic criteria for FMS were published by the College. These new criteria would use two scores, a Widespread Pain Index (WPI), which is determined by how many out of 19 areas of your body have pain, and a Symptom Severity (SS) scale, measured by your answers to a 42-question symptom survey. This would effectively eliminate the use of tender points in diagnosis, and likely make it possible for more people who do not have FMS to be diagnosed with it anyway since it is quite vague and generalized.

What’s the Prognosis?

There is no cure for FMS, but there are many medications, treatments, and therapies that can help with the pain and other symptoms. Unfortunately, since the cause is undetermined, one can only treat the symptoms rather than the problem itself, but that’s better than nothing. Those diagnosed with fibro have the option of taking pain medication or antidepressants, doing physical therapy, or trying alternative therapies such as chiropractic or massage, among other treatments.

Fibromyalgia Syndrome–How It Feels

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Giving you a list of fibromyalgia symptoms doesn’t really give you a sense of what the symptom really means for someone or how it feels to them. The way it feels to each person can also vary, so I think it’s a good idea to describe how some of the symptoms of fibromyalgia can feel.

Widespread Pain–such pain can present itself in many ways and a person can experience it in multiple forms as well, as I do; the pain usually is over the whole body but its intensity fluctuates daily and the pain in one area can worsen more than in other areas; the pain can feel like aches, soreness, throbbing, stabbing, shooting, sharp, burning, dull, deep; those words are the best adjectives to describe the pain, but they still may not be accurate because, for example, my general all-over pain comes closest to soreness, but it doesn’t feel the same as the muscle soreness you get from working out or something; I also experience sharp and stabbing pains, dull aches, and occasional burning in various spots on my body

Fatigue–this can be difficult to explain…; generally, fatigue is exhausted times at least 5, a deep weariness in your body and mind; for me, it seems inescapable as no matter how well (usually not well) or how much (usually only a little at night) I sleep, it is still there with me, like a heavy barrier between me and the world; the level of fatigue fibromyalgia sufferers endure is usually on par with chronic fatigue syndrome (CFS), and for some it actually is CFS

Tenderness/Sensitivity to Touch–think of how it feels to have a bruise:  not only is it more painful to the touch than the rest of your skin, but also you are more aware of that area than the rest of your skin/body; in this way, so does it feel to be tender and sensitive to touch; everything hurts and feels more painful than it should; I’ve always felt as if everything I feel or touch is interpreted by my brain as pain, to some degree; my other external senses–hearing, sight, and even smell–are also extra-sensitive, sometimes making me feel like a superhero, if not for their interference in my physical comfort and ability to fall asleep; some people can’t even stand to wear tight or form-fitting clothing like jeans or pantyhose; another aspect that falls into this category is the tender points on the body that are used to semi-diagnose fibromyalgia; this means that in particular there are specific spots on the body that, when touched or subjected to pressure (such as by poking), hurt even more extremely than the fibro pain; my worst spots are in my neck, shoulders, collarbone, lower back, hips, and buttocks; related to this symptom is hypersensitivity to cold or heat, which is essentially the same as sensitivity to touch but with temperature; I deal with sensitivity to cold temperatures, particularly the cold air produced by air conditioning; when cold drafts hit my body, I immediately experience an increase in pain and my muscles begin stiffening up

Brain/Fibro Fog–in addition to the concentration, memory, and speech difficulties, it actually feels like there is a fog in or around your mind that makes it work less efficiently and makes things less clear to you; one source mentions “word-finding” difficulties, something I have intimate experience with; these cognitive speed bumps are made more severe by fatigue and especially increased pain, and mine also worsen with hunger; imagine the confusion, slower thinking ability, and lack of focus that accompany the grogginess experienced after you’ve just awakened or if you’re exhausted, multiplied by 10; an example of the memory problems I experience is that I can ask my husband a question, get his answer, and go about my business, but when the topic or related activity comes up again 20 minutes later, I’ve forgotten that I already asked him about it

These are the main hallmarks of fibromyalgia syndrome. The other symptoms that may or may not occur along with these are problems that commonly afflict people and are well-known so I won’t get into those. A good analogy for describing just how chronic pain impacts a person’s life is The Spoon Theory narrative written by Christine Miserandino over at butyoudontlooksick.com and I encourage you to check it out. I hope that this post further helps you to understand what it is like to have fibro and therefore show more consideration to those who you know that have it. And anyone who does have it, feel free to add your own descriptions and illustrations below!

Fibromyalgia Syndrome–Definition and Symptoms

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What Is It?

Fibromyalgia–“fibro” = fibrous, or of fibers, and “myalgia” = muscle pain–syndrome (FMS; hereafter referred to as “FMS”, “fibromyalgia”, or “fibro”) is a musculoskeletal disorder marked by widespread muscle pain. This pain is thought to be caused by overactive nerves in the body overloading the brain with pain signals. Why this condition develops is unknown. The symptoms that characterize FMS are often part or the main feature of other diseases as well, making it easy to misdiagnose. It affects many more women than men as well as middle-aged than younger and approximately 2-5% of the American population.

What Are the Symptoms?

A syndrome is a set of symptoms that occur together, indicating the existence of a particular disease. Therefore, fibromyalgia syndrome most commonly presents the following set of symptoms:

  • as stated above, widespread pain; such pain usually occurs in the muscles, but can also be felt in the tendons and ligaments (the soft fibrous tissues), and the joints
  • tenderness, or sensitivity to touch (also considered a decreased pain threshold); this can be experienced body-wide but it is particularly noticed at specific pressure points throughout the body
  • fatigue that is chronic and disproportionate to preceding activity, possibly even debilitating; this symptom also includes low stamina
  • difficulty sleeping and/or getting restful sleep
  • memory and concentration difficulties, often referred to as “brain fog” and sometimes “fibro fog”
  • depression and/or anxiety and mood swings

Additional symptoms that accompany these main ones are commonly associated with FMS but occur in varying combinations:

  • digestive problems such as gastroesophageal reflux disease (GERD), aka acid reflux, and irritable bowel syndrome (IBS)
  • irritable or overactive bladder
  • chronic headaches, migraines, or tension headaches
  • hypersensitivity to cold or heat; skin rashes and irritation
  • temporomandibular disorder (TMJ), which can include face or jaw pain and ringing in the ears
  • muscle and/or joint stiffness, particularly in the morning
  • chronic tension, knots, cramping, weakness, and spasms in the muscles
  • abdominal pain or cramping
  • difficulty with balance and impaired coordination
  • dryness of the mouth, nose or eyes
  • tingling or numbness in the hands or feet
  • weight gain

Personally, I experience all 6 of the main symptoms and 7-12 of the additional symptoms. Any of these symptoms can be triggers for a flare-up of fibro pain. The opposite can also happen, where an increase in fibro pain can make another symptom flare-up, for example sensitivity to touch/tenderness. This sometimes ends up locking into a never-ending cycle, where each symptom is triggered by another and then triggers something else, or just triggers its trigger right back (did that make any sense?). Alleviating just one of the symptoms in the cycle can break it and give you a chance to get results treating the other symptoms, too.

What about you? What’s your personal combination of FMS symptoms?

Shoulder Pain, Shoulder Pain and More Shoulder Pain…

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Went to my chiropractor today for my bi-weekly tune-up and I am not a happy camper. Ever since my right shoulder started hurting back around the beginning of May 2014, it hasn’t gone away since. Insurance issues have prevented me from pursuing a diagnosis but hopefully that will change soon because it’s getting worse again–in the beginning, it was really bad and I could barely move or use my arm, but after some time it sort of calmed down and stayed at a constant pain level. Anyway, I had my chiropractor, Kenna–who has been a real lifesaver–, work a bit more than usual on my shoulder. Good lord! did it hurt. If I hadn’t learned a long time ago not to cry when I was in pain, I would have been in tears. Now, I’ve got a deep ache in my shoulder that extends up into my neck on that side. Even my elbow is hurting! Kenna says the nature of my personal brand of fibromyalgia is roaming inflammation that makes the affected areas more susceptible to injury and strain. Go figure <eye roll>. The only thing that’s really helped is Sombra Warm Therapy Natural Pain Relieving Gel. (There’s also a cold version but cold is my trigger.) The active ingredients are camphor 3% and menthol 3%, and even I know that these are the two biggest analgesics in muscle creams. So obviously the gel really tingles a lot, which in and of itself is a distraction from the pain, but it also seems to penetrate enough to break the rise in pain I am experiencing for a little while. I’ll definitely be putting some on my shoulder and neck before bed tonight!

No matter how much I resent the pain that my chiropractic appointments temporarily give me, that’ll never make me say it was all for nought. My improvement since starting to see Kenna last summer is undeniable. As you know, I am far from knowledgeable about any of this medical stuff (hence the newbie blog), so I used to believe the rumors that chiropractic was a sham and did more harm than good. But at the prodding of my mother, who has a lot of experience and knowledge in that regard, I took a chance. And I haven’t looked back since!

Of course, chiropractic isn’t for everyone, but since my pain leads to repetitive muscle tension and guarding, my skeleton/joints is/are constantly pulled out of alignment, giving birth to a vicious cycle of muscle pain and stiffness and joint pain. The only way to “fix” that is to realign the skeleton and joints. Though this is only temporary due to muscle memory and constant pain, I have noticed a difference in how I feel between appointments versus how I felt before I started.

That’s my limited take on chiropractic so I promise to do some real research online and offline and compile my findings all into one post. In the meantime, please feel free to add your two cents (no cursing or slanderous language please or your comment will be deleted) or correct me 🙂